Health Reform Implementation

2010 Legislative Tracker – California

Please note that there are some instances in which the state has yet to take action or they will not be required to do so by the federal government.
Reform Effective Date Description State Action
Medicare is a government administered health coverage
program provided to Americans over the age of 65. While it is a
national program, there is wide variation among the states in
Medicare Ongoing
terms of health needs and Medicare spending. One of the main
changes through the implementation effort is to close the
“doughnut hole” – a current gap in drug coverage.
AB 2477 (Jones) Would eliminate Mid-Year Status
Reporting (MSR), which requires re-enrollment of children
under 19 years old into Medi-Cal every 6 months. Instead,
re-enrollment will be required either after a 12-month
period of the date of last enrollment or when the child
exceeds 19 years old. Referred to Committee on Health
06/10/10

AB 342 (Perez) Amended bill pending Senate

Medi-Cal is the name given to California’s Medicaid program. Appropriations Committee. The bill proposes a five-year
Medi-Cal Ongoing Efforts through implementation will extend coverage to many waiver that will expand the number of childless adults
individuals and families. covered under Medi-Cal, as well as expanding coverage for
residents who fall between 133% and 200% of the federal
poverty level. Read second time 08/16/10

SB 208 (Steinberg) Companion bill to AB 342. Enacts

statutory changes which permit state and county health
agencies to implement the Comprehensive Demonstration
Project Waiver in the Medi-cal program, which would
include an expansion of current Medi-cal enrollment. Read
second time 08/16/10
SCHIP (State Children’s Health Insurance Plan) refers to a
program administered by the Department of Health and Human
Services to help states provide quality health coverage to
SCHIP Ongoing
children. Children receiving CHIP can continue to receive this
service (or Medicaid, as applicable) until 2019, at which point
they may be able to join the Exchange market.

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 Health Reform Implementation
2010 Legislative Tracker – California

Reform Effective Date Description State Action

“Preventive Care” refers to services and programs designed to
SB 220 (Yee) Effective September 23, 2010, group or
prevent the onset of diseases. The ACA contains a wealth of
individual health plans and insurance policies must comply
funding for new preventive programs, both at the Federal and
with specified requirements related to preventive care in
state levels. All new group health plans and plans in the
the ACA. Last amended 8/16/10.
individual market must provide first dollar coverage for
Preventive Care Ongoing preventive services (Effective September 2010). Provides a free,
AB 2287 (Monning) Would require the California Health
annual wellness visit and personalized prevention plan services
and Human Services Agency to direct departments to apply
for Medicare beneficiaries and eliminates cost-sharing for
for Federal funding available as part of the ACA’s
preventive services (Effective January 1, 2011). State Medicaid
Prevention and Public Health Fund. In Committee. Last
programs to cover tobacco cessation services for pregnant
Amended 7/15/10
women. (Effective Fiscal Year 2011).
“Mental Health” refers to a state of well-being in which the
individual realizes his or her own abilities, can cope with the
normal stresses of life, can work productively and fruitfully, and AB 1600 (Beall) Would require most health plans to
Mental Health
Ongoing is able to make a contribution to his or her community. The ACA provide coverage for diagnosis and treatment of mental
Care
has provisions for mental health, including coverage of mental illness. Read Second Time 08/02/10
health services under the essential health benefits plan (Section
1302, Effective January 1, 2014)
HHS is developing standards for reviewing “unreasonable”
AB 2578 (Jones) Would require the approval by the
premium increases and requirements for carriers to submit
Department of Managed Health Care or the Department of
justification information to the Secretary and post on their
Rate Review March 23, 2010 Insurance when insurers propose to increase premiums,
website. States that meet the minimum standards for rate
copayments, coinsurance, or deductibles. Third Reading.
review may apply for grants - $250 million over 5 years is
Last Amended 8/17/10
available.
ACA requires health insurers to report on the percentage of
premiums that go to coverage of medical expenses. HHS shall
Rebates begin request the National Association of Insurance Commissioners
SB 890 (Alquist) Requires health insurance issuers to
for plan year on (NAIC) develop uniform definitions and standardized
Medical Loss Ratio comply with federal regulations regarding MLR
or after January methodologies for calculating the medical loss ratio to be used
specifications.
1, 2011 to determine rebates. Letter from Secretary to NAIC sent on
April 12. The report is due December 31, 2010, but should be
completed much sooner to ensure smooth implementation.

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 Health Reform Implementation
2010 Legislative Tracker – California

Reform Effective Date Description State Action

Standardized AB 786 (Jones) Requires state health officials to develop
HHS shall request that NAIC develop the standardized
Definitions and standard definitions and terminology for covered health
definitions and uniform explanations of coverage in conjunction
Uniform March 23, 2010 benefits and cost sharing provisions applicable to individual
with a working group that includes consumer and industry
Explanation of health plans by December 31, 2011. Amended, to second
groups.
Coverage reading 08/18/10
AB 2787 (Monning) Amended bill that establishes an Office
of the California Health Ombudsman as a resource for
ACA makes available $30 million in the first fiscal year for states
consumers to address grievances and complaints and
State Ombudsman March 23, 2010 to establish and operate independent offices of consumer
access information. The state will be allowed to use
assistance and health insurance ombudsman programs.
available federal funds for this purpose. Held in
Appropriations Committee 08/12/10
To alleviate state administrative burdens, HHS will work with
Fraud Reporting
March 23, 2010 states and stakeholders to develop a standardized fraud
Form
reporting form.
Temporary
Creates temporary reinsurance for employers providing
Reinsurance
June 1, 2010 reimbursement to businesses who provide coverage to retirees
Program for Early
aged 55 and older who are not yet eligible for Medicare.
Retirees
Seniors at the “doughnut hole” will receive a $250 dollars
rebate for medication coverage. As seniors start hitting this gap
Medicare Rebate June 15, 2010
they will receive automatically this check from the Health &
Human Services (HSS) department.
SB 810 (Leno) Would establish the California Healthcare
“Single-payer” refers to a system of universal health coverage
System (CHS), a single-payer health system which would
whereby all medical costs are paid for by a single source, usually
make all California residents eligible for certain specified
a government or government-contracted entity. According to
Single-Payer health benefits. The system would be administered by the
N/A the provisions of ACA, states may apply for a waiver which
Health System newly created California Healthcare Agency, which would
would exempt them from many of the law’s reform provisions if
negotiate set fees for health services with providers. The
the state could demonstrate that its new policies and programs
bill also prohibits any other health plan or health insurance
provided greater quality care without negative fiscal impacts.
policy that is not part of CHS. Read second time 08/16/10

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 Health Reform Implementation
2010 Legislative Tracker – California

Reform Effective Date Description State Action

ACA calls for the development of Temporary High Risk Pools
which would provide insurance to those individuals with a pre-
High Risk Pools June 21, 2010 existing condition who have gone uninsured for six (6) months
or more. States were given the option to operate the pools
themselves or allow HHS to run the state pool.
Federal HHS awards contracts to State offices that have
High Risk Pool
July 1, 2010 acceptable contract proposals to operate high risk pools
Contract Awards
programs.
HHS shall develop a website through which individuals and small
businesses may receive information about their coverage
choices – including public programs. Secretary must develop in
Web portal July 1, 2010
consultation with states. See the U.S. Department of Health and
Human Services’ health care information portal,
www.healthcare.gov.
All plans (including third party administrators (TPAs)) must
Submission of September 23, submit claims, financial, enrollment, ratings, cost-sharing and
Information 2010 other information to the Secretary and the state insurance
department. There’s no timeline from HHS on this project
AB 1887 Would require Managed Risk Medical Insurance
Board to establish a temporary high risk pool to provide
health care coverage to specified individuals with pre-
existing conditions and have not been covered under
creditable coverage, as defined, for six months prior to
applying for coverage in the pool to meet specified
requirements and would require premiums to be
established at a standard rate for a standard population.
The Board would also be required to apply for Federal
funding to operate the pool. Signed by Governor, 06/30/10
SB 227 Authorizes the state of California to set up the
temporary high risk pool and contract with private insurers.
Under this bill, the insurer will be required to inform the
applicant about the temporary high risk pool established
pursuant to the bill. The bill would also impose a state-
mandated local program because any willful violation of the
requirement by a health care service plan would be a crime.
Signed by Governor, 06/30/10
The Centers for Medicare and Medicaid Services estimates
that California could be elegble to apply for up to $761
million in federal funding of their high risk pool.

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 Health Reform Implementation
2010 Legislative Tracker – California

Reform Effective Date Description State Action

AB 2244 (Feuer) Prohibits, effective January 1, 2011, a

health care service plan or health insurer (collectively
carriers) notwithstanding any other provision of state law
or regulation, from excluding or limiting coverage to
Children Coverage children due to any pre-existing conditions. Read second
September 23, Prohibits insurers denying coverage to children under the age of
with Pre-Existing time 08/17/10
2010 19 because of pre-existing conditions.
Conditions
AB 1602 (Perez) This bill will prohibit carriers from imposing
pre-existing condition exclusions for enrollees or insured
under 19 years of age. Read second time and amended
08/17/10

AB 2244 (Feuer) Prohibits a health care service plan or

health insurer (collectively carriers) notwithstanding any
Adult coverage
Prohibits exclusions of health insurance for adults with pre- other provision of state law or regulation, from excluding or
with pre-existing January 1, 2014
existing conditions. limiting coverage to adults due to any pre-existing
conditions
conditions, effective January 1, 2014. Read second time
08/17/10

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 Health Reform Implementation
2010 Legislative Tracker – California

Reform Effective Date Description State Action

AB 2470 (De La Torre) Standardizes questions used on

health insurance application forms, and requires insurers to
complete medical underwriting and review for accuracy
before issuing a health plan contract or policy. Read second
time and amended 08/17/10
AB 1602 (Perez) Companion bill to SB 900. Enacts the
California version of the Patient Protection and Affordable
Care Act (ACA). It prohibits group or individual health care
Limits on rescissions service plans or health insurers from establishing lifetime or
No cost-sharing for preventive services unreasonable annual limits on the dollar value of benefits.
Restrictions on annual limits Requires carriers to provide minimum coverage for
Plan years
No pre-existing conditions exclusions for minors specified preventive services. Prohibits carriers from
begin on or
Immediate Market Coverage for dependents under 26 year old imposing pre-existing condition exclusions for enrollees or
after
Reforms Non-discrimination provisions – regulations to be insured under 19 years of age. Allows dependent coverage
September 23,
developed by HHS during April until age 26. Creates the California Health Benefit Exchange
2010
Grandfathering details may also be forthcoming for the purchase of health care coverage. Read second time
Appeals rights and patient protections may come out by and amended 08/17/10
summer 2010
SB 1088 (Price) Would prohibit limiting the age for
dependent children covered by health care service plan
contracts and group health insurance policies to less than
26 years of age to conform to the federal law. Provides that
no employer is required to pay the cost of coverage for
dependents who are at least 23 years of age, but less than
26. Authorizes subscribers and insurers to elect to provide
coverage to those dependents by contributing the premium
for that coverage. Read second time 08/16/10

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2010 Legislative Tracker – California

Reform Effective Date Description State Action

Limits on rescissions
AB 2110 (De La Torre) Will require insurers to allow a 50
No cost-sharing for preventive services
day grace period before cancelling coverage for failure to
Restrictions on annual limits
Plan years pay premiums. Read second time 08/03/10
No pre-existing conditions exclusions for minors
begin on or
Immediate Market Coverage for dependents under 26 year old
after AB 1825 (De La Torre) Would require all insurance policies
Reforms Non-discrimination provisions – regulations to be
September 23, submitted for approval after January 1, 2011 by the state
2010 developed by HHS during April insurance commission to include maternity coverage. Read
Grandfathering details may also be forthcoming Second Time 08/17/10
Appeals rights and patient protections may come out by
summer 2010

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2010 Legislative Tracker – California

Reform Effective Date Description State Action

Consumer
Funding is available for the development of CO-OP programs or
Operated and
July 1, 2013 non-profit member-run health insurance companies, which will
Oriented Plan
offer qualified programs under the Exchange.
(CO-OP)
Health Insurance Exchanges are marketplaces for individuals SB 900 (Alquist) Would establish the State Health Benefits
and some employers to shop for insurance coverage in a Exchange within the State Health and Human Services
transparent, well regulated system. Agency and would require the Exchange to implement
specified functions imposed by the federal Patient
HHS shall develop minimums standards for state-based Protection and Affordable Care Act in a consumer-friendly
Exchanges in consultation with the NAIC. manner, enter into contracts with health care service plans
and health insurers seeking to offer coverage in the
Exchanges January 1, 2014
HHS shall develop a uniform enrollment form that must be used Exchange; and provide a choice in each region of the state
by the state Exchange. The NAIC is asked to provide criteria for between five levels of coverage. Creates the State Health
the form. Benefits Exchange Fund. Read second time 08/17/10

Insurers are required to offer an “essential benefit plan”, AB 1602 (Perez) Companion bill to SB 900. Exchange to be
prohibit annual limits and establish specific rate restrictions effective on or before January 1, 2014. Read second time
standards. 08/17/10

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 Health Reform Implementation
2010 Legislative Tracker – California

Reform Effective Date Description State Action

AB 2042 (Feuer) Prohibits insurers and HMO’s from
increasing or changing premiums, cost sharing, or benefits
more often that once a year.
Read second time 08/16/10

SB 1163 (Leno) Would require health plans to provide, in

writing, specific reasons for denial of coverage or charging
higher rates than the standard. Read second time. Second
reading amended 08/18/10

SB 890 (Alquist) Would require health care service plans

and health insurers issuing individual coverage to make
Market reforms refer to changes in the way insurance is sold
certain standard benefit plan “tiers” available to individuals
and priced. There are a number of important areas of market
with coverage choice categories. Allows a subscriber or
reforms, such as limiting insurance price variations for different
policyholder to transfer coverage on the annual renewal
characteristics, guaranteed issue of insurance, etc.
date. Would create an insurance market reform
Market Reforms January 1, 2014
commission. Relates to the minimum amount of fees and
State individual and group market regulations must meet or
premiums spent on benefits. Relates to disclosures.
exceed minimum federal standards by January 1, 2014, or
Requires coverage for basic health care services. Prohibits
federal law will preempt them. State laws that “do not prevent
lifetime benefit limits. Read Second Time 08/17/10
the application” of the federal rules are preserved.
SB 1104 (Cedillo) Would require all health insurance plans
issued, renewed, or amended after January 1, 2011 to
include coverage for diagnosis and treatment of diabetes-
related conditions. Held in Senate Appropriations
Committee

AB 1759 (Blumenfield) Would require insurers to provide a

separate disclosure document to purchasers of group plans
that specifies the conditions under which premium rates or
cost-sharing may change during the contract term.
Amended 08/18/10

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2010 Legislative Tracker – California

Reform Effective Date Description State Action

Medigap refers to private coverage which may be purchased by
Medicare beneficiaries to supplement their Medicare coverage.
Medigap Reform January 1, 2015
NAIC requested to add cost-sharing requirements to Medigap
Plans C and F, in consultation with consumer and industry
groups.
States may enter into compacts which allow carriers to sell their
Interstate products across state lines. The guidelines for these “health care
July 1, 2016
Compact choice compacts” are to be developed by the NIAC no later than
July 1, 2013.

Executive Branch Implementation

Governors have the ability to issue “executive orders” which do not require legislative action. These orders do not change the law, yet
help to initiate actions to help the implementation process.

Gov. Arnold Schwarzenegger formed a task force lead by Health and Human Services Secretary Kim Belshé, to implement key provisions
and long-term reform programs. (Effective since April 27, 2010)

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