Bill Text: CA AB2941 | 2017-2018 | Regular Session | Introduced

California Assembly Bill 2941 (Prior Session Legislation)

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

Bill Title: Health care coverage: state of emergency.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Passed) 2018-08-24 - Chaptered by Secretary of State - Chapter 196, Statutes of 2018. [AB2941 Detail]

Download: California-2017-AB2941-Introduced.html

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Assembly Bill

No. 2941

Introduced by Assembly Member Berman

February 16, 2018

An act to add Section 1368.7 to the Health and Safety Code, and to add Section 10112.95 to the Insurance Code, relating to health care coverage.

LEGISLATIVE COUNSEL'S DIGEST

AB 2941, as introduced, Berman. Health care coverage: state of emergency.

Existing law, the Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene), 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 provides for the regulation of health insurers by the Department of Insurance. Existing law requires the Department of Managed Health Care and the Insurance Commissioner to adopt regulations to ensure enrollees and insureds have access to needed health care services in a timely manner, and requires a health care service plan contract or health insurance policy to provide information to an enrollee or insured regarding the standards for timely access to care.

This bill would require a health care service plan or health insurer to ensure its enrollees or insureds who have been displaced by a state of emergency, as defined, have continued appropriate access to medically necessary health care services, as specified. 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 Local Program: YES

The people of the State of California do enact as follows:

SECTION 1.

Section 1368.7 is added to the Health and Safety Code, to read:

1368.7.

A health care service plan shall ensure an enrollee who has been displaced by a state of emergency, as declared by the Governor pursuant to Section 8625 of the Government Code, has continued appropriate access to medically necessary health care services. This may require a plan to:

(a) Relax time limits for prior authorization, precertification, or referrals.

(b) Extend filing deadlines for claims.

(c) Suspend prescription refill limitations and allow an impacted enrollee to refill his or her prescriptions at an out-of-network pharmacy.

(d) Allow an enrollee to replace medical equipment or supplies.

(e) Allow an enrollee to access an appropriate out-of-network provider if an in-network provider is unavailable due to the state of emergency or if the enrollee is out of the area due to displacement.

(f) Have a toll-free telephone number that an affected enrollee may call for answers to questions, including questions about the loss of health insurance identification cards, access to prescription refills, or how to access health care.

(g) Other actions determined to be necessary by the department.

SEC. 2.

Section 10112.95 is added to the Insurance Code, to read:

10112.95.

A health insurer shall ensure an insured who has been displaced by a state of emergency, as declared by the Governor pursuant to Section 8625 of the Government Code, has continued appropriate access to medically necessary health care services. This may require an insurer to:

(a) Relax time limits for prior authorization, precertification, or referrals.

(b) Extend filing deadlines for claims.

(c) Suspend prescription refill limitations and allow an impacted insured to refill his or her prescriptions at an out-of-network pharmacy.

(d) Allow an insured to replace medical equipment or supplies.

(e) Allow an insured to access an appropriate out-of-network provider if an in-network provider is unavailable due to the state of emergency or if the insured is out of the area due to displacement.

(f) Have a toll-free telephone number that an affected insured may call for answers to questions, including questions about the loss of health insurance identification cards, access to prescription refills, or how to access health care.

(g) Other actions determined to be necessary by the department.

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.