BILL NUMBER: AB 228	CHAPTERED  09/29/05

	CHAPTER  419
	FILED WITH SECRETARY OF STATE  SEPTEMBER 29, 2005
	APPROVED BY GOVERNOR  SEPTEMBER 29, 2005
	PASSED THE ASSEMBLY  AUGUST 29, 2005
	PASSED THE SENATE  AUGUST 23, 2005
	AMENDED IN SENATE  AUGUST 17, 2005
	AMENDED IN ASSEMBLY  APRIL 20, 2005
	AMENDED IN ASSEMBLY  APRIL 5, 2005

INTRODUCED BY   Assembly Member Koretz
   (Principal coauthor: Assembly Member Pavley)
   (Coauthors: Assembly Members Goldberg, Laird, Leno, and Lieber)
   (Coauthor: Senator Kuehl)

                        FEBRUARY 3, 2005

   An act to add Section 1374.17 to the Health and Safety Code, and
to add Section 10123.21 to the Insurance Code, relating to health
care coverage.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 228, Koretz  Transplantation services: human immunodeficiency
virus.
   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 a crime. Existing law also provides for the licensure and
regulation of health insurers by the Department of Insurance.
   This bill would prohibit a health care service plan and a health
insurer from denying coverage for the costs of organ or tissue
transplantation services on the basis that the enrollee, subscriber,
insured, or policyholder is infected with the human immunodeficiency
virus.
   Because the violation of this requirement by a health care service
plan would be a crime, the bill 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 1374.17 is added to the Health and Safety Code,
to read:
   1374.17.  (a) A health care service plan shall not deny coverage
that is otherwise available under the plan contract for the costs of
solid organ or other tissue transplantation services based upon the
enrollee or subscriber being infected with the human immunodeficiency
virus.
   (b) Notwithstanding any other provision of law, in the provision
of benefits required by this section, a health care service plan may
utilize case management, network providers, utilization review
techniques, prior authorization, copayments, or other cost sharing,
subject to the terms and conditions of the plan contract and
consistent with sound clinical processes and guidelines.
  SEC. 2.  Section 10123.21 is added to the Insurance Code, to read:

   10123.21.  (a) A health insurer shall not deny coverage that is
otherwise available under the health insurance policy for the costs
of solid organ or other tissue transplantation services based upon
the insured or policyholder being infected with the human
immunodeficiency virus.
   (b) Notwithstanding any other provision of law, in the provision
of benefits required by this section, a health insurer may utilize
case management, managed care, or utilization review, subject to the
terms and conditions of the policy and consistent with sound clinical
processes and guidelines.
  SEC. 3.  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.