SB 799, as amended, Calderon. 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) andbegin delete screeningend deletebegin insert annual screeningsend insert 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.
begin insertThis bill would declare that it is to take effect immediately as an urgency statute.
end insertVote: begin deletemajority end deletebegin insert2⁄3end insert.
Appropriation: no.
Fiscal committee: yes.
State-mandated local program: yes.
The people of the State of California do enact as follows:
Section 1367.667 is added to the Health and
2Safety Code, to read:
Every health care service plan contract, except a
4specialized health care service plan contract, that is issued,
5amended, or renewed on or after January 1, 2014, shall provide
6coverage for all of the following:
7(a) Genetic testing for hereditary nonpolyposis colorectal cancer
8(HNPCC) for an enrollee who is under 50 years of age and has
9been diagnosed with colorectal cancer.
10(b) Genetic testing for HNPCC for an enrollee who is the child
11or sibling of an individual who has been diagnosed with colorectal
12cancer and has tested positive for the gene mutation for HNPCC.
13(c) begin deleteFrequent end deletebegin insertAnnual end insertscreenings, including colonoscopies, for
14an enrollee who has tested positive for the gene mutation for
15HNPCC, and is the child or sibling of an individual who has been
16diagnosed with colorectal cancer and has tested positive for the
17gene mutation for HNPCC.
Article 4 (commencing with Section 104201) is added
2to Chapter 2 of Part 1 of Division 103 of the Health and Safety
3Code, to read:
4
If a physician and surgeon makes a diagnosis that a
8patient has colorectal cancer, the physician and surgeon shall
9recommend that the patient be tested for the genetic mutation for
10hereditary nonpolyposis colorectal cancer (HNPCC). The physician
11and surgeon shall also inform the patient that genetic testing for
12HNPCC may be covered by the patient’s health care coverage,
13and that genetic testing and screening for his or her children or
14siblings may be covered by the children’s or siblings’ health care
15coverage if the patient tests positive for the HNPCC gene mutation.
Section 10123.22 is added to the Insurance Code, to
17read:
Every health insurance policy, except a specialized
19health insurance policy, that is issued, amended, or renewed on or
20after January 1, 2014, shall provide coverage for all of the
21following:
22(a) Genetic testing for hereditary nonpolyposis colorectal cancer
23(HNPCC) for an insured who is under 50 years of age and has
24been diagnosed with colorectal cancer.
25(b) Genetic testing for HNPCC for an insured who is the child
26or sibling of an individual who has been diagnosed with colorectal
27cancer and has tested positive for the gene mutation for HNPCC.
28(c) begin deleteFrequent
end delete
29an insured who has tested positive for the gene mutation for
30HNPCC, and is the child or sibling of an individual who has been
31diagnosed with colorectal cancer and has tested positive for the
32gene mutation for HNPCC.
No reimbursement is required by this act pursuant to
34Section 6 of Article XIII B of the California Constitution because
35the only costs that may be incurred by a local agency or school
36district will be incurred because this act creates a new crime or
37infraction, eliminates a crime or infraction, or changes the penalty
38for a crime or infraction, within the meaning of Section 17556 of
39the Government Code, or changes the definition of a crime within
P4 1the meaning of Section 6 of Article XIII B of the California
2Constitution.
This act is an urgency statute necessary for the
4immediate preservation of the public peace, health, or safety within
5the meaning of Article IV of the Constitution and shall go into
6immediate effect. The facts constituting the necessity are:
7In order to protect the health of all Californians at the earliest
8possible time, it is necessary that this act take effect immediately.
O
97