BILL NUMBER: AB 56	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  APRIL 21, 2009
	AMENDED IN ASSEMBLY  APRIL 14, 2009

INTRODUCED BY   Assembly Member Portantino

                        DECEMBER 5, 2008

   An act to amend Section 1367.65 of the Health and Safety Code, and
to amend Section 10123.81 of the Insurance Code, relating to health
care coverage.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 56, as amended, Portantino. Health care coverage:
mammographies.
   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. Under
existing law, a health care service plan contract, except a
specialized health care service plan contract, that is issued,
amended, delivered, or renewed on or after January 1, 2000, is deemed
to provide coverage for mammography for screening or diagnostic
purposes upon referral by a participating nurse practitioner,
participating certified nurse-midwife, or participating physician,
providing care to the patient and operating within the scope of
practice provided under existing law. Under existing law, an
individual or group policy of disability insurance or self-insured
employee welfare benefit plan that is issued, amended, delivered, or
renewed on or after January 1, 2000, is deemed to provide specified
coverage based upon age for mammography for screening or diagnostic
purposes upon referral by a participating nurse practitioner,
participating certified nurse-midwife, or participating physician,
providing care to the patient and operating within the scope of
practice provided under existing law. Existing law also requires such
plan contracts and policies to cover screenings and diagnosis of
breast cancer, consistent with generally accepted medical practice
and scientific evidence, upon referral of an enrollee's participating
physician.
   This bill would require these plans and insurers to  send
  provide  female enrollees or insureds  a
written   wi   th  notice, as specified,
regarding eligibility for tests for screening or diagnosis of breast
cancer. The bill would provide that individual or group policies of
health insurance or self-insured employee welfare benefit plans
issued, amended, delivered, or renewed on and after July 1, 2010,
shall be deemed to provide coverage for mammographies for screening
or diagnostic purposes upon referral of a participating nurse
practitioner, participating certified nurse-midwife, or participating
physician, as specified.
   Because this bill would specify an additional requirement for a
health care service plan, the willful violation of which would be a
crime, it 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.  The Legislature hereby finds and declares the
following:
   (a) It is the intent of the Legislature to ensure that all women
have access to medically appropriate breast cancer screening and
diagnostic tests, especially those women who possess risk factors
that place them at high risk of developing breast cancer during their
lives.
   (b) In order to protect the health of California citizens, breast
cancer screening and diagnostic testing methods must be provided.
These diagnostic treatment tools, when used in accordance with
nationally accepted guidelines, offer the best chance for the
detection and timely, cost-effective treatment of breast cancer.
  SEC. 2.  Section 1367.65 of the Health and Safety Code is amended
to read:
   1367.65.  (a)  On or after January 1, 2000, every health care
service plan contract, except a specialized health care service plan
contract, that is issued, amended, delivered, or renewed shall be
deemed to provide coverage for mammography for screening or
diagnostic purposes upon referral by a participating nurse
practitioner, participating certified nurse-midwife, or participating
physician, providing care to the patient and operating within the
scope of practice provided under existing law.
   (b)  Nothing in this section shall be construed to prevent
application of copayment or deductible provisions in a plan, nor
shall this section be construed to require that a plan be extended to
cover any other procedures under an individual or a group health
care service plan contract. Nothing in this section shall be
construed to authorize a plan enrollee to receive the services
required to be covered by this section if those services are
furnished by a nonparticipating provider, unless the plan enrollee is
referred to that provider by a participating physician, nurse
practitioner, or certified nurse-midwife providing care.
   (c) A health care service plan subject to this section or Section
1367.6 shall  send a female enrollee a written  
provide a female enrollee with  notice, during the calendar
year in which national guidelines indicate she should start
undergoing tests for screening or diagnosis of breast cancer,
notifying her that she is eligible for testing.  The notice may
be provided by written letter sent to the enrollee, by publication in
a newsletter sent to the enrollee, by publication in evidence of
coverage, by direct telephone call to the enrollee, by electronic
transmission, or by any other means that will reasonably notify the
female enrollee of her eligibility for testing. 
  SEC. 3.  Section 10123.81 of the Insurance Code is amended to read:

   10123.81.  (a) On or after January 1, 2000, every individual or
group policy of disability insurance or self-insured employee welfare
benefit plan that is issued, amended, or renewed, shall be deemed to
provide coverage for at least the following, upon the referral of a
nurse practitioner, certified nurse-midwife, or physician, providing
care to the patient and operating within the scope of practice
provided under existing law for breast cancer screening or diagnostic
purposes:
   (1) A baseline mammogram for women age 35 to 39, inclusive.
   (2) A mammogram for women age 40 to 49, inclusive, every two years
or more frequently based on the women's physician's recommendation.
   (3) A mammogram every year for women age 50 and over.
   (b) On or after July 1, 2010, every individual or group policy of
health insurance or self-insured employee welfare benefit plan that
is issued, amended, delivered, or renewed shall be deemed to provide
coverage for mammography for screening or diagnostic purposes upon
referral by a participating nurse practitioner, participating
certified nurse-midwife, or participating physician, providing care
to the patient and operating within the scope of practice provided
under existing law.
   (c) Nothing in this section shall be construed to require an
individual or group policy to cover the surgical procedure known as
mastectomy or to prevent application of deductible or copayment
provisions contained in the policy or plan, nor shall this section be
construed to require that coverage under an individual or group
policy be extended to any other procedures.
   (d) Nothing in this section shall be construed to authorize an
insured or plan member to receive the coverage required by this
section if that coverage is furnished by a nonparticipating provider,
unless the insured or plan member is referred to that provider by a
participating physician, nurse practitioner, or certified
nurse-midwife providing care.
   (e) A disability insurer or self-insured employee welfare benefit
plan subject to this section or Section 10123.8 shall  send a
female insured a written   provide a female insured
with  notice, during the calendar year in which national
guidelines indicate she should start undergoing tests for screening
or diagnosis of breast cancer, notifying her that she is eligible for
testing.  The notice may be provided by written letter sent to
the insured, by publication in a newsletter sent to the insured, by
publication in evidence of coverage, by direct telephone call to the
insured, by electronic transmission, or by any other means that will
reasonably notify the female insured of her eligibility for testing.

   (f) This section shall not apply to Medicare supplement,
vision-only, dental-only, or CHAMPUS supplement insurance, or to
hospital indemnity, accident-only, or specified disease insurance
that does not pay benefits on a fixed-benefit, cash-payment-only
basis.
  SEC. 4.  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.