BILL NUMBER: AB 525 CHAPTERED 09/08/00 CHAPTER 347 FILED WITH SECRETARY OF STATE SEPTEMBER 8, 2000 APPROVED BY GOVERNOR SEPTEMBER 7, 2000 PASSED THE ASSEMBLY AUGUST 24, 2000 PASSED THE SENATE AUGUST 23, 2000 AMENDED IN SENATE AUGUST 14, 2000 AMENDED IN SENATE MARCH 27, 2000 AMENDED IN ASSEMBLY JANUARY 26, 2000 AMENDED IN ASSEMBLY JUNE 1, 1999 AMENDED IN ASSEMBLY APRIL 5, 1999 INTRODUCED BY Assembly Members Kuehl and Thomson (Coauthors: Assembly Members Aroner, Calderon, Firebaugh, Honda, Jackson, Keeley, Longville, Mazzoni, Romero, Shelley, and Wildman) (Coauthors: Senators Figueroa, Hayden, and Solis) FEBRUARY 18, 1999 An act to add Section 1363.02 to, and to add Chapter 2.15 (commencing with Section 1339.80) to Division 2 of, the Health and Safety Code, to add Section 10604.1 to the Insurance Code, and to add Section 14016.8 to the Welfare and Institutions Code, relating to health care coverage. LEGISLATIVE COUNSEL'S DIGEST AB 525, Kuehl. Health benefits: reproductive health care. Existing law provides for the regulation and licensing of health care service plans by the Department of Managed Care, effective no later than July 1, 2000, or earlier pursuant to an executive order of the Governor. A willful violation of the provisions governing health care service plans is a crime. Existing law provides for the regulation of disability insurers by the Department of Insurance and for administration of the Medi-Cal program by the State Department of Health Services. This bill would require certain health care service plans, disability insurers, and Medi-Cal managed care plans to provide a specified written statement to recipients of health care services for the purpose of informing them relative to certain reproductive health care issues, as specified. Because a violation of the bill's requirements with respect to health care service plans would be a crime, this bill would impose a state-mandated local program by creating a new crime. 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. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. Chapter 2.15 (commencing with Section 1339.80) is added to Division 2 of the Health and Safety Code, to read: CHAPTER 2.15. HOSPITAL AND OTHER PROVIDER REQUIREMENTS FOR DISSEMINATION OF INFORMATION RELATING TO REPRODUCTIVE HEALTH SERVICES 1339.80. Hospitals and other providers are not required to post, send, deliver, or otherwise provide the statement described in paragraph (1) of subdivision (b) of Section 1363.02, paragraph (1) of subdivision (b) of Section 10604.1 of the Insurance Code, or paragraph (1) of subdivision (b) of Section 14016.8 of the Welfare and Institutions Code. 1339.81. For purposes of this chapter, "provider" means any professional person, organization, health facility, or other person or institution licensed by the state to deliver or furnish health care services. SEC. 2. Section 1363.02 is added to the Health and Safety Code, to read: 1363.02. (a) The Legislature finds and declares that the right of every patient to receive basic information necessary to give full and informed consent is a fundamental tenet of good public health policy and has long been the established law of this state. Some hospitals and other providers do not provide a full range of reproductive health services and may prohibit or otherwise not provide sterilization, infertility treatments, abortion, or contraceptive services, including emergency contraception. It is the intent of the Legislature that every patient be given full and complete information about the health care services available to allow patients to make well informed health care decisions. (b) On or before July 1, 2001, a health care service plan that covers hospital, medical, and surgical benefits shall do both of the following: (1) Include the following statement, in at least 12-point boldface type, at the beginning of each provider directory: "Some hospitals and other providers do not provide one or more of the following services that may be covered under your plan contract and that you or your family member might need: family planning; contraceptive services, including emergency contraception; sterilization, including tubal ligation at the time of labor and delivery; infertility treatments; or abortion. You should obtain more information before you enroll. Call your prospective doctor, medical group, independent practice association, or clinic, or call the health plan at (insert the health plan's membership services number or other appropriate number that individuals can call for assistance) to ensure that you can obtain the health care services that you need." (2) Place the statement described in paragraph (1) in a prominent location on any provider directory posted on the health plan's website, if any, and include this statement in a conspicuous place in the plan's evidence of coverage and disclosure forms. (c) A health care service plan shall not be required to provide the statement described in paragraph (1) of subdivision (b) in a service area in which none of the hospitals, health facilities, clinics, medical groups, or independent practice associations with which it contracts limit or restrict any of the reproductive services described in the statement. (d) This section shall not apply to specialized health care service plans or Medicare supplement plans. SEC. 3. Section 10604.1 is added to the Insurance Code, to read: 10604.1. (a) The Legislature finds and declares that the right of every patient to receive basic information necessary to give full and informed consent is a fundamental tenet of good public health policy and has long been the established law of this state. Some hospitals and other providers do not provide a full range of reproductive health services and may prohibit or otherwise not provide sterilization, infertility treatments, abortion, or contraceptive services, including emergency contraception. It is the intent of the Legislature that every patient be given full and complete information about the health care services available to allow patients to make well informed health care decisions. (b) On or before July 1, 2001, every disability insurer that provides coverage for hospital, medical, or surgical benefits, and which provides a list of network providers to prospective insureds and insureds, shall do both of the following: (1) Include the following statement, in at least 12-point boldface type, at the beginning of each provider directory: "Some hospitals and other providers do not provide one or more of the following services that may be covered under your policy and that you or your family member might need: family planning; contraceptive services, including emergency contraception; sterilization, including tubal ligation at the time of labor and delivery; infertility treatments; or abortion. You should obtain more information before you become a policyholder or select a network provider. Call your prospective doctor or clinic, or call the insurer at (insert the insurer's membership services number or other appropriate number that individuals can call for assistance) to ensure that you can obtain the health care services that you need." (2) Place the statement described in paragraph (1) in a prominent location on any provider directory posted on the insurer's website, if any, and include this statement in a conspicuous place in the insurer's evidence of coverage and disclosure forms. (c) A disability insurer shall not be required to provide the statement described in paragraph (1) of subdivision (b) in a service area in which none of the hospitals, health facilities, clinics, medical groups, or independent practice associations with which it contracts limit or restrict any of the reproductive services described in the statement. (d) This section shall not apply to vision-only, dental-only, accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, or disability income insurance. SEC. 4. Section 14016.8 is added to the Welfare and Institutions Code, to read: 14016.8. (a) The Legislature finds and declares that the right of every patient to receive basic information necessary to give full and informed consent is a fundamental tenet of good public health policy and has long been the established law of this state. Some hospitals and other providers do not provide a full range of reproductive health services and may prohibit or otherwise not provide sterilization, infertility treatments, abortion, or contraceptive services, including emergency contraception. It is the intent of the Legislature that every patient be given full and complete information about the health care services available to allow patients to make well informed health care decisions. (b) On or before July 1, 2001, the department shall: (1) Ensure that all Medi-Cal beneficiaries receive the following statement by the methods described in paragraphs (2) to (6), inclusive: "Some hospitals and other providers do not provide one or more of the following services that may be covered under your plan contract and that you or your family member might need: family planning; contraceptive services, including emergency contraception; sterilization, including tubal ligation at the time of labor and delivery; infertility treatments; or abortion. You should obtain more information before you enroll. Call your prospective doctor or clinic, or call the Medi-Cal managed care plan at (insert the plan's membership services number or other appropriate number that individuals can call for information) to ensure that you can obtain the health care services that you need." (2) Require that each Medi-Cal managed care plan provide the statement described in paragraph (1), in at least 12-point boldface type at the beginning of each provider directory. (3) Require that each Medi-Cal managed care plan place the statement described in paragraph (1) in a prominent location on any provider directory posted on the plan's website, if any, and include this statement in a conspicuous place in the plan's evidence of coverage and disclosure forms, if any. (4) Require that the statement described in paragraph (1) be included in the health care option activities described in Sections 14016.5, 14087.305, subdivision (e) of Section 14089, and paragraph (2) of subdivision (f) of Section 14408. (5) Require each county organized health system to provide to Medi-Cal beneficiaries the statement described in paragraph (1). This statement shall be provided in writing in at least 12-point boldface type prior to enrollment, prior to selection of a primary care provider, and on an annual basis. (6) Ensure that the statement described in paragraph (1) is provided to any other Medi-Cal managed care beneficiary who would not receive the statement under the provisions of paragraphs (2) to (5), inclusive. This statement shall be provided in writing in at least 12-point boldface type prior to enrollment, prior to selection of a primary care provider, and on an annual basis. (c) The requirement to provide the statement described in paragraph (1) of subdivision (b) shall apply to Medi-Cal managed care programs, including, but not limited to, the following programs: (1) In areas where the department is contracting with persons or entities that are contracting with, or governed, owned, or operated by, either a county board of supervisors or a county special commission, or a county health authority, operating under Article 2.8 (commencing with Section 14087.5) or Article 7 (commencing with Section 14490) of Chapter 8, or Chapter 3 (commencing with Section 101675) of Part 4 of Division 101 of the Health and Safety Code. (2) In areas specified by the director for expansion of the Medi-Cal managed care program under Section 14087.3, including where the department is contracting with prepaid health plans, including prepaid health plans that are contracting with, governed, owned, or operated by a county board of supervisors, a county special commission or county health authority authorized by Sections 14018.7, 14087.31, 14087.316, 14087.35, 14087.36, 14087.38, and 14087.9605. (3) Where the department has entered into contracts with prepaid health plans or primary care case management providers pursuant to Article 2.9 (commencing with Section 14088) and Chapter 8 (commencing with Section 14200). (4) Where the department or the California Medical Assistance Commission has entered into contracts with any persons or entities pursuant to Section 14087.47, Article 2.91 (commencing with Section 14089), or Article 2.97 (commencing with Section 14093). (d) A Medi-Cal managed care plan shall not be required to provide the statement described in paragraph (1) of subdivision (b) in a service area in which none of the hospitals, health facilities, clinics, medical groups, or independent practice associations with which it contracts limit or restrict any of the reproductive services described in the statement. (e) This section shall not apply to specialized health care service plans. SEC. 5. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.