Bill Text: CA AB1763 | 2015-2016 | Regular Session | Enrolled
Bill Title: Health care coverage: colorectal cancer: screening and testing.
Sponsorship: Partisan Bill (Democrat 1)
Status: (Vetoed) 2016-09-23 - Vetoed by Governor. [AB1763 Detail]
Download: California-2015-AB1763-Enrolled.html
BILL NUMBER: AB 1763 ENROLLED
BILL TEXT
PASSED THE SENATE AUGUST 18, 2016
PASSED THE ASSEMBLY AUGUST 23, 2016
AMENDED IN SENATE JUNE 27, 2016
AMENDED IN ASSEMBLY MAY 31, 2016
AMENDED IN ASSEMBLY APRIL 27, 2016
INTRODUCED BY Assembly Member Gipson
FEBRUARY 3, 2016
An act to add Section 1367.667 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 1763, Gipson. Health care coverage: colorectal cancer:
screening and testing.
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
include 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, 2018, to provide coverage
without cost sharing for colorectal cancer screening examinations and
laboratory tests, as specified. The bill would require the coverage
to include additional colorectal cancer screening examinations as
listed by the United States Preventive Services Task Force as a
recommended screening strategy and at least at the frequency
established pursuant to regulations issued by the federal Centers for
Medicare and Medicaid Services for the Medicare program if the
individual is at high risk for colorectal cancer. The bill would
prohibit a health care service plan contract or a health insurance
policy from imposing cost sharing on an individual who is between 50
and 75 years of age for colonoscopies conducted for specified
purposes. The bill would also provide that it does not require a plan
or insurer to provide benefits for items or services delivered by an
out-of-network provider and does not preclude a plan or insurer from
imposing cost-sharing requirements for items or services that are
delivered by an out-of-network provider. 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.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 1367.667 is added to the Health and Safety
Code, to read:
1367.667. (a) Every health care service plan contract, except a
specialized health care service plan contract, that is issued,
amended, or renewed on or after January 1, 2018, shall provide
coverage without any cost sharing for all colorectal cancer screening
examinations and laboratory tests assigned either a grade of A or a
grade of B by the United States Preventive Services Task Force for
individuals at average risk. If an enrollee is at high risk for
colorectal cancer, the coverage required by this subdivision shall
include additional colorectal cancer screening examinations as listed
by the United States Preventive Services Task Force as a recommended
screening strategy and at least at the frequency established
pursuant to regulations issued by the federal Centers for Medicare
and Medicaid Services for the Medicare program.
(b) For an enrollee who is between 50 and 75 years of age, a
health care service plan contract shall not impose cost sharing on
colonoscopies, including the removal of polyps, when either of the
following applies:
(1) The colonoscopy is a screening procedure not occasioned by a
recent positive test or procedure.
(2) The colonoscopy has been scheduled because of a positive
result on a test or procedure, other than a colonoscopy, assigned
either a grade of A or a grade of B by the United States Preventive
Services Task Force.
(c) Nothing in this section requires a plan that has a network of
providers to provide benefits for items or services described in this
section that are delivered by an out-of-network provider or
precludes a plan that has a network of providers from imposing
cost-sharing requirements for the items or services described in this
section that are delivered by an out-of-network provider.
SEC. 2. Section 10123.205 is added to the Insurance Code, to read:
10123.205. (a) Every health insurance policy, except a
specialized health insurance policy, that is issued, amended, or
renewed on or after January 1, 2018, shall provide coverage without
cost sharing for all colorectal cancer screening examinations and
laboratory tests assigned either a grade of A or a grade of B by the
United States Preventive Services Task Force for individuals at
average risk. If an insured is at high risk for colorectal cancer,
the coverage required by this subdivision shall include additional
colorectal cancer screening examinations as listed by the United
States Preventive Services Task Force as a recommended screening
strategy and at least at the frequency established pursuant to
regulations issued by the federal Centers for Medicare and Medicaid
Services for the Medicare program.
(b) For an insured who is between 50 and 75 years of age, a health
insurance policy shall not impose cost sharing on colonoscopies,
including the removal of polyps, when either of the following
applies:
(1) The colonoscopy is a screening procedure not occasioned by a
recent positive test or procedure.
(2) The colonoscopy has been scheduled because of a positive
result on a test or procedure, other than a colonoscopy, assigned
either a grade of A or a grade of B by the United States Preventive
Services Task Force.
(c) Nothing in this section requires an insurer that has a network
of providers to provide benefits for items or services described in
this section that are delivered by an out-of-network provider or
precludes an insurer that has a network of providers from imposing
cost-sharing requirements for the items or services described in this
section that are delivered by an out-of-network provider.
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.
