BILL NUMBER: SB 220 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY JUNE 24, 2010
AMENDED IN ASSEMBLY MAY 26, 2010
AMENDED IN ASSEMBLY MARCH 11, 2010
AMENDED IN ASSEMBLY JULY 16, 2009
AMENDED IN ASSEMBLY JULY 2, 2009
AMENDED IN SENATE APRIL 13, 2009
INTRODUCED BY Senator Yee
( Coauthor: Assembly Member
Hill )
FEBRUARY 23, 2009
An act to add Section 1367.27 to the Health and Safety Code, and
to add Section 10123.175 to the Insurance Code, relating to health
care coverage.
LEGISLATIVE COUNSEL'S DIGEST
SB 220, as amended, Yee. Health care coverage: tobacco cessation
services.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975,
provides for the regulation of health care service plans by the
Department of Managed Health Care and makes a violation of the act a
crime. Existing law provides for the regulation of health insurers by
the Department of Insurance. Under existing law, a health care
service plan and a health insurer are required to provide coverage
for specified tests, including all generally medically accepted
cancer screening tests.
This bill would require certain health care service plan contracts
and health insurance policies that provide outpatient prescription
drug benefits to also provide coverage for tobacco cessation services
that include specified courses of treatment and medication, and
would prohibit the imposition of copayments, coinsurance, or
deductibles for the receipt of those benefits , as
specified .
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. The Legislature finds and declares the following:
(a) Providing tobacco cessation counseling and medication is one
of the most clinically effective and cost-effective health services
available, second only to inoculations. Tobacco cessation is 5 to 80
times more cost effective than pharmacologic interventions used to
prevent heart attacks.
(b) More than 70 percent of smokers wish they could quit tobacco,
and each year one of every two smokers attempts to quit. However, the
unassisted successful tobacco quit rate has remained constant at
less than five percent. Access to counseling and pharmaceutical
benefits doubles the successful quit rate and has achieved quit rates
of 25 to 30 percent. Experience in health plans indicates that
access to all cessation services saves four dollars ($4) for every
dollar ($1) invested.
(c) Each adult smoker costs employers one thousand seven hundred
sixty dollars ($1,760) in lost productivity and one thousand six
hundred twenty-three dollars ($1,623) in excess medical expenditures.
Men who smoke incur fifteen thousand eight hundred dollars ($15,800)
more in lifetime medical expenses than men who do not smoke. For
employers, the ultimate financial return is between five dollars ($5)
and six dollars ($6) for every dollar spent on tobacco cessation.
(d) Because of member transfers between plans, financial savings
and tobacco-related disease reductions are effective only if
universally available to the entire insured population. Therefore, a
mandate on all plans and insurers to provide cost-effective treatment
is necessary and beneficial.
(e) It is the intent of the Legislature that this act diminish the
statewide economic and personal cost of tobacco addiction by making
tobacco cessation treatments available to all smokers. California has
successfully reduced tobacco consumption in the last decade, but,
despite that success, tobacco use is responsible for the unnecessary
deaths of 40,000 residents and remains the leading cause of
preventable death in this state. Annually, tobacco addiction costs
California $8.6 billion in direct medical costs, which is
approximately 12 percent of all health care costs.
SEC. 2. Section 1367.27 is added to the Health and Safety Code, to
read:
1367.27. (a) A health care service plan contract, except a
specialized health care service plan contract, that is issued,
amended, delivered, or renewed on or after July 1, 2011, that
provides outpatient prescription drug benefits, shall include
coverage for tobacco cessation services that include two courses of
treatment in a 12-month period including personal counseling, which
may be telephone, group, or individual counseling, and all
medications approved by the FDA for the purpose of tobacco cessation,
including all prescription and over-the-counter medications. Covered
treatment shall follow recommendations in the Public Health Service
sponsored 2008 clinical practice guideline, "Treating Tobacco Use and
Dependence: 2008 Update," or its successors.
(b) No copayment, coinsurance, or deductible shall be applied to
the benefits under this section.
(c) A health care service plan may contract with qualified local,
statewide, or national providers, whether for profit or nonprofit,
for the provision of services under this section.
(d) A health care service plan shall disclose the benefits under
this section in its evidence of coverage and disclosure forms and
communicate the availability of coverage to all enrollees at least
once per year.
(e) The coverage provided pursuant to this section shall only be
available upon the order of an authorized provider. Nothing in this
subdivision shall preclude a plan from allowing enrollees to access
tobacco cessation services on a self-referral basis.
(f) As used in this section, "course of treatment" shall be
defined to consist of the following:
(1) As applied to counseling, at least four sessions of
counseling, each session lasting at least 10 minutes.
(2) As applied to a prescription or over-the-counter medication,
the duration of treatment approved by the FDA for that medication.
(g) Enrollees shall not be required to enter counseling in order
to receive tobacco cessation medications.
(h) A health care service plan shall not impose prior
authorization or stepped-care requirements on tobacco cessation
treatment.
(i) A health care service plan shall implement this section
consistent with the requirements of the Health Care Providers' Bill
of Rights, and a material change in the obligations of a plan's
contracting providers shall be considered a material change to the
provider contract, within the meaning of subdivision (b) of, and
paragraph (2) of subdivision (g) of, Section 1375.7.
SEC. 3. Section 10123.175 is added to the Insurance Code, to read:
10123.175. (a) Every individual or group health insurance policy
that is issued, amended, delivered, or renewed on or after July 1,
2011, that provides outpatient prescription drug benefits, shall
include coverage for tobacco cessation services that include two
courses of treatment in a 12-month period including personal
counseling, which may be telephone, group, or individual counseling,
and all medications approved by the FDA for the purpose of tobacco
cessation, including all prescription and over-the-counter
medications. Covered treatment shall follow recommendations in the
Public Health Service sponsored 2008 clinical practice guideline,
"Treating Tobacco Use and Dependence: 2008 Update," or its
successors.
(b) No copayment, coinsurance, or deductible shall be applied to
the benefits under this section.
(c) A health insurer may contract with qualified local, statewide,
or national providers, whether for profit or nonprofit, for the
provision of services under this section.
(d) An insurer shall disclose the benefits under this section in
its evidence of coverage and disclosure forms and communicate the
availability of coverage to all insureds at least once per year.
(e) The coverage provided pursuant to this section shall only be
available upon the order of an authorized provider. Nothing in this
subdivision shall preclude an insurer from allowing insureds to
access tobacco cessation services on a self-referral basis.
(f) As used in this section, "course of treatment" shall be
defined to consist of the following:
(1) As applied to counseling, at least four sessions of
counseling, each session lasting at least 10 minutes.
(2) As applied to a prescription or over-the-counter medication,
the duration of treatment approved by the FDA for that medication.
(g) Insureds shall not be required to enter counseling in order to
receive tobacco cessation medications.
(h) A health care service plan insurance
policy shall not impose prior authorization or stepped-care
requirements on tobacco cessation treatment.
(i) 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. 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.