The clock ticking down on the last night in the California statehouse is always a lot like waiting for last call at a rowdy bar around 2 AM — you wonder how much damage will done before the last shot.

The clock ticking down on the last night in the California statehouse is always a lot like waiting for last call at a rowdy bar around 2 AM — you wonder how much damage will done before the last shot.

For years my colleagues and I have stood watch on the California legislature,into the wee hours of the morning, to make sure that politicians and companies didn’t a pull a fast one at the last moment. There have been a lot of close calls over the years, and some lost ones too.

Here’s the roundup from Friday night’s/Saturday morning’s last call in the statehouse before 2012:

•     Last day legislation to move all ballot initiative measures to the November 2012 ballot, and stop ballot measures on the June primaries, cleared both houses of the legislature. Senate Bill 202 passed every committee and both houses in a single day. It’s not clear whether Governor Brown will sign SB 202,  but if he did, the public would win big.  Special interest groups often target the low turn-out June primary to pass measures the majority of Californians would never approve of.  It’s better to have the real sentiment of the most Californians voting on ballot measures, rather than allowing corporations, for example, to target a much more friendly electorate in June, when Republicans will turn out big for their presidential primary.  Mercury Insurance CEO George Joseph is trying to qualify his insurance surcharge initiative in June, a repeat of the failed Prop 17 from June 2010, for this very reason.  He would stand even less a chance of pulling the wool over the eyes of the majority of real California voters in November.  Turns out SB 202 stands on strong principle.   For decades, prior to 1978, initiatives only went on the November general election ballot, which is what the California constitution requires.  Then the legislature officially changed the protocol.  If the legislature can change the definition of “general election” to include primary election, it can change the definition back.

•    Legislation requiring health insurance companies to cover behavioral therapy for autistic children went to the Governor’s desk, SB 694.  Consumer Watchog sued Governor Schwarzenegger’s Department Of Managed Health Care to force such continued coverage for autistic children in 2009, when the state started allowing insurance companies to deny the treatment as “educational.”  A 9th Circuit decision recently strengthened our legal case, which is still pending, that the Mental Health Parity Law requires behavioral therapy to be covered.   The insurance companies no doubt hope the new legislation will undermine our lawsuit and other pending cases against them, because they don’t want to have to pay for the therapy they have denied since 2009.  Senator Steinberg, however, testified that he believed such therapy was always required and the legislation was clarifying existing law.  We expect to prevail.

*  The bill to force health insurance companies to get prior approval from state insurance regulators before raising rates never came up for a vote on the Senate Floor. AB 52, authored by Assembly Member Mike Feuer,  was shelved for the year  because the legislation did not have enough votes in the insurance-friendly state Senate.  Consumer Watchdog is exploring a November 2012 ballot measure to regulate health insurance premiums, rollback rates by 20% and gives patients new options. Stay tuned for developments as our opinion research and drafting continues this fall.

Governor Brown hosted a kegger in his office for the legislature after it closed down in the early morning hours.  For the public, there wasn’t much to celebrate this session, other than that more damage wasn’t done.

————————————————————————-

Jamie Court is the president of Consumer Watchdog and author of The Progressive’s Guide To Raising Hell.

Californians, including those stricken by autism, and their parents and caregivers, expect regulators to enforce the law, not to side with insurance companies seeking to boost their profits by denying patients the care they need.

Governor Schwarzenegger, however, a longtime and vocal supporter of the Special Olympics and developmentally disabled children, is allowing health insurers to evade state mental health laws and shift health care costs to already beleaguered taxpayers. Last Friday, Governor Schwarzenegger vetoed SB 1283 by Senate President pro Tem Darrell Steinberg (D-Sacramento).  The bill would have improved, but not fixed, a broken regulatory system.

Californians, including those stricken by autism, and their parents and caregivers, expect regulators to enforce the law, not to side with insurance companies seeking to boost their profits by denying patients the care they need.

Governor Schwarzenegger, however, a longtime and vocal supporter of the Special Olympics and developmentally disabled children, is allowing health insurers to evade state mental health laws and shift health care costs to already beleaguered taxpayers. Last Friday, Governor Schwarzenegger vetoed SB 1283 by Senate President pro Tem Darrell Steinberg (D-Sacramento).  The bill would have improved, but not fixed, a broken regulatory system.

SB 1283 would have set time limits on regulators at the California Department of Managed Health Care (“DMHC”) when reviewing insurance company denials of treatments for autism.  The bill is needed because regulators had been delaying such reviews for months in some cases, leaving autistic children without the care they need.

Schwarzenegger’s veto of SB 1283 is just the latest blow.  Last July, Consumer Watchdog sued the DMHC, the Schwarzenegger Administration agency responsible for regulating many of California’s health insurers. The suit alleges that the DMHC has wrongfully allowed insurance companies to refuse to pay for autism treatments, resulting in the denial of Applied Behavioral Analysis (“ABA”), an essential treatment for autism, in plain violation of the California Mental Health Parity Act.  That law requires health insurers to cover and pay for all medically necessary treatments for autism, including ABA.

Until March of last year, health care consumers were able to appeal an insurer¿s denial of ABA through the DMHC’s Independent Medical Review (“IMR”) system, in which a treatment denial is reviewed by a team of doctors that is unaffiliated with the insurance company that denied the treatment and independent of the DMHC.

However, as the IMR doctors increasingly overturned insurer ABA denials, compelling the insurers to pay for ABA, insurers privately urged the Schwarzenneger Administration to change its procedures and process the treatment denials through the DMHC’s own internal grievance review system.  Last March, the DMHC issued a memo indicating that the agency would review ABA and other autism treatment denials through the DMHC’s internal grievance system as urged by insurers.  In a key interim decision, a Superior Court judge ruled that memo to be an illegal “underground regulation” because it violated state law requiring a public process for changing insurance regulations.

Unlike the IMR system, in which independent doctors evaluate whether a treatment should be provided on the basis of whether it is medically necessary and effective, the grievance system is conducted by DMHC staff, who are not doctors and who simply defer to the insurers’ determination of whether the claim is even covered by their health care policies.  

Why would the Schwarzenegger Administration make the change the insurer’s wanted? 1,324,850 reasons–that’s the amount of money the governor has received from health insurers in the form of campaign contributions.

SB 1283 would have helped families improperly side-tracked into the DMHC grievance system by reining in outrageous delays by regulators.  But only Consumer Watchdog’s lawsuit will ensure that independent doctors, not politically-motivated regulators, get to decide whether or not kids get the treatments that their doctors say they need.  We go to trial in December.  Stay tuned.

———————–

Posted by Jerry Flanagan, Health Care Policy Director for Consumer Watchdog, a nonpartisan, nonprofit organization dedicated to providing an effective voice for taxpayers and consumers in an era when special interests dominate public discourse, government and politics. Visit us on Facebook and Twitter.