BILL ANALYSIS
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|SENATE RULES COMMITTEE | AB 56|
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THIRD READING
Bill No: AB 56
Author: Portantino (D)
Amended: 9/1/09 in Senate
Vote: 21
SENATE HEALTH COMMITTEE : 7-2, 7/15/09
AYES: Alquist, Cedillo, DeSaulnier, Leno, Negrete McLeod,
Pavley, Wolk
NOES: Aanestad, Cox
NO VOTE RECORDED: Strickland, Maldonado
SENATE APPROPRIATIONS COMMITTEE : 8-5, 8/27/09
AYES: Kehoe, Corbett, Hancock, Leno, Oropeza, Price, Wolk,
Yee
NOES: Cox, Denham, Runner, Walters, Wyland
ASSEMBLY FLOOR : 50-26, 6/3/09 - See last page for vote
SUBJECT : Health care coverage
SOURCE : American College of Obstetricians and
Gynecologists
District IX
DIGEST : This bill requires health care services plan
contracts and individual or group health care insurance
policies to provide coverage for mammography screening or
diagnostic purposes upon the referral of a participating
physician assistant and requires plans and insurers to
provide subscribers or policyholders with information
CONTINUED
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regarding recommended timelines for screening for breast
cancer.
ANALYSIS : Existing law provides for the regulation of
health care service plans and health insurance policies by
the Department of Managed Health Care (DMHC) and the
California Department of Insurance (CDI). Existing law
requires that health plans and insurers cover mammography
for screening or diagnostic purposes upon referral by a
participating nurse practitioner, certified nurse-midwife,
or physician.
This bill:
1. Requires every individual or group policy of health
insurance issued, amended, delivered, or renewed on or
after July 1, 2010, to provide coverage for mammography
for screening or diagnostic purposes upon referral of a
participating physician, nurse practitioner, or
certified nurse-midwife, without reference to age or
frequency (which current law prescribes), and
additionally includes physician assistants among the
list of providers who may provide a referral for
mammography that is covered. The bill also excludes
self-insured employee welfare benefit plans from these
requirements beginning July 1, 2010.
2. Adds physician assistants among the list of providers
who may provide a referral for mammography that is
covered by a health plan under the jurisdiction of DMHC,
beginning July 1, 2010.
3. Requires a health plan and a health insurer to provide a
subscriber or policyholder with information regarding
recommended timelines for an individual to undergo tests
for the screening or diagnosis of breast cancer. The
bill allows this information to be provided by a written
letter sent to the subscriber or policyholder by
publication in a newsletter sent to the subscriber or
policyholder, by publication in evidence of coverage, by
direct telephone call to the subscriber or policyholder,
by electronic transmission, by web-based portal
containing various plan and benefit information if the
subscriber or policyholder has access to that portal, or
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by any other means that will reasonably notify the
subscriber or policyholder of the recommended timelines
for testing. The bill provides that a plan or insurer
could comply with this requirement through
communications made by a plan or insurer's contracted
providers that satisfy the requirements of this section.
4. Exempts specialized health plans from the requirement to
provide the information above. This bill exempts the
following policies from the requirement to provide
mammograms and information above: specialized health
insurance, Medicare supplement insurance, short-term
limited duration health insurance, CHAMPUS supplement
insurance, TRI-CARE supplement insurance, or to hospital
indemnity, accident-only, or specified disease
insurance.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
According to the Senate Appropriations Committee analysis:
Fiscal Impact (in thousands)
Major Provisions 2009-10 2010-11 2011-12
Fund
Increased number of $0 up to $375 up
to $375 General/
Medi-Cal, AIM, and Federal/
MRMIP mammographies Special
SUPPORT : (Verified 8/31/09)
American College of Obstetricians and Gynecologists,
District IX (source)
American Cancer Society
American Federation of State, County, and Municipal
Employees
BayBio
California Commission on the Status of Women
California Medical Association
City of West Hollywood
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GlaxoSmithKline
Junior Leagues of California State Public Affairs Committee
Planned Parenthood Affiliates of California
ARGUMENTS IN SUPPORT : The American College of
Obstetricians and Gynecologists, the sponsor of this
measure, writes that this measure will rectify a
discrepancy between health plans and health insurers, and
correct the medical inaccuracy of the Insurance Code, which
has codified guidelines for mammography that are now
outdated. The American Cancer Society writes that this bill
will make changes to the insurance mandate for mammography
coverage to provide health care providers the flexibility
to ensure that women receive the most appropriate breast
cancer screening services regardless of age. The
California Medical Association states that the bill will
help decrease the number of deaths related to breast
cancer, as early detection is seen as the most crucial
element to successful breast cancer treatment.
GlaxoSmithKline states that the most effective way of
lowering health care costs and creating a healthy society
is through prevention and early detection.
ASSEMBLY FLOOR :
AYES: Ammiano, Arambula, Beall, Bill Berryhill,
Blumenfield, Brownley, Buchanan, Caballero, Carter,
Chesbro, Conway, Coto, Davis, De La Torre, De Leon, Eng,
Evans, Feuer, Fong, Fuentes, Furutani, Galgiani, Hall,
Hayashi, Hernandez, Hill, Huber, Huffman, Jones,
Krekorian, Lieu, Bonnie Lowenthal, Ma, Mendoza, Monning,
Nava, John A. Perez, V. Manuel Perez, Portantino, Price,
Ruskin, Salas, Saldana, Skinner, Solorio, Swanson,
Torlakson, Torres, Torrico, Bass
NOES: Adams, Anderson, Tom Berryhill, Blakeslee, Cook,
DeVore, Emmerson, Fletcher, Fuller, Gaines, Garrick,
Gilmore, Hagman, Harkey, Jeffries, Knight, Logue, Miller,
Nestande, Niello, Nielsen, Silva, Smyth, Audra
Strickland, Tran, Villines
NO VOTE RECORDED: Block, Charles Calderon, Duvall, Yamada
JJA:do 9/1/09 Senate Floor Analyses
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SUPPORT/OPPOSITION: SEE ABOVE
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