Bill Text: CA AB72 | 2011-2012 | Regular Session | Amended
Bill Title: Health care coverage: acupuncture.
Spectrum: Slight Partisan Bill (Democrat 5-2)
Status: (Introduced - Dead) 2012-02-01 - Died pursuant to Art. IV, Sec. 10(c) of the Constitution. From committee: Filed with the Chief Clerk pursuant to Joint Rule 56. [AB72 Detail]
Download: California-2011-AB72-Amended.html
BILL NUMBER: AB 72 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY APRIL 4, 2011
INTRODUCED BY Assembly Member Eng
( Coauthors: Assembly Members
Dickinson, Fong, Ma, Nielsen,
and Swanson )
( Coauthor: Senator Huff
)
DECEMBER 21, 2010
An act to amend Section 1373.10 of the Health and Safety Code, and
to amend Sections 10127.3 and 10176 of the Insurance Code, relating
to health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
AB 72, as amended, Eng. Health care coverage: acupuncture.
Existing law requires a health care service plan, that is not a
health care maintenance organization or is not a
plan that enters exclusively into specialized health care service
plan contracts, and a disability health
insurer issuing policies on a groupwide basis, to offer acupuncture
coverage under those terms and conditions as may be agreed upon by
the parties , with specified exceptions .
Existing law provides that a plan or insurer is not required to offer
"that Coverage as" part of a contract or policy covering public
employees. A willful violation of the laws
regulating health care service plans is a crime.
This bill would instead require every health care service plan,
except a plan that enters exclusively into contracts that are
accident-only, specified disease, hospital indemnity, Medicare
supplement, or specialized health care service plan contracts,
and every disability health insurer
issuing policies on a groupwide basis , except for policies that
are accident-only, specified disease, hospital indemnity, Medicare
supplement, or specialized health insurance policies
, to provide acupuncture coverage under those terms and conditions
as may be agreed upon by the parties.
Because a violation of this bill's requirements with respect to a
health care service plan would be a crime, this bill would impose a
state-mandated local program by creating a new crime.
Existing law authorizing a disability insurance policy to provide
payment for acupuncture services requires that the disability
insurance policy or contract expressly include acupuncture as a
benefit in order for a licensed or certified acupuncturist to be paid
or reimbursed under the policy for his or her services.
This bill would delete the requirement conditioning the payment
and reimbursement of a certified or licensed acupuncturist, for his
or her services, on the express inclusion of acupuncture as a benefit
in a disability insurance policy or contract. This bill would also
make technical and conforming changes.
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 1373.10 of the Health and Safety Code is
amended to read:
1373.10. (a) On and after January 1, 1985, every health care
service plan, that is not a health maintenance organization or is not
a plan that enters exclusively into specialized health care service
plan contracts, as defined by subdivision (o) of Section 1345, that
provides coverage for hospital, medical, or surgical expenses, shall
offer coverage to group contractholders for expenses incurred as a
result of treatment by holders of certificates under Section 4938 of
the Business and Professions Code, under terms and conditions as may
be agreed upon between the health care service plan and the
groupcontract holder.
(b) (1) On and after January 1, 2012,
except as provided in paragraph (2), every health care service
plan, that is not a plan that enters exclusively into
specialized health care service plan contracts, as defined by
subdivision (o) of Section 1345, plan that
provides coverage for hospital, medical, or surgical expenses, shall
provide coverage to group contractholders for expenses incurred as a
result of treatment by holders of certificates under Section 4938 of
the Business and Professions Code, under terms and conditions as may
be agreed upon between the health care service plan and the group
contractholder.
(2) This subdivision shall not apply to plan contracts that are
accident-only, specified disease, hospital indemnity, Medicare
supplement, or specialized health care service plan contracts, as
defined in subdivision (o) of Section 1345.
SEC. 2. Section 10127.3 of the Insurance Code is amended to read:
10127.3. (a) On and after January 1, 1985, every insurer issuing
group disability insurance that covers hospital, medical, or surgical
expenses shall offer coverage for expenses incurred as a result of
treatment by holders of certificates under Section 4938 of the
Business and Professions Code, under terms and conditions as may be
agreed upon between the group policyholder and the insurer.
(b) (1) On and after January 1, 2012,
except as provided in paragraph (2), every insurer issuing
group disability insurance that covers hospital, medical, or
surgical expenses health insurance shall
provide coverage for expenses incurred as a result of treatment by
holders of certificates under Section 4938 of the Business and
Professions Code, under terms and conditions as may be agreed upon
between the group policyholder and the insurer.
(2) This subdivision shall not apply to insurance policies that
are accident-only, specified disease, hospital indemnity, Medicare
supplement insurance, or specialized health insurance policies, as
defined in subdivision (c) of Section 106.
SEC. 3. Section 10176 of the Insurance Code is amended to read:
10176. In disability insurance, the policy may provide for
payment of medical, surgical, chiropractic, physical therapy, speech
pathology, audiology, acupuncture, professional mental health,
dental, hospital, or optometric expenses upon a reimbursement basis,
or for the exclusion of any of those services, and provision may be
made therein for payment of all or a portion of the amount of charge
for these services without requiring that the insured first pay the
expenses. The policy shall not prohibit the insured from selecting
any psychologist or other person who is the holder of a certificate
or license under Section 1000, 1634, 2050, 2472, 2553, 2630, 2948,
3055, or 4938 of the Business and Professions Code, to perform the
particular services covered under the terms of the policy, the
certificate holder or licensee being expressly authorized by law to
perform those services.
Nor shall the policy prohibit the insured, upon referral by a
physician and surgeon licensed under Section 2050 of the Business and
Professions Code, from selecting any licensed clinical social worker
who is the holder of a license issued under Section 4996 of the
Business and Professions Code or any occupational therapist as
specified in Section 2570.2 of the Business and Professions Code, or
any marriage and family therapist who is the holder of a license
under Section 4980.50 of the Business and Professions Code, to
perform the particular services covered under the terms of the
policy, or from selecting any speech-language pathologist or
audiologist licensed under Section 2532 of the Business and
Professions Code or any registered nurse licensed pursuant to Chapter
6 (commencing with Section 2700) of Division 2 of the Business and
Professions Code, who possesses a master's degree in
psychiatric-mental health nursing and is listed as a
psychiatric-mental health nurse by the Board of Registered Nursing or
any advanced practice registered nurse certified as a clinical nurse
specialist pursuant to Article 9 (commencing with Section 2838) of
Chapter 6 of Division 2 of the Business and Professions Code who
participates in expert clinical practice in the specialty of
psychiatric-mental health nursing, or any respiratory care
practitioner certified pursuant to Chapter 8.3 (commencing with
Section 3700) of Division 2 of the Business and Professions Code to
perform services deemed necessary by the referring physician, that
certificate holder, licensee or otherwise regulated person, being
expressly authorized by law to perform the services.
Nothing in this section shall be construed to allow any
certificate holder or licensee enumerated in this section to perform
professional mental health services beyond his or her field or fields
of competence as established by his or her education, training, and
experience. For the purposes of this section, "marriage and family
therapist" means a licensed marriage and family therapist who has
received specific instruction in assessment, diagnosis, prognosis,
and counseling, and psychotherapeutic treatment of premarital,
marriage, family, and child relationship dysfunctions that is
equivalent to the instruction required for licensure on January 1,
1981.
An individual disability insurance policy, which is issued,
renewed, or amended on or after January 1, 1988, and which includes
mental health services coverage may not include a lifetime waiver for
that coverage with respect to any applicant. The lifetime waiver of
coverage provision shall be deemed unenforceable.
SEC. 4. 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.
