BILL NUMBER: AB 137 AMENDED
BILL TEXT
AMENDED IN SENATE AUGUST 22, 2012
AMENDED IN SENATE AUGUST 6, 2012
AMENDED IN ASSEMBLY JANUARY 23, 2012
INTRODUCED BY Assembly Member Portantino
JANUARY 12, 2011
An act to amend Section 1367.65 of the Health and Safet
y Code, and to amend Section 10123.81 of 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. 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.
Existing law provides for the regulation of health insurers by the
Department of Insurance. 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 specified health care service
plan contracts, except specialized health care service
plan contracts, and individual or group policies of health
insurance 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.
Vote: majority. Appropriation: no. Fiscal committee: no
yes . State-mandated local program: no
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) On or after January 1, 2000, 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
nurse-midwife , participating physician
assistant, or participating physician, providing care to the
patient and operating within the scope of practice provided under
existing law.
(b) 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 physician, nurse
practitioner, or certified nurse midwife providing care.
SECTION 1. SEC. 2. Section 10123.81
of the Insurance Code is amended to read:
10123.81. (a) Every individual or group policy of disability
insurance or self-insured employee welfare benefit plan shall be
deemed to provide coverage for mammography for screening or
diagnostic purposes upon the referral of a participating
nurse practitioner, participating certified nurse-midwife,
participating physician assistant, or
participatin g physician, providing care
to the patient and operating within the scope of practice provided
under existing law.
(b) Nothing in this section shall be construed to prevent the
application of copayment or deductible provisions in a policy, nor
shall this section be construed to require that a policy be extended
to cover any other procedures under an individual or a group policy.
Nothing in this section shall be construed to authorize a
policyholder to receive the services required to be covered by this
section if those services are furnished by a nonparticipating
provider, unless the policyholder is referred to that provider by a
participating physician, nurse practitioner, or certified
nurse midwife nurse-midwife providing care.
(c) This section shall not apply to specialized health insurance,
Medicare supplement insurance, short-term limited duration health
insurance, CHAMPUS supplement insurance, or TRI-CARE 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.