Bill Text: CA AB1000 | 2011-2012 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Health care coverage: cancer treatment.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Vetoed) 2012-09-30 - Consideration of Governor's veto pending. [AB1000 Detail]

Download: California-2011-AB1000-Amended.html

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BILL NUMBER: AB 1000	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  JANUARY 23, 2012

INTRODUCED BY   Assembly Member Perea

                        FEBRUARY 18, 2011

   An act to add and repeal Section 1367.655 of the Health and Safety
Code, and to add and repeal Section 10123.205 of 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  plans
  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. The bill would specify that its
provisions do not apply   drugs or  to a health
care benefit plan, contract, or health insurance policy with the
Board of Administration of the Public Employees' Retirement System.
   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) A health care service plan contract issued,
amended, or renewed on or after January 1,  2012, 
 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).  
   (g) 
    (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,  2012,   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).  
   (g) 
    (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.