Employee Benefits Compliance, State-Specific Information

California: Recent Benefits News 6/11/14

Proposed AB 1522 Would Require 3 Days of Paid Sick Leave Annually

AB 1522 – which would require California employers to provide workers with at least three days of paid sick leave annually– was passed by the California Assembly on May 29, 2014, and is scheduled for a hearing June 11 in the Senate Labor and Industrial Relations Committee.  The accrual rate would be one hour of paid sick leave for every 30 hours an employee works, but employers would not be required to pay out unused sick time when an employee terminates.  Other provisions in the bill include:

  • Paid sick days could be used to care for an ill relative or to take leave related to domestic violence or sexual assault.
  • Employees covered by collective bargaining would not be eligible for paid sick leave under AB 1522
  • Unused sick leave could be carried over from year to year

AB 1522 was sponsored by Rep. Lorena Gonzalez (D-San Diego).

AB 1522 is at: http://leginfo.ca.gov/pub/13-14/bill/asm/ab_1501-1550/ab_1522_bill_20140528_amended_asm_v95.pdf

California HealthLine (May 30th, 2014) article is here: http://www.californiahealthline.org/articles/2014/5/30/legislature-advances-paid-sick–leave-rx-drug-comparison-bills


Bill To Expand Coverage to Undocumented Immigrants in California: On Hold for Now

A bill (SB 1005) introduced earlier this year by state Sen. Ricardo Lara (D-Long Beach) that would give undocumented California residents access to expanded Medi-Cal — the state’s Medicaid program — and a dedicated insurance exchange with state-funded subsidies is on hold in the Senate Appropriations Committee. Lara’s staff said the senator plans to unveil a similar measure next year.

SB 1005 would create the California Health Exchange Program For All Californians. The purpose is to (by January 1, 2016) enroll undocumented aliens into qualified health plans (QHPs), because such individuals are not eligible for full-scope Medi-Cal coverage and not eligible to buy QHPs through the Exchange (Covered California) because of their immigration status. Such enrollees would be eligible for the same premium subsidies and cost-sharing reductions that are available to eligible individuals through Covered California, but these subsidies would be funded by California funds, because the federal Medicaid Program provisions prohibit payment for medical assistance to illegal aliens.

The funds would be raised by assessing a charge on qualified health plans in California (so California residents  who buy QHPs would fund the subsidies for undocumented aliens).  The program would be governed by the executive board that governs  Covered California (the California Exchange).

California HealthLine article (June 9, 2014) is at: http://www.californiahealthline.org/articles/2014/6/9/bill-to-expand-coverage-to-undocumented-immigrants-in-calif-stalls-sen-plans-to-unveil-new-measure

SB 1005 is at: http://www.leginfo.ca.gov/pub/13-14/bill/sen/sb_1001-1050/sb_1005_bill_20140213_introduced.pdf


Insurers Expand Health Exchange Plans’ Provider Networks

Insurers in several states are expanding their hospital and physician networks for qualified health plans sold through State health insurance exchanges, in response to complaints from consumers and state officials about limited provider options. For example, in California:

  • Anthem Blue Cross since Jan. 1 has added more than 3,800 health care providers to its network;
  • Blue Shield of California since April 2013 has increased the number of physicians in its exchange plan networks by 70% and the number of hospitals by 19%;
  • Health Net has increased its physician network by more than 68%; and
  • WellPoint has also substantially expanded its network.

California HealthLine (June 10th Article) at:  http://www.californiahealthline.org/articles/2014/6/10/insurers-expand-health-exchange-plans-provider-networks


California HHS Secretary Dooley on State of Health Reform in California

During the “Health for Tomorrow” conference at UC-San Francisco, Diana Dooley — secretary of California’s Department of Health and Human Services and chair of the Covered California board — discussed the challenges and successes of implementing health reform in the state, KQED’s “State of Health” reports. Some of Dooley’s comments include:

“It is too soon to determine whether the Affordable Care Act has been successful”.  One focus now is on expanding provider networks. “Some providers are renegotiating with exchange health plans after “seeing how many new lives (are) covered, how many new patients they can get” (Aliferis, “State of Health,” KQED, 6/4).

California HealthLine (June 5th, 2014) Article at:  http://www.californiahealthline.org/articles/2014/6/5/dooley-discusses-state-of-health-reform-in-california


Anthem-HealthCare Partners ACO Reports $4.7M in Savings

A California-based accountable care organization created by Anthem Blue Cross and HealthCare Partners physician groups saved $4.7 million over the first six months of 2013, the Los Angeles Times reports.  The Anthem-HealthCare Partners ACO includes about 55,000 Southern California patients enrolled in PPO plans.  The ACO says it was able to cut costs by reducing:

  • Hospital inpatient stays by 18% per 1,000 members;
  • Overall hospital admissions by 4%; and
  • Visits for radiology and other laboratory tests by 4%.

California HealthLine (June 9, 2014) article is at:  http://www.californiahealthline.org/articles/2014/6/9/anthemhealthcare-partners-aco-reports-4-7m-in-savings


CalPERS’ ‘Reference Pricing’ Initiative Saves $5.5M Over Two Years

In 2011, CalPERS began “reference pricing,” which establishes a standard price for a medication, procedure or service and requires members to pay any charges beyond that price. CalPERS asked its PPO, Anthem Blue Cross, to research the average costs for hip and knee replacements, and as a result, the CalPERS set a maximum of $30,000 per procedure. This resulted in a $5.5 million savings over two years.

Forty-six medical institutions — including Stanford and UC-San Francisco — initially were included in the plan (California Healthline, 12/9/13).

California HealthLine (May 28, 2014) Article at:  http://www.californiahealthline.org/articles/2014/5/28/calpers-reference-pricing-initiatives-saves-5m-over-two-years