BILL ANALYSIS
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|SENATE RULES COMMITTEE | AB 113|
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THIRD READING
Bill No: AB 113
Author: Portantino (D), et al
Amended: 6/23/10 in Senate
Vote: 21
SENATE HEALTH COMMITTEE : 8-0, 6/16/10
AYES: Alquist, Strickland, Aanestad, Cedillo, Leno,
Negrete McLeod, Pavley, Romero
NO VOTE RECORDED: Cox
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
ASSEMBLY FLOOR : 68-0, 1/27/10 (Consent) - See last page
for vote
SUBJECT : Health care coverage: mammographies
SOURCE : American Congress of Obstetricians and
Gynecologists,
District IX, California
DIGEST : This bill requires health plans and insurers to
provide patients with information regarding recommended
timelines for the screening for and diagnosis of breast
cancer. This bill authorizes information to be provided in
a variety of formats including letters, newsletters,
coverage publications, or electronic communication.
ANALYSIS :
CONTINUED
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Existing law:
1. Provides for the regulation of health plans by the
Department of Managed Health Care and health insurers by
the Department of Insurance (CDI).
2. Requires health plans to cover mammography for screening
or diagnostic purposes upon the referral of the
patient's physician, nurse practitioner, or certified
nurse-midwife.
3. Requires health insurance policies to provide coverage
for a baseline mammogram for women age 35-39, inclusive;
a mammogram for women age 40-49, inclusive, every two
years or more, depending on a physician's
recommendation; and a mammogram every year for women age
50 and over for breast cancer screening or diagnostic
purposes.
This bill:
1. Requires health plan contracts and health insurance
policies that are issued, amended, delivered, or renewed
on or after July 1, 2011, to provide coverage for
mammography for screening or diagnostic purposes upon
referral of certain health care professionals,
regardless of age.
2. Exempts specialized health insurance, Medicare
supplement insurance, short-term limited duration health
insurance, CHAMPUS [Civilian Health and Medical Program
of the Uniformed Services] supplement insurance, TRICARE
supplement insurance, or to hospital indemnity,
accident-only, or specified disease insurance.
3. Requires health plans and health insurers to provide
subscribers and policyholders with information regarding
recommended timelines for breast cancer screening or
diagnosis through written letter, publication in a
newsletter, publication in evidence of coverage, direct
telephone call, electronic transmission, Web-based
portal containing various plan and benefit information
(if the enrollee or insured has access to that portal),
or by any other means that will reasonably notify the
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enrollee or insured of recommended timelines for
testing.
Background
According to the American Cancer Society's "Breast Cancer
Facts & Figures 2007-2008," excluding cancers of the skin,
breast cancer is the most common cancer among women;
accounting for more than one in four cancers diagnosed in
United States women. It is the second leading cause of
death of women in California. According to the California
Breast Cancer Research Program, the breast cancer death
rate in California has dropped 20 percent since 1973, but
California women are more likely to get breast cancer today
than in 1973. While the death rate for breast cancer has
dropped, the gains have not been shared equally among all
women. Minority and low-income women are less likely than
other women to be diagnosed at early stage, receive
effective treatment, and survive the disease. The
California Health Benefits Review Program reports that
white women are most likely to get the disease, followed
closely by African-American women, Asian Pacific Islander
women, and Hispanic women. African-American women have the
highest death rate despite being less likely than white
women to get the disease.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
SUPPORT : (Verified 7/29/10)
American Congress of Obstetricians and Gynecologists,
District IX, California (source)
American Cancer Society
BayBio
California Academy of Physician Assistants
California Medical Association
California Nurse-Midwives Association
City of West Hollywood
GlaxoSmithKline
Planned Parenthood Advocacy Project Los Angeles County
Planned Parenthood Affiliates of California
Planned Parenthood of Santa Barbara, Ventura and San Luis
Obispo Counties, Inc.
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Susan G. Komen for the Cure (seven California affiliates)
OPPOSITION : (Verified 7/29/10)
Department of Health Care Services
ARGUMENTS IN SUPPORT : The American Congress of
Obstetricians and Gynecologists, District IX, California
(ACOG), the bill's sponsor, states that the idea of the
bill is two-fold: to rectify a discrepancy and medical
inaccuracy in the Insurance Code relative to mammography
coverage, and to make women aware of their coverage. ACOG
points out that the Knox-Keene Act regulating HMOs provides
for mammography upon referral by a physician or other
appropriate health care provider. ACOG notes that the
Insurance Code cites a baseline mammography at age 35,
which is no longer the standard, provides for mammography
at age 40, which is appropriate, but makes no provision for
higher risk women that may need a mammography prior to age
40. ACOG contends that clarifying the Insurance Code could
reduce administrative costs incurred by patients having to
fight with insurers over inconsistent sections of law; and
that the notice required by the bill should be able to be
done with existing resources.
The American Cancer Society states that this bill makes
changes to the existing mammography coverage for
CDI-regulated plans by allowing health care providers the
flexibility to provide the most appropriate mammography
services.
ARGUMENTS IN OPPOSITION : The Department of Health Care
Services states that this bill is unnecessary, as it
relates to Medi-Cal managed health plans, because these
plans already send out materials educating their members on
the importance of preventive care, including breast cancer
screening.
ASSEMBLY FLOOR :
AYES: Adams, Ammiano, Anderson, Arambula, Beall, Bill
Berryhill, Tom Berryhill, Blakeslee, Block, Blumenfield,
Bradford, Brownley, Buchanan, Caballero, Charles
Calderon, Chesbro, Cook, Coto, De La Torre, Emmerson,
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Eng, Evans, Feuer, Fletcher, Fong, Fuentes, Fuller,
Furutani, Gaines, Galgiani, Garrick, Gilmore, Hagman,
Harkey, Hayashi, Hernandez, Hill, Huber, Huffman,
Jeffries, Jones, Knight, Lieu, Logue, Bonnie Lowenthal,
Ma, Mendoza, Miller, Monning, Nava, Nestande, Niello,
Nielsen, John A. Perez, Portantino, Ruskin, Saldana,
Silva, Skinner, Smyth, Solorio, Audra Strickland,
Swanson, Torres, Torrico, Tran, Villines, Yamada
NO VOTE RECORDED: Carter, Conway, Davis, De Leon, DeVore,
Hall, V. Manuel Perez, Salas, Torlakson, Bass
CTW:mw 8/2/10 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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