Essential Benefits, Medical Review Change Passed

The countdown has begun. Only three more voting days till the end of California’s legislative year. The Legislature’s 2012 session ends on Friday, making this a busy week.

A number of health-related bills are among the hundreds of laws passed so far and headed to the governor’s desk (some of them are pending technical concurrence in the house of origin):

• SB 951 by Ed Hernandez (D-West Covina) and AB 1453 by Bill Monning (D-Carmel) would set the level of essential health benefits offered by the California Health Benefit Exchange, starting in 2014. The benefits are modeled on the Kaiser Foundation Health Plan small group HMO 30 plan, and include autism, acupuncture and tobacco cessation. These bills, along with companion legislation by the same authors (SB 961 and AB 1461, which would ban discrimination based on pre-existing conditions) still need concurrence before heading to the governor for approval.  

• SB 1410,  also authored by Hernandez,  would require that the clinician conducting an independent medical review be an expert in the condition under review. It also allows the application for an IMR to be up to two pages long, so more information can be included. Amendments include delay of implementation from the original January 2013 to July 2015; and the stipulation that the name of the health plan would be included has now been withdrawn.

• SB 345 by Lois Wolk (D-Davis) would require the state Office of the Ombudsman to submit an annual advocacy report and to maintain an Internet presence. Amendments included deletion of a provision to revise the ombudsman’s appointment process and another provision for an advisory council.

• SB 336 by Ted Lieu (D-Torrance) and Kevin DeLeon (D-Los Angeles) would require acute care hospitals to monitor emergency department overcrowding, including a “crowding score” recorded every four hours to help assess overcrowding. Also requires implementation of a full-capacity protocol for overcrowding by 2014.

• AB 1640  by Holly Mitchell (D-Los Angeles) would require that pregnant mothers 18 years or younger be eligible for CalWORKS aid, up to three months before their baby is born.

• AB 540 by Jim Beall (D-San Jose) would set up the Medi-Cal Alcohol and Drug Screening and Brief Interventions Program for pregnant women or women of childbearing age in Medi-Cal coverage.

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