BILL NUMBER: AB 2209	INTRODUCED
	BILL TEXT


INTRODUCED BY   Assembly Member Bonilla

                        FEBRUARY 18, 2016

   An act to add Section 1372.5 of the Health and Safety Code, and to
add Section 10123.25 to the Insurance Code, relating to health care
coverage.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 2209, as introduced, Bonilla. Health care coverage: clinical
care pathways.
   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. A willful violation
of the act is 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.
   This bill would prohibit, on and after January 1, 2017, a health
care service plan or health insurer that provides hospital, medical,
or surgical expenses from implementing clinical care pathways, as
defined, for use by providers in order to manage an enrollee's or
insured's care. Because a willful violation of this prohibition 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:

  SECTION 1.  Section 1372.5 is added to the Health and Safety Code,
to read:
   1372.5.  (a) On and after January 1, 2017, a health care service
plan that provides coverage for hospital, medical, or surgical
expenses shall not implement clinical care pathways for use by
providers in order to manage an enrollee's care.
   (b) For purposes of this section, "clinical care pathways" means a
multidisciplinary management tool based on evidence-based practices
used by providers involved in patient care to manage the enrollee's
care, in which the different tasks, interventions, or treatment
regimens used by the provider involved in the enrollee's care are
defined, optimized, and sequenced.
  SEC. 2.  Section 10123.25 is added to the Insurance Code, to read:
   10123.25.  (a) On and after January 1, 2017, a health insurer that
provides coverage for hospital, medical, or surgical expenses shall
not implement clinical care pathways for use by providers in order to
manage an insured's care.
   (b) For purposes of this section, "clinical care pathways" means a
multidisciplinary management tool based on evidence-based practices
used by providers involved in patient care to manage the insured's
care, in which the different tasks, interventions, or treatment
regimens used by the provider involved in the insured's care are
defined, optimized, and sequenced.
  SEC. 3.  No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.