BILL NUMBER: AB 2185	CHAPTERED  09/23/04

	CHAPTER  711
	FILED WITH SECRETARY OF STATE  SEPTEMBER 23, 2004
	APPROVED BY GOVERNOR  SEPTEMBER 23, 2004
	PASSED THE ASSEMBLY  AUGUST 16, 2004
	PASSED THE SENATE  AUGUST 10, 2004
	AMENDED IN SENATE  JULY 14, 2004
	AMENDED IN SENATE  JUNE 22, 2004
	AMENDED IN SENATE  JUNE 7, 2004
	AMENDED IN ASSEMBLY  APRIL 27, 2004
	AMENDED IN ASSEMBLY  MARCH 25, 2004

INTRODUCED BY   Assembly Member Frommer
   (Coauthors:  Assembly Members Chan and Cohn)

                        FEBRUARY 18, 2004

   An act to add Section 1367.06 to the Health and Safety Code,
relating to health care coverage.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 2185, Frommer.  Asthma treatment care.
   Existing law, the Knox-Keene Health Care Service Plan Act of 1975,
provides for the licensure and regulation of health care service
plans by the Department of Managed Health Care and makes a violation
of the act's requirements a crime.  Under the act, a plan is required
to provide coverage for specified types of medications.
   This bill would require a health care service plan that covers
outpatient prescription drug benefits to provide coverage for inhaler
spacers, nebulizers, and peak flow meters when medically necessary
for the management and treatment of pediatric asthma.
   Because the bill would specify additional requirements for a
health care service plan, the violation of which would be a crime, it
would impose a state-mandated local program.
  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 1367.06 is added to the Health and Safety Code,
to read:
   1367.06.  (a) A health care service plan contract, except a
specialized health care service plan contract, that is issued,
amended, delivered, or renewed on or after January 1, 2005, that
covers outpatient prescription drug benefits shall include coverage
for inhaler spacers when medically necessary for the management and
treatment of pediatric asthma.
   (b) If a subscriber has coverage for outpatient prescription
drugs, a health care service plan contract, except a specialized
health care service plan contract, that is issued, amended,
delivered, or renewed on or after January 1, 2005, shall include
coverage for the following equipment and supplies when medically
necessary for the management and treatment of pediatric asthma:
   (1) Nebulizers, including face masks and tubing.
   (2) Peak flow meters.
   (c) The quantity of the equipment and supplies required to be
covered pursuant to subdivisions (a) and (b) may be limited by the
health care service plan if the limitations do not inhibit
appropriate compliance with treatment as prescribed by the enrollee's
physician and surgeon.  A health care service plan shall provide for
an expeditious process for approving additional or replacement
inhaler spacers, nebulizers, and peak flow meters when medically
necessary for an enrollee to maintain compliance with his or her
treatment regimen.  The process required by Section 1367.24 may be
used to satisfy the requirements of this section for an inhaler
spacer.
   (d) Education for pediatric asthma, including education to enable
an enrollee to properly use the device identified in subdivisions (a)
and (b), shall be consistent with current professional medical
practice.
   (e) The coverage required by this section shall be provided under
the same general terms and conditions, including copayments and
deductibles, applicable to all other benefits provided by the plan.
   (f) A health care service plan shall disclose the benefits under
this section in its evidence of coverage and disclosure forms.
   (g) A health care service plan may not reduce or eliminate
coverage as a result of the requirements of this section.
   (h) Nothing in this section shall be construed to deny or restrict
in any way the department's authority to ensure plan compliance with
this chapter, if a plan provides coverage for prescription drugs.
  SEC. 2.  No reimbursement is required by this act pursuant to
Section 6 of Article XIII B 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 XIII B of the California
Constitution.