Bill Text: CA AB137 | 2011-2012 | Regular Session | Chaptered
Bill Title: Health care coverage: mammographies.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Passed) 2012-09-22 - Chaptered by Secretary of State - Chapter 436, Statutes of 2012. [AB137 Detail]
Download: California-2011-AB137-Chaptered.html
BILL NUMBER: AB 137 CHAPTERED
BILL TEXT
CHAPTER 436
FILED WITH SECRETARY OF STATE SEPTEMBER 22, 2012
APPROVED BY GOVERNOR SEPTEMBER 22, 2012
PASSED THE SENATE AUGUST 28, 2012
PASSED THE ASSEMBLY AUGUST 29, 2012
AMENDED IN SENATE AUGUST 22, 2012
AMENDED IN SENATE AUGUST 6, 2012
AMENDED IN ASSEMBLY JANUARY 23, 2012
INTRODUCED BY Assembly Member Portantino
JANUARY 12, 2011
An act 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.
LEGISLATIVE COUNSEL'S DIGEST
AB 137, Portantino. Health care coverage: mammographies.
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. Under existing law, a health care
service plan contract, except a specialized health care service plan
contract, that is issued, amended, delivered, or renewed on or after
January 1, 2000, is 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, providing care to the patient and operating
within the scope of practice provided under existing law.
Existing law provides for the regulation of health insurers by the
Department of Insurance. Under existing law, an individual or group
policy of disability insurance that is issued, amended, delivered, or
renewed on or after January 1, 2000, is deemed to provide specified
coverage based upon age for mammography for screening or diagnostic
purposes upon referral by a nurse practitioner, certified
nurse-midwife, or physician, providing care to the patient and
operating within the scope of practice provided under existing law.
This bill would provide that specified health care service plan
contracts, except specialized health care service plan contracts, and
individual or group policies of health insurance shall be deemed to
provide coverage for mammographies for screening or diagnostic
purposes upon referral of a participating nurse practitioner,
participating certified nurse-midwife, participating physician
assistant, or participating physician, as specified. Because this
bill would specify additional requirements for health care service
plans, the willful violation of which would be a crime, it 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.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 1367.65 of the Health and Safety Code is
amended to read:
1367.65. (a) 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, participating
physician assistant, or participating physician, providing care to
the patient and operating within the scope of practice provided under
existing law.
(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, nurse
practitioner, or certified nurse midwife providing care.
SEC. 2. Section 10123.81 of the Insurance Code is amended to read:
10123.81. (a) Every individual or group policy of disability
insurance or self-insured employee welfare benefit plan shall be
deemed to provide coverage for mammography for screening or
diagnostic purposes upon the referral of a participating nurse
practitioner, participating certified nurse-midwife, participating
physician assistant, or participating physician, providing care to
the patient and operating within the scope of practice provided under
existing law.
(b) Nothing in this section shall be construed to prevent the
application of copayment or deductible provisions in a policy, nor
shall this section be construed to require that a policy be extended
to cover any other procedures under an individual or a group policy.
Nothing in this section shall be construed to authorize a
policyholder to receive the services required to be covered by this
section if those services are furnished by a nonparticipating
provider, unless the policyholder is referred to that provider by a
participating physician, nurse practitioner, or certified
nurse-midwife providing care.
(c) This section shall not apply to specialized health insurance,
Medicare supplement insurance, short-term limited duration health
insurance, CHAMPUS supplement insurance, or TRI-CARE supplement
insurance, or to hospital indemnity, accident-only, or specified
disease insurance.
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.
