Amended in Assembly May 9, 2016

Amended in Assembly April 25, 2016

Amended in Assembly April 13, 2016

California Legislature—2015–16 Regular Session

Assembly BillNo. 1954


Introduced by Assembly Member Burke

February 12, 2016


An act to add Section 1367.31 to the Health and Safety Code, and to add Section 10123.202 to the Insurance Code, relating to health care coverage.

LEGISLATIVE COUNSEL’S DIGEST

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:

P2    1

SECTION 1.  

This act shall be known and may be cited as the
2Direct Access to Reproductive Health Care Act.

3

SEC. 2.  

(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 health outcomes,
14including increased risk for unintended pregnancy, sexually
15transmitted diseases, and delayed care for critical and time-sensitive
16reproductive 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
P3    1health care service plans or insurers from requiring an enrollee or
2insured to secure a referral from a primary care provider prior to
3receiving in-network reproductive and sexual health care services.

4

SEC. 3.  

Section 1367.31 is added to the Health and Safety
5Code
, to read:

6

1367.31.  

(a) Every health care service plan contract issued,
7amended, renewed, or delivered on or after January 1, 2017, shall
8be prohibited from requiring an enrollee to receive a referral prior
9to receiving coverage or services for reproductive and sexual health
10care.

11(b) (1) For the purposes of this section, “reproductive and sexual
12health care services” are all reproductive and sexual health services
13described in Sectionsbegin delete 6924,end delete 6925, 6926, 6927,begin delete 6928, and 6929end deletebegin insert and
146928end insert
of the Family Code, orbegin delete Sections 121020 and 124260end deletebegin insert Section
15121020end insert
of the Health and Safety Code, obtained by a patient.

16(2) This section applies whether or not the patient is a minor.

17(c) This section shall not apply to specialized health care service
18plan contracts or any health care service plan that is governed by
19Section 14131 of the Welfare and Institutions Code.

20

SEC. 4.  

Section 10123.202 is added to the Insurance Code, to
21read:

22

10123.202.  

(a) Every health insurance policy issued, amended,
23renewed, or delivered on or after January 1, 2017, excluding
24specialized health insurance policies, shall be prohibited from
25requiring an insured to receive a referral prior to receiving coverage
26or services for reproductive and sexual health care.

27(b) (1) For the purposes of this section, “reproductive and sexual
28health care services” are all reproductive and sexual health services
29described in Sectionsbegin delete 6924,end delete 6925, 6926, 6927,begin delete 6928, and 6929end deletebegin insert and
306928end insert
of the Family Code, orbegin delete Sections 121020 and 124260end deletebegin insert Section
31121020end insert
of the Health and Safety Code, obtained by a patient.

32 (2) This section applies whether or not the patient is a minor.

33

SEC. 5.  

No reimbursement is required by this act pursuant to
34Section 6 of Article XIII B of the California Constitution because
35the only costs that may be incurred by a local agency or school
36district will be incurred because this act creates a new crime or
37infraction, eliminates a crime or infraction, or changes the penalty
38for a crime or infraction, within the meaning of Section 17556 of
39the Government Code, or changes the definition of a crime within
P4    1the meaning of Section 6 of Article XIII B of the California
2Constitution.



O

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