BILL NUMBER: AB 1795 INTRODUCED
BILL TEXT
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:
SECTION 1. Section 104150 of the Health and Safety Code is amended
to read:
104150. (a) (1) A provider or entity that participates in the
grant made to the department by the federal Centers for Disease
Control and Prevention breast and cervical cancer early detection
program established under Title XV of the federal Public Health
Service Act (42 U.S.C. Sec. 300k et seq.) in accordance with
requirements of Section 1504 of that act (42 U.S.C. Sec. 300n) may
only render screening services under the grant to an individual if
the provider or entity determines that the individual's family income
does not exceed 200 percent of the federal poverty level.
(2) Providers, or the enrolling entity, shall make available to
all applicants and beneficiaries, prior to or concurrent with
enrollment, information on the manner in which to apply for insurance
affordability programs, in a manner determined by the State
Department of Health Care Services. The information shall include the
manner in which applications can be submitted for insurance
affordability programs, information about the open enrollment periods
for the California Health Benefit Exchange, and the continuous
enrollment aspect of the Medi-Cal program.
(b) (1) The department shall provide for
breast cancer and cervical cancer screening services under the grant
at the level of funding budgeted from state and other resources
during the fiscal year in which the Legislature has appropriated
funds to the department for this purpose. These screening services
shall not be deemed to be an entitlement.
(2) The department shall provide breast cancer screening and
diagnostic services to individuals of any age who are symptomatic,
and to individuals who are 40 years of age or older, who meet the
other eligibility requirements.
(3) For purposes of this section, "symptomatic" means an
individual presenting with an abnormality or change in the look or
feel of the breast, including, but not limited to, a lump, a hard
knot, thickening or swelling of the breast tissue, a change in the
color, size, or shape of the breast, or any discharge from the
nipple.
(c) To implement the federal breast and cervical cancer early
detection program specified in this section, the department may
contract, to the extent permitted by Section 19130 of the Government
Code, with public and private entities, or utilize existing health
care service provider enrollment and payment mechanisms, including
the Medi-Cal program's fiscal intermediary. However, the Medi-Cal
program's fiscal intermediary shall only be utilized if services
provided under the program are specifically identified and reimbursed
in a manner that does not claim federal financial reimbursement. Any
contracts with, and the utilization of, the Medi-Cal program's
fiscal intermediary shall not be subject to Chapter 3 (commencing
with Section 12100) of Part 2 of Division 2 of the Public Contract
Code. Contracts to implement the federal breast and cervical cancer
early detection program entered into by the department with entities
other than the Medi-Cal program's fiscal intermediary shall not be
subject to Part 2 (commencing with Section 10100) of Division 2 of
the Public Contract Code.
(d) The department shall enter into an interagency agreement with
the State Department of Health Care Services to transfer that portion
of the grant made to the department by the federal Centers for
Disease Control and Prevention breast and cervical cancer early
detection program established under Title XV of the federal Public
Health Service Act (42 U.S.C. Sec. 300k et seq.) to the State
Department of Health Care Services. The department shall have no
other liability to the State Department of Health Care Services under
this article.
SEC. 2. Section 104161 of the Health and Safety Code is amended to
read:
104161. For the purposes of this article, the following
definitions shall apply:
(a) "Covered conditions" means breast or cervical cancer.
(b) "Breast cancer" includes primary, recurrent, and metastatic
cancers of the breast, including, but not limited to, infiltrating or
in situ.
(c) "Cervical cancer" includes all primary, recurrent, and
metastatic cancers of the cervix, including, but not limited to,
infiltrating or in situ, as well as cervical dysplasia.
(d) "Period of coverage" means the period of time beginning when
an individual is made eligible under this article for a covered
condition and shall not exceed the period of time the individual's
eligibility for treatment services for a covered condition concludes,
as described in Section 104161.1.
(e)
( d) "Treatment services" means those health
care services, goods, supplies, or merchandise medically necessary
to treat the covered condition or conditions with which the
individual made eligible under this article has been diagnosed.
(f)
( e) "Uninsured" means not covered for
breast or cervical cancer treatment services by any of the following:
(1) No cost full scope Medi-Cal.
(2) Medicare.
(3) A health care service plan contract or policy of disability
insurance.
(4) Any other form of health care coverage.
(g)
(f) "Underinsured" means either of the following:
(1) Covered for breast or cervical cancer treatment services by
any health care insurance listed in paragraph (2), (3), or (4) of
subdivision (f), (e), but the sum of
the individual's insurance deductible, premiums, and expected
copayments in the initial 12-month period that breast or cervical
cancer treatment services are needed exceeds seven hundred fifty
dollars ($750).
(2) Covered by share-of-cost or limited scope Medi-Cal, if the
individual is not otherwise eligible for treatment services under the
Medi-Cal program pursuant to Section 14007.71 of the Welfare and
Institutions Code.
SEC. 3. Section 104161.1 of the Health and Safety Code is amended
to read:
104161.1. (a) When an individual is made eligible for treatment
services under this article due to a diagnosis of breast cancer, the
period of coverage treatment services
shall not exceed 18 months. After 18 months, the individual'
s eligibility for treatment services for the cancer condition that
made this individual eligible concludes. be for the
duration of the period of treatment, as long as the individual contin
ues to meet all other eligibility
requirements.
(b) When an individual is made eligible for treatment services
under this article due to a diagnosis of cervical cancer, the
period of coverage shall not exceed 24 months. After 24
months, the individual's eligibility for treatment services
for the cancer condition that made this individual eligible
concludes. shall be for the duration of the period of
treatment, as long as the individual continues to meet all other
eligibility requirements.
(c) If an individual is diagnosed with a reoccurrence of breast
cancer or cervical cancer, whether at the original cancer site or a
different cancer site, the individual shall be eligible for coverage
for the duration of the period of treatment, as long as the
individual continues to meet all other eligibility requirements.