BILL NUMBER: SB 320	INTRODUCED
	BILL TEXT


INTRODUCED BY   Senator Beall
   (Coauthors: Senators DeSaulnier and Rubio)

                        FEBRUARY 19, 2013

   An act to add Section 1367.81 to the Health and Safety Code, and
to add Section 10123.65 to the Insurance Code, relating to health
care coverage.



	LEGISLATIVE COUNSEL'S DIGEST


   SB 320, as introduced, Beall. Health care coverage: acquired brain
injury.
   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 for specified benefits.
   This bill would prohibit a health care service plan contract or a
health insurance policy issued, amended, renewed, or delivered on or
after January 1, 2014, from denying 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 specified facilities
such as a hospital or a long-term acute care hospital, except as
provided. The bill would additionally prohibit the contract or policy
from denying coverage because the treating facility is not near the
enrollee's or insured's home. Because a willful violation of the bill'
s provisions by a health care service plan 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 1367.81 is added to the Health and Safety Code,
to read:
   1367.81.  (a) A health care service plan contract issued, amended,
renewed, or delivered on or after January 1, 2014, shall 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 any of the following facilities:
   (1) A hospital.
   (2) An acute rehabilitation hospital.
   (3) A long-term acute care hospital.
   (4) An adult residential 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.
   (5) A medical office.
   (6) Another analogous facility at which appropriate services may
be provided.
   (b) A health care service plan shall not deny coverage pursuant to
subdivision (a) because the treating facility is not near the
enrollee's home.
   (c) This section shall not apply to accident-only, specified
disease, hospital indemnity, Medicare supplement, dental-only, or
vision-only health care service plan contracts.
  SEC. 2.  Section 10123.65 is added to the Insurance Code, to read:
   10123.65.  (a) A health insurance policy issued, amended, renewed,
or delivered on or after January 1, 2014, shall 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
any of the following facilities:
   (1) A hospital.
   (2) An acute rehabilitation hospital.
   (3) A long-term acute care hospital.
   (4) An adult residential 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.
   (5) A medical office.
   (6) Another analogous facility at which appropriate services may
be provided.
   (b) A health insurance policy shall not deny coverage, pursuant to
subdivision (a) because the treating facility is not near the
insured's home.
   (c) This section shall not apply to accident-only, specified
disease, hospital indemnity, Medicare supplement, dental-only, or
vision-only health insurance policies.
  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.