BILL NUMBER: AB 113 ENROLLED
BILL TEXT
PASSED THE SENATE AUGUST 18, 2010
PASSED THE ASSEMBLY AUGUST 19, 2010
AMENDED IN SENATE AUGUST 16, 2010
AMENDED IN SENATE JUNE 23, 2010
AMENDED IN ASSEMBLY JANUARY 4, 2010
AMENDED IN ASSEMBLY APRIL 28, 2009
INTRODUCED BY Assembly Member Portantino
(Principal coauthor: Senator Alquist)
JANUARY 13, 2009
An act to amend Section 1367.65 of the Health and Safety Code, and
to amend Section 10123.81 of the Insurance Code, relating to health
care coverage.
LEGISLATIVE COUNSEL'S DIGEST
AB 113, Portantino. Health care coverage: mammographies.
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 willful
violation of the act a crime. Existing law also provides for the
regulation of health insurers by the Department of Insurance. Under
existing law, 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, 2000, is deemed
to provide coverage for mammography for screening or diagnostic
purposes upon referral by a participating nurse practitioner,
participating certified nurse-midwife, or participating physician,
providing care to the patient and operating within the scope of
practice provided under existing law. Under existing law, an
individual or group policy of disability insurance that is issued,
amended, delivered, or renewed on or after January 1, 2000, is deemed
to provide specified coverage based upon age for mammography for
screening or diagnostic purposes upon referral by a participating
nurse practitioner, participating certified nurse-midwife, or
participating physician, providing care to the patient and operating
within the scope of practice provided under existing law.
This bill would provide that health care service plan contracts
and individual or group policies of health insurance issued, amended,
delivered, or renewed on or after July 1, 2011, shall be deemed to
provide coverage for mammographies for screening or diagnostic
purposes upon referral of a participating nurse practitioner,
participating certified nurse-midwife, participating physician
assistant, or participating physician, as specified.
Because this bill would specify additional requirements for health
care service plans, the willful 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 1367.65 of the Health and Safety Code is
amended to read:
1367.65. (a) Until June 30, 2011, every health care service plan
contract, except a specialized health care service plan contract,
that is issued, amended, delivered, or renewed shall be deemed to
provide coverage for mammography for screening or diagnostic purposes
upon referral by a participating nurse practitioner, participating
certified nurse midwife, or participating physician, providing care
to the patient and operating within the scope of practice provided
under existing law.
(b) On or after July 1, 2011, every health care service plan
contract, except a specialized health care service plan contract,
that is issued, amended, delivered, or renewed shall be deemed to
provide coverage for mammography for screening or diagnostic purposes
upon referral by a participating nurse practitioner, participating
certified nurse midwife, participating physician assistant, or
participating physician, providing care to the patient and operating
within the scope of practice provided under existing law.
(c) Nothing in this section shall be construed to prevent
application of copayment or deductible provisions in a plan, nor
shall this section be construed to require that a plan be extended to
cover any other procedures under an individual or a group health
care service plan contract. Nothing in this section shall be
construed to authorize a plan enrollee to receive the services
required to be covered by this section if those services are
furnished by a nonparticipating provider, unless the plan enrollee is
referred to that provider by a participating provider identified in
subdivision (a) or (b), as applicable, providing care to the patient.
SEC. 2. Section 10123.81 of the Insurance Code is amended to read:
10123.81. (a) Until June 30, 2011, every individual or group
policy of disability insurance or self-insured employee welfare
benefit plan that is issued, amended, or renewed, shall be deemed to
provide coverage for at least the following, upon the referral of a
nurse practitioner, certified nurse-midwife, or physician, providing
care to the patient and operating within the scope of practice
provided under existing law for breast cancer screening or diagnostic
purposes:
(1) A baseline mammogram for women age 35 to 39, inclusive.
(2) A mammogram for women age 40 to 49, inclusive, every two years
or more frequently based on the women's physician's recommendation.
(3) A mammogram every year for women age 50 and over.
(b) On or after July 1, 2011, every individual or group policy of
health insurance that is issued, amended, delivered, or renewed shall
be deemed to provide coverage for mammography for screening or
diagnostic purposes upon referral by a participating nurse
practitioner, participating certified nurse-midwife, participating
physician assistant, or participating physician, providing care to
the patient and operating within the scope of practice provided under
existing law.
(c) Nothing in this section shall be construed to require an
individual or group policy to cover the surgical procedure known as
mastectomy or to prevent application of deductible or copayment
provisions contained in the policy or plan, nor shall this section be
construed to require that coverage under an individual or group
policy be extended to any other procedures.
(d) Nothing in this section shall be construed to authorize an
insured or plan member to receive the coverage required by this
section if that coverage is furnished by a nonparticipating provider,
unless the insured or plan member is referred to that provider by a
participating provider identified in subdivision (a) or (b), as
applicable, providing care to the patient.
(e) This section shall not apply to specialized health insurance,
Medicare supplement insurance, short-term limited duration health
insurance, CHAMPUS supplement insurance, TRICARE supplement
insurance, or to hospital indemnity, accident-only, or specified
disease insurance.
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.