BILL NUMBER: SB 1063 AMENDED
BILL TEXT
AMENDED IN SENATE APRIL 21, 2010
INTRODUCED BY Senator Cox
FEBRUARY 16, 2010
An act to amend Sections 12693.21 and 12693.615
Section 12693.21 of the Insurance Code, relating to
health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
SB 1063, as amended, Cox. Healthy Families Program.
Existing law creates the Healthy Families Program, administered by
the Managed Risk Medical Insurance Board, to arrange for the
provision of health care services to children less than 19 years of
age who meet certain criteria, including having a limited gross
household income. Existing law requires the board to establish the
required copayment levels for specific benefits, as specified
, and prohibits the total annual copayments charged to
subscribers from exceeding $250 per family . Existing law
also prohibits copayments from exceeding the copayment level
established for state employees through the Public Employees'
Retirement System.
This bill would prohibit the total annual copayments from
exceeding $350 per family and would delete the provision prohibiting
copayments from exceeding the copayment level established for state
employees through the Public Employees' Retirement System. The bill
would also require the board to structure copayments for
prescription drugs and emergency health care services in a specified
manner , to the extent consistent with federal law .
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 12693.21 of the Insurance Code is amended to
read:
12693.21. (a) The board may do all of the following consistent
with the standards in this part:
(1) Determine eligibility criteria for the program.
(2) Determine the participation requirements of applicants,
subscribers, purchasing credit members, and participating health,
dental, and vision plans.
(3) Determine when subscribers' coverage begins and the extent and
scope of coverage.
(4) Determine family contribution amount schedules and collect the
contributions.
(5) Determine who may be a family contribution sponsor and provide
a mechanism for sponsorship.
(6) Provide or make available subsidized coverage through
participating health, dental, and vision plans, in a purchasing pool,
which may include the use of a purchasing credit mechanism, through
supplemental coverage, or through coordination with other state
programs.
(7) Provide for the processing of applications, the enrollment of
subscribers, and the distribution of purchasing credits.
(8) Determine and approve the benefit designs and copayments
required by health, dental, or vision plans participating in the
purchasing pool component program.
(9) Approve those health plans eligible to receive purchasing
credits.
(10) Enter into contracts.
(11) Sue and be sued.
(12) Employ necessary staff.
(13) Authorize expenditures from the fund to pay program expenses
that exceed subscriber contributions, and to administer the program
as necessary.
(14) Maintain enrollment and expenditures to ensure that
expenditures do not exceed amounts available in the Healthy Families
Fund and if sufficient funds are not available to cover the estimated
cost of program expenditures, the board shall institute appropriate
measures to limit enrollment.
(15) Issue rules and regulations, as necessary. Until January 1,
2000, any rules and regulations issued pursuant to this subdivision
may be adopted as emergency regulations in accordance with the
Administrative Procedure Act (Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code).
The adoption of these regulations shall be deemed an emergency and
necessary for the immediate preservation of the public peace, health,
and safety or general welfare. The regulations shall become
effective immediately upon filing with the Secretary of State.
(16) Exercise all powers reasonably necessary to carry out the
powers and responsibilities expressly granted or imposed by this
part.
(b) The board shall do both of the following to the extent
consistent with the limitations of Section 2103 of Title XXI of the
federal Social Security Act (42 U.S.C. Sec. 1397cc):
(1) Structure copayments for prescription drugs so that the
copayment for a brand name drug is at least 150 percent of the
copayment for the equivalent generic drug, except where no generic
equivalent is available or where the use of the brand name drug is
medically necessary.
(2) Structure copayments for emergency health care services so
that the copayment charged for those services is at least 150 percent
of the highest copayment charged for nonpreventive health care
services. The emergency health care services copayment shall be
waived if the subscriber is hospitalized.
SEC. 2. Section 12693.615 of the Insurance Code
is amended to read:
12693.615. (a) The board shall establish the required subscriber
copayment levels for specific benefits consistent with the
limitations of Section 2103 of Title XXI of the federal Social
Security Act (42 U.S.C. Sec. 1397cc). The copayment levels
established by the board shall, to the extent possible, reflect the
copayment levels established for state employees, effective January
1, 1998, through the Public Employees' Retirement System. Total
annual copayments charged to subscribers shall not exceed three
hundred fifty dollars ($350) per family. The board shall instruct
participating health plans to work with their provider networks to
provide for extended payment plans for subscribers utilizing a
significant number of health services for which copayments are
charged. The board shall track the number of subscribers who meet the
copayment maximum in each year and make adjustments in the amount if
a significant number of subscribers reach the copayment maximum.
(b) No deductibles shall be charged to subscribers for health
benefits.
(c) Coverage provided to subscribers shall not contain any
preexisting condition exclusion requirements.
(d) No participating health, dental, or vision plan shall exclude
any subscriber on the basis of any actual or expected health
condition or claims experience of that subscriber or a member of that
subscriber's family.
(e) There shall be no variations in rates charged to subscribers,
including premiums and copayments, on the basis of any actual or
expected health condition or claims experience of any subscriber or
subscriber's family member. The only variation in rates charged to
subscribers, including copayments and premiums, that shall be
permitted is that which is expressly authorized by Section 12693.43
and subdivision (b) of Section 12693.21.
(f) There shall be no copayments for preventive services as
defined in Section 1367.35 of the Health and Safety Code.
(g) There shall be no annual or lifetime benefit maximums in any
of the coverage provided under the program.
(h) Plans that receive purchasing credits pursuant to Section
12693.39 shall comply with subdivisions (b), (c), (d), (e), (f), and
(g).