Amended in Senate April 1, 2013

Senate BillNo. 639


Introduced by Senator Hernandez

February 22, 2013


begin deleteAn act relating to health care coverage. end deletebegin insertAn act to amend Section 1367 of, and to add Sections 1367.006, 1367.007, and 1367.008 to, the Health and Safety Code, and to add Sections 10112.28, 10112.29, 10112.295, and 10112.7 to the Insurance Code, relating to health care coverage.end insert

LEGISLATIVE COUNSEL’S DIGEST

SB 639, as amended, Hernandez. begin deleteHealth care coverage: cost sharing. end deletebegin insertHealth care coverage.end insert

begin insert

Existing federal law, the federal Patient Protection and Affordable Care Act (PPACA), enacts various health care coverage market reforms that take effect January 1, 2014. Among other things, PPACA establishes annual limits on deductibles for employer-sponsored plans and defines bronze, silver, gold, and platinum levels of coverage for the nongrandfathered individual and small group markets.

end insert
begin insert

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.

end insert
begin insert

This bill would prohibit the deductible under a small employer health care service plan contract or health insurance policy offered, sold, or renewed on or after January 1, 2014, from exceeding $2,000 in the case of a plan contract or policy covering a single individual, or $4,000 in all other cases.

end insert
begin insert

The bill would require, for nongrandfathered products in the individual or small group markets, a health care service plan contract or health insurance policy, except a specialized health insurance policy, that is issued, amended, or renewed on or after January 1, 2014, to provide for a limit on annual out-of-pocket expenses for all covered benefits that meet the definition of essential health benefits, as defined, and would require the contract or policy, for nongrandfathered products in the large group market, to provide that limit for all covered benefits, including out-of-network emergency care.

end insert
begin insert

The bill would define bronze, silver, gold, and platinum levels of coverage for the nongrandfathered individual and small group markets consistent with the definitions in PPACA. The bill would prohibit a carrier that is not participating in the Exchange from offering a catastrophic plan, as defined, in the individual market.

end insert
begin insert

PPACA requires a health insurance issuer offering group or individual coverage that provides or covers benefits with respect to services in the emergency department of a hospital to cover emergency services without the need for prior authorization, regardless of whether the provider is a participating provider, and subject to the same cost sharing required if the services were provided by a participating provider, as specified.

end insert
begin insert

This bill would impose that requirement with respect to health insurance policies issued, amended, or renewed on or after January 1, 2014, as specified.

end insert
begin insert

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.

end insert
begin insert

This bill would provide that no reimbursement is required by this act for a specified reason.

end insert
begin delete

Existing federal law, the federal Patient Protection and Affordable Care Act (PPACA), enacts various health care coverage market reforms that take effect January 1, 2014. Among other things, PPACA establishes annual limits on deductibles for employer-sponsored plans and defines bronze, silver, gold, and platinum levels of coverage for the nongrandfathered individual and small group markets.

end delete
begin delete

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.

end delete
begin delete

This bill would declare the intent of the legislature to enact legislation that would address cost sharing as contemplated by the PPACA.

end delete

Vote: majority. Appropriation: no. Fiscal committee: begin deleteno end deletebegin insertyesend insert. State-mandated local program: begin deleteno end deletebegin insertyesend insert.

The people of the State of California do enact as follows:

P3    1begin insert

begin insertSECTION 1.end insert  

end insert

begin insertSection 1367 of the end insertbegin insertHealth and Safety Codeend insertbegin insert is
2amended to read:end insert

3

1367.  

A health care service plan and, if applicable, a specialized
4health care service plan shall meet the following requirements:

5(a)  Facilities located in this state including, but not limited to,
6clinics, hospitals, and skilled nursing facilities to be utilized by
7the plan shall be licensed by the State Department ofbegin delete Health
8Services,end delete
begin insert Public Health,end insert where licensure is required by law.
9Facilities not located in this state shall conform to all licensing
10and other requirements of the jurisdiction in which they are located.

11(b)  Personnel employed by or under contract to the plan shall
12be licensed or certified by their respective board or agency, where
13licensure or certification is required by law.

14(c)  Equipment required to be licensed or registered by law shall
15be so licensed or registered, and the operating personnel for that
16equipment shall be licensed or certified as required by law.

17(d)  The plan shall furnish services in a manner providing
18continuity of care and ready referral of patients to other providers
19at times as may be appropriate consistent with good professional
20practice.

21(e)  (1)  All services shall be readily available at reasonable
22times to each enrollee consistent with good professional practice.
23To the extent feasible, the plan shall make all services readily
24accessible to all enrollees consistent with Section 1367.03.

25(2)  To the extent thatbegin delete telemedicineend deletebegin insert telehealthend insert services are
26appropriately provided throughbegin delete telemedicine,end deletebegin insert telehealth,end insert as defined
27in subdivision (a) of Section 2290.5 of the Business and Professions
28Code, these services shall be considered in determining compliance
29with Section 1300.67.2 of Title 28 of the California Code of
30Regulations.

P4    1(3)  The plan shall make all services accessible and appropriate
2consistent with Section 1367.04.

3(f)  The plan shall employ and utilize allied health manpower
4for the furnishing of services to the extent permitted by law and
5consistent with good medical practice.

6(g)  The plan shall have the organizational and administrative
7capacity to provide services to subscribers and enrollees. The plan
8shall be able to demonstrate to the department that medical
9decisions are rendered by qualified medical providers, unhindered
10by fiscal and administrative management.

11(h)  (1)  Contracts with subscribers and enrollees, including
12group contracts, and contracts with providers, and other persons
13furnishing services, equipment, or facilities to or in connection
14with the plan, shall be fair, reasonable, and consistent with the
15objectives of this chapter. All contracts with providers shall contain
16provisions requiring a fast, fair, and cost-effective dispute
17resolution mechanism under which providers may submit disputes
18to the plan, and requiring the plan to inform its providers upon
19contracting with the plan, or upon change to these provisions, of
20the procedures for processing and resolving disputes, including
21the location and telephone number where information regarding
22disputes may be submitted.

23(2)  A health care service plan shall ensure that a dispute
24resolution mechanism is accessible to noncontracting providers
25for the purpose of resolving billing and claims disputes.

26(3)  On and after January 1, 2002, a health care service plan
27shall annually submit a report to the department regarding its
28dispute resolution mechanism. The report shall include information
29on the number of providers who utilized the dispute resolution
30mechanism and a summary of the disposition of those disputes.

31(i)  A health care service plan contract shall provide to
32subscribers and enrollees all of the basic health care services
33included in subdivision (b) of Section 1345, except that the director
34may, for good cause, by rule or order exempt a plan contract or
35any class of plan contracts from that requirement. The director
36shall by rule define the scope of each basic health care service that
37health care service plans are required to provide as a minimum for
38licensure under this chapter. Nothing in this chapter shall prohibit
39a health care service plan from charging subscribers or enrollees
40a copayment or a deductible for a basic health care service
P5    1begin insert consistent with Section 1367.006end insert orbegin insert 1367.007, provided that the
2copayments, deductibles, or other cost sharing are reported toend insert
begin insert end insertbegin insertthe
3director and set forth to the subscriber or enrollee pursuant to the
4disclosure provisions of Section 1363. Nothing in this chapter shall
5prohibit a health care service planend insert
from setting forth, by contract,
6limitations on maximum coverage of basic health care services,
7provided that thebegin delete copayments, deductibles, orend delete limitations are
8reported to, and held unobjectionable by, the director and set forth
9to the subscriber or enrollee pursuant to the disclosure provisions
10of Section 1363.

11(j)  A health care service plan shall not require registration under
12the Controlled Substances Act of 1970 (21 U.S.C. Sec. 801 et seq.)
13as a condition for participation by an optometrist certified to use
14therapeutic pharmaceutical agents pursuant to Section 3041.3 of
15the Business and Professions Code.

16Nothing in this section shall be construed to permit the director
17to establish the rates charged subscribers and enrollees for
18contractual health care services.

19The director’s enforcement of Article 3.1 (commencing with
20Section 1357) shall not be deemed to establish the rates charged
21subscribers and enrollees for contractual health care services.

22The obligation of the plan to comply with thisbegin delete sectionend deletebegin insert chapterend insert
23 shall not be waived when the plan delegates any services that it is
24required to perform to its medical groups, independent practice
25associations, or other contracting entities.

26begin insert

begin insertSEC. 2.end insert  

end insert

begin insertSection 1367.006 is added to the end insertbegin insertHealth and Safety
27Code
end insert
begin insert, to read:end insert

begin insert
28

begin insert1367.006.end insert  

(a) (1) For nongrandfathered products in the
29individual or small group markets, a health care service plan
30contract, except a specialized health care service plan contract,
31that is issued, amended, or renewed on or after January 1, 2014,
32shall provide for a limit on annual out-of-pocket expenses for all
33covered benefits that meet the definition of essential health benefits
34in paragraph (1) of subdivision (a) of Section 1367.005.

35(2) For nongrandfathered products in the large group market,
36a health care service plan contract, except a specialized health
37care service plan contract, that is issued, amended, or renewed
38on or after January 1, 2014, shall provide for a limit on annual
39out-of-pocket expenses for all covered benefits, including
40out-of-network emergency care consistent with Section 1371.4.

P6    1(b) The limit described in subdivision (a) shall apply to any
2copayment, coinsurance, deductible, incentive payment, and any
3other form of cost sharing for all covered benefits.

4(c) The limit described in subdivision (a) shall not exceed the
5limit described in Section 1302(c) of PPACA, and any subsequent
6rules, regulations, or guidance issued under that section.

7(d) Nothing in this section shall be construed to affect the
8reduction in cost sharing for eligible enrollees described in Section
91402 of PPACA, and any subsequent rules, regulations, or
10guidance issued under that section.

11(e) “PPACA” means the federal Patient Protection and
12Affordable Care Act (Public Law 111-148), as amended by the
13federal Health Care and Education Reconciliation Act of 2010
14(Public Law 111-152), and any rules, regulations, or guidance
15issued thereunder.

end insert
16begin insert

begin insertSEC. 3.end insert  

end insert

begin insertSection 1367.007 is added to the end insertbegin insertHealth and Safety
17Code
end insert
begin insert, to read:end insert

begin insert
18

begin insert1367.007.end insert  

(a) (1) For a small employer health care service
19plan contract offered, sold, or renewed on or after January 1,
202014, the deductible under the plan shall not exceed:

21(A) Two thousand dollars ($2,000) in the case of a plan contract
22covering a single individual.

23(B) Four thousand dollars ($4,000) in the case of any other
24plan contract.

25(2) The dollar amounts in this section shall be indexed consistent
26with Section 1302(c)(2) of PPACA and any federal rules or
27guidance pursuant to that section.

28(3) The limitation in this subdivision shall be applied in a
29manner that does not affect the actuarial value of any small
30employer health care service plan contract.

31(4) For small group products at the bronze level of coverage,
32as defined in Section 1367.008, the department may permit plans
33to offer a higher deductible in order to meet the actuarial value
34requirement of the bronze level. In making this determination, the
35department shall consider affordability of cost sharing for enrollees
36and shall also consider whether enrollees may be deterred from
37seeking appropriate care because of higher cost sharing.

38(b) Nothing in this section shall be construed to allow a plan
39contract to have a deductible that applies to preventive services
40as defined in Section 1367.002.

P7    1(c) “PPACA” means the federal Patient Protection and
2Affordable Care Act (Public Law 111-148), as amended by the
3federal Health Care and Education Reconciliation Act of 2010
4(Public Law 111-152), and any rules, regulations, or guidance
5issued thereunder.

end insert
6begin insert

begin insertSEC. 4.end insert  

end insert

begin insertSection 1367.008 is added to the end insertbegin insertHealth and Safety
7Code
end insert
begin insert, to read:end insert

begin insert
8

begin insert1367.008.end insert  

(a) Levels of coverage for the nongrandfathered
9individual and small group markets are defined as follows:

10(1) Bronze level: A health care service plan contract in the
11bronze level shall provide a level of coverage that is actuarially
12equivalent to 60 percent of the full actuarial value of the benefits
13provided under the plan contract. No product shall be offered at
14this level of coverage unless it is a standardized product consistent
15with Section 1366.6.

16(2) Silver level: A health care service plan contract in the silver
17level shall provide a level of coverage that is actuarially equivalent
18to 70 percent of the full actuarial value of the benefits provided
19under the plan contract. No product shall be offered at this level
20of coverage unless it is a standardized product consistent with
21Section 1366.6.

22(3) Gold level: A health care service plan contract in the gold
23level shall provide a level of coverage that is actuarially equivalent
24to 80 percent of the full actuarial value of the benefits provided
25under the plan contract. No product shall be offered at this level
26of coverage unless it is a standardized product consistent with
27Section 1366.6.

28(4) Platinum level: A health care service plan contract in the
29platinum level shall provide a level of coverage that is actuarially
30equivalent to 90 percent of the full actuarial value of the benefits
31provided under the plan contract. No product shall be offered at
32this level of coverage unless it is a standardized product consistent
33with Section 1366.6.

34(b) Actuarial value for nongrandfathered individual and
35nongrandfathered small employer health care service plan
36contracts shall be determined in accordance with the following:

37(1) Actuarial value shall not vary by more than plus or minus
382 percent.

39(2) Actuarial value shall be determined on the basis of essential
40health benefits as defined in Section 1367.005 and as provided to
P8    1a standard, nonelderly population. For this purpose, a standard
2population shall not include those receiving coverage through the
3Medi-Cal or Medicare programs.

4(3) The department may use the actuarial value methodology
5developed consistent with Section 1302(d) of PPACA.

6(4) The department, in consultation with the Department of
7Insurance and the Exchange, shall consider whether to exercise
8state-level flexibility with respect to the actuarial value calculator
9in order to take into account the unique characteristics of the
10California health care coverage market, including the prevalence
11of health care service plans, total cost of care paid for by the plan,
12price of care, patterns of service utilization, and relevant
13demographic factors.

14(5) For small group products, employer contributions toward
15health reimbursement accounts and health savings accounts shall
16count toward the actuarial value of the product in the manner
17specified in federal rules and guidance.

18(c) For all products in the nongrandfathered individual and
19small group markets, any deductible shall apply to all services.

20(d) (1) A catastrophic plan is a health care service plan contract
21that provides no benefits for any plan year until the enrollee has
22incurred cost-sharing expenses in an amount equal to the annual
23limit on out-of-pocket costs as specified in Section 1367.006 except
24that it shall provide coverage for at least three primary care visits.
25A carrier that is not participating in the Exchange shall not offer,
26market, or sell a catastrophic plan in the individual market. No
27product shall be offered at this level of coverage unless it is a
28standardized product consistent with Section 1366.6.

29(2) A catastrophic plan may be offered only in the individual
30market and only if consistent with subdivision (c) and this
31paragraph. Catastrophic plans may be offered only if either of the
32following apply:

33(A) The individual purchasing the plan has not yet attained 30
34years of age.

35(B) The individual has a certificate of exemption from Section
365000(A) of the Internal Revenue Code because the individual is
37not offered affordable coverage or because the individual faces
38hardship.

39(e) “PPACA” means the federal Patient Protection and
40Affordable Care Act (Public Law 111-148), as amended by the
P9    1federal Health Care and Education Reconciliation Act of 2010
2(Public Law 111-152), and any rules, regulations, or guidance
3issued thereunder.

end insert
4begin insert

begin insertSEC. 5.end insert  

end insert

begin insertSection 10112.28 is added to the end insertbegin insertInsurance Codeend insertbegin insert, to
5read:end insert

begin insert
6

begin insert10112.28.end insert  

(a) (1) For nongrandfathered products in the
7individual or small group markets, a health insurance policy,
8except a specialized health insurance policy, that is issued,
9amended, or renewed on or after January 1, 2014, shall provide
10for a limit on annual out-of-pocket expenses for all covered benefits
11that meet the definition of essential health benefits in paragraph
12(1) of subdivision (a) of Section 10112.27.

13(2) For nongrandfathered products in the large group market,
14a health insurance policy, except a specialized health insurance
15policy, that is issued, amended, or renewed on or after January 1,
162014, shall provide for a limit on annual out-of-pocket expenses
17for all covered benefits, including out-of-network emergency care.

18(b) The limit described in subdivision (a) shall apply to any
19copayment, coinsurance, deductible, incentive payment and any
20other form of cost sharing for all covered benefits.

21(c) The limit described in subdivision (a) shall not exceed the
22limit described in Section 1302(c) of PPACA and any subsequent
23rules, regulations, or guidance issued under that section.

24(d) Nothing in this section shall be construed to affect the
25reduction in cost sharing for eligible enrollees described in Section
261402 of PPACA and any subsequent rules, regulations, or guidance
27issued under that section.

28(e) “PPACA” means the federal Patient Protection and
29Affordable Care Act (Public Law 111-148), as amended by the
30federal Health Care and Education Reconciliation Act of 2010
31(Public Law 111-152), and any rules, regulations, or guidance
32issued thereunder.

end insert
33begin insert

begin insertSEC. 6.end insert  

end insert

begin insertSection 10112.29 is added to the end insertbegin insertInsurance Codeend insertbegin insert, to
34read:end insert

begin insert
35

begin insert10112.29.end insert  

(a) (1) For a small employer health insurance
36policy offered, sold, or renewed on or after January 1, 2014, the
37deductible under the policy shall not exceed:

38(A) Two thousand dollars ($2,000) in the case of a policy
39covering a single individual.

P10   1(B) Four thousand dollars ($4,000) in the case of any other
2policy.

3(2) The dollar amounts in this section shall be indexed consistent
4with Section 1302(c)(2) of PPACA and any federal rules or
5guidance pursuant to that section.

6(3) The limitation in this subdivision shall be applied in a
7manner that does not affect the actuarial value of any small
8employer health insurance policy.

9(4) For small group products at the bronze level of coverage,
10as defined in Section 10112.295, the department may permit
11insurers to offer a higher deductible in order to meet the actuarial
12value requirement of the bronze level. In making this determination,
13the department shall consider affordability of cost sharing for
14insureds and shall also consider whether insureds may be deterred
15from seeking appropriate care because of higher cost sharing.

16(b) Nothing in this section shall be construed to allow a policy
17to have a deductible that applies to preventive services as defined
18in PPACA.

19(c) “PPACA” means the federal Patient Protection and
20Affordable Care Act (Public Law 111-148), as amended by the
21federal Health Care and Education Reconciliation Act of 2010
22(Public Law 111-152), and any rules, regulations, or guidance
23issued thereunder.

end insert
24begin insert

begin insertSEC. 7.end insert  

end insert

begin insertSection 10112.295 is added to the end insertbegin insertInsurance Codeend insertbegin insert, to
25read:end insert

begin insert
26

begin insert10112.295.end insert  

(a) Levels of coverage for the nongrandfathered
27individual and small group markets are defined as follows:

28(1) Bronze level: A health insurance policy in the bronze level
29shall provide a level of coverage that is actuarially equivalent to
3060 percent of the full actuarial value of the benefits provided under
31the policy. No product shall be offered at this level of coverage
32unless it is a standardized product consistent with Section 10112.3.

33(2) Silver level: A health insurance policy in the silver level
34shall provide a level of coverage that is actuarially equivalent to
3570 percent of the full actuarial value of the benefits provided under
36the policy. No product shall be offered at this level of coverage
37unless it is a standardized product consistent with Section 10112.3.

38(3) Gold level: A health insurance policy in the gold level shall
39provide a level of coverage that is actuarially equivalent to 80
40percent of the full actuarial value of the benefits provided under
P11   1the policy. No product shall be offered at this level of coverage
2unless it is a standardized product consistent with Section 10112.3.

3(4) Platinum level: A health insurance policy in the platinum
4level shall provide a level of coverage that is actuarially equivalent
5to 90 percent of the full actuarial value of the benefits provided
6under the policy. No product shall be offered at this level of
7coverage unless it is a standardized product consistent with Section
810112.3.

9(b) Actuarial value for nongrandfathered individual and
10nongrandfathered small employer health insurance policies shall
11be determined in accordance with the following:

12(1) Actuarial value shall not vary by more than plus or minus
132 percent.

14(2) Actuarial value shall be determined on the basis of essential
15health benefits as defined in Section 10112.27 and as provided to
16a standard, nonelderly population. For this purpose, a standard
17population shall not include those receiving coverage through the
18Medi-Cal or Medicare programs.

19(3) The department may use the actuarial value methodology
20developed consistent with Section 1302(d) of PPACA.

21(4) The department, in consultation with the Department of
22Managed Health Care and the Exchange, shall consider whether
23to exercise state-level flexibility with respect to the actuarial value
24calculator in order to take into account the unique characteristics
25of the California health care coverage market, including the
26prevalence of health care service plans, total cost of care paid for
27by the plan, price of care, patterns of service utilization, and
28relevant demographic factors.

29(5) For small group products, employer contributions toward
30health reimbursement accounts and health savings accounts shall
31count toward the actuarial value of the product in the manner
32specified in federal rules and guidance.

33(c) For all products in the nongrandfathered individual and
34small group markets, any deductible shall apply to all services.

35(d) (1) A catastrophic policy is a health insurance policy that
36provides no benefits for any plan year until the insured has
37incurred cost-sharing expenses in an amount equal to the annual
38limit on out-of-pocket costs as specified in Section 10112.28 except
39that it shall provide coverage for at least three primary care visits.
40No product shall be offered at this level of coverage unless it is a
P12   1standardized product consistent with Section 10112.3. A carrier
2that is not participating in the Exchange shall not offer, market,
3or sell a catastrophic plan in the individual market.

4(2) A catastrophic policy may be offered only in the individual
5market and only if consistent with subdivision (c) and this
6paragraph. Catastrophic policies may be offered only if either of
7the following apply:

8(A) The individual purchasing the policy has not yet attained
930 years of age.

10(B) The individual has a certificate of exemption from Section
115000(A) of the Internal Revenue Code because the individual is
12not offered affordable coverage or because the individual faces
13hardship.

14(e) “PPACA” means the federal Patient Protection and
15Affordable Care Act (Public Law 111-148), as amended by the
16federal Health Care and Education Reconciliation Act of 2010
17(Public Law 111-152), and any rules, regulations, or guidance
18issued thereunder.

end insert
19begin insert

begin insertSEC. 8.end insert  

end insert

begin insertSection 10112.7 is added to the end insertbegin insertInsurance Codeend insertbegin insert, to
20read:end insert

begin insert
21

begin insert10112.7.end insert  

(a) A group or individual health insurance policy
22issued, amended, or renewed on or after January 1, 2014, that
23provides or covers any benefits with respect to services in an
24emergency department of a hospital shall cover emergency services
25as follows:

26(1) Without the need for any prior authorization determination.

27(2) Whether the health care provider furnishing the services is
28a participating provider with respect to those services.

29(3) In a manner so that, if the services are provided to an
30insured:

31(A) By a nonparticipating health care provider with or without
32prior authorization; or

33(B) (i) The services will be provided without imposing any
34requirement under the policy for prior authorization of services
35or any limitation on coverage where the provider of services does
36not have a contractual relationship with the insurer for the
37providing of services that is more restrictive than the requirements
38or limitations that apply to emergency department services received
39from providers who do have such a contractual relationship with
40the insurer; and

P13   1(ii) If the services are provided to an insured out-of-network,
2the cost-sharing requirement, expressed as a copayment amount
3or coinsurance rate, is the same requirement that would apply if
4the services were provided in-network.

5(b) For the purposes of this section, the term “emergency
6services” means, with respect to an emergency medical condition:

7(1) A medical screening examination that is within the capability
8of the emergency department of a hospital, including ancillary
9services routinely available to the emergency department to
10evaluate that emergency medical condition.

11(2) Within the capabilities of the staff and facilities available
12at the hospital, further medical examination and treatment as are
13required under Section 1867(e)(3) of the federal Social Security
14Act (42 U.S.C. 1395dd(e)(3)) to stabilize the patient.

end insert
15begin insert

begin insertSEC. 9.end insert  

end insert
begin insert

No reimbursement is required by this act pursuant to
16Section 6 of Article XIII B of the California Constitution because
17the only costs that may be incurred by a local agency or school
18district will be incurred because this act creates a new crime or
19infraction, eliminates a crime or infraction, or changes the penalty
20for a crime or infraction, within the meaning of Section 17556 of
21the Government Code, or changes the definition of a crime within
22the meaning of Section 6 of Article XIII B of the California
23Constitution.

end insert
begin delete
24

SECTION 1.  

It is the intent of the Legislature to enact
25legislation to address cost sharing as contemplated by the federal
26Patient Protection and Affordable Care Act.

end delete


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