Amended in Senate August 24, 2016

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 Bill No. 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 Sections 104150 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 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. 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, begin insert and meets all other applicable eligibility requirements, end insert the individual shall be eligible for begin delete 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 end delete begin insert an additional period of treatment end insert begin insert coverage, as end insert described above.

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 following individuals shall be eligible for breast cancer
screening and diagnostic services pursuant to this section if they
meet all other eligibility requirements:

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

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

(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 104161.1 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 shall not exceed 18 begin delete months. end delete begin insert months of
treatment. end insert After 18 months, the individual’s eligibility for treatment
services for the cancer condition that made this individual eligible
concludes.

(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 begin delete months. end delete begin insert months of treatment. end insert After
24 months, the individual’s eligibility for treatment services for
the cancer condition that made this individual eligible concludes.

(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, begin insert and meets all other applicable eligibility
requirements, end insert the individual shall be eligible for begin insert an additional
period of treatment end insert coverage, as begin delete long as the individual continues
to meet all other eligibility requirements and as long as the
individual has not exhausted the period of coverage end delete described in
subdivision (a) or (b), respectively.