BILL ANALYSIS Ó
AB 460
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CONCURRENCE IN SENATE AMENDMENTS
AB 460 (Ammiano)
As Amended August 20, 2013
Majority vote
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|ASSEMBLY: |50-24|(May 20, 2013) |SENATE: |26-11|(August 26, |
| | | | | |2013) |
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Original Committee Reference: HEALTH
SUMMARY : Requires coverage for the treatment of infertility,
and if purchased, to be offered and provided without
discrimination on the basis of age, ancestry, color, disability,
domestic partner status, gender, gender expression, gender
identity, genetic information, marital status, national origin,
race, religion, sex, or sexual orientation.
The Senate amendments :
1)Clarify that nothing in this bill shall be construed to
interfere with the clinical judgment of a physician and
surgeon.
2)Clarify that coverage for the treatment of infertility shall
be consistent with existing law which prohibits discrimination
of contract availability or terms based on race, color,
national origin, ancestry, religion, sex, marital status,
sexual orientation, or age, as specified.
EXISTING LAW :
1)Requires health plans and health insurers to offer coverage
under group contracts, as specified, for the treatment of
infertility, except in vitro fertilization, under those terms
and conditions as may be agreed upon between the group
subscriber and the plan. Requires plans and insurers to
communicate the availability of that coverage to all group
contract holders and to all prospective group contract holders
with whom they are negotiating.
2)Defines, "infertility" as either: a) the presence of a
demonstrated condition recognized by a licensed physician and
surgeon as a cause of infertility; or, b) the inability to
AB 460
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conceive a pregnancy or to carry a pregnancy to a live birth
after a year or more of regular sexual relations without
contraception. "Treatment for infertility" means procedures
consistent with established medical practices in the treatment
of infertility by licensed physicians and surgeons including,
but not limited to, diagnosis, diagnostic tests, medication,
surgery, and gamete intrafallopian transfer. "In vitro
fertilization" means the laboratory medical procedures
involving the actual in vitro fertilization process.
FISCAL EFFECT : According to the Senate Appropriations
Committee, minor costs to both the Department of Insurance and
Department of Managed Health Care to enforce the requirements of
the bill (Insurance Fund and Managed Care Fund). Both
departments have indicated that health insurers and health plans
are already subject to general provisions in law against
discrimination by sex or gender in the provision of benefits.
Therefore this bill clarifies existing law and does not create a
new obligation that must be enforced. No anticipated costs to
the Medi-Cal program (General Fund and federal funds). Medi-Cal
generally does not provide coverage for infertility services
(unless infertility is a secondary diagnosis to another medical
condition, for which treatment is covered). Therefore, there is
no anticipated additional cost to Medi-Cal. No anticipated
costs to California Public Employees' Retirement System
(CalPERS) (General Fund and special funds). CalPERS health
plans are subject to regulation by the Department of Insurance
or the Department of Managed Health care. As noted above, those
carriers are already subject to non-discrimination requirements.
Analysis Prepared by : Teri Boughton / HEALTH / (916) 319-2097
FN: 0001879