[authors: John M. LeBlanc and Natalie J. Ferrall]
The California Assembly Committee on Health recently heard and approved two high-profile health care reform bills with the stated purpose of bringing California into compliance with the federal Affordable Care Act (“ACA”).
The first bill, Senate Bill 951 (Hernandez, D-West Covina), would require individual and small group health care service plans and insurance policies to cover essential health benefits beginning in 2014. Under the ACA, essential health benefits must include the following ten categories of items and services:
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Ambulatory patient services
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Emergency services
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Hospitalization
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Maternity and newborn care
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Mental health and substance use disorder services, including behavioral health treatment
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Prescription drugs
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Rehabilitative and “habilitative” services and devices (to date, there is no guidance as to what the “habilitative” umbrella will include)
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Laboratory services
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Preventive and wellness services and chronic disease management
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Pediatric services, including oral and vision care
SB 951 designates the Kaiser Small Group HMO as the benchmark standard for essential health benefits coverage in California.
The second piece of legislation, Senate Bill 961 (Hernandez, D-West Covina), prohibits health care service plans and insurers from denying coverage to individuals based on preexisting conditions. It requires guaranteed issue of individual health service plans and insurance policies. The bill only allows health plans and insurers to use age, geographic region, and family size in establishing individual coverage rates.
