New California Legislation Affects Health Care

New 2022 California laws on COVID-19, housing and policing - Los Angeles  TimesSource: Word & Brown, by Paul Roberts

California Governor Gavin Newsom signed a package of new laws in late September that significantly affect health care and access to abortive care in the Golden State. These changes impact most Californians, especially those covered by fully insured group health plans, individual plans, or Medi-Cal.

Among the latest measures are bills that support health care providers, expand access to contraception, protect Californians from legal retaliation regarding health care services, boost uninsured care, and prohibit law enforcement and corporations from cooperating with out-of-state entities regarding abortion records in California.

In comments at the bill signing, Governor Newsom explained the intentions behind the new laws, “An alarming number of states continue to outlaw abortion and criminalize women, and it’s more important than ever to fight like hell for those who need these essential services. We’re doing everything we can to protect people from any retaliation for accessing abortion care while also making it more affordable to get contraceptives. Our Legislature has been on the frontlines of this fight, and no other legislative body in the country is doing more to protect these fundamental rights – I’m proud to stand with them again and sign these critical bills into law.”

The health care-related measures included in the September legislative package are:

  • * ASSEMBLY BILL 2223: PROTECTIONS FROM CRIMINAL & CIVIL LIABILITIES: Helps ensure that pregnancy loss is not criminalized, prohibiting a person from being criminally or civilly liable for miscarriage, stillbirth, abortion, or perinatal death due to causes that occurred in utero.
  • * ASSEMBLY BILL 2091: KEEPS MEDICAL RECORDS PRIVATE: Prohibits a health care provider from releasing medical information on an individual seeking abortion care in response to a subpoena or request from out-of-state.
  • * ASSEMBLY BILL 1242: PROHIBITS COOPERATION WITH OUT-OF-STATE ENTITIES: Prohibits law enforcement and California corporations from cooperating with out-of-state entities regarding a lawful abortion in California. Also prohibits law enforcement from knowingly arresting a person for aiding in a lawful abortion in California.
  • * SENATE BILL 523: EXPANDS BIRTH CONTROL ACCESS: Expands birth control access – regardless of gender or insurance coverage status – by requiring health plans to cover certain over-the-counter birth control without cost sharing. Also prohibits employment-related discrimination based on reproductive health decisions. Note: The state of California does not have authority over self-funded plans. Thus, these changes generally do not apply to such plans.
  • * SENATE BILL 1375: TRAINING FOR HEALTH CARE PROVIDERS: Expands training options for Nurse Practitioners and Certified Nurse-Midwives for purposes of performing abortion care by aspiration techniques.
  • * SENATE BILL 1142: CARE WEBSITE: Requires the establishment of an abortion care services website and an evaluation of the Abortion Practical Support Fund.
  • * ASSEMBLY BILL 2134: HEALTH EQUITY PROGRAM: Establishes the CA Reproductive Health Equity Program, which will provide grants to providers who provide uncompensated care to patients with low-incomes and those who face other financial barriers.
  • * ADDITIONAL MEASURES: Other legislation expedites licensure for health care practitioners coming to California to provide abortion care services, prohibits license suspension or revocation for performing an abortion in accordance with the licensee’s practice, establishes an LA County reproductive health pilot project to safeguard abortion access, and creates a program to support comprehensive reproductive/sexual health education to disproportionately impacted communities.

The Governor had previously signed legislation to eliminate cost-sharing for abortion services, Senate Bill 245, and to protect those in California from civil liability for providing, aiding, or receiving abortion care in the state, Assembly Bill 1666. These measures build on the state’s earlier efforts to reduce costs and expand access for those in need of abortion care services, including allocation of $200+ million to help pay for travel costs, cover uninsured care, support health care facilities and providers, and bolster security.

Governor Newsom also issued an executive order preventing medical records, patient data, and other information from being shared by state agencies in response to inquiries or investigations brought by other states or individuals looking to restrict abortion access.

Beyond what’s happening legislatively, in November, California voters will face a ballot measure to decide whether to amend the state’s constitution to enshrine the right to an abortion. Public opinion polls in California show a majority of voters across the political spectrum support women’s rights and reproductive freedom.
Still, there are groups in the state that are expected to challenge some recent legislation in court. Time will tell if any measures end up being scaled back or eliminated altogether.

You can expect further updates from our Compliance team on changes that might further impact your employer-clients and their employees or dependents.

Health Care Spending For Mental Health Disorders Increases Between 2013 And 2020

Health care spending for mental health disorders increases between 2013 and  2020 | BenefitsPRO

Source: BenefitsPRO, by Michael Popke

Overall spending on mental health services increased from 6.8% to 8.2% between 2013 and 2020, according to a new study published by the Employee Benefit Research Institute (EBRI).

“Approximately 1 in 5 adults and 1 in 6 youth experience mental illness each year, and these rates have been rising,” Paul Fronstin, director of EBRI’s Health Benefits Research and co-author of the study, says in a statement. “Over 20 million Americans have a substance use disorder. The COVID-19 pandemic has exacerbated mental health issues nationally and in the workplace. With increases in both the number of individuals diagnosed with mental health disorders and use of health care services, higher spending is of great concern to plan sponsors of health benefit programs.”

Here are five key findings from EBRI’s research:

  1. 1. The percentage of the population under the age of 65 with employment-based health coverage diagnosed with a mental health disorder increased from 14.2% in 2013 to 18.5% in 2020.
  1. 2. Use of mental health care services increased between 2013 and 2020, and use of outpatient services increased the most. The percentage of enrollees using outpatient services increased from 12% to 16%, a 33% increase.
  1. 3. Among enrollees with a mental health diagnosis, average annual spending on mental health care services increased from $1,987 to $2,380 between 2013 and 2020 — an average of 3% per year.
  1. 4. Spending on outpatient mental health services increased 37%, while spending on prescription drugs for mental health disorders fell 15%.
  1. 5. Outpatient mental health care services accounted for two-thirds of total spending in 2020, up from just over one-half in 2013.

“Employers and workers spent nearly $77 billion on mental health disorders in 2020,” Fronstin adds. “Employers are looking for ways to address the mental health needs of workers given the current economic climate, and they are especially interested in addressing mental health needs because of the connection between depression and productivity losses. Taking responsibility for workers’ mental health may not only reduce spending on health care but may increase worker productivity.”

What’s Ahead For Telehealth Policy After The Pandemic

Opportunities and Barriers for Telemedicine in the U.S. During the COVID-19  Emergency and Beyond | KFFSource: Healthcare IT News, by Andrea Fox

The American Telehealth Association is working with Congress and several federal agencies to shape the fate of policies and payments for telehealth services that experienced a rapid uptake during the COVID-19 pandemic.

WHY IT MATTERS

Now that President Joe Biden has declared the COVID-19 pandemic over, the ATA’s Telehealth Awareness Week policy update webinar explored how federal and state telehealth policies may be affected as Congress decides whether or not to end the public health emergency (PHE).

Federal priorities for telehealth have evolved with the pandemic with restrictions lifted by a Congress deciding if the limiting of certain restrictions should be lifted permanently.

The PHE must be reviewed every 90 days, so Congress will have to revisit the renewal by mid-October, according to policy experts presenting during Wednesday’s online event.

“As we know, [President] Biden has said in recent days that the pandemic is over, so it’s possible that the technical public health emergency might expire sometime in the very near future,” said Megan Herber, director at Faegre Drinker who advises ATA and ATA Action on all things Federal policy.

Telehealth payments and provider practices are highly regulated on the Federal level, said Quinn Shean, strategic advisor at Tusk Ventures and the state policy advisor for ATA and ATA Action.

But even if providers do not serve Medicare populations, “Medicare policy trickles down,” added Herber.

For example, before the pandemic, patients had to be in a rural area in a hospital or clinical setting to receive reimbursement for telehealth.

“That is the current status quo right now – as long as the COVID-19 public health emergency is in place,” Herber explained. But in about five months, “all of those waivers go away automatically unless Congress does something.”

Approaches to policy can be different in different contexts, noted moderator Alexis Gilroy, co-leader of the healthcare and life sciences practice at Jones Day. “Where do you come at it based on the particular lane it sits in?”

In terms of state-level telehealth policy, there are multiple state priorities because states differ in their approaches to telehealth coverage requirements for public and private health plans, reimbursement for services provided via telehealth, and eligibility to deliver reimbursable services.

States also differ in how they regulate synchronous and asynchronous telehealth and remote patient monitoring. They vary on which types of providers can deliver telehealth, what establishes a valid patient/provider relationship and if out-of-state practitioners can treat patients in the state remotely without a license, explained Shean.

“We have a patchwork of 50 different state requirements here,” she said.

The ATA has been focused on developing a consistent regulatory framework so telehealth can be deployed across states and fully leveraged.

“The ATA is committed to modality-neutral policies,” instead of dictating which tools clinicians choose to use to deliver telehealth, she said. ATA is pushing for fair payment for telehealth and home health as well as licensure flexibility across state lines.

“It’s really aligning our state frameworks with the 21st Century care model,” and the states are moving quickly, she said. There have been hundreds of pieces of legislation to update state telehealth policies.

The organization is also working with the U.S. Drug Enforcement Agency and Congress to address the future of online prescribing of controlled substances.

Many of the barriers to telehealth policy have been based on perceptions that telehealth is somehow substandard and that romanticizes in-patient care, but telehealth has often delivered care where there was no prior access to healthcare, said Shean.

“We need to recognize the access gaps that telehealth can fill” and recognize the guardrails that are in place with telehealth as they are with other care settings, said Shean.

As more retail providers like CVSAmazon and others enter the space through mergers and acquisitions, they will also have an impact on the direction of telehealth policy, including how to protect the patient data these companies will have more access to.

But with more stakeholders pushing for telehealth on the state level, “having a broader tent now helps show the different patient populations that can be served here and brings more focus,” Shean pointed out.

THE LARGER TREND

Under the CARES Act, Congress granted the Centers for Medicare & Medicaid Services authority to waive certain restrictions for Medicare coverage of telehealth.

The agency was able to remove geographic restrictions, expand care at home, increase the amount of Medicare-covered services via telehealth and more.

Additional legislative proposals, including the Telehealth Benefit Expnasion for Workers Act, Telehealth Extension Act and others, suggest broadening access to telehealth.

“Throughout the pandemic, telehealth has proven to be a vital tool for Americans to receive timely and quality care from their own home,” said Tim Walberg, R-Mich, during the bill’s introduction at the Capitol in March.

“For rural communities in particular, telemedicine has helped remove barriers to care, expand access to specialists and improve health outcomes.”

ON THE RECORD

“There is urgency [for Congress] to act – don’t wait until four months and 20 days after the pandemic ends; we need some stability,” said Herber.

“We’d love to make it permanent, and a lot of these policies we have been asking for since before the pandemic, so it’s not really new,” she concluded.

Last Updated 10/05/2022

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