Amended in Senate August 15, 2016

Amended in Assembly May 31, 2016

Amended in Assembly March 28, 2016

California Legislature—2015–16 Regular Session

Assembly BillNo. 1795


Introduced by Assembly Member Atkins

(Principal coauthor: Assembly Member Cristina Garcia)

(Principal coauthor: Senator Pan)

(Coauthor: Assembly Member Gonzalez)

February 4, 2016


An act to amend Sectionsbegin delete 104150, 104161,end deletebegin insert 104150end insert 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 wouldbegin delete 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 wouldend delete provide that an individual of any age who is symptomatic, as defined, or an individual whose age is within the age range for routine breast cancer screening, as specified, and who meets all other eligibility requirements is eligible for breast cancer screening and diagnostic services pursuant to these provisions.begin insert The bill would also provide that 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, as long as the individual continues to meet all other eligibility requirements and as long as the individual has not exhausted the period of coverage described above.end insert

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) (1) 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
P3    1department for this purpose. These screening services shall not be
2deemed to be an entitlement.

3(2) The following individuals shall be eligible for breast cancer
4screening and diagnostic services pursuant to this section if they
5meet all other eligibility requirements:

6(A) An individual of any age who is symptomatic.

7(B) An individual whose age is within the age range for routine
8breast cancer screening, as recommended by the United States
9Preventive Services Task Force, subject to any federal action
10relating to breast cancer screening that overrides those
11recommendations.

12(3) For purposes of this section, “symptomatic” means an
13individual presenting with an abnormality or change in the look
14or feel of the breast, including, but not limited to, a lump, a hard
15knot, thickening or swelling of the breast tissue, a change in the
16color, size, or shape of the breast, or any discharge from the nipple.

17(c) To implement the federal breast and cervical cancer early
18detection program specified in this section, the department may
19contract, to the extent permitted by Section 19130 of the
20Government Code, with public and private entities, or utilize
21existing health care service provider enrollment and payment
22mechanisms, including the Medi-Cal program’s fiscal intermediary.
23However, the Medi-Cal program’s fiscal intermediary shall only
24be utilized if services provided under the program are specifically
25identified and reimbursed in a manner that does not claim federal
26financial reimbursement. Any contracts with, and the utilization
27of, the Medi-Cal program’s fiscal intermediary shall not be subject
28to Chapter 3 (commencing with Section 12100) of Part 2 of
29Division 2 of the Public Contract Code. Contracts to implement
30the federal breast and cervical cancer early detection program
31entered into by the department with entities other than the Medi-Cal
32program’s fiscal intermediary shall not be subject to Part 2
33(commencing with Section 10100) of Division 2 of the Public
34Contract Code.

35(d) The department shall enter into an interagency agreement
36with the State Department of Health Care Services to transfer that
37portion of the grant made to the department by the federal Centers
38for Disease Control and Prevention breast and cervical cancer early
39detection program established under Title XV of the federal Public
40Health Service Act (42 U.S.C. Sec. 300k et seq.) to the State
P4    1Department of Health Care Services. The department shall have
2no other liability to the State Department of Health Care Services
3under this article.

begin delete
4

SEC. 2.  

Section 104161 of the Health and Safety Code is
5amended to read:

6

104161.  

For the purposes of this article, the following
7definitions shall apply:

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

9(b) “Breast cancer” includes primary, recurrent, and metastatic
10cancers of the breast, including, but not limited to, infiltrating or
11in situ.

12(c) “Cervical cancer” includes all primary, recurrent, and
13metastatic cancers of the cervix, including, but not limited to,
14infiltrating or in situ, as well as cervical dysplasia.

15(d)


16“Treatment services” means those health care services, goods,
17supplies, or merchandise medically necessary to treat the covered
18condition or conditions with which the individual made eligible
19under this article has been diagnosed.

20(e)


21“Uninsured” means not covered for breast or cervical cancer
22treatment services by any of the following:

23(1) No-cost full-scope Medi-Cal.

24(2) Medicare.

25(3) A health care service plan contract or policy of disability
26insurance.

27(4) Any other form of health care coverage.

28(f)


29“Underinsured” means either of the following:

30(1) Covered for breast or cervical cancer treatment services by
31any health care insurance listed in paragraph (2), (3), or (4) of
32subdivision (e), but the sum of the individual’s insurance
33deductible, premiums, and expected copayments in the initial
3412-month period that breast or cervical cancer treatment services
35are needed exceeds seven hundred fifty dollars ($750).

36(2) Covered by share-of-cost or limited-scope Medi-Cal, if the
37individual is not otherwise eligible for treatment services under
38the Medi-Cal program pursuant to Section 14007.71 of the Welfare
39and Institutions Code.

end delete
P5    1

begin deleteSEC. 3.end delete
2
begin insertSEC. 2.end insert  

Section 104161.1 of the Health and Safety Code is
3amended to read:

4

104161.1.  

(a) When an individual is made eligible for treatment
5services under this article due to a diagnosis of breast cancer, the
6
begin delete treatment services shall be for the duration of the period of
7treatment, as long as the individual continues to meet all other
8eligibility requirements.end delete
begin insert end insertbegin insertperiod of coverage shall not exceed 18
9months. After 18 months, the individual’s eligibility for treatment
10services for the cancer condition that made this individual eligible
11concludes.end insert

12(b) When an individual is made eligible for treatment services
13under this article due to a diagnosis of cervical cancer, thebegin delete treatment
14services shall be for the duration of the period of treatment, as long
15as the individual continues to meet all other eligibility
16requirements.end delete
begin insert end insertbegin insertperiod of coverage shall not exceed 24 months. After
1724 months, the individual’s eligibility for treatment services for
18the cancer condition that made this individual eligible concludes.end insert

19(c) If an individual is diagnosed with a reoccurrence of breast
20cancer or cervical cancer, whether at the original cancer site or a
21different cancer site, the individual shall be eligible forbegin delete coverage
22for the duration of the period of treatment,end delete
begin insert coverage,end insert as long as
23the individual continues to meet all other eligibilitybegin delete requirements.end delete
24
begin insert requirements and as long as the individual has not exhausted the
25period of coverage described in subdivision (a) or (b), respectively.end insert



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