SB 1279, as introduced, Calderon. Marcella Calderon Lynch Syndrome Prevention Act.
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 individual and group 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 requires an individual or small group health care service plan contract or insurance policy issued, amended, or renewed on or after January 1, 2014, to, at a minimum, include coverage for essential health benefits, which includes preventive services, pursuant to the federal Patient Protection and Affordable Care Act.
This bill would require a health care service plan contract or a health insurance policy, except as specified, that is issued, amended, or renewed on or after January 1, 2015, to provide coverage for genetic testing for Lynch syndrome and annual screenings for Lynch Syndrome under specified circumstances. 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.
This bill would also require a physician and surgeon who makes a diagnosis that a patient has Lynch syndrome to provide the patient with specified information.
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.
This bill would declare that it is to take effect immediately as an urgency statute.
Vote: 2⁄3. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes.
The people of the State of California do enact as follows:
This act shall be known, and may be cited, as the
2Marcella Calderon Lynch Syndrome Prevention Act.
Section 1367.667 is added to the Health and Safety
4Code, to read:
(a) Every health care service plan contract, except
6a specialized health care service plan contract, that is issued,
7amended, or renewed on or after January 1, 2015, shall provide
8coverage for all of the following:
9(1) Genetic testing for Lynch Syndrome for an enrollee who
10has been diagnosed with Lynch Syndrome.
11(2) Genetic testing for Lynch Syndrome for an enrollee who is
12the child or sibling of an individual who has been diagnosed with
13Lynch Syndrome and has tested positive for the gene mutation for
14Lynch Syndrome.
15(3) Annual screens, including colonoscopies, for an enrollee
16who has tested positive for the gene
mutation for Lynch Syndrome,
17and is the child or sibling of an individual who has been diagnosed
18with Lynch Syndrome and has tested positive for the gene mutation
19for Lynch Syndrome.
20(b) Notwithstanding subdivision (f) of Section 100503 of the
21Government Code and subdivision (c) of Section 1366.6, to the
22extent that this section requires health benefits to be provided that
P3 1exceed the essential health benefits required to be provided under
2Section 18022 of Title 42 of the United States Code by qualified
3health plans offering those benefits in the California Health Benefit
4Exchange (Exchange) pursuant to Title 22 (commencing with
5Section 100500) of the Government Code, the specific benefits
6that exceed the federally required essential health benefits are not
7required to be provided when offered by a health care service plan
8contract through the Exchange. However, those specific benefits
9are required to be provided if offered by a health care
service plan
10contract outside of the Exchange.
Article 4 (commencing with Section 104201) is added
12to Chapter 2 of Part 1 of Division 103 of the Health and Safety
13Code, to read:
14
If a physician and surgeon makes a diagnosis that a
18patient has Lynch Syndrome, the physician and surgeon shall
19recommend that the patient be tested for the genetic mutation for
20Lynch Syndrome. The physician and surgeon shall also inform the
21patient that genetic testing for Lynch Syndrome may be covered
22by the patient’s health care coverage, and that genetic testing and
23screening for his or her children or siblings may be covered by the
24children’s or siblings’ health care coverage if the patient tests
25positive for the Lynch Syndrome gene mutation.
Section 10123.22 is added to the Insurance Code, to
27read:
(a) Every health insurance policy, except a
29specialized health insurance policy, that is issued, amended, or
30renewed on or after January 1, 2015, shall provide coverage for
31all of the following:
32(1) Genetic testing for Lynch Syndrome for an insured who has
33been diagnosed with Lynch Syndrome.
34(2) Genetic testing for Lynch Syndrome for an insured who is
35the child or sibling of an individual who has been diagnosed with
36Lynch Syndrome and has tested positive for the gene mutation for
37Lynch Syndrome.
38(3) Annual screens, including colonoscopies, for an insured who
39has tested positive for the gene mutation for Lynch
Syndrome, and
40is the child or sibling of an individual who has been diagnosed
P4 1with Lynch Syndrome and has tested positive for the gene mutation
2for Lynch Syndrome.
3(b) Notwithstanding subdivision (f) of Section 100503 of the
4Government Code and subdivision (c) of Section 10112.3, to the
5extent that this section requires health benefits to be provided that
6exceed the essential health benefits required to be provided under
7Section 18022 of Title 42 of the United States Code by qualified
8health plans offering those benefits in the California Health Benefit
9Exchange (Exchange) pursuant to Title 22 (commencing with
10Section 100500) of the Government Code, the specific benefits
11that exceed the federally required essential health benefits are not
12required to be provided when offered by a health insurance policy
13through the Exchange. However, those specific benefits are
14required to be provided if offered by a health insurance policy
15outside of the
Exchange.
No reimbursement is required by this act pursuant to
17Section 6 of Article XIII B of the California Constitution because
18the only costs that may be incurred by a local agency or school
19district will be incurred because this act creates a new crime or
20infraction, eliminates a crime or infraction, or changes the penalty
21for a crime or infraction, within the meaning of Section 17556 of
22the Government Code, or changes the definition of a crime within
23the meaning of Section 6 of Article XIII B of the California
24Constitution.
This act is an urgency statute necessary for the
26immediate preservation of the public peace, health, or safety within
27the meaning of Article IV of the Constitution and shall go into
28immediate effect. The facts constituting the necessity are:
29In order to protect the health of all Californians at the earliest
30possible time, it is necessary that this act take effect immediately.
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