BILL NUMBER: AB 1000 AMENDED
BILL TEXT
AMENDED IN SENATE JUNE 20, 2012
AMENDED IN SENATE MAY 16, 2012
AMENDED IN ASSEMBLY JANUARY 23, 2012
INTRODUCED BY Assembly Member Perea
FEBRUARY 18, 2011
An act to add Section 1367.655 to the Health and Safety Code, and
to add Section 10123.205 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 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 , as
specified . 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 service plan contract or health
insurance policy that does not provide prescription drug
coverage or 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
, directly or indirectly, 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 service plan
contract that does not provide coverage for prescription drugs.
(d)
(e) 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)
(f) 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
, directly or indirectly, 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 insurance policy that
does not provide coverage for prescription drugs.
(d)
(e) 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)
(f) 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. 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.