BILL NUMBER: SB 799 AMENDED
BILL TEXT
AMENDED IN SENATE APRIL 1, 2013
INTRODUCED BY Senator Calderon
FEBRUARY 22, 2013
An act to amend Section 127405 of add
Section 1367.667 to, and to add Article 4 (commencing with Section
104201) to Chapter 2 of Part 1 of Division 103 of, the Health
and Safety Code, and to add Section 10123.22 to the
Insurance Code, relating to hospitals
health care coverage .
LEGISLATIVE COUNSEL'S DIGEST
SB 799, as amended, Calderon. Hospitals: fair pricing.
Health care coverage: colorectal cancer: genetic
testing and screening.
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.
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.
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.
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.
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.
This bill would make a technical, nonsubstantive change to that
provision.
Vote: majority. Appropriation: no. Fiscal committee: no
yes . State-mandated local program: no
yes .
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 1367.667 is added to the
Health and Safety Code , to read:
1367.667. 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.
SEC. 2. Article 4 (commencing with Section 104201)
is added to Chapter 2 of Part 1 of Division 103 of the
Health and Safety Code , to read:
Article 4. Colorectal Cancer
104201. 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.
SEC. 3. Section 10123.22 is added to the
Insurance Code , to read:
10123.22. 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.
SEC. 4. 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.
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.