AB 1954, as amended, Burke. Health care coverage: reproductive health care services.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance.
This bill would prohibit every health care service plan contract or health insurance policy issued, amended, renewed, or delivered on or after January 1, 2017, with exceptions, from requiring an enrollee or insured to receive a referral in order to receive reproductive or sexual health care services, as defined. Because a willful violation of these provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes.
The people of the State of California do enact as follows:
This act shall be known and may be cited as the
2Direct Access to Reproductive Health Care Act.
(a) The Legislature hereby finds and declares all of
4the following:
5(1) For many women, reproductive health care is primary health
6care.
7(2) According to the Guttmacher Institute, one-half of all
8pregnancies in the United States each year, more than three million
9pregnancies, are unintended. By 45 years of age, more than one-half
10of all women in the United States will have experienced an
11unintended pregnancy, and three in 10 will have had an abortion.
12(3) The inability to access comprehensive reproductive health
13care
in a timely manner can lead to negative healthbegin delete outcomesend delete
14begin insert outcomes,end insert including increased risk for unintended pregnancy,
15sexually transmitted diseases, and delayed care for critical and
16time-sensitive reproductive health services.
17(4) Providing timely access to comprehensive reproductive
18health services is cost effective.
19(5) California has a long history of, and commitment to,
20expanding access to services that aim to reduce the risk of
21unintended pregnancies, improve reproductive and sexual health
22outcomes, and reduce costs.
23(6) The Legislature
has also passed measures to help health plan
24enrollees and insureds access timely health care by setting
25standards and policies regarding wait times for an appointment.
26(b) It is hereby the intent of the Legislature in enacting this act
27to build on current state and federal law to increase timely, equal,
28and direct access to time-sensitive and comprehensive reproductive
29and sexual health care services for enrollees in health care service
30plans or insureds under health insurance policies by prohibiting
31health care service plans or insurers from requiring an enrollee or
32insured to secure a referral from a primary care provider prior to
33receiving in-network reproductive and sexual health care services.
Section 1367.31 is added to the Health and Safety
2Code, to read:
(a) Every health care service plan contract issued,
4amended, renewed, or delivered on or after January 1, 2017, shall
5be prohibited from requiring an enrollee to receive a referral prior
6to receiving coverage or services for reproductive and sexual health
7care.
8(b) begin insert(1)end insertbegin insert end insertFor the purposes of this section, “reproductive and sexual
9health care services” are all reproductive and sexual health services
10described in Sections 6924, 6925, 6926, 6927, 6928, and 6929 of
11the Family Code, or Sections 121020 and 124260 of the Health
12and Safety Code, obtained by
abegin delete patient at or above the minimum begin insert
patient.end insert
13age specified in that section.end delete
14
(2) This section applies whether or not the patient is a minor.
15(c) This section shall not apply to specialized health care service
16plan contracts or any health care service plan that is governed by
17Section 14131 of the Welfare and Institutions Code.
Section 10123.202 is added to the Insurance Code, to
19read:
(a) Every health insurance policy issued, amended,
21renewed, or delivered on or after January 1, 2017, excluding
22specialized health insurance policies, shall be prohibited from
23requiring an insured to receive a referral prior to receiving coverage
24or services for reproductive and sexual health care.
25(b) begin insert(1)end insertbegin insert end insert For the purposes of this section, “reproductive and
26sexual health care services” are all reproductive and sexual health
27services described in
Sections 6924, 6925, 6926, 6927, 6928, and
286929 of the Family Code, or Sections 121020 and 124260 of the
29Health and Safety Code, obtained by abegin delete patient at or above the begin insert
patient.end insert
30minimum age specified in that section.end delete
31
(2) This section applies whether or not the patient is a minor.
No reimbursement is required by this act pursuant to
33Section 6 of Article XIII B of the California Constitution because
34the only costs that may be incurred by a local agency or school
35district will be incurred because this act creates a new crime or
36infraction, eliminates a crime or infraction, or changes the penalty
37for a crime or infraction, within the meaning of Section 17556 of
38the Government Code, or changes the definition of a crime within
P4 1the meaning of Section 6 of Article XIII B of the California
2Constitution.
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