BILL NUMBER: SB 1063	AMENDED
	BILL TEXT

	AMENDED IN SENATE  MAY 24, 2010
	AMENDED IN SENATE  APRIL 21, 2010

INTRODUCED BY   Senator Cox

                        FEBRUARY 16, 2010

   An act to amend 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. Existing law also   specified, and 
prohibits copayments from exceeding the copayment level established
for state employees through the Public Employees' Retirement System.
   This bill would 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  ,  
and would specify that these copayments do not apply to subscribers
in families with household incomes equal to or less than 150% of the
federal poverty level  .
   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)  (1)    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) 
    (A)  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) 
    (B)  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. 
   (2) The copayments established pursuant to paragraph (1) shall not
apply to a subscriber in a family with an annual household income
equal to or less than 150 percent of the federal poverty level.