Amended in Assembly May 31, 2016

Amended in Assembly April 26, 2016

Amended in Assembly March 9, 2016

California Legislature—2015–16 Regular Session

Assembly BillNo. 2004


Introduced by Assembly Member Bloom

(Coauthors: Assembly Members Dodd, Gallagher, Cristina Garcia, and Mullin)

February 16, 2016


An act to addbegin insert and repealend insert Section 1367.72begin delete toend deletebegin insert ofend insert the Health and Safety Code, and to addbegin insert and repealend insert Section 10123.72begin delete toend deletebegin insert ofend insert the Insurance Code, relating to health care coverage.

LEGISLATIVE COUNSEL’S DIGEST

AB 2004, as amended, Bloom. Hearing aids: minors.

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 also provides for the regulation of health insurers by the Department of Insurance. Existing law requires health care service plan contracts and health insurance policies to provide coverage for specified benefits.

Thisbegin delete billend deletebegin insert bill, until January 1, 2019,end insert would require a health care service plan contract or a health insurance policy issued, amended, or renewed on or after January 1, 2017, to include coverage for hearing aids for an enrollee or insured under 18 years of age, as specified.begin insert These provisions would become inoperative if the Department of Managed Health Care and the Department of Insurance receive a notification from the federal Centers for Medicare and Medicaid Services or any other applicable federal agency that these provisions constitute a discriminatory age limitation under federal law and the state is required to defray the costs of requiring a plan contract or policy to include coverage for hearing aids on behalf of enrollees or insureds who are 18 years of age or older pursuant to a specified federal law.end insert Because a willful violation of these requirements by a health care service plan would be a crime, this 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    1begin insert

begin insertSECTION 1.end insert  

end insert

begin insertIt is the intent of the Legislature to explore
2alternate approaches to ensure the continuation of broad coverage
3of pediatric hearing benefits upon expiration of this mandate,
4including exploring ways to add pediatric hearing as an essential
5health benefit, without incurring ongoing state costs.end insert

6

begin deleteSECTION 1.end delete
7
begin insertSEC. 2.end insert  

Section 1367.72 is added to the Health and Safety
8Code
, to read:

9

1367.72.  

(a) (1) A health care service plan contract issued,
10amended, or renewed on or after January 1, 2017, shall include
11coverage for hearing aids for all enrollees under 18 years of age
12when medically necessary.

13(2) Coverage for hearing aids includes an initial assessment,
14new hearing aids at least every five years, new ear molds, new
15hearing aids if alterations to existing hearing aids cannot meet the
16needs of the child, a new hearing aid if the existing one is no longer
17working, fittings, adjustments, auditory training, and maintenance
18of the hearing aids.

19(b) For purposes of this section, “hearing aid” means an
20electronic device usually worn in or behind the ear of a deaf and
21hard of hearing person for the purpose of amplifying sound.

P3    1(c) This section shall not apply to Medicare supplement,
2dental-only, or vision-only health care service plan contracts.

begin insert

3
(d) (1) This section shall become inoperative if the department
4receives a notification from the federal Centers for Medicare and
5Medicaid Services or any other applicable federal agency that this
6section constitutes a discriminatory age limitation under federal
7law and the state is required to defray the costs of requiring a plan
8contract to include coverage for hearing aids on behalf of enrollees
9who are 18 years of age or older pursuant to Section 1311 of the
10Patient Protection and Affordable Care Act (42 U.S.C. Sec.
1118031(d)(3)).

end insert
begin insert

12
(2) This section shall become inoperative 30 days after the
13director executes a declaration, which shall be retained by the
14director, stating that the department received the notification
15described in paragraph (1). The director shall post the declaration
16on the department’s Internet Web site, and the director shall send
17the declaration to the appropriate policy committees of the
18Legislature and to the Legislative Counsel.

end insert
begin insert

19
(e) This section shall remain in effect only until January 1, 2019,
20and as of that date is repealed, unless a later enacted statute, that
21is enacted before January 1, 2019, deletes or extends that date.

end insert
22

begin deleteSEC. 2.end delete
23
begin insertSEC. 3.end insert  

Section 10123.72 is added to the Insurance Code, to
24read:

25

10123.72.  

(a) (1) A health insurance policy issued, amended,
26or renewed on or after January 1, 2017, shall include coverage for
27hearing aids for all insureds under 18 years of age when medically
28necessary.

29(2) Coverage for hearing aids includes an initial assessment,
30new hearing aids at least every five years, new ear molds, new
31hearing aids if alterations to existing hearing aids cannot meet the
32needs of the child, a new hearing aid if the existing one is no longer
33working, fittings, adjustments, auditory training, and maintenance
34of the hearing aids.

35(b) For purposes of this section, “hearing aid” means an
36electronic device usually worn in or behind the ear of a deaf and
37hard of hearing person for the purpose of amplifying sound.

38(c) This section shall not apply to accident-only, specified
39disease, hospital indemnity, Medicare supplement, dental-only, or
40vision-only health insurance policies.

begin insert

P4    1
(d) (1) This section shall become inoperative if the department
2receives a notification from the federal Centers for Medicare and
3Medicaid Services or any other applicable federal agency that this
4section constitutes a discriminatory age limitation under federal
5law and the state is required to defray the costs of requiring a
6health insurance policy to include coverage for hearing aids on
7behalf of insureds who are 18 years of age or older pursuant to
8Section 1311 of the Patient Protection and Affordable Care Act
9(42 U.S.C. Sec. 18031(d)(3)).

end insert
begin insert

10
(2) This section shall become inoperative 30 days after the
11commissioner executes a declaration, which shall be retained by
12the commissioner, stating that the department received the
13notification described in paragraph (1). The commissioner shall
14post the declaration on the department’s Internet Web site, and
15the commissioner shall send the declaration to the appropriate
16policy committees of the Legislature and to the Legislative Counsel.

end insert
begin insert

17
(e) This section shall remain in effect only until January 1, 2019,
18and as of that date is repealed, unless a later enacted statute, that
19is enacted before January 1, 2019, deletes or extends that date.

end insert
20

begin deleteSEC. 3.end delete
21
begin insertSEC. 4.end insert  

No reimbursement is required by this act pursuant to
22Section 6 of Article XIII B of the California Constitution because
23the only costs that may be incurred by a local agency or school
24district will be incurred because this act creates a new crime or
25infraction, eliminates a crime or infraction, or changes the penalty
26for a crime or infraction, within the meaning of Section 17556 of
27the Government Code, or changes the definition of a crime within
28the meaning of Section 6 of Article XIII B of the California
29Constitution.



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