SB 743: Medi-Cal: family planning providers.
- Session Year: 2017-2018
- House: Senate
- Latest Version Date: 2017-10-07
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services through fee-for-service or managed care delivery systems. The Medi-Cal program is, in part, governed by, and funded pursuant to, federal Medicaid program provisions. Existing law provides that family planning services are a covered Medi-Cal benefit, subject to utilization controls, as specified.
This bill would prohibit a Medi-Cal managed care plan, as defined, from restricting the choice of the qualified provider, as defined, from whom a Medi-Cal beneficiary enrolled in the plan may receive family planning services. The bill would require a Medi-Cal managed care plan to reimburse an out-of-plan or out-of-network qualified provider at the applicable fee-for-service rate. If federal approval is required to implement these provisions, the bill would be implemented only to the extent that federal approval is obtained. The bill would make related legislative findings and declarations.
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services through fee-for-service or managed care delivery systems. The Medi-Cal program is, in part, governed by, and funded pursuant to, federal Medicaid program provisions. Existing law provides that family planning services are a covered Medi-Cal benefit, subject to utilization controls, as specified.
This bill would prohibit a Medi-Cal managed care plan, as defined, from restricting the choice of the qualified provider, as defined, from whom a Medi-Cal beneficiary enrolled in the plan may receive family planning services. The bill would require a Medi-Cal managed care plan to reimburse an out-of-plan or out-of-network qualified provider at the applicable fee-for-service rate. If federal approval is required to implement these provisions, the bill would be implemented only to the extent that federal approval is obtained. The bill would make related legislative findings and declarations.
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services through fee-for-service or managed care delivery systems. The Medi-Cal program is, in part, governed by, and funded pursuant to, federal Medicaid program provisions. Existing law provides that family planning services are a covered Medi-Cal benefit, subject to utilization controls, as specified.
This bill would prohibit a Medi-Cal managed care plan plan, as defined, from restricting the choice of the qualified provider, as defined, from whom a Medi-Cal beneficiary enrolled in the plan may receive family planning services. The bill would require a Medi-Cal managed care plan to reimburse an out-of-plan or out-of-network qualified provider at the applicable fee-for-service rate. If federal approval is required to implement these provisions, the bill would be implemented only to the extent that federal approval is obtained. The bill would make related legislative findings and declarations.
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services through fee-for-service or managed care delivery systems. The Medi-Cal program is, in part, governed by, and funded pursuant to, federal Medicaid program provisions. Existing law provides that family planning services are a covered Medi-Cal benefit, subject to utilization controls, as specified.
This bill would prohibit a Medi-Cal managed care plan from restricting the choice of the qualified provider, as defined, from whom a Medi-Cal beneficiary enrolled in the plan may receive family planning services. The bill would require a Medi-Cal managed care plan to reimburse an out-of-plan or out-of-network qualified provider at the applicable fee-for-service rate. The bill would make related legislative findings and declarations.
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services through fee-for-service or managed care delivery systems. The Medi-Cal program is, in part, governed by, and funded pursuant to, federal Medicaid program provisions. Existing law provides that family planning services are a covered Medi-Cal benefit, subject to utilization controls, as specified.
This bill would prohibit a Medi-Cal managed care plan from restricting the choice of the qualified provider, as defined, from whom a Medi-Cal beneficiary enrolled in the plan may receive family planning services. The bill would make related legislative findings and declarations.
This act shall be known, and may be cited as, the Protection of Choice for Family Planning Act.
SEC. 2.The Legislature hereby finds and declares all of the following:
(a)California has a long history of, and commitment to, expanding access to services that aim to reduce the risk of unintended pregnancies, improve reproductive and sexual health outcomes, and reduce state costs.
(b)According to the Guttmacher Institute, one-half of all pregnancies in the United States each year are unintended. By 45 years of age, more than one-half of all women in the United States will have experienced an unintended pregnancy, and 3 in 10 will have had an abortion.
(c)Recognizing the importance of timely, confidential access to reproductive health care, the current federal freedom of choice provision passed in 1986 allows Medicaid managed care beneficiaries to access reproductive health care from any willing provider that serves patients covered by Medicaid, even if the provider is out of the managed care plans network.
(d)The federal Balanced Budget Act of 1997 further cemented the ability of Medicaid managed care beneficiaries to go out of network to have direct access to family planning providers.
(e)California has implemented the federal freedom of choice provision for decades, but it is not codified in California law.
(f)To ensure that Californians enrolled in Medi-Cal managed care plans do not lose the existing ability to go out of network if the freedom of choice provision is repealed on the federal level, the provision must be established in California statute.
SEC. 3.Section 14132.07 is added to the Welfare and Institutions Code, to read:14132.07.(a)A Medi-Cal managed care plan shall not restrict the choice of the qualified provider from whom a beneficiary enrolled in the managed care plan may receive family planning services covered by the Medi-Cal program pursuant to subdivision (n) of Section 14132.
(b)The following definitions shall apply for purposes of this section:
(1)Medi-Cal managed care plan means an applicable organization or entity that contracts with the department to provide services to enrolled Medi-Cal beneficiaries pursuant to any of the following:
(A)Article 2.7 (commencing with Section 14087.3).
(B)Article 2.8 (commencing with Section 14087.5).
(C)Article 2.81 (commencing with Section 14087.96).
(D)Article 2.82 (commencing with Section 14087.98).
(E)Article 2.91 (commencing with Section 14089).
(F)Chapter 8 (commencing with Section 14200).
(2)Qualified provider means a provider that is licensed to furnish family planning services, is an enrolled Medi-Cal provider, and is willing to furnish family planning services to an enrollee. A qualified provider may be an out-of-plan or out-of-network provider.
(c)A Medi-Cal managed care plan shall reimburse an out-of-plan or out-of-network qualified provider at the applicable fee-for-service rate.
(d)If federal approval is required to implement this section, the section shall be implemented only to the extent that federal approval is obtained.
This act shall be known, and may be cited as, the Protection of Choice for Family Planning Act.
SEC. 2.The Legislature hereby finds and declares all of the following:
(a)California has a long history of, and commitment to, expanding access to services that aim to reduce the risk of unintended pregnancies, improve reproductive and sexual health outcomes, and reduce state costs.
(b)According to the Guttmacher Institute, one-half of all pregnancies in the United States each year are unintended. By 45 years of age, more than one-half of all women in the United States will have experienced an unintended pregnancy, and 3 in 10 will have had an abortion.
(c)Recognizing the importance of timely, confidential access to reproductive health care, the current federal freedom of choice provision passed in 1986 allows Medicaid managed care beneficiaries to access reproductive health care from any willing provider that serves patients covered by Medicaid, even if the provider is out of the managed care plans network.
(d)The federal Balanced Budget Act of 1997 further cemented the ability of Medicaid managed care beneficiaries to go out of network to have direct access to family planning providers.
(e)California has implemented the federal freedom of choice provision for decades, but it is not codified in California law.
(f)To ensure that Californians enrolled in Medi-Cal managed care plans do not lose the existing ability to go out of network if the freedom of choice provision is repealed on the federal level, the provision must be established in California statute.
SEC. 3.Section 14132.07 is added to the Welfare and Institutions Code, to read:14132.07.(a)A Medi-Cal managed care plan shall not restrict the choice of the qualified provider from whom a beneficiary enrolled in the managed care plan may receive family planning services covered by the Medi-Cal program pursuant to subdivision (n) of Section 14132.
(b)The following definitions shall apply for purposes of this section:
(1)Medi-Cal managed care plan means an applicable organization or entity that contracts with the department to provide services to enrolled Medi-Cal beneficiaries pursuant to any of the following:
(A)Article 2.7 (commencing with Section 14087.3).
(B)Article 2.8 (commencing with Section 14087.5).
(C)Article 2.81 (commencing with Section 14087.96).
(D)Article 2.82 (commencing with Section 14087.98).
(E)Article 2.91 (commencing with Section 14089).
(F)Chapter 8 (commencing with Section 14200).
(2)Qualified provider means a provider that is licensed to furnish family planning services, is an enrolled Medi-Cal provider, and is willing to furnish family planning services to an enrollee. A qualified provider may be an out-of-plan or out-of-network provider.
(c)A Medi-Cal managed care plan shall reimburse an out-of-plan or out-of-network qualified provider at the applicable fee-for-service rate.
(d)If federal approval is required to implement this section, the section shall be implemented only to the extent that federal approval is obtained.
This act shall be known, and may be cited as, the Protection of Choice for Family Planning Act.
SEC. 2.The Legislature hereby finds and declares all of the following:
(a)California has a long history of, and commitment to, expanding access to services that aim to reduce the risk of unintended pregnancies, improve reproductive and sexual health outcomes, and reduce state costs.
(b)According to the Guttmacher Institute, one-half of all pregnancies in the United States each year are unintended. By 45 years of age, more than one-half of all women in the United States will have experienced an unintended pregnancy, and 3 in 10 will have had an abortion.
(c)Recognizing the importance of timely, confidential access to reproductive health care, the current federal freedom of choice provision passed in 1986 allows Medicaid managed care beneficiaries to access reproductive health care from any willing provider that serves patients covered by Medicaid, even if the provider is out of the managed care plans network.
(d)The federal Balanced Budget Act of 1997 further cemented the ability of Medicaid managed care beneficiaries to go out of network to have direct access to family planning providers.
(e)California has implemented the federal freedom of choice provision for decades, but it is not codified in California law.
(f)To ensure that Californians enrolled in Medi-Cal managed care plans do not lose the existing ability to go out of network if the freedom of choice provision is repealed on the federal level, the provision must be established in California statute.
SEC. 3.Section 14132.07 is added to the Welfare and Institutions Code, to read:14132.07.(a)A Medi-Cal managed care plan shall not restrict the choice of the qualified provider from whom a beneficiary enrolled in the managed care plan may receive family planning services covered by the Medi-Cal program pursuant to subdivision (n) of Section 14132.
(b)For the purposes of this section, qualified provider means a provider who is licensed to furnish family planning services within the scope of his or her practice, is an enrolled Medi-Cal provider, and is willing to furnish family planning services to an enrollee. A qualified provider may be an out-of-plan or out-of-network provider.(b)The following definitions shall apply for purposes of this section:
(1)Medi-Cal managed care plan means an applicable organization or entity that contracts with the department to provide services to enrolled Medi-Cal beneficiaries pursuant to any of the following:
(A)Article 2.7 (commencing with Section 14087.3).
(B)Article 2.8 (commencing with Section 14087.5).
(C)Article 2.81 (commencing with Section 14087.96).
(D)Article 2.82 (commencing with Section 14087.98).
(E)Article 2.91 (commencing with Section 14089).
(F)Chapter 8 (commencing with Section 14200).
(2)Qualified provider means a provider that is licensed to furnish family planning services, is an enrolled Medi-Cal provider, and is willing to furnish family planning services to an enrollee. A qualified provider may be an out-of-plan or out-of-network provider.
(c)A Medi-Cal managed care plan shall reimburse an out-of-plan or out-of-network qualified provider at the applicable fee-for-service rate.
(d)If federal approval is required to implement this section, the section shall be implemented only to the extent that federal approval is obtained.
This act shall be known, and may be cited as, the Protection of Choice for Family Planning Act.
SEC. 2.The Legislature hereby finds and declares all of the following:
(a)California has a long history of, and commitment to, expanding access to services that aim to reduce the risk of unintended pregnancies, improve reproductive and sexual health outcomes, and reduce state costs.
(b)According to the Guttmacher Institute, one-half of all pregnancies in the United States each year are unintended. By 45 years of age, more than one-half of all women in the United States will have experienced an unintended pregnancy, and 3 in 10 will have had an abortion.
(c)Recognizing the importance of timely, confidential access to reproductive health care, the current federal freedom of choice provision passed in 1986 allows Medicaid managed care beneficiaries to access reproductive health care from any willing provider that serves patients covered by Medicaid, even if the provider is out of the managed care plans network.
(d)The federal Balanced Budget Act of 1997 further cemented the ability of Medicaid managed care beneficiaries to go out of network to have direct access to family planning providers.
(e)California has implemented the federal freedom of choice provision for decades, but it is not codified in California law.
(f)To ensure that Californians enrolled in Medi-Cal managed care plans do not lose existing benefits the existing ability to go out of network if the freedom of choice provision is repealed on the federal level, the provision must be established in California statute.
SEC. 3.Section 14132.07 is added to the Welfare and Institutions Code, to read:14132.07.(a)A Medi-Cal managed care plan shall not restrict the choice of the qualified provider from whom a beneficiary enrolled in the managed care plan may receive family planning services covered by the Medi-Cal program pursuant to subdivision (n) of Section 14132.
(b)For the purposes of this section, qualified provider means a provider who is licensed to furnish family planning services within the scope of his or her practice, is an enrolled Medi-Cal provider, and is willing to furnish family planning services to an enrollee. A qualified provider may be an out-of-plan or out-of-network provider.
(c)A Medi-Cal managed care plan shall reimburse an out-of-plan or out-of-network qualified provider at the applicable fee-for-service rate.
This act shall be known, and may be cited as, the Protection of Choice for Family Planning Act.
SEC. 2.The Legislature hereby finds and declares all of the following:
(a)California has a long history of, and commitment to, expanding access to services that aim to reduce the risk of unintended pregnancies, improve reproductive and sexual health outcomes, and reduce state costs.
(b)According to the Guttmacher Institute, one-half of all pregnancies in the United States each year are unintended. By 45 years of age, more than one-half of all women in the United States will have experienced an unintended pregnancy, and 3 in 10 will have had an abortion.
(c)Recognizing the importance of timely, confidential access to reproductive health care, the current federal freedom of choice provision passed in 1986 allows Medicaid managed care beneficiaries to access reproductive health care from any willing provider that serves patients covered by Medicaid, even if the provider is out of the managed care plan's network.
(d)The federal Balanced Budget Act of 1997 further cemented the ability of Medicaid managed care beneficiaries to go out of network to have direct access to family planning providers.
(e)California has implemented the federal freedom of choice provision for decades, but it is not codified in California law.
(f)To ensure that Californians enrolled in Medi-Cal managed care plans do not lose existing benefits if the freedom of choice provision is repealed on the federal level, the provision must be established in California statute.
SEC. 3.Section 14132.07 is added to the Welfare and Institutions Code, to read:14132.07.(a)A Medi-Cal managed care plan shall not restrict the choice of the qualified provider from whom a beneficiary enrolled in the managed care plan may receive family planning services covered by the Medi-Cal program pursuant to subdivision (n) of Section 14132.
(b)For the purposes of this section, qualified provider means a provider who is licensed to furnish family planning services within the scope of his or her practice, is an enrolled Medi-Cal provider, and is willing to furnish family planning services to an enrollee. A qualified provider may be an out-of-plan or out-of-network provider.
|
Date
|
Status
|
|---|---|
| Oct 7, 2017 | Chaptered by Secretary of State. Chapter 572, Statutes of 2017. |
| Oct 7, 2017 | Approved by the Governor. |
| Sep 21, 2017 | Enrolled and presented to the Governor at 5:30 p.m. |
| Sep 14, 2017 | Assembly amendments concurred in. (Ayes 27. Noes 12.) Ordered to engrossing and enrolling. |
| Sep 14, 2017 | In Senate. Concurrence in Assembly amendments pending. |
| Sep 13, 2017 | Read third time. Passed. Ordered to the Senate. |
| Sep 6, 2017 | Read second time. Ordered to third reading. |
| Sep 5, 2017 | Read second time and amended. Ordered to second reading. |
| Sep 1, 2017 | From committee: Do pass as amended. (Ayes 11. Noes 5.) (September 1). |
| Jul 19, 2017 | July 19 set for first hearing. Placed on APPR. suspense file. |
| Jun 28, 2017 | From committee: Do pass and re-refer to Com. on APPR. (Ayes 12. Noes 3.) (June 27). Re-referred to Com. on APPR. |
| Jun 12, 2017 | Referred to Coms. on HEALTH and APPR. |
| May 31, 2017 | In Assembly. Read first time. Held at Desk. |
| May 30, 2017 | Read third time. Passed. (Ayes 27. Noes 13. Page 1261.) Ordered to the Assembly. |
| May 23, 2017 | Read second time. Ordered to third reading. |
| May 22, 2017 | From committee: Be ordered to second reading pursuant to Senate Rule 28.8. |
| May 16, 2017 | Set for hearing May 22. |
| May 11, 2017 | May 15 hearing postponed by committee. |
| May 4, 2017 | Set for hearing May 15. |
| May 3, 2017 | May 8 hearing postponed by committee. |
| May 1, 2017 | Set for hearing May 8. |
| Apr 20, 2017 | From committee: Do pass and re-refer to Com. on APPR. (Ayes 7. Noes 1. Page 808.) (April 19). Re-referred to Com. on APPR. |
| Mar 23, 2017 | From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH. |
| Mar 10, 2017 | Set for hearing April 19. |
| Mar 9, 2017 | Referred to Coms. on HEALTH and APPR. |
| Feb 21, 2017 | From printer. May be acted upon on or after March 23. |
| Feb 17, 2017 | Introduced. Read first time. To Com. on RLS. for assignment. To print. |
|
Date
|
Description
|
Location
|
Votes
|
|
|---|---|---|---|---|
| Sep 14, 2017 | Unfinished Business SB743 Hernandez et al. Concurrence | Senate Floor |
Passed |
|
| Sep 13, 2017 | SB 743 Hernandez Senate Third Reading By GONZALEZ FLETCHER | Assembly Floor |
Passed |
|
| Sep 1, 2017 | Do pass as amended. | Assembly Standing Committee on Appropriations |
Passed |
|
| Jun 27, 2017 | Do pass and be re-referred to the Committee on [Appropriations] | Assembly Standing Committee on Health |
Passed |
|
| May 30, 2017 | Senate 3rd Reading SB743 Hernandez et al. | Senate Floor |
Passed |
|
| Apr 19, 2017 | Do pass, but first be re-referred to the Committee on [Appropriations] | Senate Standing Committee on Health |
Passed |
This list shows positions taken on this bill by organizations on the date displayed, which is linked to the original source.
Positions by individuals are not included.
|
Organization
|
Position
|
Date
|
|---|---|---|
| Access Women's Health Justice | ** Support | Sep 14, 2017 |
| Act for Women and Girls | ** Support | Sep 14, 2017 |
| American Academy Of Pediatrics, California | ** Support | Sep 14, 2017 |
| American Nurses Association, California | ** Support | Sep 14, 2017 |
| Anti-Defamation League | ** Support | Sep 14, 2017 |
| black women for wellness | ** Support | Sep 14, 2017 |
| California Academy of Preventive Medicine | ** Support | Sep 14, 2017 |
| California Catholic Conference, Inc. | ** Against | Sep 14, 2017 |
| California Immigrant Policy Center | ** Support | Sep 14, 2017 |
| California Latinas for Reproductive Justice | ** Support | Sep 14, 2017 |
| California Pan-Ethnic Health Network | ** Support | Sep 14, 2017 |
| California Physicians Alliance | ** Support | Sep 14, 2017 |
| California ProLife Council | ** Against | Sep 14, 2017 |
| California Right to Life Committee | ** Against | Jun 23, 2017 |
| California Women's Law Center | ** Support | Sep 14, 2017 |
| CaliforniaHealth + Advocates | ** Support | Sep 14, 2017 |
| Community Clinic Association of Los Angeles County | ** Support | Sep 14, 2017 |
| Consumer Attorneys Of California | ** Support | Sep 14, 2017 |
| Courage Campaign | ** Support | Sep 14, 2017 |
| Equality California Forward Together | ** Support | Sep 14, 2017 |
| Essential Access Health | ** Support | Sep 14, 2017 |
| Essential Health Access | * Support | Apr 19, 2017 |
| Forward Together | ** Support | Jun 23, 2017 |
| gyn clinic | ** Support | Jun 23, 2017 |
| Health Access California | ** Support | Sep 14, 2017 |
| if when how | ** Support | Jun 23, 2017 |
| Individual | ** Against | Jun 23, 2017 |
| La Clinica de La Raza, Inc. | ** Support | Sep 14, 2017 |
| NARAL Pro-Choice California | ** Support | Sep 14, 2017 |
| National Association of Social Workers | ** Support | Sep 14, 2017 |
| National Association of Social Workers - California Chapter | ** Support | Jun 23, 2017 |
| National Council of Jewish Women, California | ** Support | Sep 14, 2017 |
| National Council of Jewish Women, Los Angeles | ** Support | Sep 14, 2017 |
| National Health Law Program | ** Support | Sep 14, 2017 |
| nevada county citizen's for choice | ** Support | Sep 14, 2017 |
| Physicians for Reproductive Health | ** Support | Sep 14, 2017 |
| Planned Parenthood Action Fund of the Pacific Southwest | ** Support | Sep 14, 2017 |
| Planned Parenthood Advocacy Project Los Angeles County | ** Support | Sep 14, 2017 |
| Planned Parenthood Advocates Pasadena and San Gabriel Valley | ** Support | Sep 14, 2017 |
| Planned Parenthood Affiliates Of California | ** Support | Sep 14, 2017 |
| Planned Parenthood Central Coast Action Fund | ** Support | Sep 14, 2017 |
| Planned Parenthood Mar Monte | ** Support | Sep 14, 2017 |
| Planned Parenthood Northern California Action Fund | ** Support | Sep 14, 2017 |
| Positive Women's Network | ** Support | Sep 14, 2017 |
| San Bernardino Counties | ** Support | Sep 14, 2017 |
| ucla ob | ** Support | Jun 23, 2017 |
| Voices For Progress Education Fund | ** Support | Sep 14, 2017 |
| western center on law & poverty | ** Support | Sep 14, 2017 |
| Women's Community Clinic | ** Support | Sep 14, 2017 |
| Women's Health Specialists of California | ** Support | Sep 14, 2017 |
Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | SB |
UNFINISHED BUSINESS
Bill No: SB 743
:
SENATE HEALTH COMMITTEE: 7-1, 4/19/17
AYES: Hernandez, Atkins, Leyva, Mitchell, Monning, Newman, Roth
NOES: Nielsen
NO VOTE RECORDED: Nguyen
SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8
SENATE FLOOR: 27-13, 5/30/17
AYES: Allen, Atkins, Beall, Bradford, De León, Dodd, Galgiani, Glazer, Hernandez, Hertzberg, Hill, Hueso, Jackson, Lara, Leyva, McGuire, Mendoza, Mitchell, Monning, Newman, Pan, Portantino, Roth, Skinner, Stern, Wieckowski, Wiener
NOES: Anderson, Bates, Berryhill, Cannella, Fuller, Gaines, Moorlach, Morrell, Nguyen, Nielsen, Stone, Vidak, Wilk
ASSEMBLY FLOOR: 55-21, 9/13/17 - See last page for vote
SOURCE: Essential Access Health
Planned Parenthood Affiliates of California
DIGEST:
This bill prohibits Medi-Cal managed care plan from restricting the choice of a qualified provider, as defined, from whom a beneficiary enrolled in the managed care plan may receive family planning services covered by Medi-Cal.
Assembly Amendments require this bill to be implemented only to the extent that federal approval is obtained if federal approval is required, and make technical, clarifying changes.
ANALYSIS: Existing federal law prohibits Medicaid managed care organizations from restricting the choice of a qualified person from whom an individual may receive family planning services.
Existing state law:
- Establishes the Medi-Cal program, administered by the State Department of Health Care Services (DHCS), under which qualified low-income individuals receive health care benefits.
- Requires family planning services to be a covered Medi-Cal benefit, subject to utilization controls, as specified.
This bill:
- Prohibits Medi-Cal managed care plan from restricting the choice of a “qualified provider” from whom a beneficiary enrolled in the managed care plan may receive family planning services covered by Medi-Cal.
- Defines a “qualified provider” as a provider that is licensed to furnish family planning services, is an enrolled Medi-Cal provider, and is willing to furnish family planning services to an enrollee. Permits a qualified provider to be an out-of-plan or out-of-network provider.
- Permits a qualified provider to be an out-of-plan or out-of-network provider.
- Requires a Medi-Cal managed care plan to reimburse an out-of-plan or out-of-network qualified provider at the applicable fee-for-service rate.
- Requires this bill to be implemented only to the extent that federal approval is obtained if federal approval is required.
Background
As mandatory Medicaid managed care enrollment began to grow in the 1980s, enrollees in Medicaid managed care plans sought family planning care from out-of-network, community-based providers instead of their managed care providers. In order to promote access to these services, in 1986 Congress passed a law allowing Medicaid managed care enrollees to obtain family planning services from any qualified, willing provider that accepts Medicaid patients. This “free choice of provider law” ensures that individuals can receive sensitive services outside of a managed care plan’s network. The Balanced Budget Act of 1997 further secured the ability of Medicaid managed care enrollees to go out-of-network for family planning services and have direct access to family planning providers. Since then, DHCS has implemented this federal law through All Plan Letters and contract language.
Comments
- Author’s statement. According to the author, California has a long history of free choice for family planning provider protections, but they are not codified in state law. For decades, California health plans have implemented the federal “free choice of provider law,” which ensures that women can receive reproductive and family planning services both within and outside of a managed care plan’s network. However, the hostile environment on the federal level toward reproductive rights, made apparent by calls from the Trump Administration and the Republican Congress to roll back the progress made in improving access to sexual and reproductive health care, has made the future of the federal law uncertain. To ensure that Californians enrolled in Medi-Cal managed care plans do not lose the ability to receive family planning and related services from willing providers, the federal free choice of provider provision must be codified in California statute. This bill will ensure that Medi-Cal managed care enrollees continue to maintain flexibility in choosing family planning providers if a federal rule, which California has implemented for decades, is repealed. This bill is a pathway for protecting reproductive health access and ensuring that Medi-Cal enrollees do not lose critical benefits in the face of anticipated threats to access on the federal level.
- Family planning services. According to the Guttmacher Institute, federal and state governments have worked for decades to expand access to family planning services for young and low-income women and men, channeling public funds through multiple programs. The Medicaid program provides the large majority of public funding for clinical care through coverage of these services. Title X national family planning program provides additional funding for family planning centers, sets standards of care, and fills gaps in services and coverage. A September 2016 Guttmacher Institute Fact Sheet states that the contraceptive services provided help individuals avoid unintended and unwanted pregnancies, unplanned births, and abortions that might follow. Publicly supported family planning visits also include screenings for STIs such as chlamydia, gonorrhea and HIV; cervical cancer prevention services, including Pap tests and testing and vaccination for human papillomavirus (HPV); and other key preventive care services, all of which have their own health benefits. Collectively, these family planning services yield substantial government savings—$13.6 billion nationally in 2010, or $7.09 for every public dollar spent.
FISCAL EFFECT: Appropriation: Fiscal Com.: Local:
SUPPORT: (Verified 9/13/17)
Essential Access Health (co-source)
Planned Parenthood Affiliates of California (co-source)
ACCESS Women’s Health Justice
ACT for Women and Girls
American Academy of Pediatrics, California
American Nurses Association, California
Anti-Defamation League
Black Women for Wellness
California Academy of Preventive Medicine
CaliforniaHealth + Advocates
California Immigrant Policy Center
California Latinas for Reproductive Justice
California Pan-Ethnic Health Network
California Women’s Law Center
California Physicians Alliance
Community Action Fund of Planned Parenthood of Orange and
San Bernardino Counties
Community Clinic Association of Los Angeles County
Consumer Attorneys of California
Courage Campaign
Equality California
Forward Together
Health Access California
La Clinica de La Raza, Inc.
Naral Pro-Choice California
National Association of Social Workers
National Council of Jewish Women, California
National Council of Jewish Women, Los Angeles
National Health Law Program
Nevada County Citizen’s for Choice
Physicians for Reproductive Health
Planned Parenthood Action Fund of the Pacific Southwest
Planned Parenthood Advocacy Project Los Angeles County
Planned Parenthood Advocates Pasadena and San Gabriel Valley
Planned Parenthood Central Coast Action Fund
Planned Parenthood Mar Monte
Planned Parenthood Northern California Action Fund
Positive Women’s Network
Voices for Progress Education Fund
Western Center on Law & Poverty
Women’s Community Clinic
Women’s Health Specialists of California
OPPOSITION: (Verified 9/13/17)
California Catholic Conference, Inc.
California ProLife Council
One Individual
ARGUMENTS IN SUPPORT: Planned Parenthood Affiliates of California (PPAC) writes that this bill would ensure that all Californians, including their patients, continue to have the choice and flexibility when it comes to family planning providers. PPAC writes that Planned Parenthood community-based health centers operating throughout California are critical to providing reproductive health, primary care and other preventive health services, and this policy will enable the effective operation of their health centers. Essential Access Health and numerous supporters state that California has a long history of implementing the federal free choice of family planning provider provision. Supporters further state that managed care enrollees seek care from out-of-network community-based family planning providers for many reasons, including confidentiality issues, patient preference and comfort, and timely access to sensitive services, and the inability to access family planning services in a timely manner can lead to negative health outcomes, including increased risk for unintended pregnancy, sexually transmitted diseases and delayed care. Supporters write that providing patients the ability to choose their preferred family planning provider ensures that they can receive timely services where they feel most comfortable.
ARGUMENTS IN OPPOSITION: The California Catholic Conference writes that this bill is another example of the unfortunate tradition that exists in a so called ”pro-choice” state to further promote abortion as a standard practice of women’s health care and that California should have no role in encouraging state-funded abortions, particularly within its poorest communities and amongst the most vulnerable populations, including Medi-Cal recipients. One individual objects to this bill because it ensures government funding of abortion under all Medi-Cal providers and Planned Parenthood.
ASSEMBLY FLOOR: 55-21, 9/13/17
AYES: Aguiar-Curry, Arambula, Baker, Berman, Bloom, Bocanegra, Bonta, Burke, Caballero, Calderon, Cervantes, Chau, Chiu, Chu, Cooley, Cooper, Dababneh, Daly, Eggman, Frazier, Friedman, Cristina Garcia, Eduardo Garcia, Gipson, Gloria, Gonzalez Fletcher, Gray, Grayson, Holden, Irwin, Jones-Sawyer, Kalra, Levine, Low, Maienschein, McCarty, Medina, Mullin, Muratsuchi, Nazarian, O'Donnell, Quirk, Quirk-Silva, Reyes, Ridley-Thomas, Rodriguez, Rubio, Salas, Santiago, Mark Stone, Thurmond, Ting, Weber, Wood, Rendon
NOES: Acosta, Bigelow, Brough, Chávez, Chen, Choi, Cunningham, Dahle, Flora, Fong, Gallagher, Harper, Kiley, Lackey, Mathis, Mayes, Melendez, Obernolte, Patterson, Voepel, Waldron
NO VOTE RECORDED: Travis Allen, Limón, Steinorth
9/14/17 10:06:23
**** END ****
SENATE THIRD READING
STR Bill Id:SB 743
Author:(Hernandez and Leyva)
As Amended Ver:
Majority vote
SENATE VOTE: 27-13
Committee | Votes | Ayes | Noes |
Health | 12-3 | Wood, Maienschein, Bonta, Kalra, Limón, McCarty, Nazarian, Ridley-Thomas, Rodriguez, Santiago, Thurmond, Chau | Gallagher, Patterson, Waldron |
Appropriations | 11-5 | Gonzalez Fletcher, Bloom, Bocanegra, Bonta, Calderon, Chau, Eggman, Friedman, Eduardo Garcia, Jones-Sawyer, Reyes | Bigelow, Brough, Fong, Gallagher, Obernolte |
SUMMARY: Establishes the Protection of Choice for Family Planning Act and prohibits Medi-Cal managed care plans (MCPs) from restricting the choice of a qualified provider, as defined, from whom a beneficiary enrolled in the MCP may receive family planning services covered by Medi-Cal. Specifically, this bill:
- Prohibits a Medi-Cal MCP from restricting the choice of a qualified provider from whom a beneficiary enrolled in the MCP may receive family planning services covered by Medi-Cal.
- Defines Medi-Cal MCP as an applicable organization or entity that contracts with the Department of Health Care Services (DHCS) to provide services to enrolled Medi-Cal beneficiaries pursuant to existing law.
- Defines a "qualified provider" as a provider who is licensed to furnish family planning services, is an enrolled Medi-Cal provider, and is willing to furnish family planning services to an enrollee. Allows a qualified provider to be an out-of-plan or out-of-network provider.
- Requires a Medi-Cal MCP to reimburse an out-of-plan or out-of-network qualified provider at the applicable fee-for-service rate.
- States that if federal approval is required to implement this bill, this bill will be implemented only to the extent that federal approval is obtained.
- Makes legislative findings and declarations related to family planning services and California's commitment to ensuring women can receive reproductive and family planning services from their choice of qualified provider.
FISCAL EFFECT: According to the Assembly Appropriations Committee, as this bill mirrors current federal regulations and the current practice as reflected in state Medi-Cal MCP contractual requirements, it has no practical fiscal impact.
However, it should be noted that pending federal legislation includes provisions that would prohibit federal Medicaid funding from being made available to certain family planning providers. This bill would preserve the ability of Medi-Cal enrollees to access any qualified provider, regardless of the availability of federal matching funds. If federal law changes are made that reduce or prohibit federal matching funds from being used to reimburse certain providers, Medi-Cal reimbursement to such providers would be made by the General Fund.
COMMENTS: According to the author, California has a long history of free choice for family planning provider protections, but they are not codified in state law. For decades, California health plans have implemented the federal "free choice of provider law," which ensures that women can receive reproductive and family planning services both within and outside of a MCP's network. However, the hostile environment on the federal level toward reproductive rights, made apparent by calls from the Trump Administration and the Republican Congress to roll back the progress made in improving access to sexual and reproductive health care, has made the future of the federal law uncertain.
To ensure that Californians enrolled in Medi-Cal MCPs do not lose the ability to receive family planning and related services from willing providers, the federal free choice of provider provision must be codified in California law. This bill will ensure that Medi-Cal MCP enrollees continue to maintain flexibility in choosing family planning providers if a federal rule, which California has implemented for decades, is repealed. The author states that this bill is a pathway for protecting reproductive health access and ensuring that Medi-Cal enrollees do not lose critical benefits in the face of anticipated threats to access on the federal level.
According to a 2016 Health Affairs article, family planning services and supplies have been a part of the Medicaid program since it was first established half a century ago. Additionally, over the past several decades, Medicaid has become the dominant public funding source for family planning in the United States, accounting for three-quarters of that funding at last count. According to the Guttmacher Institute, in 2015, the federal program covered 20% of women aged 15 to 44, including 48% of those living below the federal poverty line.
Since 1972, federal law has required all state Medicaid programs to cover family planning services and supplies for all enrollees of reproductive age, and to do so without copayments or other forms of patient out-of-pocket costs. Federal regulations expand on that requirement, making it clear that Medicaid enrollees must be "free from coercion or mental pressure and free to choose the method of family planning to be used." Beyond those basic rules, however, states have traditionally had considerable leeway in deciding which family planning services and supplies would be covered under Medicaid. DHCS has implemented this federal law through All Plan Letters and contract language.
Analysis Prepared by: Kristene Mapile / HEALTH / (916) 319-2097 FN: 0001742
Date of Hearing: July 19, 2017
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Lorena Gonzalez Fletcher, Chair
SBPCA Bill Id:SB 743
Author:(Hernandez) – As Amended Ver:March 23, 2017
Policy Committee: | Health | Vote: | 12 - 3 |
Urgency: No State Mandated Local Program: No Reimbursable: No
SUMMARY:
This bill prohibits Medi-Cal managed care plans from restricting an enrollee’s choice of a family planning services provider, even if they are out-of-network, and requires Medi-Cal managed care plans to reimburse out-of-network providers at the applicable fee-for-service rate.
FISCAL EFFECT:
As this bill mirrors current federal regulations and the current practice as reflected in state Medi-Cal managed care plan contractual requirements, it has no practical fiscal impact.
However, it should be noted that pending federal legislation includes provisions that would prohibit federal Medicaid funding from being made available to certain family planning providers. This bill would preserve the ability of Medi-Cal enrollees to access any qualified provider, regardless of the availability of federal matching funds. If federal law changes are made that reduce or prohibit federal matching funds from being used to reimburse certain providers, Medi-Cal reimbursement to such providers would be made by the GF.
COMMENTS:
- Purpose. This bill ensures that Californians continue to have access to family planning services by codifying the ability of Medi-Cal enrollees to choose their provider. This bill will protect a patient's choice of family planning provider, should the existing requirement in federal law be repealed.
- Background. Family planning care is commonly sought from out-of-network, community-based providers due to confidentiality concerns, confidence in such professionals, and ease of access. In 1986, the U.S. Congress passed a “free choice of provider” law that allowed patients on Medicaid to receive family planning services from any provider. In 1997, the federal Balanced Budget Act addressed family planning in Medicaid managed care, ensuring enrollees had direct access to family planning services from out-of-network providers. Federal regulations specify how Medicaid programs must implement these laws, and the requirements are reflected in state contracts with Medi-Cal managed care plans.
This bill ensures that Medi-Cal enrollees still have the right to choose their own provider in regards to family planning services, should the law change on a federal level. - Congressional Budget Office (CBO) estimate of federal funding prohibition. In their analysis of pending federal legislation titled the American Health Care Act of 2017 (H.R 1628), which passed the U.S. House of Representatives in May, the CBO notes a one-year ban on Medicaid reimbursement to Planned Parenthood clinics would reduce overall federal Medicaid spending, but would reduce access to care and increase unintended pregnancies and births. They also find people most likely to experience reduced access to care would probably reside in areas without other health care clinics or medical practitioners who serve low-income populations.
- Support. This bill is co-sponsored by Essential Access Health and Planned Parenthood, and is supported by Health Access California, community clinics, and a large number of other advocacy organizations supporting women's health, immigrant rights, and reproductive justice. Planned Parenthood argues that this bill will protect the ability of Medi-Cal enrollees to choose their providers. Essential Access Health and Health Access California argues this bill will reduce state costs and the risk of unintended pregnancies, as it improves reproductive and sexual health outcomes.
- Opposition. The California Catholic Conference and the California Right to Life Committee write in opposition, stating the bill encourages abortion as a part of reproductive health care.
Analysis Prepared by: Kaitlyn Trevino and Lisa Murawski / APPR. / (916) 319-2081
Date of Hearing: June 27, 2017
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
SBPCA Bill Id:SB 743
Author:(Hernandez and Leyva) – As Amended Ver:March 23, 2017
SENATE VOTE: 27-13
SUBJECT: Medi-Cal: family planning providers.
SUMMARY: Establishes the Protection of Choice for Family Planning Act and prohibits Medi-Cal managed care plans (MCPs) from restricting the choice of a qualified provider, as defined, from whom a beneficiary enrolled in the MCP may receive family planning services covered by Medi-Cal. Specifically, this bill:
- Prohibits a Medi-Cal MCP from restricting the choice of a qualified provider from whom a beneficiary enrolled in the MCP may receive family planning services covered by Medi-Cal.
- Defines a “qualified provider” as a provider who is licensed to furnish family planning services within the scope of his or her practice, is an enrolled Medi-Cal provider, and is willing to furnish family planning services to an enrollee.
- Permits a qualified provider to be an out-of-plan or out-of-network provider.
- Requires a Medi-Cal MCP to reimburse an out-of-plan or out-of-network qualified provider at the applicable fee-for-service rate.
- Makes legislative findings and declarations related to family planning services and California’s commitment to ensuring women can receive reproductive and family planning services from their choice of qualified provider.
EXISTING LAW:
- Establishes the Medi-Cal program, which is administered by the California Department of Health Care Services (DHCS), under which qualified low-income persons receive health care benefits and, in part, governed and funded by federal Medicaid program provisions.
- Requires family planning services to be a covered Medi-Cal benefit, subject to utilization controls, as specified.
- Establishes in federal law, the right of Medicaid beneficiaries to generally obtain medical services from any institution, agency, community pharmacy, or person, qualified to perform the service or services required and is referred to as “any willing provider” or “free choice of provider” provision. Sets forth in federal regulations a requirement that a state plan allow a beneficiary to obtain Medicaid services from any institution, agency, pharmacy, person, or organization that is qualified to furnish the services and willing to furnish them to that particular beneficiary. Provides for an exception for beneficiaries enrolled in certain MCPs, except that such plans cannot restrict free choice of family planning providers.
FISCAL EFFECT: According to the Senate Appropriations Committee, pursuant to Senate Rule 28.8, negligible state costs.
COMMENTS:
- PURPOSE OF THIS BILL. According to the author, California has a long history of free choice for family planning provider protections, but they are not codified in state law. For decades, California health plans have implemented the federal “free choice of provider law,” which ensures that women can receive reproductive and family planning services both within and outside of a MCP’s network. However, the hostile environment on the federal level toward reproductive rights, made apparent by calls from the Trump Administration and the Republican Congress to roll back the progress made in improving access to sexual and reproductive health care, has made the future of the federal law uncertain.
To ensure that Californians enrolled in Medi-Cal MCPs do not lose the ability to receive family planning and related services from willing providers, the federal free choice of provider provision must be codified in California law. This bill will ensure that Medi-Cal MCP enrollees continue to maintain flexibility in choosing family planning providers if a federal rule, which California has implemented for decades, is repealed. The author states that this bill is a pathway for protecting reproductive health access and ensuring that Medi-Cal enrollees do not lose critical benefits in the face of anticipated threats to access on the federal level. - BACKGROUND. According to a 2016 Health Affairs article, family planning services and supplies have been a part of the Medicaid program since it was first established half a century ago. Additionally, over the past several decades, Medicaid has become the dominant public funding source for family planning in the United States, accounting for three-quarters of that funding at last count. According to the Guttmacher Institute, in 2015, the federal program covered 20% of women aged 15 to 44, including 48% of those living below the federal poverty line.
Since 1972, federal law has required all state Medicaid programs to cover family planning services and supplies for all enrollees of reproductive age, and to do so without copayments or other forms of patient out-of-pocket costs. Federal regulations expand on that requirement, making it clear that Medicaid enrollees must be “free from coercion or mental pressure and free to choose the method of family planning to be used.” Beyond those basic rules, however, states have traditionally had considerable leeway in deciding which family planning services and supplies would be covered under Medicaid. DHCS has implemented this federal law through All Plan Letters and contract language.
- SUPPORT. Planned Parenthood, a cosponsor of this bill, states that the federal free choice of provider provision must be codified in state law to ensure that Californians enrolled in Medi-Cal MCPs do not lose the ability to choose their preferred family planning provider. Health Access California states that this bill ensures that consumers in Medi-Cal MCPs receive services that reduce the risk of unintended pregnancies, improve reproductive and sexual outcomes, and reduce state costs.
- OPPOSITION. The California Catholic Conference states that this bill expands the ability for out of network abortion providers to bill for their services.
- PREVIOUS LEGISLATION.
- AB 1954 (Burke), Chapter 495, Statutes of 2016, establishes the Direct Access to Reproductive Health Care Act, which prohibits health insurers from requiring an enrollee to receive a referral prior to receiving coverage or services for reproductive and sexual health care.
- SB 1053 (Mitchell), Chapter 576, Statutes of 2014, requires health plans and insurers to provide coverage for all federal Food and Drug Administration (FDA) approved contraceptive drugs, devices, and products.
- AB 12 (Davis), Chapter 22, Statutes of 1998, requires health plans to allow enrollees to seek obstetrical and gynecological physician services directly from an obstetrician/ gynecologist (OB-GYN) or a family practice physician.
- AB 2493 (Speier), Chapter 759, Statutes of 1994, and AB 396 (Speier), Chapter 353, Statutes of 1995, require health plans to include OB-GYNs as primary care physicians, provided they meet the plan's eligibility criteria for all specialists seeking primary care physician status.
- DOUBLE REFERRAL. This bill is double referred; upon passage in this committee, it will be referred to the Assembly Appropriations Committee.
REGISTERED SUPPORT / OPPOSITION:
Support
Essential Access Health (cosponsor)
Planned Parenthood (cosponsor)
Access Women’s Health Justice
ACT for Women and Girls
American Academy of Pediatrics
American Nurses Association California
Black Women for Wellness
California Academy of Preventive Medicine
California Health+ Advocates
California Immigrant Policy Center
California Latinas for Reproductive Justice
California Pan-Ethnic Health Network (+ 6.19)
California Physicians Alliance
California Women’s Law Center
Citizens for Choice
Community Clinic Association of Los Angeles County
Consumer Attorneys of California
Courage Campaign
Equality California
Forward Together
Health Access California
If When How
La Clinica de La Raza, Inc.
NARAL Pro-Choice America
NARAL Pro-Choice California
National Association of Social Workers – California Chapter
National Council of Jewish Women, California
National Council of Jewish Women, Los Angeles
National Health Law Program
Physicians for Reproductive Health
Planned Parenthood Action Fund of the Pacific Southwest
Planned Parenthood Advocacy Project Los Angeles County
Planned Parenthood Advocates Pasadena and San Gabriel Valley
Planned Parenthood Affiliates of California
Planned Parenthood Mar Monte
Planned Parenthood Northern California Action Fund
Planned Parenthood of Orange and San Bernardino Counties Community Action Fund
Positive Women’s Network
UCLA OB/GYN Clinic
Voices for Progress Education Fund
Western Center on Law & Poverty
Women’s Community Clinic
Opposition
California Catholic Conference
California Right to Life Committee
Individual
Analysis Prepared by: Kristene Mapile / HEALTH / (916) 319-2097
Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | SB |
THIRD READING
Bill No: SB 743
:
SENATE HEALTH COMMITTEE: 7-1, 4/19/17
AYES: Hernandez, Atkins, Leyva, Mitchell, Monning, Newman, Roth
NOES: Nielsen
NO VOTE RECORDED: Nguyen
SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8
SOURCE: Essential Access Health
Planned Parenthood Affiliates of California
DIGEST: This bill prohibits Medi-Cal managed care plan from restricting the choice of a qualified provider, as defined, from whom a beneficiary enrolled in the managed care plan may receive family planning services covered by Medi-Cal.
ANALYSIS: Existing federal law prohibits Medicaid managed care organizations from restricting the choice of a qualified person from whom an individual may receive family planning services.
Existing state law:
- Establishes the Medi-Cal program, administered by the State Department of Health Care Services (DHCS), under which qualified low-income individuals receive health care benefits.
- Requires family planning services to be a covered Medi-Cal benefit, subject to utilization controls, as specified.
This bill:
- Prohibits Medi-Cal managed care plan from restricting the choice of a qualified provider from whom a beneficiary enrolled in the managed care plan may receive family planning services covered by Medi-Cal.
- Defines a “qualified provider” as a provider who is licensed to furnish family planning services within the scope of his or her practice, is an enrolled Medi-Cal provider, and is willing to furnish family planning services to an enrollee.
- Permits a qualified provider to be an out-of-plan or out-of-network provider.
- Requires a Medi-Cal managed care plan to reimburse an out-of-plan or out-of-network qualified provider at the applicable fee-for-service rate.
Background
As mandatory Medicaid managed care enrollment began to grow in the 1980s, enrollees in Medicaid managed care plans sought family planning care from out-of-network, community-based providers instead of their managed care providers. In order to promote access to these services, in 1986 Congress passed a law allowing Medicaid managed care enrollees to obtain family planning services from any qualified, willing provider that accepts Medicaid patients. This “free choice of provider law” ensures that individuals can receive sensitive services outside of a managed care plan’s network. The Balanced Budget Act of 1997 further secured the ability of Medicaid managed care enrollees to go out-of-network for family planning services and have direct access to family planning providers. Since then, DHCS has implemented this federal law through All Plan Letters and contract language.
Comments
- Author’s statement. According to the author, California has a long history of free choice for family planning provider protections, but they are not codified in state law. For decades, California health plans have implemented the federal “free choice of provider law,” which ensures that women can receive reproductive and family planning services both within and outside of a managed care plan’s network. However, the hostile environment on the federal level toward reproductive rights, made apparent by calls from the Trump Administration and the Republican Congress to roll back the progress made in improving access to sexual and reproductive health care, has made the future of the federal law uncertain. To ensure that Californians enrolled in Medi-Cal managed care plans do not lose the ability to receive family planning and related services from willing providers, the federal free choice of provider provision must be codified in California statute. This bill will ensure that Medi-Cal managed care enrollees continue to maintain flexibility in choosing family planning providers if a federal rule, which California has implemented for decades, is repealed. This bill is a pathway for protecting reproductive health access and ensuring that Medi-Cal enrollees do not lose critical benefits in the face of anticipated threats to access on the federal level.
- Family planning services. According to the Guttmacher Institute, federal and state governments have worked for decades to expand access to family planning services for young and low-income women and men, channeling public funds through multiple programs. The Medicaid program provides the large majority of public funding for clinical care through coverage of these services. Title X national family planning program provides additional funding for family planning centers, sets standards of care, and fills gaps in services and coverage. A September 2016 Guttmacher Institute Fact Sheet states that the contraceptive services provided help individuals avoid unintended and unwanted pregnancies, unplanned births, and abortions that might follow. Publicly supported family planning visits also include screenings for STIs such as chlamydia, gonorrhea and HIV; cervical cancer prevention services, including Pap tests and testing and vaccination for human papillomavirus (HPV); and other key preventive care services, all of which have their own health benefits. Collectively, these family planning services yield substantial government savings—$13.6 billion nationally in 2010, or $7.09 for every public dollar spent.
FISCAL EFFECT: Appropriation: Fiscal Com.: Local:
Essential Access Health (co-source)
Planned Parenthood Affiliates of California (co-source)
ACCESS Women’s Health Justice
ACT for Women and Girls
American Academy of Pediatrics, California
American Nurses Association, California
Black Women for Wellness
CaliforniaHealth + Advocates
California Immigrant Policy Center
California Latinas for Reproductive Justice
California Pan-Ethnic Health Network
California Women’s Law Center
California Physicians Alliance
Community Action Fund of Planned Parenthood of Orange and
San Bernardino Counties
Community Clinic Association of Los Angeles County
Consumer Attorneys of California
Courage Campaign
Equality California
Forward Together
Health Access California
La Clinica de La Raza, Inc.
Naral Pro-Choice California
National Council of Jewish Women, California
National Council of Jewish Women, Los Angeles
National Health Law Program
Nevada County Citizen’s for Choice
Physicians for Reproductive Health
Planned Parenthood Action Fund of the Pacific Southwest
Planned Parenthood Advocacy Project Los Angeles County
Planned Parenthood Advocates Pasadena and San Gabriel Valley
Planned Parenthood Central Coast Action Fund
Planned Parenthood Mar Monte
Planned Parenthood Northern California Action Fund
Positive Women’s Network
Voices for Progress Education Fund
Western Center on Law & Poverty
Women’s Community Clinic
Women’s Health Specialists of California
OPPOSITION: (Verified 5/22/17)
California Catholic Conference, Inc.
California ProLife Council
One Individual
ARGUMENTS IN SUPPORT: Planned Parenthood Affiliates of California (PPAC) writes that this bill would ensure that all Californians, including their patients, continue to have the choice and flexibility when it comes to family planning providers. PPAC writes that Planned Parenthood community-based health centers operating throughout California are critical to providing reproductive health, primary care and other preventive health services, and this policy will enable the effective operation of their health centers. Essential Access Health and numerous supporters state that California has a long history of implementing the federal free choice of family planning provider provision. Supporters further state that managed care enrollees seek care from out-of-network community-based family planning providers for many reasons, including confidentiality issues, patient preference and comfort, and timely access to sensitive services, and the inability to access family planning services in a timely manner can lead to negative health outcomes, including increased risk for unintended pregnancy, sexually transmitted diseases and delayed care. Supporters write that providing patients the ability to choose their preferred family planning provider ensures that they can receive timely services where they feel most comfortable.
ARGUMENTS IN OPPOSITION: The California Catholic Conference writes that this bill is another example of the unfortunate tradition that exists in a so called ”pro-choice” state to further promote abortion as a standard practice of women’s health care and that California should have no role in encouraging state-funded abortions, particularly within its poorest communities and amongst the most vulnerable populations, including Medi-Cal recipients. One individual objects to this bill because it ensures government funding of abortion under all Medi-Cal providers and Planned Parenthood.
5/24/17 13:26:00
**** END ****
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 743
AUTHOR: | Hernandez and Leyva | ||
VERSION: | March 23, 2017 | ||
HEARING DATE: | April 19, 2017 | ||
CONSULTANT: | Melanie Moreno | ||
SUBJECT: Medi-Cal: family planning providers
SUMMARY:
- Prohibits Medi-Cal managed care plan from restricting the choice of a qualified provider, as defined, from whom a beneficiary enrolled in the managed care plan may receive family planning services covered by Medi-Cal.
Existing federal law: prohibits Medicaid managed care organizations from restricting the choice of a qualified person from whom an individual may receive family planning services.
Existing state law:
- Establishes the Medi-Cal program, administered by the State Department of Health Care Services (DHCS), under which qualified low-income individuals receive health care benefits.
- Requires family planning services to be a covered Medi-Cal benefit, subject to utilization controls, as specified.
This bill:
- Prohibits Medi-Cal managed care plan from restricting the choice of a qualified provider from whom a beneficiary enrolled in the managed care plan may receive family planning services covered by Medi-Cal.
- Defines a “qualified provider” as a provider who is licensed to furnish family planning services within the scope of his or her practice, is an enrolled Medi-Cal provider, and is willing to furnish family planning services to an enrollee.
- Permits a qualified provider to be an out-of-plan or out-of-network provider.
- Requires a Medi-Cal managed care plan to reimburse an out-of-plan or out-of-network qualified provider at the applicable fee-for-service rate.
FISCAL EFFECT:
This bill has not been analyzed by a fiscal committee.
COMMENTS:
- Author’s statement. According to the author, California has a long history of free choice for family planning provider protections, but they are not codified in state law. For decades, California health plans have implemented the federal “free choice of provider law,” which ensures that women can receive reproductive and family planning services both within and outside of a managed care plan’s network. However, the hostile environment on the federal level toward reproductive rights, made apparent by calls from the Trump Administration and the Republican Congress to roll back the progress made in improving access to sexual and reproductive health care, has made the future of the federal law uncertain. To ensure that Californians enrolled in Medi-Cal managed care plans do not lose the ability to receive family planning and related services from willing providers, the federal free choice of provider provision must be codified in California statute. This bill will ensure that Medi-Cal managed care enrollees continue to maintain flexibility in choosing family planning providers if a federal rule, which California has implemented for decades, is repealed. This bill is a pathway for protecting reproductive health access and ensuring that Medi-Cal enrollees do not lose critical benefits in the face of anticipated threats to access on the federal level.
- Background. As mandatory Medicaid managed care enrollment began to grow in the 1980s, enrollees in Medicaid managed care plans sought family planning care from out-of-network, community-based providers instead of their managed care providers. In order to promote access to these services, in 1986 Congress passed a law allowing Medicaid managed care enrollees to obtain family planning services from any qualified, willing provider that accepts Medicaid patients. This “free choice of provider law” ensures that individuals can receive sensitive services outside of a managed care plan’s network. The Balanced Budget Act of 1997 further secured the ability of Medicaid managed care enrollees to go out-of-network for family planning services and have direct access to family planning providers. Since then, DHCS has implemented this federal law through All Plan Letters and contract language.
- Family planning services. According to the Guttmacher Institute, federal and state governments have worked for decades to expand access to family planning services for young and low-income women and men, channeling public funds through multiple programs. The Medicaid program provides the large majority of public funding for clinical care through coverage of these services. Title X national family planning program provides additional funding for family planning centers, sets standards of care, and fills gaps in services and coverage. A September 2016 Guttmacher Institute Fact Sheet states that the contraceptive services provided help individuals avoid unintended and unwanted pregnancies, unplanned births, and abortions that might follow. Publicly supported family planning visits also include screenings for STIs such as chlamydia, gonorrhea and HIV; cervical cancer prevention services, including Pap tests and testing and vaccination for human papillomavirus (HPV); and other key preventive care services, all of which have their own health benefits. Collectively, these family planning services yield substantial government savings—$13.6 billion nationally in 2010, or $7.09 for every public dollar spent.
- Support. Planned Parenthood Affiliates of California (PPAC) writes that this bill would ensure that all Californians, including their patients, continue to have the choice and flexibility when it comes to family planning providers. PPAC writes that Planned Parenthood community-based health centers operating throughout California are critical to providing reproductive health, primary care and other preventive health services, and this policy will enable the effective operation of their health centers. Essential Access Health and numerous supporters state that California has a long history of implementing the federal free choice of family planning provider provision. Supporters further state that managed care enrollees seek care from out-of-network community-based family planning providers for many reasons, including confidentiality issues, patient preference and comfort, and timely access to sensitive services, and the inability to access family planning services in a timely manner can lead to negative health outcomes, including increased risk for unintended pregnancy, sexually transmitted diseases and delayed care. Supporters write that providing patients the ability to choose their preferred family planning provider ensures that they can receive timely services where they feel most comfortable.
- Opposition. The California Catholic Conference writes that this bill is another example of the unfortunate tradition that exists in a so called ”pro-choice” state to further promote abortion as a standard practice of women’s health care and that California should have no role in encouraging state-funded abortions, particularly within its poorest communities and amongst the most vulnerable populations, including Medi-Cal recipients. One individual objects to this bill because it ensures government funding of abortion under all Medi-Cal providers and Planned Parenthood.
SUPPORT AND OPPOSITION:
Support: Essential Access Health (co-sponsor)
Planned Parenthood Affiliates of California (co-sponsor)
ACCESS Women’s Health
ACT for Women and Girls
American Nurses Association, California
Black Women for Wellness
CaliforniaHealth + Advocates
California Immigrant Policy Center
California Latinas for Reproductive Justice
California Pan-Ethnic Health Network
California Women’s Law Center
California Physicians Alliance
Community Action Fund of Planned Parenthood of Orange and San Bernardino Counties
Community Clinic Association of Los Angeles County
Consumer Attorneys of California
Courage Campaign
Equality California
Forward Together
La Clinica de La Raza, Inc.
Naral Pro-Choice California
National Council of Jewish Women, California
National Council of Jewish Women, Los Angeles
National Health Law Program
Nevada County Citizen’s for Choice
Physicians for Reproductive Health
Planned Parenthood Action Fund of the Pacific Southwest
Planned Parenthood Advocacy Project Los Angeles County
Planned Parenthood Advocates Pasadena and San Gabriel Valley
Planned Parenthood Central Coast Action Fund
Planned Parenthood Mar Monte
Planned Parenthood Northern California Action Fund
Positive Women’s Network
Voices for Progress Education Fund
Western Center on Law & Poverty
Women’s Community Clinic
Women’s Health Specialists of California
Oppose: California Catholic Conference, Inc.
California ProLife Council
One Individual
-- END --
Discussed in Hearing
2MIN
Senate Floor
1MIN
Assembly Floor
1H
Assembly Standing Committee on Appropriations
4MIN
Assembly Standing Committee on Health
1MIN
Senate Floor
12MIN
Senate Standing Committee on Health
Bill Co-Author(s):
