Today's Law As Amended


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AB-18 Health care coverage: pediatric oral care benefits.(2013-2014)



As Amends the Law Today


SECTION 1.

 Section 1367.013 is added to the Health and Safety Code, to read:

1367.013.
 (a) Beginning on January 1, 2014, a specialized health care service plan contract described in Section 1311(d)(2)(B)(ii) of PPACA (42 U.S.C. Sec. 18031(d)(2)(B)(ii)) that provides pediatric oral care benefits, whether or not it is bundled with a qualified health plan or standing alone, shall be subject to Sections 1367 and 1367.03.
(b) Beginning on January 1, 2015, a specialized health care service plan contract described in Section 1311(d)(2)(B)(ii) of PPACA (42 U.S.C. Sec. 18031(d)(2)(B)(ii)) that provides pediatric oral care benefits, whether or not it is bundled with a qualified health plan or standing alone, shall be subject to Article 6.2 (commencing with Section 1385.01).

SEC. 2.

 Section 1367.37 is added to the Health and Safety Code, to read:

1367.37.
 (a) (1) Notwithstanding Section 1367.003, beginning on January 1, 2015, every specialized health care service plan contract described in Section 1311(d)(2)(B)(ii) of PPACA (42 U.S.C. Sec. 18031(d)(2)(B)(ii)), as defined in Section 1367.005, providing pediatric oral care benefits, whether or not it is bundled with a qualified health plan or standing alone, shall provide an annual rebate to each enrollee under that coverage, on a pro rata basis, if the ratio of the amount of premium revenue expended by the specialized health care service plan on the costs for reimbursement for services provided to enrollees under that coverage and for activities that improve dental care quality to the total amount of premium revenue, excluding federal and state taxes and licensing or regulatory fees, and after accounting for payments or receipts for risk adjustment, risk corridors, and reinsurance, is less than 75 percent.
(2) Every specialized health care service plan contract described in this subdivision shall maintain a minimum medical loss ratio of 75 percent.
(b) (1) The director may adopt regulations in accordance with the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code) that are necessary to implement the medical loss ratio as described under Section 2718 of the federal Public Health Service Act (42 U.S.C. Sec. 300gg-18), and any federal rules or regulations issued under that section.
(2) The director may also adopt emergency regulations in accordance with the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code) when it is necessary to implement the applicable provisions of this section and to address specific conflicts between state and federal law that prevent implementation of federal law and guidance pursuant to Section 2718 of the federal Public Health Service Act (42 U.S.C. Sec. 300gg-18). The initial adoption of the emergency regulations shall be deemed to be an emergency and necessary for the immediate preservation of the public peace, health, safety, or general welfare.
(c) The department shall consult with the Department of Insurance in adopting necessary regulations, and in taking any other action for the purpose of implementing this section.

SEC. 4.SEC. 3.

 Section 1385.02 of the Health and Safety Code is amended to read:

1385.02.
 This article shall apply to a  health care service plan contract contracts  offered in the individual or group market in California. However, this article shall not apply to a specialized health care service plan contract, a  other than one providing pediatric oral care benefits, whether or not it is bundled with a qualified health plan or standing alone, as described in Section 1367.013; a  Medicare supplement contract subject to Article 3.5 (commencing with Section 1358.1), 1358.1);  a health care service plan contract offered in the Medi-Cal program (Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of the Welfare and Institutions Code), Code);  a health care service plan contract offered in the Healthy Families Program (Part 6.2 (commencing with Section 12693) of Division 2 of the Insurance Code), the Access for Infants and Mothers Program (Part 6.3 (commencing with Section 12695) of Division 2 of the Insurance Code), the  California Major Risk Medical Insurance Program (Part 6.5 (commencing with Section 12700) of Division 2 of the Insurance Code), or the Federal Temporary High Risk Pool (Part 6.6 (commencing with Section 12739.5) of Division 2 of the Insurance Code);  a health care service plan conversion contract offered pursuant to Section 1373.6,  1373.6; or  a health care service plan contract offered to a federally eligible defined individual under Article 4.6 (commencing with Section 1366.35) or Article 10.5 11.5  (commencing with Section 1399.801), or a Mexican prepaid health plan subject to Section 1351.2. This article does not limit, impair, or interfere with the authority of the California Public Employees’ Retirement System, as set forth in Section 22794 of the Government Code and Article 6 (commencing with Section 22850) of Part 5 of Division 5 of Title 2 of the Government Code. 1399.801). 

SEC. 4.

 Section 10112.35 is added to the Insurance Code, to read:

10112.35.
 (a) Beginning on January 1, 2014, a specialized health insurance policy described in Section 1311(d)(2)(B)(ii) of PPACA (42 U.S.C. Sec. 18031(d)(2)(B)(ii)) that provides pediatric oral care benefits, whether or not it is bundled with a qualified health plan or standing alone, shall be subject to Section 10133.5.
(b) Beginning on January 1, 2015, a specialized health insurance policy described in Section 1311(d)(2)(B)(ii) of PPACA (42 U.S.C. Sec. 18031(d)(2)(B)(ii)) that provides pediatric oral care benefits, whether or not it is bundled with a qualified health plan or standing alone, shall be subject to Article 4.5 (commencing with Section 10181).

SEC. 5.

 Section 10123.56 is added to the Insurance Code, to read:

10123.56.
 (a) (1) Notwithstanding Section 10112.25, beginning on January 1, 2015, every specialized health insurance policy described in Section 1311(d)(2)(B)(ii) of PPACA (42 U.S.C. Sec. 18031(d)(2)(B)(ii)), as defined in Section 10112.27, providing pediatric oral care benefits, whether or not it is bundled with a qualified health plan or standing alone, shall provide an annual rebate to each insured under that coverage, on a pro rata basis, if the ratio of the amount of premium revenue expended by the health insurer on the costs for reimbursement for services provided to insureds under that coverage and for activities that improve dental care quality to the total amount of premium revenue, excluding federal and state taxes and licensing or regulatory fees and after accounting for payments or receipts for risk adjustment, risk corridors, and reinsurance, is less than 75 percent.
(2) Every specialized health insurance policy described in this subdivision shall maintain a minimum medical loss ratio of 75 percent.
(b) (1) The commissioner may adopt regulations in accordance with the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code) that are necessary to implement the medical loss ratio as described under Section 2718 of the federal Public Health Service Act (42 U.S.C. Sec. 300gg-18), and any federal rules or regulations issued under that section.
(2) The commissioner may also adopt emergency regulations in accordance with the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code) when it is necessary to implement the applicable provisions of this section and to address specific conflicts between state and federal law that prevent implementation of federal law and guidance pursuant to Section 2718 of the federal Public Health Service Act (42 U.S.C. Sec. 300gg-18). The initial adoption of the emergency regulations shall be deemed to be an emergency and necessary for the immediate preservation of the public peace, health, safety, or general welfare.
(c) The department shall consult with the Department of Managed Health Care in adopting necessary regulations, and in taking any other action for the purpose of implementing this section.

SEC. 8.SEC. 6.

 Section 10181.2 of the Insurance Code is amended to read:

10181.2.
 This article shall apply to a  health insurance policy policies  offered in the individual or group market in California. However, this article shall not apply to a specialized health insurance policy, a  other than one providing pediatric oral care benefits, whether or not it is bundled with a qualified health plan or standing alone, as described in Section 10112.35; a  Medicare supplement policy subject to Article 6 (commencing with Section 10192.05), 10192.05);  a health insurance policy offered in the Medi-Cal program (Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of the Welfare and Institutions Code), Code);  a health insurance policy offered in the Healthy Families Program (Part 6.2 (commencing with Section 12693)), the Access for Infants and Mothers Program (Part 6.3 (commencing with Section 12695)), the  California Major Risk Medical Insurance Program (Part 6.5 (commencing with Section 12700)), or the Federal Temporary High Risk Pool (Part 6.6 (commencing with Section 12739.5));  a health insurance conversion policy offered pursuant to Section 12682.1,  12682.1; or  a health insurance policy offered to a federally eligible defined individual under Chapter 9.5 (commencing with Section 10900), or a Mexican prepaid health plan subject to Section 1351.2 of the Health and Safety Code. 10900). 
SEC. 7.
 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. 8.
 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 update state law consistent with federal requirements at the earliest possible time, it is necessary that this bill take effect immediately.