BILL NUMBER: AB 1000 AMENDED
BILL TEXT
AMENDED IN SENATE MAY 16, 2012
AMENDED IN ASSEMBLY JANUARY 23, 2012
INTRODUCED BY Assembly Member Perea
FEBRUARY 18, 2011
An act to add and repeal Section 1367.655
of to the Health and Safety Code, and
to add and repeal Section 10123.205 of
to the Insurance Code, relating to health care
coverage.
LEGISLATIVE COUNSEL'S DIGEST
AB 1000, as amended, Perea. Health care coverage: cancer
treatment.
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 also provides for the
regulation of health insurers by the Department of Insurance.
Existing law requires health care service plan contracts and health
insurance policies to provide coverage for all generally medically
accepted cancer screening tests and requires those contracts and
policies to also provide coverage for the treatment of breast cancer.
Existing law imposes various requirements on contracts and policies
that cover prescription drug benefits.
This bill, until January 1, 2016, would require health care
service plan contracts and health insurance policies that provide
coverage for cancer chemotherapy treatment to provide coverage for a
prescribed, orally administered, nongeneric cancer medication, as
specified. The bill would require a health care service plan or
health insurer to review the percentage cost share, as defined, for
oral nongeneric cancer medications and intravenous or injected
nongeneric cancer medications and to apply the lower of the 2 as the
cost-sharing provision for oral nongeneric cancer medications. The
bill would limit increases in cost sharing for nongeneric cancer
medications, as specified. The bill would provide, however, that no
benefits are required to be provided under its provisions that exceed
the essential health benefits that will be required under specified
federal law. The bill would also specify that its provisions do not
apply to health care service plan contracts or health insurance
policies that do not provide coverage for prescription drugs or to a
health care benefit plan, contract, or health insurance policy with
the Board of Administration of the Public Employees' Retirement
System.
This bill would prohibit a health care service plan contract and a
health insurance policy that provides coverage for cancer
chemotherapy treatment from, directly or indirectly, requiring a
higher copayment, deductible, or coinsurance amount for a prescribed,
orally administered anticancer medication than the health care
service plan or health insurer requires for an intravenously
administered or injected cancer medication. The bill would prohibit a
health care service plan or a health insurer from being deemed to
have complied with these provisions by increasing the copayment,
deductible, or coinsurance amount for an intravenously administered
or injected cancer chemotherapy agent. The bill would specify that
its provisions do not apply to a health care benefit plan, contract,
or policy with the Board of Administration of the Public Employees'
Retirement System. The bill would also provide that no benefits are
required to be provided under its provisions that exceed the
essential health benefits that will be required under specified
federal law.
Because a willful violation of the bill's requirements 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 1367.655 is added to the
Health and Safety Code , to read:
1367.655. (a) Notwithstanding any other provision of law, a
health care service plan contract issued, amended, or renewed on or
after January 1, 2013, that provides coverage for cancer chemotherapy
treatment shall not, directly or indirectly, require a higher
copayment, deductible, or coinsurance amount for a prescribed, orally
administered anticancer medication that is used to kill or slow the
growth of cancerous cells than the health care service plan requires
for an intravenously administered or injected cancer medication,
regardless of formulation or benefit category determination by the
health care service plan.
(b) A health care service plan shall not be deemed to have
complied with this section by increasing the copayment, deductible,
or coinsurance amount for an intravenously administered or injected
cancer chemotherapy agent covered by the health care service plan.
(c) Nothing in this section shall be interpreted to prohibit a
health care service plan from requiring prior authorization or
imposing other appropriate utilization controls in approving coverage
for any chemotherapy.
(d) This section shall not apply to a health care benefit plan or
contract entered into with the Board of Administration of the Public
Employees' Retirement System pursuant to the Public Employees'
Medical and Hospital Care Act (Part 5 (commencing with Section 22750)
of Division 5 of Title 2 of the Government Code).
(e) Notwithstanding subdivision (a), as of the date that proposed
final rulemaking for essential health benefits is issued, this
section does not require any benefits to be provided that exceed the
essential health benefits that all health plans will be required by
federal regulations to provide under Section 1302(b) of the federal
Patient Protection and Affordable Care Act (Public Law 111-148), as
amended by the federal Health Care and Education Reconciliation Act
of 2010 (Public Law 111-152).
SEC. 2. Section 10123.205 is added to the
Insurance Code , to read:
10123.205. (a) Notwithstanding any other provision of law, a
health insurance policy issued, amended, or renewed on or after
January 1, 2013, that provides coverage for cancer chemotherapy
treatment shall not, directly or indirectly, require a higher
copayment, deductible, or coinsurance amount for a prescribed, orally
administered anticancer medication that is used to kill or slow the
growth of cancerous cells than the health insurer requires for an
intravenously administered or injected cancer medication, regardless
of formulation or benefit category determination by the health
insurer.
(b) A health insurer shall not be deemed to have complied with
this section by increasing the copayment, deductible, or coinsurance
amount for an intravenously administered or injected cancer
chemotherapy agent covered by the health insurer.
(c) Nothing in this section shall be interpreted to prohibit a
health insurer from requiring prior authorization or imposing other
appropriate utilization controls in approving coverage for any
chemotherapy.
(d) This section shall not apply to a health care benefit plan or
policy entered into with the Board of Administration of the Public
Employees' Retirement System pursuant to the Public Employees'
Medical and Hospital Care Act (Part 5 (commencing with Section 22750)
of Division 5 of Title 2 of the Government Code).
(e) Notwithstanding subdivision (a), as of the date that proposed
final rulemaking for essential health benefits is issued, this
section does not require any benefits to be provided that exceed the
essential health benefits that all health plans will be required by
federal regulations to provide under Section 1302(b) of the federal
Patient Protection and Affordable Care Act (Public Law 111-148), as
amended by the federal Health Care and Education Reconciliation Act
of 2010 (Public Law 111-152).
SECTION 1. Section 1367.655 is added to the
Health and Safety Code, to read:
1367.655. (a) A health care service plan contract issued,
amended, or renewed on or after January 1, 2013, that provides
coverage for cancer chemotherapy treatment shall provide coverage for
a prescribed, orally administered, nongeneric cancer medication used
to kill or slow the growth of cancerous cells and shall review the
percentage cost share for oral nongeneric cancer medications and
intravenous or injected nongeneric cancer medications and apply the
lower of the two as the cost-sharing provision for oral nongeneric
cancer medications. A health care service plan contract shall not
provide for an increase in enrollee cost sharing for nongeneric
cancer medications to any greater extent than the contract provides
for an increase in enrollee cost sharing for other nongeneric covered
medications.
(b) For purposes of this section, "cost share" means copayment,
coinsurance, or deductible provisions applicable to coverage for
oral, intravenous, or injected nongeneric cancer medications.
(c) Nothing in this section shall be construed to require a health
care service plan contract to provide coverage for any additional
medication not otherwise required by law.
(d) Nothing in this section shall prohibit a health care service
plan from removing a prescription drug from its formulary of covered
prescription drugs.
(e) This section shall not apply to a health care service plan
contract that does not provide coverage for prescription drugs.
(f) This section shall not apply to a health care benefit plan or
contract entered into with the Board of Administration of the Public
Employees' Retirement System pursuant to the Public Employees'
Medical and Hospital Care Act (Part 5 (commencing with Section 22750)
of Division 5 of Title 2 of the Government Code).
(g) Notwithstanding subdivision (a), as of the date that proposed
final rulemaking for essential health benefits is issued, this
section does not require any benefits to be provided that exceed the
essential health benefits that all health plans will be required by
federal regulations to provide under Section 1302(b) of the federal
Patient Protection and Affordable Care Act (Public Law 111-148), as
amended by the federal Health Care and Education Reconciliation Act
of 2010 (Public Law 111-152).
(h) This section shall remain in effect only until January 1,
2016, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2016, deletes or extends
that date.
SEC. 2. Section 10123.205 is added to the
Insurance Code, to read:
10123.205. (a) A health insurance policy issued, amended, or
renewed on or after January 1, 2013, that provides coverage for
cancer chemotherapy treatment shall provide coverage for a
prescribed, orally administered, nongeneric cancer medication used to
kill or slow the growth of cancerous cells and shall review the
percentage cost share for oral nongeneric cancer medications and
intravenous or injected nongeneric cancer medications and apply the
lower of the two as the cost-sharing provision for oral nongeneric
cancer medications. A health insurance policy shall not provide for
an increase in insured cost sharing for nongeneric cancer medications
to any greater extent than the policy provides for an increase in an
insured's cost sharing for other nongeneric covered medications.
(b) For purposes of this section, "cost share" means copayment,
coinsurance, or deductible provisions applicable to coverage for
oral, intravenous, or injected nongeneric cancer medications.
(c) Nothing in this section shall be construed to require a health
insurance policy to provide coverage for any additional medication
not otherwise required by law.
(d) Nothing in this section shall prohibit a health insurer from
removing a prescription drug from its formulary of covered
prescription drugs.
(e) This section shall not apply to a health insurance policy that
does not provide coverage for prescription drugs.
(f) This section shall not apply to a policy of health insurance
purchased by the Board of Administration of the Public Employees'
Retirement System pursuant to the Public Employees' Medical and
Hospital Care Act (Part 5 (commencing with Section 22750) of Division
5 of Title 2 of the Government Code).
(g) Notwithstanding subdivision (a), as of the date that proposed
final rulemaking for essential health benefits is issued, this
section does not require any benefits to be provided that exceed the
essential health benefits that all health plans will be required by
federal regulations to provide under Section 1302(b) of the federal
Patient Protection and Affordable Care Act (Public Law 111-148), as
amended by the federal Health Care and Education Reconciliation Act
of 2010 (Public Law 111-152).
(h) This section shall remain in effect only until January 1,
2016, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2016, deletes or extends
that date.
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.