BILL NUMBER: AB 2345 AMENDED
BILL TEXT
AMENDED IN SENATE JULY 15, 2010
AMENDED IN SENATE JUNE 16, 2010
AMENDED IN ASSEMBLY APRIL 22, 2010
AMENDED IN ASSEMBLY APRIL 8, 2010
INTRODUCED BY Assembly Member De La Torre
FEBRUARY 19, 2010
An act to add Section 1367.001 to the Health and Safety Code, and
to add Section 10112.1 to the Insurance Code, relating to health care
coverage.
LEGISLATIVE COUNSEL'S DIGEST
AB 2345, as amended, De La Torre. Health care coverage:
federal health care reform. preventive services.
Existing law, the federal Patient Protection and Affordable Care
Act (PPACA) , enacts various health care coverage market
reforms. With respect to plan years beginning on and after September
23, 2010, the act requires health insurance issuers to provide
coverage, and not impose cost-sharing requirements, for certain
preventive services.
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 that act a crime. Existing law also provides for the
regulation of health insurers by the Department of Insurance.
This bill would require health care service plan contracts and
health insurance policies issued, amended, renewed, or delivered on
or after September 23, 2010, to provide coverage, and not impose
cost-sharing requirements, for certain preventive services. Because a
willful violation of this requirement by a health care service plan
would be a crime, the bill would impose a state-mandated local
program.
The bill would also state the intent of the Legislature to enact
legislation that would implement other provisions of the
federal Patient Protection and Affordable Care Act, including, among
other things, requiring plans and insurers to provide an internal
claims and appeals process that complies with the federal act and
requiring plans and insurers to comply with certain patient
protections specified in the federal act require the
Department of Managed Health Care and the Department of Insurance to
post a link on their Internet Web sites to the Internet Web site of
the federal Department of Health and Human Services where consumers
may easily obtain information about affordable and comprehensive
health care coverage options under PPACA .
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. Section 1367.001 is added to the Health and Safety
Code, to read:
1367.001. (a) (1) Subject to the minimum interval established by
the United States Secretary of Health and Human Services pursuant to
subsection (b) of Section 2713 of the federal Public Health Service
Act, as added by Section 1001 of the federal Patient Protection and
Affordable Care Act (Public Law 111-148), a group or individual
health care service plan contract that is issued, amended, renewed,
or delivered on or after September 23, 2010, shall, at a minimum,
provide coverage for, and shall not impose any cost-sharing
requirements for, all of the following:
(A) Evidence-based items or services that have in effect a rating
of "A" or "B" in the current recommendations of the United States
Preventive Services Task Force.
(B) Immunizations that have in effect a recommendation from the
Advisory Committee on Immunization Practices of the federal Centers
for Disease Control and Prevention with respect to the individual
involved.
(C) With respect to infants, children, and adolescents,
evidence-informed preventive care and screenings provided for in the
comprehensive guidelines supported by the federal Health Resources
and Services Administration.
(D) With respect to women, any additional preventive care and
screenings not described in subparagraph (A) as provided for in the
comprehensive guidelines supported by the federal Health Resources
and Services Administration.
(2) For purposes of this subdivision, the current recommendations
of the United States Preventive Services Task Force regarding breast
cancer screening, mammography, and prevention shall be considered the
most current, other than recommendations issued by the task force in
November of 2009, or within 30 days of that month.
(3) Nothing in this subdivision shall be construed to prohibit a
plan from providing coverage for services in addition to those
recommended by the United States Preventive Services Task Force or to
deny coverage for services that are not recommended by the task
force.
(b) This section shall not apply to Medicare supplement
plans plan contracts or to coverage offered by
specialized health care service plans including, but not limited to,
ambulance, dental, vision, behavioral health, chiropractic, and
naturopathic.
SEC. 2. Section 10112.1 is added to the Insurance Code, to read:
10112.1. (a) (1) Subject to the minimum interval established by
the United States Secretary of Health and Human Services pursuant to
subsection (b) of Section 2713 of the federal Public Health Service
Act, as added by Section 1001 of the federal Patient Protection and
Affordable Care Act (Public Law 111-148), a group or individual
health insurance policy that is issued, amended, renewed, or
delivered on or after September 23, 2010, shall, at a minimum,
provide coverage for, and shall not impose any cost-sharing
requirements for, all of the following:
(A) Evidence-based items or services that have in effect a rating
of "A" or "B" in the current recommendations of the United States
Preventive Services Task Force.
(B) Immunizations that have in effect a recommendation from the
Advisory Committee on Immunization Practices of the federal Centers
for Disease Control and Prevention with respect to the individual
involved.
(C) With respect to infants, children, and adolescents,
evidence-informed preventive care and screenings provided for in the
comprehensive guidelines supported by the federal Health Resources
and Services Administration.
(D) With respect to women, any additional preventive care and
screenings not described in subparagraph (A) as provided for in the
comprehensive guidelines supported by the federal Health Resources
and Services Administration.
(2) For purposes of this subdivision, the current recommendations
of the United States Preventive Services Task Force regarding breast
cancer screening, mammography, and prevention shall be considered the
most current, other than recommendations issued by the task force in
November of 2009, or within 30 days of that month.
(3) Nothing in this subdivision shall be construed to prohibit a
health insurer from providing coverage for services in addition to
those recommended by the United States Preventive Services Task Force
or to deny coverage for services that are not recommended by the
task force.
(b) This section shall not apply to specialized health insurance
policies, Medicare supplement policies, CHAMPUS-supplement insurance
policies, TRICARE supplement insurance policies, accident-only
insurance policies, or insurance policies excluded from the
definition of "health insurance" under subdivision (b) of Section
106.
SEC. 3. It is the intent of the Legislature to
enact legislation that would do all of the following:
(a) Prohibit group health plans, other than self-insured plans,
from discriminating in favor of highly compensated individuals as to
eligibility to participate in the plan and benefits included in the
plan in a manner consistent with Section 2716 of the federal Public
Health Service Act (42 U.S.C. Sec. 300gg-16), as added by Section
1001 of, and amended by Section 10101 of, the federal Patient
Protection and Affordable Care Act (Public Law 111-148).
(b) Require health care service plans and health insurers to
provide an internal claims and appeals process that complies with
Section 2719 of the federal Public Health Service Act (42 U.S.C. Sec.
300gg-19), as added by Section 1001 of, and amended by Section 10101
of, the federal Patient Protection and Affordable Care Act (Public
Law 111-148).
(c) Require health care service plans and health insurers to
comply with the patient protections set forth in Section 2719A of the
federal Public Health Service Act (42 U.S.C. Sec. 300gg-19a), as
added by Section 10101 of the federal Patient Protection and
Affordable Care Act (Public Law 111-148).
(d) Require the Department of Managed Health Care and the
SEC. 3. It is the intent of the Legislature to
enact legislation that would require the Department of Managed Health
Care and the Department of Insurance to post a link on their
respective Internet Web sites to the Internet Web site of the federal
Department of Health and Human Services where consumers may easily
obtain information about affordable and comprehensive health care
coverage options under the federal Patient Protection and Affordable
Care Act (Public Law 111-148).
SEC. 4. 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.
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