BILL ANALYSIS
AB 513
Page 1
CONCURRENCE IN SENATE AMENDMENTS
AB 513 (De Leon)
As Amended September 1, 2009
Majority vote
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|ASSEMBLY: |50-28|(June 2, 2009) |SENATE: |24-15|(September 3, |
| | | | | |2009) |
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Original Committee Reference: HEALTH
SUMMARY : Requires health plans and those health insurers that
provide maternity benefits to provide coverage for lactation
consultation with an international board certified lactation
consultant and the provision of, or the rental of, a breast
pump, as specified.
The Senate amendments :
1)Specify the types of breast pumps covered under this bill.
2)Clarify that the exemption provided for specified specialized
health plans and insurance policies includes short-term
limited duration health insurance, except when specifically
for coverage during pregnancy or a postpartum period or both.
3)Prohibit the provisions of this bill from being 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.
EXISTING LAW :
1)Provides for the regulation of health plans by the Department
of Managed Health Care (DMHC) and health insurers by the
California Department of Insurance (CDI).
2)Requires full-service health plans licensed under the
Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene)
to cover all medically necessary basic health care services,
including physician services; hospital inpatient and
outpatient services; diagnostic services; preventive and
routine care; emergency and urgent care services; medically
appropriate home health services; and, rehabilitation therapy.
AB 513
Page 2
There is no requirement for health insurers subject to
regulation by CDI to cover medically necessary basic services
or any specific minimum basic benefits.
3)Provides, under Knox-Keene, that health plans must provide all
medically necessary basic health care services, including
maternity services necessary to prevent serious deterioration
of the health of the enrollee or the enrollee's fetus, and
preventive health care services, specifically including
prenatal care.
4)Defines health plans that cover only certain kinds of care,
such as dental and vision care plans, behavioral or mental
health plans, and chiropractic plans, as specialized plans.
5)Defines a policy of health insurance for covered benefits in a
single specialized area of health care, including dental-only,
vision-only, and behavioral health-only policies, as a
specialized health insurance policy.
AS PASSED BY THE ASSEMBLY , this bill was substantially similar
to the version approved by the Senate.
FISCAL EFFECT : According to the Senate Appropriations
Committee, special fund costs to DMHC of $50,000 in fiscal year
(FY) 2009-10 for start-up and general, special, and private fund
costs for California Public Employees Retirement System benefits
of $50,000 in FY 2009-10 and $100,000 in FY 2010-11 and 2011-12.
Analysis Prepared by : Cassie Rafanan / HEALTH / (916)
319-2097
FN: 0002892