BILL NUMBER: AB 1738 INTRODUCED
BILL TEXT
INTRODUCED BY Assembly Member Huffman
FEBRUARY 16, 2012
An act to add Section 1367.667 to the Health and Safety Code, and
to add Section 10123.25 to the Insurance Code, relating to health
care coverage.
LEGISLATIVE COUNSEL'S DIGEST
AB 1738, as introduced, Huffman. Health care coverage: tobacco
cessation.
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.
Existing law requires health care service plan contracts and health
insurance policies to provide coverage, and not impose cost-sharing
requirements, for certain preventive services, including
evidence-based items or services with a rating of "A" or "B" in the
current recommendations of the United States Preventive Services Task
Force, as specified.
This bill would require health care service plan contracts and
health insurance policies issued, amended, renewed, or delivered on
or after January 1, 2013, to provide coverage for 2 courses of
treatment in a 12-month period for tobacco cessation preventive
services rated "A" or "B" by the United States Preventive Services
Task Force, and would prohibit plans and insurers from charging a
copayment, coinsurance, or deductible for those services. The bill
would also prohibit a plan or insurer from requiring enrollees or
insureds to enter counseling in order to receive tobacco cessation
medications or from imposing prior authorization or stepped-care
requirements on tobacco cessation treatments.
Because a willful violation of the bill's provisions relative to
health care service plans would be a crime, the bill 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 hereby finds and declares the
following:
(a) It is the intent of the Legislature that this act diminish the
statewide economic and personal cost of tobacco addiction by making
tobacco cessation treatments available to all smokers.
(b) Cigarette smoking and other uses of tobacco remain the leading
cause of preventable death in California, as well as the cause of
many other serious health problems, including heart disease,
emphysema, and other chronic illnesses.
(c) The treatment of tobacco-related diseases continues to impose
a significant burden on California's health care system, including
local and state-funded health care systems. Tobacco use costs
Californians billions of dollars a year in medical expenses and lost
productivity.
(d) Providing tobacco cessation counseling and medication is one
of the most clinically effective and cost-effective health services
available, second only to inoculations.
(e) Reducing the smoking rate in California by one percentage
point will result in approximately $91 million saved over five years
from fewer smoking-caused heart attacks and strokes.
(f) The United States Public Health Service Clinical Practice
Guideline entitled Treating Tobacco Use and Dependence has identified
the medications and counseling that are scientifically proven to be
effective in helping smokers quit.
SEC. 2. Section 1367.667 is added to the Health and Safety Code,
to read:
1367.667. (a) (1) A health care service plan contract issued,
amended, renewed, or delivered on or after January 1, 2013, shall
cover a minimum of two courses of treatment in a 12-month period for
all tobacco cessation preventive services rated "A" or "B" by the
United States Preventive Services Task Force, which shall include
counseling and over-the-counter medication and prescription
pharmacotherapy approved by the federal Food and Drug Administration.
(2) No copayment, coinsurance, or deductible shall be applied to
the benefits covered under this section.
(3) As used in this section, "course of treatment" shall be
defined to consist of the following:
(A) As applied to counseling, at least four sessions of
counseling, which may be telephone, group, or individual counseling
with each session lasting at least 10 minutes.
(B) As applied to a prescription or over-the-counter medication,
the duration of treatment approved by the federal Food and Drug
Administration for that medication.
(4) Enrollees shall not be required to enter counseling in order
to receive tobacco cessation medications.
(5) A health care service plan shall not impose prior
authorization or stepped-care requirements on tobacco cessation
treatments.
(b) This section shall not apply to Medicare supplement plan
contracts or to specialized health care service plan contracts.
SEC. 3. Section 10123.25 is added to the Insurance Code, to read:
10123.25. (a) (1) A health insurance policy issued, amended,
renewed, or delivered on or after January 1, 2013, shall cover a
minimum of two courses of treatment in a 12-month period for all
tobacco cessation preventive services rated "A" or "B" by the United
States Preventive Services Task Force, which shall include counseling
and over-the-counter medication and prescription pharmacotherapy
approved by the federal Food and Drug Administration.
(2) No copayment, coinsurance, or deductible shall be applied to
the benefits covered under this section.
(3) As used in this section, "course of treatment" shall be
defined to consist of the following:
(A) As applied to counseling, at least four sessions of
counseling, which may be telephone, group, or individual counseling
with each session lasting at least 10 minutes.
(B) As applied to a prescription or over-the-counter medication,
the duration of treatment approved by the federal Food and Drug
Administration for that medication.
(4) Insureds shall not be required to enter counseling in order to
receive tobacco cessation medications.
(5) A health insurer shall not impose prior authorization or
stepped-care requirements on tobacco cessation treatments.
(b) This section shall not apply to Medicare supplement policies
or to specialized health insurance policies.
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.