CDCAN REPORT #176-2011: Governor signs SB 946, autism private health insurance mandate reform bill

GOVERNOR SIGNS SB 946 AUTISM PRIVATE HEALTH INSURANCE MANDATE REFORM BILL - MAJOR LANDMARK VICTORY IN DISABILITY RIGHTS SUPPORTERS SAY

SACRAMENTO, CA (CDCAN)  [Last updated 10/09/2011 01:00 PM] - Governor Jerry Brown signed SB 946 by Senate President Pro Tem Darrell Steinberg (Democrat - Sacramento, 6th State Senate District), known as the Autism Private Health Insurance Mandate Reform bill that would HAVE required private health care service plans and health insurers to provide coverage for behavioral health treatment for persons with autism spectrum and certain other related pervasive developmental disorders from July 1, 2012 through July 1, 2014.  Supporters said that the approval of the bill by the Governor meant a major landmark step and victory in disability rights for tens of thousands of children with autism spectrum and other disorders and their families across the State.

Senate President Pro Tem Steinberg said in a statement that "..this is a critical victory for thousands of California children and families. For many of them, having this therapy covered by their insurance is the difference between despair and hope."

He added that “The science clearly shows that treating the mind through behavioral therapy is no different than treating a broken arm or a heart condition. I commend the Governor for acknowledging that every child in this state matters, by signing a measure that will literally benefit thousands of kids for generations to come. I would also like to applaud the countless families and advocates who have been working tirelessly on this issue for many years. And as our state’s fiscal health improves, I will keep working to ensure that when it comes to autism treatment, every child, every young adult, and every family in California has affordable access to this therapy.”

The Legislature passed SB 946, authored by Steinberg,  in the final days of its 2011 Legislative session, that advocates say is a landmark bill in protecting the rights of children and adults with disabilities.

More details will be reported in a later CDCAN Report today along with status of other bills the Governor took action today - the State Constitutional deadline for the Governor to sign, veto (or allow to become law without his signature) bills passed by the Legislature in their final days before adjouring for the year on September 9th.

Bill Drew Strong Suport and Opposition

Supporters - including thousands of families with children with autism spectrum and other related developmental disorders, and also a wide range of statewide and local disability rights advocacy groups said that the bill was needed because that thousands of children were being denied treatment for services they had a right to have under their private health insurance or service plans. Supporters also claimed the issue was a major disability rights issue.

Two rallies in support of the bill were held on September 26 at the State Capitol and on September 30th at the Ed Roberts Campus in Berkeley.  Those rallies, attended by Senate President Pro Tem Steinberg and others can be viewed at:
Septmeber 26th Rally in Support of SB 946:  http://www.youtube.com/watch?v=x21OaMQvXCw
September 30th Rally in Support of SB 946:  http://www.youtube.com/watch?v=c5TtXj_jrCA

Opponents - including health insurance plans, said that the bill required behavioral treatments that are not medical and should be provided by the school districts or through community-based services  for persons with developmental disabilities funded through the 21 non-profit regional centers.  Some individuals and groups opposed the bill because it exempted those covered under the Medi-cal (Medicaid), Healthy Families programs and also those under the California Public Employees Retirement System (CALPERS).

CDCAN SUMMARY OF BILL

SB 946 - AUTISM HEALTH INSURANCE MANDATE REFORM

AUTHOR: Senate President Pro Tem Darrell Steinberg (Democrat - Sacramento, 6th State Senate District)
CDCAN SUMMARY:

• Would require private health care service plans and health insurers to provide coverage for behavioral health treatment for pervasive developmental disorder or autism (PDD/A) from July 1, 2012, through July 1, 2014, with implementation that is consistent with existing state mental health parity law.
• Would provide that as of the date that proposed final rulemaking for essential health benefits is issued under the federal Patient Protection and Affordable Care Act (PPACA), the provisions in this bill would not require any benefits to be provided that exceed the essential health benefits, which all health plans and insurers would be required  to offer. If the federal rules are defined prior to July 1, 2014, then the provisions in this bill would sunset (end or be repealed) prior to that date. Additionally, these provisions in this bill may effectively sunset  earlier than July 1, 2014, since the Patient Protection Affordable Care Act essential health  benefits law would go into effect January 1, 2014.
• Would define "behavioral health treatment" as  professional services and treatment programs, including applied behavior analysis and evidence-based behavior intervention programs, that develop or restore, to the maximum extent practicable, the functioning of an individual with pervasive developmental disorder or autism and that are provided by licensed, unlicensed, or uncertified providers, as specified in the bill
• Would require the Department of Managed Health Care (DMHC) to establish the Autism Advisory Task Force and to submit a report to the Governor and the Legislature by December 31, 2012.
• Provisions of this bill would not apply to specialized health care service plans or insurance policies that do not deliver mental or behavioral health services and health plans or insurers that contract with the state's Medi-Cal (Medicaid) Program (Medi-Cal), Healthy Families Program (Healthy Families), and the California Public Employees' Retirement System (CalPERS).

PREVIOUS ACTION 09/16/2011: Sent to Governor.
LATEST ACTION 10/09/2011: SIGNED by Governor.
COPY OF BILL (AS SENT TO GOVERNOR) - HTML:  http://www.leginfo.ca.gov/pub/11-12/bill/sen/sb_0901-0950/sb_946_bill_20110914_enrolled.html
COPY OF 32 PAGE BILL (AS SENT TO GOVERNOR) - PDF: http://www.leginfo.ca.gov/pub/11-12/bill/sen/sb_0901-0950/sb_946_bill_20110914_enrolled.pdf
 ASSEMBLY & STATE SENATE FINAL VOTE:
State Senate - Final Passage Vote 09/09/2011 by vote of 25 to 4.
Assembly - Final Passage Vote 09/09/2011 by vote of 52 to 21.
WHY THIS BILL SHOULD BE IMPORTANT TO YOU:  Impacts thousands of families with children with autism spectrum and related disorders who need access to behavioral intervention treatments for their children.  Also impacts State general fund spending for those services in the budgets of the Department of Developmental Services (through the 21 non-profit regional centers) and also school districts.   
CDCAN COMMENT:

• The bill was strongly supported by nearly every major statewide and national autism advocacy organizations, families and a wide range of disability advocacy groups (including CDCAN) who argued that behavioral intervention treatments are medical or health services that should be covered by health plans and health insurance as other treatments and services are and that denying such coverage harms their children at a crucial stage of lives - and is outright discrimination due to their disability.
• It was strongly opposed by private health insurance groups who argued that the bill would raise premiums for everyone in their plans - and also that behaviorial treatments should remain the responsibility of schools and the State funded programs for people with developmental disabilities coordinated through the 21 non-profit regional centers.   Some opposed the bill because it exempted persons who are covered under the Medi-Cal, Healthy Families programs and also those under the state retirement programs (California Public Employees Retirement System or CALPERS).  However none of those persons covered under those programs would lose any existing services or nullify any settlemetns reached under those programs since the bill expressly states that its provisions does not cover those persons in those programs.

PRIORITY: VERY HIGH

File Attachments: 

sb_946_bill_20110914_enrolled.pdf (122.44 KB)