Ed Hernandez
- Democratic
Author
Existing federal law, the federal Patient Protection and Affordable Care Act (PPACA) , enacts various health care coverage market reforms that take effect January 1, 2014. Among other things, PPACA requires a health insurance issuer that offers coverage in the small group or individual market to ensure that the coverage includes the essential health benefits package, as defined. PPACA requires each state, by January 1, 2014, to establish an American Health Benefit Exchange that facilitates the purchase of qualified health plans by qualified individuals and qualified small employers. PPACA defines a qualified health plan as a plan that, among other requirements, provides an essential health benefits package. Existing state law creates the California Health Benefit Exchange (the Exchange) to facilitate the purchase of qualified health plans by qualified individuals and qualified small employers. Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires an individual or small group health care service plan contract or individual or small group health insurance policy issued, amended, or renewed on or after January 1, 2014, to cover essential health benefits, defined to include rehabilitative and habilitative services and the health benefits covered by particular benchmark plans, including a certain plan offered during the first quarter of 2012. Existing law requires habilitative services to be covered under the same terms and conditions applied to rehabilitative services under the plan contract or policy, and defines habilitative services to mean medically necessary health care services and health care devices that assist an individual in partially or fully acquiring or improving skills and functions and that are necessary to address a health condition. Existing law specifies that these provisions do not apply to specified plans, including grandfathered plans. Existing law authorizes the Department of Managed Health Care and the Department of Insurance to adopt emergency regulations implementing these provisions until March 1, 2016. This bill would, for an individual or small group health care service plan contract or an individual or small group health insurance policy issued, amended, or renewed on or after January 1, 2017, prohibit limits on habilitative and rehabilitative services from being combined and would define essential health benefits to include the health benefits covered by particular benchmark plans as of the first quarter of 2014, as specified. The bill, for plan years commencing on or after January 1, 2016, would revise the definition of "habilitative services" to conform to federal regulations. The bill would authorize the Department of Managed Health Care and the Department of Insurance to adopt emergency regulations implementing amendments made to the above-described provisions during the 2015–16 Regular Session of the Legislature until July 1, 2018. Because a willful violation of the bill's requirements by a health care service plan would be a crime, this bill would impose a state-mandated local program. The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that no reimbursement is required by this act for a specified reason.
Chaptered by Secretary of State. Chapter 648, Statutes of 2015.
Approved by the Governor.
Enrolled and presented to the Governor at 4:30 p.m.
Assembly amendments concurred in. (Ayes 40. Noes 0. Page 2421.) Ordered to engrossing and enrolling.
Read third time. Passed. (Ayes 79. Noes 0. Page 2726.) Ordered to the Senate.
In Senate. Concurrence in Assembly amendments pending.
From committee: Do pass. (Ayes 17. Noes 0.) (August 27).
Read second time. Ordered to third reading.
August 19 set for first hearing. Placed on APPR. suspense file.
From committee with author's amendments. Read second time and amended. Re-referred to Com. on APPR.
(Corrected August 17)
Read second time and amended. Re-referred to Com. on APPR.
From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 17. Noes 1.) (July 14).
July 7 hearing postponed by committee.
In Assembly. Read first time. Held at Desk.
Read third time. Passed. (Ayes 37. Noes 0. Page 1194.) Ordered to the Assembly.
Read second time. Ordered to third reading.
From committee: Do pass. (Ayes 7. Noes 0. Page 1146.) (May 28).
Set for hearing May 28.
May 11 hearing: Placed on APPR. suspense file.
Set for hearing May 11.
From committee: Do pass and re-refer to Com. on APPR. (Ayes 9. Noes 0. Page 859.) (April 29). Re-referred to Com. on APPR.
From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH.
Set for hearing April 29.
Read first time.
From printer. May be acted upon on or after January 7.
Introduced. To Com. on RLS. for assignment. To print.
| Bill Text Versions | Format |
|---|---|
| SB43 | HTML |
| 12/05/14 - Introduced | |
| 04/20/15 - Amended Senate | |
| 07/16/15 - Amended Assembly | |
| 08/17/15 - Amended Assembly | |
| 09/03/15 - Enrolled | |
| 10/08/15 - Chaptered |
| Document | Format |
|---|---|
| No related documents. |
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