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 SENATE  AUGUST 9, 2012
	AMENDED IN SENATE  AUGUST 6, 2012
	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  issued, amended, or renewed on or after
July 1, 2013,  that provides coverage for cancer chemotherapy
treatment from 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 outpatient 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   July 1, 2013, that
provides coverage for cancer chemotherapy treatment shall not require
a higher copayment, deductible, or coinsurance amount for a
prescribed, orally administered anticancer medication that is used to
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
conducting utilization review 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 outpatient prescription
drugs.
   (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).
   (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   July  1, 2013, that provides
coverage for cancer chemotherapy treatment shall not require a higher
copayment, deductible, or coinsurance amount for a prescribed,
orally administered anticancer medication that is used to 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 conducting
utilization review in approving coverage for any chemotherapy.
   (d) This section shall not apply to a health insurance policy that
does not provide coverage for outpatient prescription drugs.
   (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).
   (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.