BILL NUMBER: AB 513 AMENDED
BILL TEXT
AMENDED IN SENATE SEPTEMBER 1, 2009
AMENDED IN SENATE JULY 23, 2009
AMENDED IN ASSEMBLY MAY 5, 2009
INTRODUCED BY Assembly Member De Leon
(Coauthors: Assembly Members Brownley, Buchanan, Carter, Evans,
Fuentes, Furutani, Lieu, Bonnie Lowenthal, Ma, Salas, and Skinner)
(Coauthors: Senators Alquist, Leno, and Pavley)
FEBRUARY 24, 2009
An act to add Section 1367.625 to the Health and Safety Code, and
to add Section 10123.875 to the Insurance Code, relating to health
care coverage.
LEGISLATIVE COUNSEL'S DIGEST
AB 513, as amended, De Leon. Health care coverage: breast-feeding.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975
(Knox-Keene Act), provides for the licensure and regulation of health
care service plans by the Department of Managed Health Care and
makes a willful violation of that act a crime. Existing law also
provides for the regulation of health insurers by the Department of
Insurance. Under existing law, health care service plans and health
insurers are required to offer specified types of coverage as part of
their health care service plan contracts or health insurance
policies. Existing law imposes specified requirements upon a health
care service plan contract or health insurance policy that provides
maternity coverage.
This bill would require specified health care service plans and
health insurers to include coverage for lactation consultation and
for the provision or rental of
specified types of breast pumps, as defined, as part of their
health care service plan contracts or health insurance policies that
provide maternity coverage.
Because this bill would specify additional requirements under the
Knox-Keene Act, 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.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. The Legislature finds and declares the following:
(a) Breast-feeding significantly reduces children's risk for
chronic diseases, such as diabetes, asthma, allergies, and infections
in the gastrointestinal, urinary, and respiratory tracts. Breast-fed
children have fewer visits to the doctor's office, fewer days of
hospitalization, and take fewer medications than children who were
formula-fed. Research provides strong evidence that breast-feeding
decreases the incidence or severity of diarrhea, lower respiratory
infection, otitis media, bacteremia, bacterial meningitis, botulism,
and necrotizing enterocolitis. There are a number of studies that
show a possible protective effect of exclusive breast-feeding against
sudden infant death syndrome (SIDS), insulin-dependent diabetes
mellitus, Crohn's disease, ulcerative colitis, lymphoma, allergic
diseases, and other chronic digestive diseases. Breast-feeding has
also been related to possible enhancement of cognitive development
and a decreased chance of obesity in childhood and adulthood. Studies
show that breast-feeding also reduces the mother's risk for type 2
diabetes and breast and ovarian cancers.
(b) All major health organizations recommend that babies get no
other food or drink besides breast milk for the first six months of
their life, with continued breast-feeding for at least the first one
to two years of life, as long as it is mutually desired. Exclusive
breast-feeding for three months has been shown to reduce health care
costs for infants in the first year of life alone by up to four
hundred seventy-five dollars ($475), compared to nonbreast-fed
infants.
(c) Lactation consultation provided by an international board
certified lactation consultant (IBCLC) has been shown to help women
address the difficulties with breast-feeding and can assist with the
initiation and continuance of breast-feeding.
(d) Therefore, it is essential to clarify that all health coverage
made available to California consumers that provides maternity
coverage, whether issued by health care service plans regulated by
the Department of Managed Health Care or by health insurers regulated
by the Department of Insurance, shall include coverage for lactation
consultation by an international board certified lactation
consultant (IBCLC) and coverage for the rental of breast
pumps the provision of a personal electric or personal
manual breast pump or coverage for the rental of a
hospital grade electric breast pump .
SEC. 2. Section 1367.625 is added to the Health and Safety Code,
to read:
1367.625. (a) Every health care service plan contract ,
except a specialized health care service plan contract,
that provides maternity coverage, and that is issued, amended,
renewed, or delivered on or after January 1, 2010, shall provide
coverage for lactation consultation with an international board
certified lactation consultant (IBCLC) and for the rental of
breast pumps the provision of a personal electric or
personal manual breast pump or coverage for the rental of a hospital
grade electric breast pump .
(b) For the purposes of this section, "breast pump" means an
FDA-approved reusable breast pump that is considered to be durable
medical equipment, and meets state or federal quality standards for
durable medical equipment.
(c) This section shall not apply to specialized health care
service plans, Medicare supplement, short-term limited duration
health insurance, CHAMPUS-supplement insurance, TRI-CARE supplement,
or to hospital indemnity, accident-only, or specified disease plans.
(c) This section shall not apply to any of the following:
(1) Specialized health care service plans.
(2) Medicare supplement plans.
(3) Short-term limited duration health insurance, except when
specifically for coverage during pregnancy or a postpartum period or
both.
(4) CHAMPUS-supplement plans.
(5) TRI-CARE supplement plans.
(6) Hospital indemnity, accident-only, or specified disease plans.
SEC. 3. Section 10123.875 is added to the Insurance Code, to read:
10123.875. (a) Every policy of health insurance that provides
maternity coverage, and that is issued, amended, renewed, or
delivered on or after January 1, 2010, shall provide coverage for
lactation consultation with an international board certified
lactation consultant (IBCLC) and for the rental of breast
pumps the provision of a personal electric or personal
manual breast pump or coverage for the rental of a hospital grade
electric breast pump .
(b) For the purposes of this section, "breast pump" means an
FDA-approved reusable breast pump that is considered to be durable
medical equipment, and meets state or federal quality standards for
durable medical equipment.
(c) This section shall not apply to specialized health insurance,
Medicare supplement, short-term limited duration health insurance,
CHAMPUS-supplement insurance, TRI-CARE supplement, or to hospital
indemnity, accident-only, or specified disease insurance.
(c) This section shall not apply to any of the following:
(1) Specialized health insurance.
(2) Medicare supplement insurance.
(3) Short-term limited duration health insurance, except when
specifically for coverage during pregnancy or a postpartum period or
both.
(4) CHAMPUS-supplement insurance.
(5) TRI-CARE supplement insurance.
(6) Hospital indemnity, accident-only, or specified disease
insurance.
SEC. 4. Section 1367.625 of the Health and Safety
Code and Section 10123.875 of the Insurance Code, as added by this
act, shall not be construed to affect any other requirement to
provide breast pumps or lactation consultation in the Medi-Cal,
Healthy Families, or Access for Infants and Mothers programs.
SEC. 4. SEC. 5. 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.