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Thursday, September 8, 2011

California Mandate Action

The Sacramento Bee reports that California Senate President Pro Tem Darrell Steinberg is using the final days of the legislative session to push an insurance mandate.

"When this is done it's going to be a huge victory for families and for children," Steinberg said. "It's certainly a very high priority for me."

Insurance companies are lobbying to kill the measure, saying behavioral therapy is an educational strategy not a health need. They also say the cost of covering the therapy will drive up rates for their customers by at least $200 million.

Many children who receive the therapy now get it through schools, research projects, or publicly funded regional centers that care for people with disabilities. Shifting the cost burden to private insurance companies is unfair, said Charles Bacchi, executive vice president of the California Association of Health Plans.

"We understand the state is in tough fiscal times but so are our customers who are buying our services," said Bacchi, whose group represents most of the state's HMOs.

Senate Bill 946 would exempt publicly funded health plans – including MediCal, Healthy Families and plans that cover state employees – from covering behavioral therapy. That means the bill has no cost to the state's general fund, making Steinberg hopeful it will sail through the Legislature and earn the governor's signature.

The bill is his third attempt this year to require insurance companies to cover behavioral therapy for children with autism. Earlier versions of the bill stalled in committee.

"Clearly, this has been an issue where the Legislature has agreed that caution is warranted," Bacchi said. "And unfortunately this bill appears to be poised to pass in the final hours of session with very little public discourse."

On Tuesday – four days before the legislative session ends – Steinberg engaged in the hasty end-of-session law-making process known as "gut-and-amend" when he deleted most of what had been in SB 946 and inserted the language from his autism bill. It cleared the Assembly Health Committee on Wednesday night.


California has no process for licensing therapists who use the technique, creating more tension between private insurers and state leaders who would like them to pay for the service. Private insurers say the fact that there is no state licensing exam is proof that behavioral therapy is about learning and life skills – not medicine.

Another point of contention concerns the federal health care overhaul. The federal government is preparing a list of health services that insurers must cover beginning in 2014. Private insurance plans say they want to wait and see if behavioral therapy will be on that list. Steinberg says California has the chance to influence federal policy by requiring insurers to cover the therapy now.

"If California defines the essential benefits, that's going to guide the federal government's determination," he said.

The mandate would take effect on July 1, 2012, and last for two years, though Steinberg said he would work to extend the benefits beyond that.