Bill Text: CA SB136 | 2011-2012 | Regular Session | Amended

California Senate Bill 136 (Prior Session Legislation)

NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Public contracts: prevailing wages.

Spectrum: Partisan Bill (Democrat 2-0)

Status: (Passed) 2011-10-09 - Chaptered by Secretary of State. Chapter 698, Statutes of 2011. [SB136 Detail]

Download: California-2011-SB136-Amended.html
BILL NUMBER: SB 136	AMENDED
	BILL TEXT

	AMENDED IN SENATE  APRIL 28, 2011

INTRODUCED BY   Senator Yee

                        JANUARY 31, 2011

    An act to add Section 1367.667 to the Health and Safety
Code, and to add Section 10123.25 to the Insurance Code, relating to
health care coverage.   An act to amend Section
14132.725 of the Welfare and Institution   s Code, relating
to Medi-Cal. 



	LEGISLATIVE COUNSEL'S DIGEST


   SB 136, as amended, Yee.  Health care coverage: tobacco
cessation.   Medi-Cal: telemedicine.  
   Existing law establishes the Medi-Cal program, administered by the
State Department of Health Care Services, under which basic health
care services are provided to qualified low-income persons. The
Medi-Cal program is, in part, governed and funded by federal Medicaid
Program provisions. Existing law provides, to the extent that
federal financial participation is available, that face-to-face
contact between a health care provider and a patient shall not be
required under the Medi-Cal program for teleophthalmology and
teledermatology by store and forward, as defined. Existing law
requires the department to report to the Legislature, on or before
January 1, 2008, the number and type of services provided, and the
payments made related to the application of store and forward
telemedicine as a Medi-Cal benefit. Existing law repeals these
provisions on January 1, 2013.  
   This bill would delete the reporting requirement and would extend
the implementation of these provisions until January 1, 2018. 

   Existing law, the Knox-Keene Health Care Service Plan Act of 1975,
provides for the regulation of health care service plans by the
Department of Managed Health Care and makes a violation of the act a
crime. Existing law provides for the regulation of health insurers by
the Department of Insurance. Existing law requests the University of
California to establish the California Health Benefit Review Program
to assess legislation proposing to mandate a benefit or service and
legislation proposing to repeal a mandated benefit or service, as
specified.  
   This bill would require certain health care service plan contracts
and health insurance policies issued, amended, renewed, or delivered
on or after January 1, 2012, to provide coverage for tobacco
cessation treatment that includes specified courses of treatment and
medication. The bill would request the University of California, as
part of the California Health Benefit Review Program, to prepare a
report regarding any state savings as a result of this coverage
requirement. The bill would make the coverage requirement inoperative
upon a determination that it will result in the state assuming
additional costs, as specified.  
   Because a willful violation of the bill's provisions 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.
State-mandated local program:  yes   no  .


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

   SECTION 1.    Section 14132.725 of the  
Welfare and Institutions Code   is amended to read: 
   14132.725.  (a) Commencing July 1, 2006, to the extent that
federal financial participation is available, face-to-face contact
between a health care provider and a patient shall not be required
under the Medi-Cal program for teleophthalmology and teledermatology
by store and forward. Services appropriately provided through the
store and forward process are subject to billing and reimbursement
policies developed by the department.
   (b) For purposes of this section, "teleophthalmology and
teledermatology by store and forward" means an asynchronous
transmission of medical information to be reviewed at a later time by
a physician at a distant site who is trained in ophthalmology or
dermatology or, for teleophthalmology, by an optometrist who is
licensed pursuant to Chapter 7 (commencing with Section 3000) of
Division 2 of the Business and Professions Code, where the physician
or optometrist at the distant site reviews the medical information
without the patient being present in real time. A patient receiving
teleophthalmology or teledermatology by store and forward shall be
notified of the right to receive interactive communication with the
distant specialist physician or optometrist, and shall receive an
interactive communication with the distant specialist physician or
optometrist, upon request. If requested, communication with the
distant specialist physician or optometrist may occur either at the
time of the consultation, or within 30 days of the patient's
notification of the results of the consultation. If the reviewing
optometrist identifies a disease or condition requiring consultation
or referral pursuant to Section 3041 of the Business and Professions
Code, that consultation or referral shall be with an ophthalmologist
or other appropriate physician and surgeon, as required.
   (c) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department may implement, interpret, and make specific this section
by means of all-county letters, provider bulletins, and similar
instructions. 
   (d) On or before January 1, 2008, the department shall report to
the Legislature the number and type of services provided, and the
payments made related to the application of store and forward
telemedicine as provided, under this section as a Medi-Cal benefit.
 
   (e) 
    (d)  The health care provider shall comply with the
informed consent provisions of subdivisions (c) to (g), inclusive,
of, and subdivisions (i) and (j) of, Section 2290.5 of the Business
and Professions Code when a patient receives teleophthalmology or
teledermatology by store and forward. 
   (f) 
    (e)  This section shall remain in effect only until
January 1,  2013   2018  , and as of that
date is repealed, unless a later enacted statute, that is enacted
before January 1,  2013   2018  , deletes
or extends that date. 
  SECTION 1.    The Legislature hereby finds and
declares the following:
   (a) It is the intent of the Legislature that this act diminish the
statewide economic and personal cost of tobacco addiction by making
tobacco cessation treatments available to all smokers.
   (b) Cigarette smoking and other uses of tobacco remain the leading
cause of preventable death in California, as well as the cause of
many other serious health problems, including heart disease,
emphysema, and other chronic illnesses.
   (c) The treatment of tobacco-related diseases continues to impose
a significant burden on California's health care system, including
local and state-funded health care systems. Tobacco use costs
Californians billions of dollars a year in medical expenses and lost
productivity.
   (d) Providing tobacco cessation counseling and medication is one
of the most clinically effective and cost-effective health services
available, second only to inoculations.
   (e) Reducing the smoking rate in California by one percentage
point will result in approximately $91 million saved over five years
from fewer smoking-caused heart attacks and strokes.
   (f) The United States Public Health Service Clinical Practice
Guideline entitled Treating Tobacco Use and Dependence has identified
the medications and counseling that are scientifically proven to be
effective in helping smokers quit.  
  SEC. 2.    Section 1367.667 is added to the Health
and Safety Code, to read:
   1367.667.  (a) (1) A health care service plan contract issued,
amended, renewed, or delivered on or after January 1, 2012, shall
cover a minimum of two courses of treatment in a 12-month period for
all smoking cessation treatments rated "A" or "B" by the United
States Preventive Services Task Force, which shall include counseling
and over-the-counter medication and prescription pharmacotherapy
approved by the federal Food and Drug Administration.
   (2) The coverage provided pursuant to this section shall only be
available upon the order of an authorized provider. Nothing in this
section shall preclude a health care service plan from allowing
enrollees to access tobacco cessation services on a self-referral
basis.
   (3) As used in this section, "course of treatment" shall be
defined to consist of the following:
   (A) As applied to counseling, at least four sessions of
counseling, which may be telephone, group, or individual counseling
with each session lasting at least 10 minutes.
   (B) As applied to a prescription or over-the-counter medication,
the duration of treatment approved by the federal Food and Drug
Administration for that medication.
   (4) Enrollees shall not be required to enter counseling in order
to receive tobacco cessation medications after the patient's first
course of treatment.
   (5) A health care service plan may not impose prior authorization
or stepped-care requirements on tobacco cessation treatments after
the patient's first course of treatment.
   (b) This section shall not apply to Medicare supplement plan
contracts or to specialized health care service plan contracts.
   (c) The Legislature hereby requests that the University of
California, as part of the California Health Benefit Review Program
established under Section 127660, prepare a report by December 31,
2014, evaluating the requirements of this section and determining any
state savings as a result of those requirements. The Legislature
requests that this report be made available to the Legislature, the
Department of Insurance, and the Department of Managed Health Care.
   (d) This section shall become inoperative on the date that the
state determines that, taking into account any state savings
identified under subdivision (c), the requirements of this section
will result in the state assuming additional costs pursuant to
subparagraph (B) of paragraph (3) of subsection (d) of Section 1311
of the federal Patient Protection and Affordable Care Act (Public Law
111-148), as amended by subsection (e) of Section 10104 of Title X
of that act.  
  SEC. 3.    Section 10123.25 is added to the
Insurance Code, to read:
   10123.25.  (a) (1) A health insurance policy issued, amended,
renewed, or delivered on or after January 1, 2012, shall cover a
minimum of two courses of treatment in a 12-month period for all
smoking cessation treatments rated "A" or "B" by the United States
Preventive Services Task Force, which shall include counseling and
over-the-counter medication and prescription pharmacotherapy approved
by the federal Food and Drug Administration.
   (2) The coverage provided pursuant to this section shall only be
available upon the order of an authorized provider. Nothing in this
section shall preclude an insurer from allowing insureds to access
tobacco cessation services on a self-referral basis.
   (3) As used in this section, "course of treatment" shall be
defined to consist of the following:
   (A) As applied to counseling, at least four sessions of
counseling, which may be telephone, group, or individual counseling
with each session lasting at least 10 minutes.
   (B) As applied to a prescription or over-the-counter medication,
the duration of treatment approved by the federal Food and Drug
Administration for that medication.
   (4) Insureds shall not be required to enter counseling in order to
receive tobacco cessation medications after the patient's first
course of treatment.
   (5) A health insurer shall not impose prior authorization or
stepped-care requirements on tobacco cessation treatments after the
patient's first course of treatment.
   (b) This section shall not apply to Medicare supplement policies
or to specialized health insurance policies.
   (c) The Legislature hereby requests that the University of
California, as part of the California Health Benefit Review Program
established under Section 127660 of the Health and Safety Code,
prepare a report by December 31, 2014, evaluating the requirements of
this section and determining any state savings as a result of those
requirements. The Legislature requests that this report be made
available to the Legislature, the Department of Insurance, and the
Department of Managed Health Care.
   (d) This section shall become inoperative on the date that the
state determines that, taking into account any state savings
identified under subdivision (c), the requirements of this section
will result in the state assuming additional costs pursuant to
subparagraph (B) of paragraph (3) of subsection (d) of Section 1311
of the federal Patient Protection and Affordable Care Act (Public Law
111-148), as amended by subsection (e) of Section 10104 of Title X
of that act.  
  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.