Council on Legislation Report: Regarding California Legislation By William Bonney, MD, CUA Representative to COL

To Members of the California Urological Association,

On March 26th the California Medical Association convened its Council on Legislation, discussion and vote by delegates to finalize CMA's position on current issues in the California legislature.

It was my privilege to represent you at the Council. While our organization lacked voting privilege, it was nonetheless a worthwhile and informative experience.

The purpose of this message is to provide an update on selected legislative issues of possible interest to our CUA members.

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Sources of additional information:
Official California Legislative Information www.leginfo.ca.gov/
-- Home Page
-- Updates on specific Assembly or Senate bills
-- To contact legislative members from your own district

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Specific bills:

DENIAL OF CARE BY HEALTH CARE SERVICE PLANS
This bill, sponsored by the California Medical Association (CMA), seeks to shift the burden of proof to a health care plan in any legal action challenging a health care plan's denial of medical coverage. This bill would create a presumption that any medical treatment ordered by the provider is "medically necessary," and thereby shift the burden of proof to the plan to show that the treatment was not necessary.
CMA recommends support.

MEASURE : A.B. No. 2847
AUTHOR(S) : Krekorian.
COMMITTEE : APPROPRIATIONS
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MANDATORY ELECTRONIC TRANSMISSION OF ALL PHARMACEUTICAL PRESCRIPTIONS
This bill would, commencing January 1, 2010, require a prescriber to ensure that any prescription issued or made by him or her be type-written and electronically transmitted to the patient's pharmacy of choice, except as specified.
CMA recommends oppose.

MEASURE : A.B. No. 2516
AUTHOR(S) : Mendoza.
COMMITTEE: BUSINESS AND PROFESSIONS

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SIX MONTH LIMIT FOR CANCELLATION OF INDIVIDUAL HEALTH CARE COVERAGE
This bill would prohibit a health care service plan or health insurer from rescinding an individual health care service plan contract or individual health insurance policy for any reason after 6 months following the issuance of the contract or policy. The bill would authorize a subscriber, enrollee, policyholder, or insured who believes his or her individual contract or policy was wrongfully rescinded to request review of that rescission.
CMA recommends support.

MEASURE : A.B. No. 2549
AUTHOR(S) : Hayashi.
COMMITTEE: APPROPRIATIONS

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REGULATORY APPROVAL BEFORE A HEALTH PLAN/INSURER CAN CANCEL A CONTRACT OR POLICY
This bill would additionally require a health care service plan or health insurer to seek and obtain final approval from its regulator prior to rescinding a plan contract or insurance policy, as applicable. The bill would require the director and commissioner to contract with one or more appropriately qualified independent review organizations in this regard. The bill would also authorize each regulator to suspend or revoke the license or certificate of a plan or insurer in violation of this prohibition or to assess administrative penalties.
CMA recommends support.

MEASURE : A.B. No. 1945
AUTHOR(S) : De La Torre.
COMMITTEE: APPROPRIATIONS

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REIMBURSEMENT DIRECTLY TO PROVIDER
This bill would require health care service plans to authorize assignment of a patient's reimbursement (for covered services) directly to the provider furnishing those services. Under current practice, some health plans provide service reimbursement to the patient--and require the physician to bill the patient--even when the patient specifies that the provider be paid directly.
CMA recommends support.

MEASURE : A.B. No. 2805
AUTHOR(S) : Ma.
COMMITTEE: APPROPRIATIONS

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REGULATORY AGENCY MUST APPROVE CANCELLATION OF HEALTHCARE PLAN OR INSURANCE
This bill would require a health care service plan or health insurer to obtain final approval from its regulator prior to rescinding a plan contract or insurance policy. The state Director and Commissioner would then contract with one or more appropriately qualified independent review organizations to investigate the matter.
CMA recommends support.

MEASURE : A.B. No. 1945
AUTHOR(S) : De La Torre.
COMMITTEE: APPROPRIATIONS

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PHARMACY INSTRUCTIONS MAILED TO PATIENTS
This bill would allow a pharmacy to mail specified written communications to a patient, without the patient's authorization. The written communication instructs the patient to contact the prescribing or dispensing healthcare professional if:

(A) The patient has questions about the medication.
(B) The patient is having difficulty adhering to the medication due to adverse effects, dosing requirements, or other causes.

CMA policy regards this as interference with doctor-patient relationship.
CMA recommends oppose.

MEASURE : S.B. No. 1096
AUTHOR(S) : Calderon.
COMMITTEE: SEN JUDICIARY

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RETENTION OF INDIVIDUAL PATIENT MEDICAL RECORDS
This bill would require health care providers, at the time an initial patient record is created, to provide a statement (to be signed by the patient) which sets forth the patient's rights, as specified, and the intended retention period for the records.

This bill would also require health care providers, who plan to destroy patient records earlier than the period specified in the signed statement, to notify the patient no fewer than 60 days before the records are to be destroyed.

CMA recommends further study/referral to Committee on Medical Services.

MEASURE : S.B. No. 1415
AUTHOR(S) : Kuehl.
COMMITTEE: SEN JUDICIARY

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HEALTH INSURERS AND SERVICE PLANS:
OF ALL PREMIUM PAYMENTS RECEIVED, 85% MUST GO TO BENEFITS
This Senate bill would require health care service plans and health insurers to expend on health care benefits no less than 85% of the aggregate payments they receive with respect to plan contracts or policies issued, amended, or renewed on or after January 1, 2009. The bill would require those plans and insurers to provide written affirmation of compliance.

A roughly comparable Assembly bill would require the Insurance Commissioner to establish the minimum % of income expended as benefits (reasonable "pure loss ratio") for all workers' compensation insurers.

CMA recommends support for both bills.

MEASURE : S.B. No. 1440
AUTHOR(S) : Kuehl.
COMMITTEE: SEN APPROPRIATIONS

MEASURE : A.B. No. 2692
AUTHOR(S) : Hernandez.
COMMITTEE: INSURANCE