BILL NUMBER: SB 446 CHAPTERED 10/09/01 CHAPTER 634 FILED WITH SECRETARY OF STATE OCTOBER 9, 2001 APPROVED BY GOVERNOR OCTOBER 8, 2001 PASSED THE SENATE SEPTEMBER 13, 2001 PASSED THE ASSEMBLY SEPTEMBER 12, 2001 AMENDED IN ASSEMBLY SEPTEMBER 10, 2001 AMENDED IN ASSEMBLY SEPTEMBER 5, 2001 AMENDED IN ASSEMBLY AUGUST 20, 2001 AMENDED IN ASSEMBLY JULY 2, 2001 AMENDED IN SENATE APRIL 25, 2001 INTRODUCED BY Senator Vasconcellos (Principal coauthor: Senator Kuehl) (Coauthor: Senator Romero) (Coauthors: Assembly Members Alquist, Aroner, Goldberg, Keeley, Koretz, Migden, and Robert Pacheco) FEBRUARY 21, 2001 An act to add Section 22793.2 to the Government Code, to add Section 1367.45 to the Health and Safety Code, and to add Section 10145.2 to the Insurance Code, relating to health care coverage. LEGISLATIVE COUNSEL'S DIGEST SB 446, Vasconcellos. Health care coverage: AIDS vaccine. Existing law authorizes the Board of Administration of the Public Employees' Retirement System to contract with carriers for health benefits plans and to approve health benefits plans offered by employee organizations in order to provide health benefits coverage to specified public employees. This bill would require a plan or contract to provide coverage for an approved AIDS vaccine. Existing law provides for the regulation and licensing of health care service plans by the Director of the Department of Managed Health Care and for the regulation of disability insurers by the Insurance Commissioner. Existing law provides that a willful violation of provisions governing health care service plans is a crime. This bill would provide that health care service plans and disability insurers that provide coverage for hospital, medical, or surgery expenses shall also provide coverage for an approved AIDS vaccine, as specified. The bill would not apply to specified types of disability insurance policies. Because a willful violation of the bill's requirements with respect to health care service plans would be a crime, the bill would impose a state-mandated local program by creating a new crime. The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that no reimbursement is required by this act for a specified reason. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. Section 22793.2 is added to the Government Code, to read: 22793.2. (a) A plan or contract shall provide coverage for a vaccine for acquired immune deficiency syndrome (AIDS) that is approved for marketing by the federal Food and Drug Administration and that is recommended by the United States Public Health Service. (b) This section shall not be construed to require a plan or contract to provide coverage for any clinical trials relating to an AIDS vaccine or for any AIDS vaccine that has been approved by the federal Food and Drug Administration in the form of an investigational new drug application. (c) Nothing in this section is to be construed in any manner to limit or impede the board's power or responsibility to negotiate the most cost-effective price for vaccine purchases. SEC. 2. Section 1367.45 is added to the Health and Safety Code, to read: 1367.45. (a) Every individual or group health care service plan contract that is issued, amended, or renewed on or after January 1, 2002, that covers hospital, medical, or surgery expenses shall provide coverage for a vaccine for acquired immune deficiency syndrome (AIDS) that is approved for marketing by the federal Food and Drug Administration and that is recommended by the United States Public Health Service. (b) This section may not be construed to require a health care service plan to provide coverage for any clinical trials relating to an AIDS vaccine or for any AIDS vaccine that has been approved by the federal Food and Drug Administration in the form of an investigational new drug application. (c) A health care service plan that contracts directly with an individual provider or provider organization may not delegate the risk adjusted treatment cost of providing services under this section unless the requirements of Section 1375.5 are met. (d) Nothing in this section is to be construed in any manner to limit or impede a health care service plan's power or responsibility to negotiate the most cost-effective price for vaccine purchases. SEC. 3. Section 10145.2 is added to the Insurance Code, to read: 10145.2. (a) Every policy of disability insurance that is issued, amended, or renewed on or after July 1, 2002, that covers hospital, medical, or surgery expenses shall provide coverage for a vaccine for acquired immune deficiency syndrome (AIDS) that is approved for marketing by the federal Food and Drug Administration and that is recommended by the United States Public Health Service. (b) This section may not be construed to require a policy to provide coverage for any clinical trials relating to an AIDS vaccine or for any AIDS vaccine that has been approved by the federal Food and Drug Administration in the form of an investigational new drug application. (c) This section shall not apply to vision only, dental only, accident only, specified disease, hospital indemnity, Medicare supplement, CHAMPUS supplement, long-term care, or disability income insurance. For hospital indemnity, accident only, or specified disease insurance coverage, benefits under this section shall apply only to the extent that the benefits are covered under the general terms and conditions that apply to all other benefits under the policy or certificate. Nothing in this section shall be construed as imposing a new benefit mandate on accident only, hospital indemnity, or specified disease insurance. (d) Nothing in this section is to be construed in any manner to limit or impede a disability insurer's power or responsibility to negotiate the most cost-effective price for vaccine purchases. SEC. 4. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.