New Laws Affecting Optometry – 2015

California enacted many new laws addressing health care, employment, licensure and vision screenings that may well affect California doctors’ of optometry patient care and day-to-day practice operations and policies in 2015. Below are the bills that were signed by Governor Brown in 2014 that took effect January 1, 2015, unless otherwise noted. 

Note: Click on bill number to read the bill in its entirety. 

Health/Managed Care

AB 369           (Pan) Chapter 4 - Continuity of care. Requires a health care service plan and a health insurer to arrange for the completion of covered services by a nonparticipating provider for a newly covered enrollee and a newly covered insured under an individual health care service plan contract or an individual health insurance policy whose prior coverage was withdrawn from the market between December 1, 2013, and March 31, 2014, inclusive (generally, most of those affected by this law lost coverage because the policy did not comply with the Affordable Care Act’s minimum policy coverage requirements). This bill took effect March 20, 2014.

Health Care Service Plans

AB 505           (Nazarian) Chapter 788 - Medi-Cal managed care plans: language assistance services.  Requires the Department of Health Care Services to require all managed care plans contracting with Medi-Cal to provide language assistance services, which includes oral interpretation and translation services, to limited-English-proficient Medi-Cal beneficiaries.

AB 617           (Nazarian) Chapter 869 - California Health Benefit Exchange: appeals.  Establishes an appeals process for Californians who have been denied or otherwise had their enrollment delayed in health care plans offered through Covered California, Medi-Cal or CHIP. 

AB 809           (Logue) Chapter 404 – Healing arts: telehealth.  Changes the consent rules regarding use of telehealth by allowing providers to secure either verbal or written consent the first time patients use the technology and removes the requirement to get patient consent every time a new appointment is made. Provides the consent must be documented by the provider. This measure took effect September 18, 2014.

SB 20 (Hernandez, OD) Chapter 24 - Individual health care coverage enrollment periods. Conforms 2015 open enrollment dates for the individual health insurance market to federal rules, which is November 15, 2014, through and including February 15, 2015. The bill took effect June 16, 2014

SB 508            (Hernandez, OD) Chapter 831 – Medi-Cal eligibility.  Conforms state to federal law that expanded Medi-Cal eligibility by raising the income threshold eligibility for low-income children, parents and relative caretakers, and pregnant women and infants; includes qualified individuals in foster care until the age 26; eliminates income restrictions for the medically needy, e.g., aged, blind, disabled; covers individuals under 21 years of age placed in foster homes or specified private institutions, and certain adopted children under 21 years of age.

SB 959            (Hernandez, OD) Chapter 572 - Health care coverage. Among other things, clarifies health insurers participating in the state Exchange small group market (SHOP) must offer platinum, gold, silver and bronze levels of coverage and that health insurers not participating in Covered California must offer at least one standardized product designated by the Exchange in each of those levels of coverage for both individual and small group markets if it offers plans to those markets.

SB 964            (Hernandez, OD) Chapter 573 – Health Care Coverage. Increases oversight of managed care and Medi-Cal managed care health plans, including those offered through Covered California, by authorizing the Department of Managed Health Care (DMHC) to develop, and require these health plans to use, standardized methodologies for timely access and network adequacy reporting, and to annually review these plan-submitted reports and post its findings to the DMHC Internet page for use by consumers.

SB 1034          (Monning) Chapter 195 - Health care coverage: waiting periods.  Prohibits a health care service plan or health insurer offering group coverage from imposing a separate waiting period in addition to any waiting period imposed by an employer for a group health plan on an otherwise eligible employee or dependent. Provides that the required notice an employer must provide to a person who fails to enroll in an employer-sponsored health plan during an open enrollment period must state the employee or dependent may be excluded from eligibility for coverage until the next open enrollment period instead of the current notice that states a specified period of time. 

SB 1052          (Torres) Chapter 575 – Health care coverage. Requires a health care service plan or health insurer that provides prescription drug benefits and maintains one or more drug formularies to post those formularies on its website and update that posting on a monthly basis, and requires Covered California to post a direct link to the formularies for each plan offered through the Exchange. Additionally, requires the Department of Managed Health Care and Department of Insurance to jointly develop by January 2017 a standardized template, including cost-sharing information for drugs subject to coinsurance, required to be used by plans and insurers for the posting of their formularies.

SB 1315          (Monning) Chapter 844 – Medi-Cal providers: suspension.  Specifies what is required to be in a notice of temporary suspension of a Medi-Cal provider’s status, including, among other things, a list of discrepancies, and timelines of no less than 60 days to remediate them.  A provider who fails to remediate the identified discrepancies will be removed from enrollment as a provider in the Medi-Cal program.

SB 1340          (Hernandez, OD) Chapter 83 - Health care provider contracts. Prohibits contracts between a health plan or insurer and a provider from containing a provision that restricts the ability of the plan or insurer to furnish information to consumers or purchasers on the cost range of a procedure or full course of treatment or the quality of services performed by the provider. Requires a plan or insurer to provide a provider the information 30 days in advance of its release to allow for the review of the methodology and data used for the foregoing and requires the plan or insurer to provide a link on its website, if requested, to the provider’s website for the public to access the provider’s response to the plan or insurer’s information.

SB 1446          (DeSaulnier ) Chapter 84 - Health care coverage: small employer market.  Allows small employers to extend their pre-Affordable Care Act (ACA) health care policies in effect as of December 31, 2013, that do not meet ACA’s requirements through December 31, 2015.

Employment

AB 326           (Morrell) Chapter 91 - Mandatory reporting to Cal/OSHA.  Allows employers the option to email a report to Cal/OSHA that is required to be made immediately when a work-related serious illness, injury or death has occurred.