TABLE 2.

Health Insurance Benefit Mandate Bills Analyzed by the California Health Benefits Review Program (CHBRP)

Year	Bill No.	Topic	Status	Conclusion of CHBRP's Medical Effectiveness Review
2004	ABa 438	Osteoporosis screening	Died in the legislatureb	Evidence shows that screening women aged 65 or older is effective, but there is insufficient evidence to determine the effectiveness of screening younger women.
	AB 547	Ovarian cancer screening	Gutted/amendedc	Evidence is insufficient to determine whether screening improves outcomes.
	AB 1084	Vision services providers	Reintroduced as AB 1927	N/A: Relative effectiveness of optometrists and ophthalmologists was not assessed.
	AB 1549	Asthma self-management for children	Reintroduced as AB 2185	Evidence shows that pediatric asthma self-management education improves health outcomes and reduces use of acute care services.
	AB 1927	Vision services providers	Gutted/amended	Same as AB 1084.
	AB 2185	Asthma self-management for children and asthma devices	Enacted	Evidence shows that pediatric asthma self-management education improves health outcomes and reduces use of acute care services. Evidence shows that using a metered-dose inhaler (MDI) with a spacer is as effective as using a nebulizer. Evidence is insufficient to ascertain whether peak flow meters are effective and whether using an MDI with a spacer is more effective than using an MDI alone.
	SB 101	Substance use disorders	Reintroduced as SB 1192	Evidence shows that treatment of substance use disorders is effective but that effectiveness may vary by type of addiction.
	SB 174	Hearing aids for children	Reintroduced as SB 1158	Evidence suggests that treatment of hearing loss is effective, but evidence is insufficient to determine the relative effectiveness of different types of hearing aid circuitry.
	SB 897	Maternity services	Reintroduced as SB 1555	Evidence suggests that many individual maternity services are effective, but evidence is insufficient to determine which combination(s) of maternity services improve outcomes for pregnant women and infants.
	SB 1157	Elimination of intoxication exclusion	Vetoed by governor	Medical effectiveness could not be analyzed because this bill does not mandate coverage of a particular health care service but instead prohibits coverage exclusions and because there are no published data on the medical effects of removing coverage exclusions.
	SB 1158	Hearing aids for children	Vetoed by governor	Same as SB 174.
	SB 1192	Substance use disorders	Died in the legislature	Same as SB 101.
	SB 1555	Maternity services	Vetoed by governor	Same as SB 897.
2005	AB 8	Mastectomies and lymph node dissections: length of stay	Gutted/amended	Evidence is insufficient to determine whether longer length of inpatient stay is associated with better outcomes for women who have a mastectomy or lymph node dissection.
	AB 213	Lymphedema	Died in the legislature	Evidence shows that manual lymphatic drainage and compression therapy are associated with reduction in limb size, but evidence is insufficient to determine whether smaller limb size is associated with improvement in health outcomes (e.g., limb function).
	AB 228	Transplant services for persons with human immunodeficiency virus	Enacted	Evidence from case series and case reports suggests that patients with human immunodeficiency virus (HIV) undergoing kidney transplantation have survival rates similar to those of patients without HIV. Among persons who do not have hepatitis C, survival rates for liver transplantation also are similar for patients both with and without HIV. Few studies have assessed the impact of HIV on the success of transplantation of other organs.
	AB 1185	Chiropractic services	Died in the legislature	Evidence from studies with major methodological limitations suggests that chiropractic care reduces pain and improves functional status. Evidence is insufficient to determine whether chiropractic care affects quality of life.
	SB 415	Alzheimer's disease drugs	Gutted/amended	Evidence indicates that Alzheimer's disease drugs provide modest, short-term improvements in cognitive, functional, behavioral, and neuropsychological outcomes. Evidence of effects on nursing home placement is inconsistent.
	SB 572	Mental health benefits	Died in the legislature; reintroduced as AB 423	Evidence suggests that mental health parity laws are associated with reductions in out-of-pocket costs for consumers but do not substantially increase the numbers of persons receiving mental health services.
	SB 573	Elimination of intoxication exclusion	Vetoed by governor	Same as SB 1157.
	SB 576	Tobacco cessation services	Vetoed by governor	Much evidence indicates that tobacco cessation counseling and medication are effective.
	SB 749	Autism diagnosis	Died in the legislature	No studies have assessed the specific diagnostic process mandated in the bill. Expert opinion suggests the bill would increase the accuracy of autism diagnoses, decrease the time between first referral and diagnosis, and lower the average age at diagnosis.
	SB 913	Rheumatic disease drugs	Died in the legislature	Evidence indicates that biological response modifier (BRM) medications are effective treatments for rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis.
2006	AB 264	Pediatric asthma education	Vetoed by governor	Evidence shows that pediatric asthma self-management education improves health outcomes and reduces use of acute care services.
	AB 2012	Orthotic and prosthetic devices	Enacted	The effectiveness of prosthetic devices compared with no treatment was not evaluated because use of conventional prosthetic devices has been established as the standard of care for improving physical and psychological functioning of persons with amputations and congenital limb deformities. Evidence from small observational studies suggests that new prosthetic technologies may benefit nonelderly adults with lower limb amputations or deformities who are healthy and active.
	AB 2281	High-deductible health plans: coverage for preventive services	Died in the legislature	Evidence shows that many preventive services improve health and well-being. No studies have assessed the effect of high-deductible health plans on use of preventive services. However, most studies of persons with other types of health insurance have found that lower cost sharing is associated with greater use of beneficial preventive services.
	SB 1223	Hearing aids for children	Vetoed by governor	Same as SB 174, with the addition of evidence from small studies suggesting that certain newer hearing aid technologies (e.g., dual microphones) are more effective than older technologies.
	SB 1245	Cervical cancer screening	Enacted	Evidence shows that use of human papillomavirus (HPV) testing as an adjunct to the conventional Pap test for cervical cancer increases the accuracy of screening and improves the efficiency of screening programs.
	SB 1508	Propofol for colonoscopies	Died in the legislature	Evidence shows that propofol is associated with shorter recovery time and fewer side effects than traditional methods for sedating persons undergoing colonoscopies. Evidence of effects on cognitive and physiological outcomes is inconsistent. The safety of propofol is similar to that of other sedative and analgesic agents.
2007	AB 30	Inborn errors of metabolism: coverage of medical formulas and foods	Vetoed by governor	No controlled studies of treatments for inborn errors of metabolism (IEM) were identified. However, IEM disorders are single-cause conditions for which the scientific basis and rationale for treatment with medical formulas and foods are strong.
	AB 54	Acupuncture	Vetoed by governor	Evidence shows that acupuncture is an effective treatment for lateral elbow pain, neck disorders, osteoarthritis of the knee, and postoperative nausea and vomiting and is more effective than other nonsurgical treatments for chronic headache, osteoarthritis of the knee, and pelvic pain associated with pregnancy.
	AB 368	Hearing aids for children	Vetoed by governor	Same as SB 1223.
	AB 423	Mental health and substance abuse services	Vetoed by governor; reintroduced as AB 1887	Same as SB 572, except findings from new studies were added that showed that mental health parity laws were associated with modest improvement in treatment of depression but did not affect suicide rates.
	AB 1214	Waiver of mandated benefits	Died in the legislature	Evidence shows that many of California's health insurance benefit mandates require health plans to cover medically effective services.
	AB 1429	Human papillomavirus vaccine	Vetoed by governor; reintroduced as AB 16	Evidence from the only clinical trial published to date suggests that for women and girls who received all three doses of the vaccine and were not previously exposed to the human papillomavirus (HPV), the vaccine is highly effective for prevention of precancerous cervical lesions and adenocarcinoma associated with the four types of HPV to which it is targeted (i.e., types 6, 11, 16, and 18).
	AB 1461	Elimination of intoxication exclusion	Enacted	Same as SB 1157.
	SB 24	Tobacco cessation services	Never introducedd	Same as SB 576.
	SB 365	Out-of-state carriers	Died in the legislature	No medical effectiveness analysis was undertaken.
2008	AB 16	Human papillomavirus vaccine	Vetoed by governor; reintroduced as SB 158	Same as AB 1429.
	AB 1774	Gynecological cancer screening	Died in the legislature	Findings differ across gynecological cancers. Evidence shows that cervical cancer screening reduces the incidence of cervical cancer in asymptomatic women who are sexually active and have not had a hysterectomy. The evidence suggests that screening asymptomatic women at average risk for ovarian cancer can detect ovarian cancer at an earlier stage, but evidence is insufficient to determine whether screening asymptomatic women at average risk reduces morbidity and mortality. No studies have assessed the effectiveness of screening asymptomatic women for endometrial cancer.
	AB 1887	Mental health and substance abuse services	Vetoed by governor; reintroduced as AB 244	Same as AB 423.
	AB 1894	Human immunodeficiency virus testing	Enacted	Substantial indirect evidence shows that screening for human immunodeficiency virus (HIV) is effective. Findings from multiple studies suggest that tests for HIV are highly accurate (i.e., have high sensitivity and specificity) and that highly active antiretroviral therapy (HAART), prophylaxis for opportunistic infection, and vaccination against hepatitis B and influenza reduce the risk of clinical progression of HIV, opportunistic infection, and death. Delivering infants born to HIV-positive mothers by elective cesarean section and feeding them formula instead of breast milk further reduce the risk of mother-to-child transmission above and beyond the reduction in risk achieved through use of HAART.
	AB 1962	Maternity services	Vetoed by governor; reintroduced as AB 98	The medical effectiveness analysis for this bill focused on prenatal care services. Randomized controlled trials (RCTs) have consistently found no association between the numbers of pregnant women's prenatal visits and birth outcomes for either infants or mothers. However, there is evidence from multiple RCTs that some individual prenatal care services are effective (e.g., smoking cessation counseling, screening for hepatitis B, treatment of women at increased risk for preterm delivery with corticosteroids and progestational agents).
	AB 2174	Amino acid–based elemental formulas for eosinophilic disorders and short bowel syndrome	Died in the legislature; revised and reintroduced as AB 163	The only evidence regarding the effectiveness of amino acid–based elemental formula for the treatment of eosinophilic disorders (ED) and short bowel syndrome (SBS) comes from studies with weak research designs and small sample sizes. Findings suggest that both elemental formula and elimination diet are effective treatments for ED. Among persons with SBS, elemental formula is associated with shorter duration of use of parenteral nutrition and fewer hospitalizations.
	AB 2234	Breast cancer screening	Died in the legislature; revised and reintroduced as AB 56	Evidence shows that screening mammography reduces breast cancer morbidity and mortality. Evidence also shows that digital mammography improves the rate of cancer detection among women with radiologically dense breasts, pre- and perimenopausal women, and women younger than age 50. Evidence suggests as well that breast magnetic resonance imaging (BMRI) may be useful for detecting cancers in high-risk women. Evidence shows that notifying women for whom screening mammography is recommended increases the rate at which women are screened.
	SB 1198	Durable medical equipment	Vetoed by governor; revised and reintroduced as AB 214	Few studies have assessed the effectiveness of durable medical equipment (DME). However, expert opinion and observation suggest that use of DME can improve health, functioning, and quality of life. Findings from studies on the effect of insurance coverage on use of DME are inconsistent.
	SB 1522	Standardization of coverage sold in the individual health insurance market	Died in the legislature; reintroduced as AB 786	No medical effectiveness analysis was undertaken.
	SB 1634	Orthodontic procedures for cleft palate	Vetoed by governor	Orthodontic services, coordinated with surgeries, are a central part of the standard of care for treatment of oral clefts. Expert consensus for treatment of oral clefts is that all care should be provided by multidisciplinary teams of experts. No studies were identified that directly addressed whether having additional coverage of orthodontic services beyond the previously mandated coverage of surgical care would affect health outcomes.
2009	AB 56	Mammography	Vetoed by governor	Same as AB 2234, except that this version of the bill addressed only coverage for mammography and notification of women for whom screening mammography is recommended.
	AB 98	Maternity services	Vetoed by governor	Same as AB 1962.
	AB 163	Amino acid–based elemental formula	Pending in the legislature	Same as AB 2174, except that this version of the bill only addresses eosinophilic disorders (i.e., does not address short bowel syndrome).
	AB 214	Durable medical equipment	Pending in the legislature	Same as SB 1198.
	AB 244	Mental health services	Vetoed by governor	Same as AB 423 and AB 1887, except for the addition of new studies suggesting that mental health parity laws are associated with small increases in use of mental health services by persons employed by moderately small firms (50 to 100 employees) who have poor mental health or low incomes.
	AB 259	Certified nurse midwives: direct access	Pending in the legislature	Evidence suggests that outcomes for pregnant women and infants cared for by certified nurse midwives are as good or better than outcomes for those treated by physicians.
	AB 513	Breastfeeding: lactation consultation and breast pumps	Vetoed by governor	Evidence as to whether providing extra lactation consultation beyond usual care increases duration of breastfeeding is inconsistent; evidence that coverage for breast pumps is associated with longer duration of breastfeeding among low-income women is limited.
	AB 786	Standardization of coverage sold in the individual health insurance market	Pending in the legislature	Same as SB 1522.
	SB 92	Health insurance reform	Pending in the legislature	Same as AB 1214.
	SB 158	Human papillomavirus vaccine	Vetoed by governor	Same as AB 1429, except for the addition of evidence from new clinical trials suggesting that the vaccine is less effective among females who have not completed all three doses of the vaccine and/or were exposed to the human papillomavirus (HPV) prior to vaccination than among females who received all three doses and were not previously exposed to HPV. Results from the new trials also suggest that the vaccine is not very effective in preventing precancerous cervical lesions associated with HPV types other than the four HPV types the vaccine targets. The evidence suggests that females who are vaccinated should continue to be screened for cervical cancer.
	SB 161	Orally administered anticancer medications	Vetoed by governor	Evidence-based guidelines recommend the use of 38 oral anticancer medications to treat more than 50 types of cancer. Many oral anticancer medications have no intravenous or injectable substitutes, although there are some important exceptions.

Notes:

^a“AB” indicates a bill that originated in the California State Assembly. “SB” indicates a bill that originated in the California State Senate.

^b“Died in the legislature” means that a bill was not approved by both houses of the California legislature before the end of the legislative session.

^c“Gutted/amended” indicates that the California legislature amended a health insurance benefit mandate bill to strip the bill of its contents and replace it with legislative language on a different topic.

^dCHBRP analyzed a proposed amendment to SB 24 that would have inserted provisions into the bill requiring health plans to cover tobacco cessation counseling and pharmacotherapy. After CHBRP issued its report, the bill's author elected not to amend the bill to add these provisions.

Sources:Legislative Counsel of the State of California 2009; Philip 2006.