Amended in Senate April 1, 2013

Senate Bill No. 799

Introduced by Senator Calderon

February 22, 2013

An act to begin delete amend Section 127405 of end delete begin insert add Section 1367.667 to, and to add Article 4 (commencing with Section 104201) to Chapter 2 of Part 1 of Division 103 of, end insert the Health and Safety Code, begin insert and to add Section 10123.22 to the Insurance Code, end insert relating to begin delete hospitals end delete begin insert health care coverage end insert .

LEGISLATIVE COUNSEL’S DIGEST

SB 799, as amended, Calderon. begin delete Hospitals: fair pricing. end delete begin insert Health care coverage: colorectal cancer: genetic testing and screening. end insert

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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 individual and group health care service plan contracts and health insurance policies to provide coverage for all generally medically accepted cancer screening tests and requires those contracts and policies to also provide coverage for the treatment of breast cancer. Existing law requires an individual or small group health care service plan contract or insurance policy issued, amended, or renewed on or after January 1, 2014, to, at a minimum, include coverage for essential health benefits, which includes preventive services, pursuant to the federal Patient Protection and Affordable Care Act.

end insert begin insert

This bill would require a health care service plan contract or a health insurance policy, except as specified, that is issued, amended, or renewed on or after January 1, 2014, to provide coverage for genetic testing for hereditary nonpolyposis colorectal cancer (HNPCC) and screening for colorectal cancer under specified circumstances. Because a willful violation of the bill’s requirements relative to health care service plans would be a crime, the bill would impose a state-mandated local program.

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This bill would also require a physician and surgeon who makes a diagnosis that a patient has colorectal cancer to provide the patient with specified information.

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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.

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

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Existing law requires each hospital to maintain an understandable written policy regarding discount payments for financially qualified patients as well as an understandable written charity care policy. Uninsured patients or patients with high medical costs who are at or below 350% of the federal poverty level, as defined, are eligible to apply for participation under a hospital’s charity care policy or discount payment policy.

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This bill would make a technical, nonsubstantive change to that provision.

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Vote: majority. Appropriation: no. Fiscal committee:  begin delete no end delete begin insert yes end insert . State-mandated local program:  begin delete no end delete begin insert yes end insert .

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

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begin insert SECTION 1. end insert   

end insert

begin insert Section 1367.667 is added to the end insert begin insert Health and
Safety Code end insert begin insert , to read: end insert

begin insert

begin insert 1367.667. end insert   

Every health care service plan contract, except a
specialized health care service plan contract, that is issued,
amended, or renewed on or after January 1, 2014, shall provide
coverage for all of the following:

(a) Genetic testing for hereditary nonpolyposis colorectal cancer
(HNPCC) for an enrollee who is under 50 years of age and has
been diagnosed with colorectal cancer.

(b) Genetic testing for HNPCC for an enrollee who is the child
or sibling of an individual who has been diagnosed with colorectal
cancer and has tested positive for the gene mutation for HNPCC.

(c) Frequent screenings, including colonoscopies, for an
enrollee who has tested positive for the gene mutation for HNPCC,
and is the child or sibling of an individual who has been diagnosed
with colorectal cancer and has tested positive for the gene mutation
for HNPCC.

end insert

begin insert

begin insert SEC. 2. end insert   

end insert

begin insert Article 4 (commencing with Section 104201) is added
to Chapter 2 of Part 1 of Division 103 of the end insert begin insert Health and Safety
Code end insert begin insert , to read: end insert

begin insert

 

Article begin insert 4. end insert   Colorectal Cancer

 

begin insert 104201. end insert   

If a physician and surgeon makes a diagnosis that a
patient has colorectal cancer, the physician and surgeon shall
recommend that the patient be tested for the genetic mutation for
hereditary nonpolyposis colorectal cancer (HNPCC). The
physician and surgeon shall also inform the patient that genetic
testing for HNPCC may be covered by the patient’s health care
coverage, and that genetic testing and screening for his or her
children or siblings may be covered by the children’s or siblings’
health care coverage if the patient tests positive for the HNPCC
gene mutation.

end insert

begin insert

begin insert SEC. 3. end insert   

end insert

begin insert Section 10123.22 is added to the end insert begin insert Insurance Code end insert begin insert , to
read: end insert

begin insert

begin insert 10123.22. end insert   

Every health insurance policy, except a specialized
health insurance policy, that is issued, amended, or renewed on
or after January 1, 2014, shall provide coverage for all of the
following:

(a) Genetic testing for hereditary nonpolyposis colorectal cancer
(HNPCC) for an insured who is under 50 years of age and has
been diagnosed with colorectal cancer.

(b) Genetic testing for HNPCC for an insured who is the child
or sibling of an individual who has been diagnosed with colorectal
cancer and has tested positive for the gene mutation for HNPCC.

(c) Frequent screenings, including colonoscopies, for an insured
who has tested positive for the gene mutation for HNPCC, and is
the child or sibling of an individual who has been diagnosed with
colorectal cancer and has tested positive for the gene mutation
for HNPCC.

end insert

begin insert

begin insert SEC. 4. end insert   

end insert begin insert

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.

end insert

begin delete

SECTION 1.  

Section 127405 of the Health and Safety Code
is amended to read:

127405.  

(a) (1) (A) Each hospital shall maintain an
understandable written policy regarding discount payments for
financially qualified patients as well as an understandable written
charity care policy. Uninsured patients or patients with high
medical costs who are at or below 350 percent of the federal
poverty level, as defined in subdivision (b) of Section 127400,
shall be eligible to apply for participation under a hospital’s charity
care policy or discount payment policy. Notwithstanding any other
provision of this article, a hospital may choose to grant eligibility
for its discount payment policy or charity care policies to patients
with incomes over 350 percent of the federal poverty level. Both
the charity care policy and the discount payment policy shall state
the process the hospital uses to determine whether a patient is
eligible for charity care or discounted payment. In the event of a
dispute, a patient may seek review from the business manager,
chief financial officer, or other appropriate manager as designated
in the charity care policy and the discount payment policy.

(B) The written policy regarding discount payments shall also
include a statement that an emergency physician, as defined in
Section 127450, who provides emergency medical services in a
hospital that provides emergency care is also required by law to
provide discounts to uninsured patients or patients with high
medical costs who are at or below 350 percent of the federal
poverty level. This statement shall not be construed to impose any
additional responsibilities upon the hospital.

(2) Rural hospitals, as defined in Section 124840, may establish
eligibility levels for financial assistance and charity care at less
than 350 percent of the federal poverty level as appropriate to
maintain their financial and operational integrity.

(b) A hospital’s discount payment policy shall clearly state
eligibility criteria based upon income consistent with the
application of the federal poverty level. The discount payment
policy shall also include an extended payment plan to allow
payment of the discounted price over time. The policy shall provide
that the hospital and the patient may negotiate the terms of the
payment plan.

(c) The charity care policy shall state clearly the eligibility
criteria for charity care. In determining eligibility under its charity
care policy, a hospital may consider income and monetary assets
of the patient. For purposes of this determination, monetary assets
shall not include retirement or deferred compensation plans
qualified under the Internal Revenue Code, or nonqualified deferred
compensation plans. Furthermore, the first ten thousand dollars
($10,000) of a patient’s monetary assets shall not be counted in
determining eligibility, nor shall 50 percent of a patient’s monetary
assets over the first ten thousand dollars ($10,000) be counted in
determining eligibility.

(d) A hospital shall limit expected payment for services it
provides to a patient at or below 350 percent of the federal poverty
level, as defined in subdivision (b) of Section 127400, eligible
under its discount payment policy to the amount of payment the
hospital would expect, in good faith, to receive for providing
services from Medicare, Medi-Cal, the Healthy Families Program,
or another government-sponsored health program of health benefits
in which the hospital participates, whichever is greater. If the
hospital provides a service for which there is no established
payment by Medicare or any other government-sponsored program
of health benefits in which the hospital participates, the hospital
shall establish an appropriate discounted payment.

(e) A patient, or patient’s legal representative, who requests a
discounted payment, charity care, or other assistance in meeting
his or her financial obligation to the hospital shall make every
reasonable effort to provide the hospital with documentation of
income and health benefits coverage. If the person requests charity
care or a discounted payment and fails to provide information that
is reasonable and necessary for the hospital to make a
determination, the hospital may consider that failure in making its
determination.

(1) For purposes of determining eligibility for discounted
payment, documentation of income shall be limited to recent pay
stubs or income tax returns.

(2) For purposes of determining eligibility for charity care,
documentation of assets may include information on all monetary
assets, but shall not include statements on retirement or deferred
compensation plans qualified under the Internal Revenue Code,
or nonqualified deferred compensation plans. A hospital may
require waivers or releases from the patient or the patient’s family,
authorizing the hospital to obtain account information from
financial or commercial institutions, or other entities that hold or
maintain the monetary assets, to verify their value.

(3) Information obtained pursuant to paragraph (1) or (2) shall
not be used for collections activities. This paragraph does not
prohibit the use of information obtained by the hospital, collection
agency, or assignee independently of the eligibility process for
charity care or discounted payment.

(4) Eligibility for discounted payments or charity care may be
determined at any time the hospital is in receipt of information
specified in paragraph (1) or (2), respectively.

end delete