Amended in Assembly March 28, 2016

California Legislature—2015–16 Regular Session

Assembly Bill No. 1795

Introduced by Assembly Member Atkins

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(Principal coauthor: Assembly Member Cristina Garcia)

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(Principal coauthor: Senator Pan)

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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 amended, 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) “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.

(e) “Uninsured” means not covered for breast or cervical cancer
treatment services by any of the following:

(1)  begin delete No cost full scope end delete begin insert No-cost full-scope end insert Medi-Cal.

(2) Medicare.

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

(4) Any other form of health care coverage.

(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 (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 begin delete limited scope end delete begin insert limited-scope end insert
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
treatment services shall be for the duration of the period of
treatment, as long as the individual continues 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 treatment
services 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.