BILL NUMBER: AB 163	INTRODUCED
	BILL TEXT


INTRODUCED BY   Assembly Member Emmerson

                        JANUARY 27, 2009

   An act to add Section 1367.27 to the Health and Safety Code, and
to add Section 10123.197 to the Insurance Code, relating to health
care coverage.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 163, as introduced, Emmerson. Amino acid-based elemental
formulas.
   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 provides for the
regulation of health insurers by the Department of Insurance.
   This bill would require specified health care service plan
contracts and health insurance policies to provide coverage for the
use of amino acid-based elemental formulas, regardless of the
delivery method, for the diagnosis and treatment of eosinophilic
gastrointestinal disorders, as defined, when the prescribing
physician has issued a written order stating that the amino
acid-based elemental formula is medically necessary.
   Because a willful violation of the bill's provisions relative to
health care service plans would be a crime, the 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 1367.27 is added to the Health and Safety Code,
to read:
   1367.27.  (a) Every health care service plan contract, except a
specialized health care service plan contract, that is issued,
amended, or renewed on or after January 1, 2010, that provides
coverage for hospital, medical, or surgical expenses shall provide
coverage for the use of amino acid-based elemental formulas,
regardless of the delivery method, for the diagnosis and treatment of
eosinophilic gastrointestinal disorders when the prescribing
physician has issued a written order stating that the amino
acid-based elemental formula is medically necessary.
   (b) For purposes of this section, "eosinophilic gastrointestinal
disorders" means disorders that are characterized by having above
normal amounts of eosinophils, a type of white blood cell, in the
digestive system.
  SEC. 2.  Section 10123.197 is added to the Insurance Code, to read:

   10123.197.  (a) Every health insurance policy issued, amended, or
renewed on or after January 1, 2010, that provides coverage for
hospital, medical, or surgical expenses shall provide coverage for
the use of amino acid-based elemental formulas, regardless of the
delivery method, for the diagnosis and treatment of eosinophilic
gastrointestinal disorders when the prescribing physician has issued
a written order stating that the amino acid-based elemental formula
is medically necessary.
   (b) For purposes of this section, "eosinophilic gastrointestinal
disorders" means disorders that are characterized by having above
normal amounts of eosinophils, a type of white blood cell, in the
digestive system.
   (c) This section shall not apply to Medicare supplement,
short-term limited duration health insurance, vision-only,
dental-only, or CHAMPUS supplement insurance, or to hospital
indemnity, hospital-only, accident-only, or specified disease
insurance that does not pay benefits on a fixed benefit, cash payment
only basis.
  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.