BILL NUMBER: AB 1324	ENROLLED
	BILL TEXT

	PASSED THE SENATE  SEPTEMBER 5, 2007
	PASSED THE ASSEMBLY  SEPTEMBER 5, 2007
	AMENDED IN SENATE  AUGUST 29, 2007
	AMENDED IN SENATE  JULY 17, 2007
	AMENDED IN SENATE  JULY 5, 2007
	AMENDED IN ASSEMBLY  APRIL 18, 2007
	AMENDED IN ASSEMBLY  APRIL 11, 2007

INTRODUCED BY   Assembly Member De La Torre
   (Coauthor: Senator Cedillo)

                        FEBRUARY 23, 2007

   An act to amend Section 1371.8 of the Health and Safety Code, and
to amend Section 796.04 of the Insurance Code, relating to health
care coverage.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 1324, De La Torre. Health care coverage: treatment
authorization.
   Existing law provides for regulation of health care service plans
by the Director of the Department of Managed Health Care. Existing
law provides for the regulation of health insurers by the Insurance
Commissioner.
   Existing law provides that a health care service plan or a health
insurer that authorizes a specific type of treatment by a health care
provider shall not rescind or modify this authorization after the
provider renders the health care service in good faith and pursuant
to the authorization.
   This bill would additionally specify that a health care service
plan or a health insurer is precluded from rescinding or modifying
its authorization for any reason, including its subsequent
rescission, cancellation, or modification of the contract or its
subsequent determination that it did not make an accurate eligibility
determination. The bill would also state that it is not the intent
of the Legislature to instruct a court as to whether these provisions
make a change to existing law.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 1371.8 of the Health and Safety Code is amended
to read:
   1371.8.  A health care service plan that authorizes a specific
type of treatment by a provider shall not rescind or modify this
authorization after the provider renders the health care service in
good faith and pursuant to the authorization for any reason,
including, but not limited to, the plan's subsequent rescission,
cancellation, or modification of the enrollee's or subscriber's
contract or the plan's subsequent determination that it did not make
an accurate determination of the enrollee's or subscriber's
eligibility. This section shall not be construed to expand or alter
the benefits available to the enrollee or subscriber under a plan.
The Legislature finds and declares that by adopting the amendments
made to this section by Assembly Bill 1324 of the 2007-08 Regular
Session it does not intend to instruct a court as to whether or not
the amendments are existing law.
  SEC. 2.  Section 796.04 of the Insurance Code is amended to read:
   796.04.  A health insurer that provides coverage for hospital,
medical, or surgical expenses that authorizes a specific type of
treatment for services covered under a policyholder's contract or
plan by a provider shall not rescind or modify this authorization
after the provider renders the health care service in good faith and
pursuant to the authorization for any reason, including, but not
limited to, the insurer's subsequent rescission, cancellation, or
modification of the insured's or policyholder's contract or the
insurer's subsequent determination that it did not make an accurate
determination of the insured's eligibility. This section shall not be
construed to expand or alter the benefits available or the terms and
conditions of the contract as may be agreed upon between a
policyholder, certificate holder, or trust, and the insurer. The
Legislature finds and declares that by adopting the amendments made
to this section by Assembly Bill 1324 of the 2007-08 Regular Session
it does not intend to instruct a court as to whether or not the
amendments are existing law.