network and that the health plan may not cover some of the services, provide an estimate of the cost of the services
Bills of Interest
and direct the enrollee to contact the health plan for a list of contracted providers. Additionally, it prohibits a health facility or provider group from stating that it is part of a network unless all of the providers working at the facility are contracted with the insurer. The bill also requires plans
AB 369 (Huffman): Step Therapy Reform (CMA Position: Support)
to pay out-of-network providers the same rate as they pay in network providers on a non-capitated basis within the same geographic region as the contracted provider. A potential amendment would be to require disclosure language on an assignment of benefit agreement between a patient and a provider. Status: Failed pursuant to legislative deadline. SB 1528 (Steinberg): Damages–Medical Services This bill would overturn the, Howell v. Hamilton Meats case, by allowing an injured party of medical services to be compensated based upon the reasonable value of services rather than amount actually paid. Despite the trial attorneys’ assertion that the bill doesn’t affect damages under 3333.1, it would dramatically increase economic damage awards in ALL personal injury cases in the state. The rationale stated for the bill is flawed – that every person be treated the same regardless of how much was paid. Damages are intended to make someone whole. For medical expenses, that means giving them back in monetary damages the amount that was put out on their behalf – i.e., the amount paid. Lawsuits are not supposed to be like winning the lottery where you are put in a position more favorable than where you began. In other words, monetary damages are not supposed to go beyond recouping what was lost–for medical expenses, those are the dollars spent on medical care. Non-economic or emotional distress damages are the damages that compensate for the pain and suffering caused by the injury. This bill is going to bring up discussions about physicians billing practices and the definitions of, and differences between, billed amounts, usual and customary charges and reasonable value. Status: Failed pursuant to legislative deadline.
This bill would limit a health plan’s or health insurer’s ability to use step therapy or “fail first” protocols for the treatment of pain. The bill would require that the duration of any step therapy or fail first protocol be determined by the prescribing physician and would prohibit a health plan or health insurer from requiring that a patient try and fail on more than two pain medications before allowing the patient access to other pain medication prescribed by the physician. This bill would still allow step therapy to be used, but closes loopholes and puts the medical decisions back in the doctor’s hands so the patient can get the right medication in a timely fashion. Status: Enrolled and sent to Governor. Vetoed 9/30/12. AB 1000 (Perea) Health Care Coverage: Cancer Treatment (CMA Position: Support) This bill would help ensure that cancer patients are not denied the most appropriate and effective treatment by putting costs above care. According to the author, “there are significantly greater patient out-of-pocket costs for oral cancer therapies covered under the pharmacy benefit than IV therapies covered under the medical benefit. These out-of-pocket costs become a de facto denial of access, which, in a study by Prime Therapeutics, resulted in 1 in 6 patients not receiving treatment solely due to cost. Therefore, patient access to potentially the only life-saving cancer therapy available to them is restricted. Status: Enrolled and sent to Governor. Vetoed 9/30/12. AB 1533 (Mitchell) International Medical Graduates (CMA Position: Support) This bill would allow the UCLA International Medical Graduate program to create a five-year pilot for participants to engage in a physician supervised patient care activities, as part of an approved and supervised clinical clerkship/rotation at UCLA. With this legislation, UCLA International Medical Graduates would receive valuable clinical learning opportunities and not be at risk
NOVEMBER / DECEMBER 2012 | THE BULLETIN | 15