California Legislature—2015–16 Regular Session

Assembly BillNo. 1795


Introduced by Assembly Member Atkins

February 4, 2016


An act to amend Sections 104150, 104161, and 104161.1 of the Health and Safety Code, relating to health care programs.

LEGISLATIVE COUNSEL’S DIGEST

AB 1795, as introduced, Atkins. Health care programs: cancer.

Existing law requires the State Department of Health Care Services to perform various health functions, including providing breast and cervical cancer screening and treatment for low-income individuals. Existing law defines “period of coverage” as beginning when an individual is made eligible for a covered condition and not to exceed 18 or 24 months, respectively, for a diagnosis of breast cancer or a diagnosis of cervical cancer.

This bill would delete that definition and, instead, provide that the treatment services be for the duration of the period of treatment for an individual made eligible for treatment due to a diagnosis of breast cancer or cervical cancer, or who is diagnosed with a reoccurrence of breast cancer or cervical cancer, as long as the individual continues to meet all other eligibility requirements. The bill would require the department to provide breast cancer screening and diagnostic services to individuals of any age who are symptomatic, as defined, and to individuals who are 40 years of age or older, who meet the other eligibility requirements.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

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

P2    1

SECTION 1.  

Section 104150 of the Health and Safety Code
2 is amended to read:

3

104150.  

(a) (1) A provider or entity that participates in the
4grant made to the department by the federal Centers for Disease
5Control and Prevention breast and cervical cancer early detection
6program established under Title XV of the federal Public Health
7Service Act (42 U.S.C. Sec. 300k et seq.) in accordance with
8requirements of Section 1504 of that act (42 U.S.C. Sec. 300n)
9may only render screening services under the grant to an individual
10if the provider or entity determines that the individual’s family
11income does not exceed 200 percent of the federal poverty level.

12(2) Providers, or the enrolling entity, shall make available to all
13applicants and beneficiaries, prior to or concurrent with enrollment,
14information on the manner in which to apply for insurance
15affordability programs, in a manner determined by the State
16Department of Health Care Services. The information shall include
17the manner in which applications can be submitted for insurance
18affordability programs, information about the open enrollment
19periods for the California Health Benefit Exchange, and the
20continuous enrollment aspect of the Medi-Cal program.

21(b) begin insert(1)end insertbegin insertend insert The department shall provide for breast cancer and
22cervical cancer screening services under the grant at the level of
23funding budgeted from state and other resources during the fiscal
24year in which the Legislature has appropriated funds to the
25department for this purpose. These screening services shall not be
26deemed to be an entitlement.

begin insert

27(2) The department shall provide breast cancer screening and
28diagnostic services to individuals of any age who are symptomatic,
29and to individuals who are 40 years of age or older, who meet the
30other eligibility requirements.

end insert
begin insert

31(3) For purposes of this section, “symptomatic” means an
32individual presenting with an abnormality or change in the look
33or feel of the breast, including, but not limited to, a lump, a hard
34knot, thickening or swelling of the breast tissue, a change in the
35color, size, or shape of the breast, or any discharge from the nipple.

end insert

36(c) To implement the federal breast and cervical cancer early
37detection program specified in this section, the department may
38contract, to the extent permitted by Section 19130 of the
P3    1Government Code, with public and private entities, or utilize
2existing health care service provider enrollment and payment
3mechanisms, including the Medi-Cal program’s fiscal intermediary.
4However, the Medi-Cal program’s fiscal intermediary shall only
5be utilized if services provided under the program are specifically
6identified and reimbursed in a manner that does not claim federal
7financial reimbursement. Any contracts with, and the utilization
8of, the Medi-Cal program’s fiscal intermediary shall not be subject
9to Chapter 3 (commencing with Section 12100) of Part 2 of
10Division 2 of the Public Contract Code. Contracts to implement
11the federal breast and cervical cancer early detection program
12entered into by the department with entities other than the Medi-Cal
13program’s fiscal intermediary shall not be subject to Part 2
14(commencing with Section 10100) of Division 2 of the Public
15Contract Code.

16(d) The department shall enter into an interagency agreement
17with the State Department of Health Care Services to transfer that
18portion of the grant made to the department by the federal Centers
19for Disease Control and Prevention breast and cervical cancer early
20detection program established under Title XV of the federal Public
21Health Service Act (42 U.S.C. Sec. 300k et seq.) to the State
22Department of Health Care Services. The department shall have
23no other liability to the State Department of Health Care Services
24under this article.

25

SEC. 2.  

Section 104161 of the Health and Safety Code is
26amended to read:

27

104161.  

For the purposes of this article, the following
28definitions shall apply:

29(a)  “Covered conditions” means breast or cervical cancer.

30(b)  “Breast cancer” includes primary, recurrent, and metastatic
31cancers of the breast, including, but not limited to, infiltrating or
32in situ.

33(c)  “Cervical cancer” includes all primary, recurrent, and
34metastatic cancers of the cervix, including, but not limited to,
35infiltrating or in situ, as well as cervical dysplasia.

begin delete

36(d)  “Period of coverage” means the period of time beginning
37when an individual is made eligible under this article for a covered
38condition and shall not exceed the period of time the individual’s
39eligibility for treatment services for a covered condition concludes,
40as described in Section 104161.1.

P4    1(e)

end delete

2begin insert(end insertbegin insertd) end insert “Treatment services” means those health care services,
3goods, supplies, or merchandise medically necessary to treat the
4covered condition or conditions with which the individual made
5eligible under this article has been diagnosed.

begin delete

6(f)

end delete

7begin insert(end insertbegin inserte) end insert “Uninsured” means not covered for breast or cervical cancer
8treatment services by any of the following:

9(1)  No cost full scope Medi-Cal.

10(2)  Medicare.

11(3)  A health care service plan contract or policy of disability
12insurance.

13(4)  Any other form of health care coverage.

begin delete

14(g)

end delete

15begin insert(f) end insert “Underinsured” means either of the following:

16(1)  Covered for breast or cervical cancer treatment services by
17any health care insurance listed in paragraph (2), (3), or (4) of
18subdivisionbegin delete (f),end deletebegin insert (e),end insert but the sum of the individual’s insurance
19deductible, premiums, and expected copayments in the initial
2012-month period that breast or cervical cancer treatment services
21are needed exceeds seven hundred fifty dollars ($750).

22(2)  Covered by share-of-cost or limited scope Medi-Cal, if the
23 individual is not otherwise eligible for treatment services under
24the Medi-Cal program pursuant to Section 14007.71 of the Welfare
25and Institutions Code.

26

SEC. 3.  

Section 104161.1 of the Health and Safety Code is
27amended to read:

28

104161.1.  

(a)  When an individual is made eligible for
29treatment services under this article due to a diagnosis of breast
30cancer, thebegin delete period of coverageend deletebegin insert treatment servicesend insert shallbegin delete not exceed
3118 months. After 18 months, the individual’s eligibility for
32treatment services for the cancer condition that made this individual
33eligible concludes.end delete
begin insert be for the duration of the period of treatment,
34as long as the individual continend insert
begin insertues to meet all other eligibility
35requirements.end insert

36(b)  When an individual is made eligible for treatment services
37under this article due to a diagnosis of cervical cancer, thebegin delete period
38of coverage shall not exceed 24 months. After 24 months, the
39individual’s eligibility forend delete
treatment servicesbegin delete for the cancer
40condition that made this individual eligible concludes.end delete
begin insert shall be for
P5    1the duration of the period of treatment, as long as the individual
2continues to meet all other eligibility requirements.end insert

begin insert

3(c) If an individual is diagnosed with a reoccurrence of breast
4cancer or cervical cancer, whether at the original cancer site or
5a different cancer site, the individual shall be eligible for coverage
6for the duration of the period of treatment, as long as the individual
7continues to meet all other eligibility requirements.

end insert


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