BILL NUMBER: SB 253	INTRODUCED
	BILL TEXT


INTRODUCED BY   Senator Alquist

                        FEBRUARY 10, 2011

   An act to add Section 1367.605 to the Health and Safety Code, and
to add Section 10123.815 to the Insurance Code, relating to health
care coverage.



	LEGISLATIVE COUNSEL'S DIGEST


   SB 253, as introduced, Alquist. Health care coverage: acquired
brain injuries.
   (1) Existing law provides for licensing and regulation of health
care service plans by the Department of Managed Health Care. A
willful violation of these provisions is a crime. Existing law
provides for licensing and regulation of health insurers by the
Insurance Commissioner. Existing law requires health care service
plan contracts and health insurance policies to provide coverage for
specified matters.
   This bill would provide that health care service plan contracts
and health insurance policies may not deny coverage for medically
necessary treatment of acquired brain injuries at any of various
facilities that are properly licensed and accredited, as specified.
The bill would also prohibit denial of coverage because the treating
facility is not in or near the home of the enrollee or insured.
Because the bill would change the definition of a crime with respect
to health care service plans, it would thereby impose a
state-mandated local program.
   (2) 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 1367.605 is added to the Health and Safety
Code, to read:
   1367.605.  A health care service plan may not deny coverage for
medically necessary medical or rehabilitation treatment for an
acquired brain injury at a facility that is properly licensed and
accredited at which appropriate services may be provided, including,
but not limited to, a hospital; an acute rehabilitation hospital; a
long-term acute care hospital; a skilled nursing facility; an
assisted living or acute or postacute residential transitional
rehabilitation facility accredited by the Commission on Accreditation
of Rehabilitation Facilities as a specialty brain injury
rehabilitation program, such as an interdisciplinary outpatient
medical rehabilitation program, a brain injury program, or a
residential rehabilitation program; a medical office; or another
analogous facility at which appropriate services may be provided. A
plan may not deny coverage because the treating facility is not in or
near the enrollee's home.
  SEC. 2.  Section 10123.815 is added to the Insurance Code, to read:

   10123.815.  A health insurer may not deny coverage for medically
necessary medical or rehabilitation treatment for an acquired brain
injury at a facility that is properly licensed and accredited at
which appropriate services may be provided, including, but not
limited to, a hospital; an acute rehabilitation hospital; a long-term
acute care hospital; a skilled nursing facility; an assisted living
or acute or postacute residential transitional rehabilitation
facility accredited by the Commission on Accreditation of
Rehabilitation Facilities as a specialty brain injury rehabilitation
program, such as an interdisciplinary outpatient medical
rehabilitation program, a brain injury program, or a residential
rehabilitation program; a medical office; or another analogous
facility at which appropriate services may be provided. A health
insurer may not deny coverage because the treating facility is not in
or near the insured's home.
  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.