Bill Text: CA SB974 | 2021-2022 | Regular Session | Amended
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Health care coverage: diagnostic imaging.
Spectrum: Moderate Partisan Bill (Democrat 7-2)
Status: (Vetoed) 2022-09-27 - In Senate. Consideration of Governor's veto pending. [SB974 Detail]
Download: California-2021-SB974-Amended.html
Bill Title: Health care coverage: diagnostic imaging.
Spectrum: Moderate Partisan Bill (Democrat 7-2)
Status: (Vetoed) 2022-09-27 - In Senate. Consideration of Governor's veto pending. [SB974 Detail]
Download: California-2021-SB974-Amended.html
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Amended
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Senate
April 25, 2022 |
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Amended
IN
Senate
April 06, 2022 |
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Amended
IN
Senate
March 17, 2022 |
CALIFORNIA LEGISLATURE—
2021–2022 REGULAR SESSION
Senate Bill
No. 974
| Introduced by Senator Portantino (Principal coauthor: Assembly Member Cristina Garcia) (Coauthors: Senators Archuleta, Borgeas, Hueso, and Nielsen) (Coauthors: Assembly Members Cooley and Luz Rivas) |
February 10, 2022 |
An act to amend Section 1367.65 of the Health and Safety Code, and to amend Section 10123.81 of the Insurance Code, relating to health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
SB 974, as amended, Portantino.
Health care coverage: diagnostic imaging.
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 provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan contract issued, amended, delivered, or renewed on or after January 1, 2000, or an individual or group policy of disability insurance or self-insured employee welfare benefit plan to provide coverage for mammography for screening or diagnostic purposes upon referral by specified professionals. Under existing law, mammography performed pursuant to those requirements or that meets the current recommendations of the United States Preventive Services Task Force is provided to an enrollee or an insured without cost
sharing.
This bill would require a health care service plan contract, an individual or group policy of disability insurance that provides hospital, medical, or surgical coverage, or a self-insured employee welfare benefit plan issued, amended, or renewed on or after January 1, 2023, to provide coverage without imposing cost sharing for screening mammography and medically necessary diagnostic breast imaging, including diagnostic breast imaging following an abnormal mammography result and for an enrollee or insured indicated to have a risk factor associated with breast cancer.
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 1367.65 of the Health and Safety Code is amended to read:1367.65.
(a) (1) A health care service plan contract issued, amended, or renewed on or after January 1, 2000, excluding a specialized health care service plan contract, shall provide coverage for mammography for screening or diagnostic purposes upon referral by a participating nurse practitioner, participating certified nurse-midwife, participating physician assistant, or participating physician, providing care to the patient and operating within the scope of practice provided under existing law.(2) This subdivision does not prevent application of copayment or deductible provisions in a plan, nor shall this subdivision be construed to require that a plan be extended to cover any
other procedures under an individual or a group health care service plan contract.
(b) A health care service plan contract issued, amended, or renewed on or after January 1, 2023, excluding a specialized health care service plan contract, shall provide coverage without imposing cost sharing for screening mammography and medically necessary diagnostic breast imaging, including diagnostic breast imaging following an abnormal mammography result and for an enrollee indicated to have a risk factor associated with breast cancer, including family history or known genetic mutation. Diagnostic breast imaging includes breast magnetic resonance imaging, breast ultrasound, and other clinically indicated diagnostic testing. Diagnostic breast imaging is covered under this
subdivision to the extent it is consistent with nationally recognized evidence-based clinical guidelines.
(c) This section does not authorize an enrollee to receive the services required to be covered by this section if those services are furnished by a nonparticipating provider, unless the enrollee is referred to that provider by a participating physician, nurse practitioner, or certified nurse-midwife providing care. provider.
(d) Subdivision (b) does not preclude a health care service plan that provides coverage for out-of-network
benefits from imposing cost-sharing requirements for the items or services described in this section that are delivered by an out-of-network provider.
SEC. 2.
Section 10123.81 of the Insurance Code is amended to read:10123.81.
(a) (1) An individual or group policy of disability insurance or self-insured employee welfare benefit plan shall be deemed to provide coverage for mammography for screening or diagnostic purposes upon the referral of a participating nurse practitioner, participating certified nurse-midwife, participating physician assistant, or participating physician, providing care to the patient and operating within the scope of practice provided under existing law.(2) This subdivision does not prevent the application of copayment or deductible provisions in a policy, nor does this section require that a policy be extended to cover any other procedures under an
individual or a group policy.
(b) An individual or group policy of disability insurance that provides hospital, medical, or surgical coverage or a self-insured employee welfare benefit plan issued, amended, or renewed on or after January 1, 2023, shall provide coverage without imposing cost sharing for screening mammography and necessary diagnostic breast imaging, including diagnostic breast imaging following an abnormal mammography result and for an insured indicated to have a risk factor associated with breast cancer, including family history or known genetic mutation. Diagnostic breast imaging includes breast magnetic resonance imaging, breast ultrasound, and other clinically indicated diagnostic testing. Diagnostic breast imaging is covered under this subdivision
to the extent it is consistent with nationally recognized evidence-based clinical guidelines.
(c) This section does not authorize a policyholder an insured to receive the services required to be covered by this section if those services are furnished by a nonparticipating provider, unless the policyholder insured is referred to that provider by a participating physician, nurse practitioner, or certified nurse-midwife providing care.
(d) This section does not apply to specialized health insurance, Medicare supplement insurance, CHAMPUS supplement insurance, or TRI-CARE supplement insurance, or to hospital indemnity, accident-only, or specified disease insurance.
(e) Subdivision (b) does not preclude a disability insurer that provides coverage for out-of-network benefits from imposing cost-sharing requirements for the items or services described in this section that are delivered by an out-of-network provider.
