Today's Law As Amended


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AB-993 Health care coverage: HIV specialists.(2019-2020)



As Amends the Law Today


SECTION 1.

 Section 1367.693 is added to the Health and Safety Code, immediately following Section 1367.69, to read:

1367.693.
 (a) Every health care service plan contract that is issued, amended, or renewed on or after January 1, 2020, that provides hospital, medical, or surgical coverage, excluding specialized health care service plan contracts, shall permit an HIV specialist to be an eligible primary care provider, if the provider requests primary care provider status and meets the health care service plan’s eligibility criteria for all specialists seeking primary care provider status.
(b) For purposes of this section, “primary care provider” means a physician or a nonphysician medical practitioner, as each term is defined in Section 14254 of the Welfare and Institutions Code, who has the responsibility for providing initial and primary care to patients, for maintaining the continuity of patient care, and for initiating referral for specialist care. This means providing care for the majority of health care problems, including, but not limited to, preventive services, acute and chronic conditions, and psychosocial issues.
(c) For purposes of this section, “HIV specialist” means a physician, physician assistant, or a nurse practitioner who meets the criteria for an HIV specialist as published by the American Academy of HIV Medicine or the HIV Medicine Association, or who is contracted to provide outpatient medical care under the federal Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990 (Public Law 101-381).
(d) This section does not include an HIV specialist as a primary care physician for the purposes of network adequacy requirements under this chapter.
(e) This section does not require a health care service plan contract to include provisions to pay an HIV specialist providing primary care services more than the contract would pay any other primary care provider for providing primary care services.

SEC. 2.

 Section 10123.833 is added to the Insurance Code, to read:

10123.833.
 (a) Every health insurance policy that is issued, amended, or renewed on or after January 1, 2020, that provides hospital, medical, or surgical coverage, excluding specialized health insurance policies, shall permit an HIV specialist to be an eligible primary care provider, if the provider requests primary care provider status and meets the health insurer’s eligibility criteria for all specialists seeking primary care provider status.
(b) For purposes of this section, “primary care provider” means a physician or a nonphysician medical practitioner, as each term is defined in Section 14254 of the Welfare and Institutions Code, who has the responsibility for providing initial and primary care to patients, for maintaining the continuity of patient care, and for initiating referral for specialist care. This means providing care for the majority of health care problems, including, but not limited to, preventive services, acute and chronic conditions, and psychosocial issues.
(c) For purposes of this section, “HIV specialist” means a physician, physician assistant, or a nurse practitioner who meets the criteria for an HIV specialist as published by the American Academy of HIV Medicine or the HIV Medicine Association, or who is contracted to provide outpatient medical care under the federal Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990 (Public Law 101-381).
(d) This section does not include an HIV specialist as a primary care physician for the purposes of the department’s network adequacy requirements.
(e) This section does not apply to a health insurance policy that does not require an insured to obtain a referral from the primary care physician prior to seeking covered health care services from a specialist.
(f) This section does not require a health insurance policy to include provisions to pay an HIV specialist providing primary care services more than the policy would pay any other primary care provider for providing primary care services.
SEC. 3.
 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.