BILL NUMBER: SB 1279 INTRODUCED
BILL TEXT
INTRODUCED BY Senator Calderon
FEBRUARY 21, 2014
An act to add Section 1367.667 to, and to add Article 4
(commencing with Section 104201) to Chapter 2 of Part 1 of Division
103 of, the Health and Safety Code, and to add Section 10123.22 to
the Insurance Code, relating to health care coverage, and declaring
the urgency thereof, to take effect immediately.
LEGISLATIVE COUNSEL'S DIGEST
SB 1279, as introduced, Calderon. Marcella Calderon Lynch Syndrome
Prevention Act.
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
includes 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, 2015, to provide coverage
for genetic testing for Lynch syndrome and annual screenings for
Lynch Syndrome under specified circumstances. 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.
This bill would also require a physician and surgeon who makes a
diagnosis that a patient has Lynch syndrome to provide the patient
with specified information.
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.
This bill would declare that it is to take effect immediately as
an urgency statute.
Vote: 2/3. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. This act shall be known, and may be cited, as the
Marcella Calderon Lynch Syndrome Prevention Act.
SEC. 2. 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, 2015, shall provide
coverage for all of the following:
(1) Genetic testing for Lynch Syndrome for an enrollee who has
been diagnosed with Lynch Syndrome.
(2) Genetic testing for Lynch Syndrome for an enrollee who is the
child or sibling of an individual who has been diagnosed with Lynch
Syndrome and has tested positive for the gene mutation for Lynch
Syndrome.
(3) Annual screens, including colonoscopies, for an enrollee who
has tested positive for the gene mutation for Lynch Syndrome, and is
the child or sibling of an individual who has been diagnosed with
Lynch Syndrome and has tested positive for the gene mutation for
Lynch Syndrome.
(b) Notwithstanding subdivision (f) of Section 100503 of the
Government Code and subdivision (c) of Section 1366.6, to the extent
that this section requires health benefits to be provided that exceed
the essential health benefits required to be provided under Section
18022 of Title 42 of the United States Code by qualified health plans
offering those benefits in the California Health Benefit Exchange
(Exchange) pursuant to Title 22 (commencing with Section 100500) of
the Government Code, the specific benefits that exceed the federally
required essential health benefits are not required to be provided
when offered by a health care service plan contract through the
Exchange. However, those specific benefits are required to be
provided if offered by a health care service plan contract outside of
the Exchange.
SEC. 3. Article 4 (commencing with Section 104201) is added to
Chapter 2 of Part 1 of Division 103 of the Health and Safety Code, to
read:
Article 4. Lynch Syndrome
104201. If a physician and surgeon makes a diagnosis that a
patient has Lynch Syndrome, the physician and surgeon shall recommend
that the patient be tested for the genetic mutation for Lynch
Syndrome. The physician and surgeon shall also inform the patient
that genetic testing for Lynch Syndrome may be covered by the patient'
s health care coverage, and that genetic testing and screening for
his or her children or siblings may be covered by the children's or
siblings' health care coverage if the patient tests positive for the
Lynch Syndrome gene mutation.
SEC. 4. Section 10123.22 is added to the Insurance Code, to read:
10123.22. (a) Every health insurance policy, except a specialized
health insurance policy, that is issued, amended, or renewed on or
after January 1, 2015, shall provide coverage for all of the
following:
(1) Genetic testing for Lynch Syndrome for an insured who has been
diagnosed with Lynch Syndrome.
(2) Genetic testing for Lynch Syndrome for an insured who is the
child or sibling of an individual who has been diagnosed with Lynch
Syndrome and has tested positive for the gene mutation for Lynch
Syndrome.
(3) Annual screens, including colonoscopies, for an insured who
has tested positive for the gene mutation for Lynch Syndrome, and is
the child or sibling of an individual who has been diagnosed with
Lynch Syndrome and has tested positive for the gene mutation for
Lynch Syndrome.
(b) Notwithstanding subdivision (f) of Section 100503 of the
Government Code and subdivision (c) of Section 10112.3, to the extent
that this section requires health benefits to be provided that
exceed the essential health benefits required to be provided under
Section 18022 of Title 42 of the United States Code by qualified
health plans offering those benefits in the California Health Benefit
Exchange (Exchange) pursuant to Title 22 (commencing with Section
100500) of the Government Code, the specific benefits that exceed the
federally required essential health benefits are not required to be
provided when offered by a health insurance policy through the
Exchange. However, those specific benefits are required to be
provided if offered by a health insurance policy outside of the
Exchange.
SEC. 5. 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.
SEC. 6. This act is an urgency statute necessary for the
immediate preservation of the public peace, health, or safety within
the meaning of Article IV of the Constitution and shall go into
immediate effect. The facts constituting the necessity are:
In order to protect the health of all Californians at the earliest
possible time, it is necessary that this act take effect
immediately.