BILL NUMBER: AB 137	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  JANUARY 23, 2012

INTRODUCED BY   Assembly Member Portantino

                        JANUARY 12, 2011

   An act to amend Section 1367.65 of, and to add Section 1367.651
to, the Health and Safety Code, and to amend Section 10123.81 of, and
to add Section 10123.815 to, the Insurance Code, relating to health
care coverage.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 137, as amended, 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,  2012 
 2013  , 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. The bill would, commencing July 1, 
2012   2013  , require plans and insurers subject
to these provisions to provide subscribers or policyholders with
information regarding recommended timelines for an individual to
undergo tests for the screening or diagnosis of breast cancer, 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.
   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 1367.65 of the Health and Safety Code is
amended to read:
   1367.65.  (a) Until June 30,  2012   2013
 , 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,  2012   2013  ,
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 1367.651 is added to the Health and Safety Code,
to read:
   1367.651.  Commencing July 1,  2012   2013
 , a health care service plan subject to Section 1367.6 or
1367.65 shall provide a subscriber with information regarding
recommended timelines for an individual to undergo tests for the
screening or diagnosis of breast cancer. This information may be
provided by written letter sent to the subscriber, by publication in
a newsletter sent to the subscriber, by publication in evidence of
coverage, by direct telephone call to the subscriber, by electronic
transmission, by Web-based portal containing various plan and benefit
information if the subscriber has access to that portal, or by any
other means that will reasonably notify the subscriber of the
recommended timelines for testing. Communications made by a plan's
contracted providers that satisfy the requirements of this section
shall constitute compliance by the plan with this section.
  SEC. 3.  Section 10123.81 of the Insurance Code is amended to read:

   10123.81.  (a) Until June 30,  2012   2013
 , 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,  2012   2013  ,
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, TRI-CARE supplement
insurance, or to hospital indemnity, accident-only, or specified
disease insurance.
  SEC. 4.  Section 10123.815 is added to the Insurance Code, to read:

   10123.815.  (a) Commencing July 1,  2012  
2013  , a health insurer subject to Section 10123.8 or 10123.81
shall provide a policyholder with information regarding recommended
timelines for an individual to undergo tests for the screening or
diagnosis of breast cancer. This information may be provided by
written letter sent to the policyholder, by publication in a
newsletter sent to the policyholder, by publication in evidence of
coverage, by direct telephone call to the policyholder, by electronic
transmission, by Web-based portal containing various plan or policy
and benefit information if the policyholder has access to that
portal, or by any other means that will reasonably notify the
policyholder of the recommended timelines for testing. Communications
made by an insurer's contracted providers that satisfy the
requirements of this section shall constitute compliance by the
insurer with this section.
   (b) This section shall not apply to specialized health insurance,
Medicare supplement insurance, short-term limited duration health
insurance, CHAMPUS supplement insurance, TRI-CARE supplement
insurance, or to hospital indemnity, accident-only, or specified
disease insurance.
  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.