BILL ANALYSIS �
AB 137
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CONCURRENCE IN SENATE AMENDMENTS
AB 137 (Portantino)
As Amended August 22, 2012
Majority vote
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|ASSEMBLY: |71-0 |(January 26, |SENATE: |36-0 |(August 28, |
| | |2012) | | |2012) |
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Original Committee Reference: HEALTH
SUMMARY : Requires every individual or group policy of health
insurance to provide coverage for mammography, for screening or
diagnostic purposes, upon the referral by a participating nurse
practitioner, participating certified nurse-midwife,
participating physician assistant, or participating physician,
as specified, based on medical need regardless of age.
The Senate amendments :
1)Delete all reference to health care service plan contracts
covered under the Knox-Keene Health Care Service Plan Act of
1975 (Knox-Keene).
2)Delete the age guidelines for mammography coverage for
screening or diagnostic purposes currently in statute for
individual or group policy health insurance regulated under
the California Department of Insurance (CDI).
3)Delete the requirement for individual or group policy health
insurers, after July 1, 2013, 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
enrollee or insured of recommended timelines for testing.
EXISTING LAW :
1)Establishes Knox-Keene to regulate and license health plans
and specialized health plans by the Department of Managed
AB 137
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Health Care and provides for the regulation of health insurers
by 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.
AS PASSED BY THE ASSEMBLY , this bill was substantially similar
to the version as passed by the Senate.
FISCAL EFFECT : According to the Senate Appropriations
Committee, pursuant to Senate Rule 28.8, negligible state costs.
COMMENTS : According to the author, this bill is needed to
remove the age-based utilization of mammograms contained in the
Insurance Code. The author believes that a woman's decision to
have a mammogram should be based upon the specific risks of the
woman and in consultation with her physician, rather than
dictated by statute based on her age.
Analysis Prepared by : Tanya Robinson-Taylor / HEALTH / (916)
319-2097
FN: 0005527