BILL NUMBER: SB 173 AMENDED
BILL TEXT
AMENDED IN SENATE MAY 3, 2011
AMENDED IN SENATE MARCH 30, 2011
INTRODUCED BY Senator Simitian
( Principal coauthor: Senator
Alquist )
FEBRUARY 7, 2011
An act to add Section 687 to the Business and Professions Code,
to amend Section 1367.65 of the Health and Safety Code, and
to amend Section 10123.81 of the Insurance Code, relating to health
care coverage. relating to healing arts.
LEGISLATIVE COUNSEL'S DIGEST
SB 173, as amended, Simitian. Health care coverage:
Healing arts: mammograms.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975
(Knox-Keene Act), provides for the licensure and regulation of health
care service plans by the Department of Managed Health Care
, and makes a willful violation of its provisions a crime
. Existing law provides for the licensure and regulation of health
insurers by the Department of Insurance. Existing law provides for
the regulation of health care practitioners, as defined. Existing law
requires health care service plan contracts, except specialized
health care service plan contracts, and certain health insurance
policies to provide a certain level of coverage for mammograms and
breast cancer screening and diagnosis, as specified.
This bill would require those health care service plan
contracts and health insurance policies to include additional
benefits for comprehensive breast cancer screening under specified
circumstances. The bill would require a health care
practitioner who performs a mammography examination under those
provisions to include in the mammography report specified
information and, when applicable, a specified notice on
breast density , as specified .
Because a willful violation of the bill's provisions under the
Knox-Keene Act is 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
no . State-mandated local program: yes
no .
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 687 is added to the Business and Professions
Code, to read:
687. (a) A health care practitioner who performs a mammography
examination pursuant to Section 1367.65 of the Health and Safety Code
or Section 10123.81 of the Insurance Code shall include in the
mammography report information about breast density, based on the
Breast Imaging Reporting and Data System established by the American
College of Radiology. When applicable, the report shall also include
the following notice:
"If your mammogram demonstrates that you have dense breast tissue,
which could hide small abnormalities, you might benefit from
supplementary screening tests, which can include a breast
ultrasound screening or a breast MRI examination, or both,
depending on your individual risk factors. A report of your
mammography results, which contains information about your breast
density, has been sent to your physician's office and you should
contact your physician if you have any questions or concerns about
this report."
(b) "Health care practitioner" means a person licensed or
certified pursuant to this division or licensed pursuant to the
Osteopathic Initiative Act.
SEC. 2. Section 1367.65 of the Health and
Safety Code is amended to read:
1367.65. (a) (1) On or after January 1, 2000, every health care
service plan contract, except a specialized health care service plan
contract, that is issued, amended, delivered, or renewed shall be
deemed to provide coverage for mammography for screening or
diagnostic purposes upon referral by a participating nurse
practitioner, participating certified nurse midwife, or participating
physician and surgeon, providing care to the patient and operating
within the scope of practice provided under existing law.
(2) In addition to the coverage required under paragraph (1), on
or after January 1, 2012, every health care service plan contract,
except a specialized health care service plan contract, that is
issued, amended, delivered, or renewed shall also provide additional
benefits for comprehensive screening of an entire breast or breasts
if a mammogram demonstrates heterogeneous or dense breast tissue
based on the Breast Imaging Reporting and Data System established by
the American College of Radiology or if a patient is believed to be
at increased risk for breast cancer due to family history or prior
history of breast cancer, positive genetic testing, or other
indications as determined by his or her nurse practitioner, nurse
midwife, or physician and surgeon.
(b) Nothing in this section shall be construed to prevent
application of copayment or deductible provisions in a plan, nor
shall this section be construed to require that a plan be extended to
cover any other procedures under an individual or a group health
care service plan contract. Nothing in this section shall be
construed to authorize a plan enrollee to receive the services
required to be covered by this section if those services are
furnished by a nonparticipating provider, unless the plan enrollee is
referred to that provider by a participating physician and surgeon,
nurse practitioner, or certified nurse midwife providing care.
SEC. 3. Section 10123.81 of the Insurance Code
is amended to read:
10123.81. (a) On or after January 1, 2000, every individual or
group policy of disability insurance or self-insured employee welfare
benefit plan that is issued, amended, or renewed, shall be deemed to
provide coverage for at least the following, upon the referral of a
nurse practitioner, certified nurse midwife, or physician and
surgeon, providing care to the patient and operating within the scope
of practice provided under existing law for breast cancer screening
or diagnostic purposes:
(1) A baseline mammogram for women age 35 to 39, inclusive.
(2) A mammogram for women age 40 to 49, inclusive, every two years
or more frequently based on the women's physician's recommendation.
(3) A mammogram every year for women age 50 and over.
(b) In addition to the coverage required under subdivision (a), on
or after January 1, 2012, every health insurance policy, except a
specialized health insurance policy, that is issued, amended,
delivered, or renewed shall also provide additional benefits for
comprehensive screening of an entire breast or breasts if a mammogram
demonstrates heterogeneous or dense breast tissue based on the
Breast Imaging Reporting and Data System established by the American
College of Radiology or if a patient is believed to be at increased
risk for breast cancer due to family history or prior history of
breast cancer, positive genetic testing, or other indications as
determined by his or her nurse practitioner, nurse midwife, or
physician and surgeon.
(c) Nothing in this section shall be construed to require an
individual or group policy to cover the surgical procedure known as
mastectomy or to prevent application of deductible or copayment
provisions contained in the policy or plan, nor shall this section be
construed to require that coverage under an individual or group
policy be extended to any other procedures.
(d) Nothing in this section shall be construed to authorize an
insured or plan member to receive the coverage required by this
section if that coverage is furnished by a nonparticipating provider,
unless the insured or plan member is referred to that provider by a
participating physician and surgeon, nurse practitioner, or certified
nurse midwife providing care.
SEC. 4. 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.