Welcome to California Health Benefits Review Program

Resources

Health Insurance Benefit Mandates in California State and Federal Law (January 2023)

This resource has been prepared by CHBRP to inform interested parties of existing state and federal health insurance benefit mandate laws that may relate to the subject or purpose of a proposed state health insurance benefit mandate or repeal bill.

Deductibles in State-Regulated Health Insurance for 2023 (November 2022)

This resource discusses deductibles and their interaction with other forms of cost sharing, as well as estimates regarding their presence among state-regulated health insurance, potential impacts of new prohibitions on their application, and related state and federal law.

Sources of Health Insurance in California for 2023 (February 2022)

This resource discusses CHBRP's 2023 estimates of sources of health insurance in California.

Pharmacy Benefit Coverage in State-Regulated Health Insurance for 2023 (February 2022)

This resource notes the presence or absence of a pharmacy benefit among Californians enrolled in health plans regulated by the California Department of Managed Health Care (DMHC) and health policies regulated by the California Department of Insurance (CDI).

The Federal Preventive Services Benefit Mandate and Related California Mandates (February 2022)

This resource identifies potential overlap between the federal benefit mandate requiring health insurance coverage of some preventive services and California state benefit mandates.

Academic Rigor on a Legislature's Timeline (June 2022)

CHBRP, drawing on multi-disciplinary faculty and researchers based at the University of California, provides the California Legislature with timely, independent, and rigorous evidence-based analyses of introduced health insurance benefits-related legislation.

Issue Briefs

California State Benefit Mandates and the Affordable Care Act's Essential Health Benefits (January 2022)

This issue brief provides background on Essential Health Benefits (EHBs) in California and how they interact with current and proposed state benefit mandates. This brief also describes changes to federal EHB regulations and discusses California's options for future modifications of the state's selected set of EHBs.

Medical Necessity Determination Process for Covered Benefits (December 2021)

This issue brief discusses the medical necessity determination process, which may involve multiple clinicians, for enrollees in health plans and health policies regulated by the Department of Managed Health Care (DMHC) or the California Department of Insurance (CDI).

Balance Billing Prohibitions and the No Surprises Act (November 2021)

This issue brief discusses laws and regulations that prohibit out-of-network (OON) providers from issuing surprise bills to enrollees in plans or policies regulated by DMHC or CDI.

Outpatient Prescription Drug Cost Sharing (January 2021)

This issue brief discusses cost sharing laws and limits that are applicable to outpatient prescription drug benefits regulated by the Department of Managed Health Care (DMHC) and the California Department of Insurance (CDI). This brief also discusses pharmacy benefits, cost sharing, and the laws that are relevant to them.

Genetic Biomarker Testing and Prior Authorization (August 2020)

This issue brief includes background information on genetic biomarker testing for Californians with advanced cancer, and, where possible, the presence and the impact of prior authorization on such testing.

Analysis: California's EHB Base Benchmark Options (July 2015)

This issue brief analyzes and compares the health services covered by the ten plans available to California as options for California's Essential Health Benefit (EHB) benchmark effective January 1, 2017.

Pediatric Dental and Pediatric Vision Essential Health Benefits (December 2013)

This issue brief describes the choices California has made to comply with the Affordable Care Act's (ACA) pediatric dental and pediatric vision Essential Health Benefit (EHB) requirement.

Mammography Mandates, Benchmark Plan Choices, and Essential Health Benefits (June 2012)

This issue brief demonstrates how state benefit mandates may exceed Essential Health Benefits (EHBs) and how evidence-based analysis of the impacts of such mandates may inform discussions of whether to keep or repeal them.

Immunization Mandates, Benchmark Plan Choices, and Essential Health Benefits (June 2012)

This issue brief provides an example of how state benefit mandates could exceed Essential Health Benefits (EHBs) and how evidence-based analysis may inform discussions of whether to keep or repeal state benefit mandates that exceed EHBs, specifically looking at immunization coverage requirements.

Policy Snapshots

Public Health Insurance Option Plans (November 2021)

This policy snapshot provides an overview of a public option and details recent public option related state activity from 2018 to 2021.

Telehealth: Current State of the Evidence (February 2021)

This policy snapshot summarizes the state of the evidence on telehealth, and focuses on the following common types of telehealth modalities and services: live video, telephone, and eConsult.

Federal Contraceptive Mandate and California Laws (October 2017)

This policy snapshot is intended to help readers understand the Affordable Care Act's (ACA) federal contraceptive coverage mandate, California's more recent state coverage laws, and the variability between those laws.

Selling Health Insurance Across State Lines (October 2017)

In September of 2017, President Trump discussed his intent to sign an Executive Order to allow consumers to buy health insurance "across state lines". This policy snapshot provides an overview of efforts to introduce similar legislation federally and within California within the past 10 years, along with findings from CHBRP analyses of related California legislation and how the findings inform current discussion.

Explainers

California's Population Aged 65 Years and Older (November 2022)

This explainer provides an overview of the population aged 65 and older in California, including sources of health insurance, demographic information, and how legislation and regulations may impact insurance coverage for this population.

An Overview of Claims Data and How CHBRP Estimates Utilization and Unit Cost (October 2021)

This explainer provides an overview of claims data, including how the data is collected, what information may be available within the datasets, and how the data are used to inform CHBRP's analyses.

What is Cost Sharing in Health Insurance? (August 2020)

This explainer aims to help clarify and explain the common cost-sharing terms often addressed in health policy legislation.

Insurer Provider Networks (July 2015)

This explainer explores California's existing regulations related to measuring the adequacy of provider networks, and begins to re-evaluate questions of network adequacy in light of new state and federal laws and new health care business models and practices.

Reports on Implementing CHBRP's Authorizing Statute

Implementation Report (2019)

Implementation Report (2019)

Implementation Report (2016)

Implementation Report (2016)

Implementation Report (2013)

Implementation Report (2013)

Implementation Report (2009)

Implementation Report (2009)

Implementation Report (2005)

Implementation Report (2005)

External Publications

Policy Considerations for Routine Screening for Adverse Childhood Events (ACEs)

The Current State of Telehealth Evidence: A Rapid Review

This rapid review examines recent evidence both about telehealth’s efficacy by clinical area and about telehealth’s impact on utilization

Universal Lead Screening Requirement: A California Case Study

AJPH Letters and Responses - September 2018, Vol 108, No. 9

Overview and Commentary

Overview and Commentary

Evaluating Medical Effectiveness for the California Health Benefits Review Program

Evaluating Medical Effectiveness for the California Health Benefits Review Program

The California Cost and Coverage Model: Analyses of the Financial Impacts of Benefit Mandates for the California Legislature

The California Cost and Coverage Model: Analyses of the Financial Impacts of Benefit Mandates for the California Legislature

Assessing the Public Health Impact of State Health Benefit Mandates

Assessing the Public Health Impact of State Health Benefit Mandates

An Analysis of California Assembly Bill 2185: Mandating Coverage of Pediatric Asthma Self-Management Training and Education

An Analysis of California Assembly Bill 2185: Mandating Coverage of Pediatric Asthma Self-Management Training and Education

A Comparative Analysis of Mandated Benefit Laws, 1949 - 2002

A Comparative Analysis of Mandated Benefit Laws, 1949 - 2002

State-Mandated Benefit Review Laws

State-Mandated Benefit Review Laws

Health Services Research as a Source of Legislative Analyses and Input: The Role of the California Health Benefits Review Program

Health Services Research as a Source of Legislative Analyses and Input: The Role of the California Health Benefits Review Program

Additional Publications

Survey and Analysis of Other States' Health Benefit Mandate Review Programs (January 2015)

This document outlines findings from CHBRP's 2014 survey of every state and the District of Columbia to explore the status of benefit mandate review programs and processes outside of California.

Other Publications