Bill Text: CA AB2668 | 2023-2024 | Regular Session | Introduced
Bill Title: Coverage for cranial prostheses.
Spectrum: Slight Partisan Bill (Democrat 4-2)
Status: (Introduced) 2024-05-16 - In committee: Held under submission. [AB2668 Detail]
Download: California-2023-AB2668-Introduced.html
CALIFORNIA LEGISLATURE—
2023–2024 REGULAR SESSION
Assembly Bill
No. 2668
| Introduced by Assembly Member Berman |
February 14, 2024 |
An act to add Section 1367.651 to the Health and Safety Code, to add Section 10123.811 to the Insurance Code, and to add Section 14132.65 to the Welfare and Institutions Code, relating to health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
AB 2668, as introduced, Berman.
Coverage for cranial prostheses.
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 plans and health insurers to provide coverage for prosthetic devices in connection with specified health conditions and procedures.
This bill would require a health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2025, to cover cranial prostheses, as defined, for individuals experiencing permanent or temporary medical hair loss. The bill would require a licensed provider to prescribe the cranial prosthesis for an individual’s
course of treatment for a diagnosed health condition, chronic illness, or injury, as specified. The bill would limit coverage to once every 12 months and $750 for each instance of coverage. The bill would not apply these provisions to a specialized health care service plan or specialized health insurance policy. Because a violation of these requirements by a health care service plan would be a crime, the bill would impose a state-mandated local program.
Existing law also establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.
Commencing January 1, 2025, this bill would require coverage for cranial prostheses for individuals experiencing permanent or temporary medical hair loss. or treatment for those
conditions as a Medi-Cal benefit, subject to the same requirements with respect to provider prescription, coverage frequency, and amount. The bill would not apply these provisions to a specialized health care service plan.
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.
Digest Key
Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YESBill Text
The people of the State of California do enact as follows:
SECTION 1.
Section 1367.651 is added to the Health and Safety Code, to read:1367.651.
(a) A health care service plan contract issued, amended, or renewed on and after January 1, 2025, shall cover cranial prostheses for individuals experiencing permanent or temporary medical hair loss, in accordance with subdivision (b).(b) Coverage under this section shall meet all of the following requirements:
(1) A licensed provider prescribes the cranial prosthesis for an enrollee’s or subscriber’s course of treatment for the diagnosed health condition, chronic illness, or injury, including, but not limited to, alopecia areata, alopecia medicamentosa, scarring alopecia, and lupus. For purposes of this section, “cranial prosthesis” means a wig or hairpiece.
(2) The contract provides coverage for a cranial prosthesis to an individual enrollee or subscriber no more frequently than once every 12 months.
(3) The coverage is limited to seven hundred fifty dollars ($750) for each instance of coverage, and shall be subject to any cost-sharing requirements that are otherwise applicable under the health care service plan contract.
(c) This section shall not apply to specialized health care service plans.
SEC. 2.
Section 10123.811 is added to the Insurance Code, to read:10123.811.
(a) A health insurance policy issued, amended, or renewed on and after January 1, 2025, shall provide coverage for cranial prostheses for individuals experiencing permanent or temporary medical hair loss, in accordance with subdivision (b).(b) Coverage under this section shall meet all of the following requirements:
(1) A licensed provider prescribes the cranial prosthesis for an insured’s or policyholder’s course of treatment for the diagnosed health condition, chronic illness, or injury including, but not limited to, alopecia areata, alopecia medicamentosa, scarring alopecia, and lupus. For purposes of this section, “cranial prosthesis” means a wig or hairpiece.
(2) The contract provides coverage for a cranial prosthesis to an individual insured or policyholder no more frequently than once every 12 months.
(3) The coverage is limited to seven hundred fifty dollars ($750) for each instance of coverage, and shall be subject to any cost-sharing requirements that are otherwise applicable under the health insurance policy.
(c) This section shall not apply to specialized health insurance policies.
SEC. 3.
Section 14132.65 is added to the Welfare and Institutions Code, to read:14132.65.
(a) Commencing January 1, 2025, cranial prostheses for individuals experiencing permanent or temporary medical hair loss are a covered benefit, in accordance with subdivision (b).(b) Coverage under this section shall meet all of the following requirements:
(1) A licensed provider prescribes the cranial prosthesis for a beneficiary’s course of treatment for a diagnosed health condition, chronic illness, or injury including, but not limited to, alopecia areata, alopecia medicamentosa, scarring alopecia, and lupus. For purposes of this section, “cranial prosthesis” means a wig or hairpiece.
(2) Coverage for a cranial
prosthesis is provided to an individual beneficiary no more frequently than once every 12 months.
(3) Coverage is limited to seven hundred fifty dollars ($750) for each instance of coverage.
(c) This section shall not apply to specialized health care service plans.
