How the California Health Benefits Review Program Conducts Its Analyses

Analyses conducted by the California Health Benefits Review Program (CHBRP) assess the medical effectiveness of a proposed mandated benefit, the cost impact of the mandated benefit, and the mandate's projected impact on public health. Within 60 days of the receipt of a request to analyze a benefit mandate bill, CHBRP staff, members of its Task Force, and its actuarial consultants, Milliman, analyze the bill; members of a National Advisory Council (NAC) review the analysis; and the final report is produced and sent to the California Legislature.

CHBRP has developed a timeline for scheduling all of the work that needs to be accomplished within the prescribed 60-day time frame. During the first week after a request is received, CHBRP conducts a review of all analytic participants' potential conflicts of interest and obtains appropriate recusals; identifies key aspects of the mandate that need to be considered in an analysis; consults with the bill author's staff to determine the nature of the problem the bill is trying to address; consults with appropriate experts (for example, a clinical expert helps to identify the scope of the medical effectiveness literature review); conducts an initial literature review; develops survey questions for health plans to determine baseline coverage of the proposed benefit mandate; begins identifying parameters of the cost analysis; and identifies and notifies a group of expert reviewers from the NAC.

After the first week, CHBRP spends the next month conducting and drafting its analysis of a mandate bill. The activities during these days-literature reviews and assessment of the medical effectiveness of the benefit, modeling of the cost impact, development of the public health impact, and analysis of input from health plans, insurers, and any public input received are highly coordinated. Faculty from each of the three teams (Medical EffectivenessCost, and Public Health), actuarial consultants, and CHBRP staff work together to develop interdependent sections of the analysis. The methods that CHBRP has developed for analyzing medical effectiveness, cost impact, and public health impact of proposed benefit mandates weigh the strength of research evidence in a rigorous and objective manner; CHBRP documents its methods to the public to support the transparency of its work. In addition, each complete analysis is reviewed internally by members of the Task Force.

A subgroup of NAC members review the draft analysis for (1) accuracy and objectivity, (2) responsiveness to the legislative request, (3) completeness, and (4) clarity of presentation. Feedback from the NAC is advisory and has the intended goal of providing CHBRP with expert and varied stakeholder perspectives. After CHBRP makes revisions in response to the NAC reviewers' comments, analyses are copy edited, final reviews are conducted by the Faculty Task Force and internal staff, and the final analysis is simultaneously sent to the legislative committee that requested the analysis either the California Senate Committee on Banking, Finance and Insurance or the California Assembly Committee on Health and placed on the CHBRP Web site.

Since authorization, CHBRP has been regularly required to produce implementation reports, which are available on the Other Publications page of this website.