State Considers Coverage Mandates

by David Gorn

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The deadline to pass legislation left over from last year has come and gone, with single payer, insurance rate regulation and the basic health plan all temporarily halted. The next big legislative push is coming up fast, as all new bills for 2012 have to be introduced by the end of next week, on Feb. 24.

A number of health-related laws recently were passed by the state Senate or Assembly. Many of them call for coverage mandates by health insurance providers.



  • Mammograms: AB 137  by Anthony Portantino (D-Pasadena) would require coverage of mammograms when ordered by a health care provider.
  • Autism: Pervasive developmental disorders (also known as autism spectrum disorders) are currently mandated for coverage in California, butAB 171 by Jim Beall (D-San Jose) would extend that coverage to include screening, diagnosis, and treatment for autism outside of behavioral health treatment. Benefits could not exceed federal essential health benefits.
  • Mental health: Severe mental illness is already a state-mandated coverage, but AB 154, also authored by Beall, would expand that coverage to include any mental illness defined in the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV). It would exempt some MRMIB (Managed Risk Medical Insurance Board) contracts and CalPERS (California Public Employees’ Retirement System) from these requirements.
  • Prescription drugs: AB 369  by Jared Huffman (D-San Rafael) would impose certain requirements on plans and insurers that restrict medications for the treatment of pain.
  • Oral chemotherapy: AB 1000  by Henry Perea (D-Fresno) would require coverage of oral chemotherapy alternatives.
  • Breast cancer: Health plans and insurers currently are required to cover breast cancer diagnosis and treatment. SB 255  by Fran Pavley (D-Agoura Hills) contends that coverage of a mastectomy should also include coverage for a lumpectomy, or partial mastectomy.

These proposals aren't yet law. If passed by the Legislature and approved by the governor, it is still unclear how they will apply to the list of federal essential health benefits that eventually will be adopted by the California Health Benefit Exchange.

All of these bills passed their house of origin, so now the Senate bills go to the Assembly, and vice versa.


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