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SB-406 Health care: omnibus bill.(2019-2020)

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Date Published: 07/21/2020 09:00 PM
SB406:v96#DOCUMENT

Amended  IN  Assembly  July 27, 2020
Amended  IN  Assembly  June 24, 2020
Amended  IN  Senate  January 06, 2020

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Senate Bill
No. 406


Introduced by Senators Pan, Lena Gonzalez, Grove, Hurtado, Leyva, Melendez, Mitchell, Monning, and Rubio
(Coauthor: Senator Bates)

February 20, 2019


An act to amend Sections 11833.05 and 110840 110840, 11833.05, and 127662 of, and to repeal and add Sections 1367.001 and 1367.002 1367.001, 1367.002, and 127665 of, the Health and Safety Code, and to repeal and add Sections 10112.1 and 10112.2 of the Insurance Code, relating to health care.


LEGISLATIVE COUNSEL'S DIGEST


SB 406, as amended, Pan. Health care: omnibus bill.
(1) Existing federal law, the Patient Protection and Affordable Care Act (PPACA), enacts various health care market reforms. 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 group or individual health care service plan contract or health insurance policy issued, amended, renewed, or delivered on or after September 23, 2010, to comply with the requirements of the PPACA, and any rules or regulations issued under the PPACA, that require a group health plan and health insurance issuer offering group or individual health insurance coverage to, at a minimum, provide coverage for specified preventive services, and prohibits the plan or health insurance issuer from imposing any cost-sharing requirements for those preventive services. Existing law also prohibits a plan or health insurer offering group or individual coverage from imposing lifetime or annual limits on the dollar value of benefits for a participant, beneficiary, or insured. Existing law requires a plan and a health insurance issuer to comply with those provisions to the extent required by federal law.
This bill would delete the requirement that a plan or a health insurer comply with the requirement to cover preventive health services without cost sharing to the extent required by federal law, and would instead require a group or individual health care service plan contract or health insurer to, at a minimum, provide coverage for specified preventive services without any cost-sharing requirements for those preventive services, thereby indefinitely extending those requirements. The bill would also delete the requirement that a plan or a health insurer comply with the prohibition on lifetime or annual limits to the extent required by federal law, and would instead prohibit an individual or group health care service plan contract or health insurer from establishing lifetime or annual limits on the dollar value of benefits for an enrollee or insured, thereby indefinitely extending the prohibitions on lifetime or annual limits, except as specified. Because a willful violation of these provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program.
(2) Existing law requires the State Department of Health Care Services to license and regulate facilities that provide residential nonmedical services to adults who are recovering from problems related to alcohol, drug, or alcohol and drug misuse or abuse, and who need alcohol, drug, or alcohol and drug recovery treatment or detoxification services. Existing law also requires the department to implement a voluntary certification procedure for alcohol and other drug treatment recovery services. Existing law requires all programs certified and licensed by the department to disclose, among other things, ownership or control of, or financial interest in, a recovery residence, as defined. Existing law requires the department to conduct a site visit to investigate an allegation of an operating unlicensed alcoholism or drug abuse recovery or treatment facility and issue a notice to cease providing services under specified conditions.
The bill would require the department to take action against an unlicensed facility that is disclosed as a recovery residence pursuant to these disclosure requirements. The bill would authorize the department to refer a substantiated complaint against a recovery residence to other enforcement entities as appropriate under state or federal law. The bill would make a technical change to refer to licensed facilities in these requirements.
(3) Existing law, the California Organic Products Act of 2003 (the act), 2003, requires the Secretary of Food and Agriculture, county agricultural commissioners, and the Director of the State Department of Public Health to enforce state and federal laws governing the production, labeling, and marketing of organic products, as specified. Under existing law, all persons who handle or sell at retail organic products must keep accurate records that include specified information, which includes, if applicable, the registration numbers issued pursuant to state law, of all suppliers and other persons who sell, purchase, or otherwise transfer organic products, subject to specified exceptions.
The bill would remove the requirement that the registration numbers issued pursuant to state law be included in the required records.
(4) Existing law establishes the Health Care Benefits Fund to support the University of California’s implementation of the California Health Benefit Review Program. Existing law imposes an annual charge on health care service plans and health insurers, as specified, to be deposited into the fund. Under existing law, the fund and the program became inoperative on July 1, 2020, and are repealed as of January 1, 2021.
This bill would extend the operation of the program and the fund, and would authorize the continued assessment of the annual charge on health care service plans and health insurers for that purpose.
This bill would make these provisions inoperative on July 1, 2022, and would repeal them as of January 1, 2023.
(5)This bill would include a change in state statute that would result in a taxpayer paying a higher tax within the meaning of Section 3 of Article XIII A of the California Constitution, and thus would require for passage the approval of 2/3 of the membership of each house of the Legislature.

(4)

(5) 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: MAJORITY2/3   Appropriation: NO   Fiscal Committee: YES   Local Program: YES  

The people of the State of California do enact as follows:


SECTION 1.

 Section 1367.001 of the Health and Safety Code is repealed.

SEC. 2.

 Section 1367.001 is added to the Health and Safety Code, to read:

1367.001.
 (a) An individual or group health care service plan contract shall not establish either of the following:
(1) Lifetime limits on the dollar value of benefits for an enrollee.
(2) Annual limits on the dollar value of benefits for an enrollee.
(b) Subdivision (a) does not prevent a group health care service plan contract from placing annual or lifetime per-enrollee limits on specific covered benefits that are not essential health benefits, as defined under Section 1367.005, to the extent that those limits are otherwise permitted under federal or state law.
(c) This section does not apply to a health care service plan contract or insurance policy issued, sold, renewed, or offered for health care services or coverage provided in the Medi-Cal program (Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of the Welfare and Institutions Code), the Medi-Cal Access Program (Chapter 2 (commencing with Section 15810) of Part 3.3 of Division 9 of the Welfare and Institutions Code), or the California Major Risk Medical Insurance Program (Chapter 4 (commencing with Section 15870) of Part 3.3 of Division 9 of the Welfare and Institutions Code).

SEC. 3.

 Section 1367.002 of the Health and Safety Code is repealed.

SEC. 4.

 Section 1367.002 is added to the Health and Safety Code, to read:

1367.002.
 (a) A group or individual nongrandfathered health care service plan contract shall, at a minimum, provide coverage for and shall not impose any cost-sharing requirements for all of the following:
(1) Evidence-based items or services that have in effect a rating of “A” or “B” in the recommendations of the United States Preventive Services Task Force, as periodically updated.
(2) Immunizations that have in effect a recommendation, as periodically updated, from the Advisory Committee on Immunization Practices of the federal Centers for Disease Control and Prevention with respect to the individual involved.
(3) With respect to infants, children, and adolescents, evidence-informed preventive care and screenings provided in the comprehensive guidelines, as periodically updated, supported by the United States Health Resources and Services Administration.

Because a willful violation of these provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program.

(4) With respect to women, those additional preventive care and screenings not described in paragraph (1) as provided for in comprehensive guidelines supported by the United States Health Resources and Services Administration for purposes of this paragraph.
(5) For the purposes of this section, the current recommendations of the United States Preventive Services Task Force regarding breast cancer screening, mammography, and prevention shall be considered the most current other than those issued in or around November 2009.
(b) This section does not prohibit a health care service plan contract from providing coverage for services in addition to those recommended by the United States Preventive Services Task Force or to deny coverage for services that are not recommended by the United States Preventive Services Task Force.
(c) The department shall establish through regulations a minimum interval of no less than one year between the date on which a recommendation described in paragraph (1) or paragraph (2) of subdivision (a) or a guideline under paragraph (3) of subdivision (a) is issued and the plan year with respect to which the requirement described in subdivision (a) is effective with respect to the service described in such recommendation or guideline. The department shall coordinate with the Department of Insurance to align these requirements.
(d) This section shall only apply to a health savings account-eligible health care service plan to the extent it does not fail to be treated as a high deductible health plan under Section 223 of Title 26 of the United States Code.

SEC. 5.Section 11833.05 of the Health and Safety Code is amended to read:
11833.05.

(a)All programs certified by the department pursuant to Chapter 7 (commencing with Section 11830) or facilities licensed by the department pursuant to Chapter 7.5 (commencing with Section 11834.01) shall disclose to the department the following information:

(1)Ownership or control of, or financial interest in, a recovery residence.

(2)Any contractual relationship with an entity that regularly provides professional services or addiction treatment or recovery services to clients of programs certified or facilities licensed by the department, if the entity is not a part of the program certified or facility licensed by the department.

(b)All programs certified or facilities licensed by the department shall make the disclosures pursuant to subdivision (a) upon initial licensure or certification, upon renewal of licensure or certification, and upon a licensed facility or certified program acquiring or starting a relationship that meets paragraph (1) or (2) of subdivision (a).

(c)The department may suspend or revoke the certification of a program or license of a facility for failing to disclose the information required in subdivision (a).

(d)The department shall take action pursuant to Section 11834.31 against an unlicensed facility that is disclosed as a recovery residence pursuant to paragraph (1) of subdivision (a).

(e)The department may refer a substantiated complaint against a recovery residence to other enforcement entities as appropriate under state or federal law, including the Department of Insurance, the Department of Managed Health Care, the Attorney General, and the United States Attorney General.

(f)For the purposes of this section, “recovery residence” means a residential dwelling that provides primary housing for individuals who seek a cooperative living arrangement that supports personal recovery from a substance use disorder and that does not require licensure by the department or does not provide licensable services, pursuant to Chapter 7.5 (commencing with Section 11834.01). A recovery residence may include, but is not limited to, residential dwellings commonly referred to as “sober living homes,” “sober living environments,” or “unlicensed alcohol and drug free residences.”

SEC. 6.SEC. 5.

 Section 110840 of the Health and Safety Code is amended to read:

110840.
 (a)  All persons who handle products sold as organic shall keep accurate and specific records of the following:
(1)  Except when sold to the consumer, the name and address of all persons, to whom or from whom the product is sold, purchased, or otherwise transferred, the quantity of product sold or otherwise transferred, and the date of the transaction.
(2)  Invoices, bills of lading, or other documents that show transfer of title of certified organic products must indicate the product is “organic” or “certified organic.”
(3)  Any person selling a product which that is exempt or excluded from certification under NOP rules, shall follow the requirements of Section 205.101 of Title 7 of the Code of Federal Regulations.
(4)  All substances applied to the product or used in or around any area where product is kept, including the quantity applied and the date of each application. All pesticide chemicals shall be identified by brand name, if any, and by source.
(b)  All persons who sell, at retail, products sold as organic shall keep accurate and specific records of the following:
(1)  Except when sold to the consumer, the name and address of all suppliers of persons, to whom or from whom the product is sold, purchased, or otherwise transferred, the quantity of product purchased or otherwise transferred, and the date of the transaction.
(2)  Invoices, bills of lading or other documents that show transfer of title of certified organic products must indicate the product is “organic” or “certified organic.”
(3)  Any person selling a product that is exempt or excluded from certification under NOP rules, shall follow the requirements of Section 205.101 of Title 7 of the Code of Federal Regulations.
(4)  All substances applied to the product or used in or around any area where product is kept, including the quantity applied and the date of each application. All pesticide chemicals shall be identified by brand name, if any, and by source.
(c)  All records required to be kept under this section shall be maintained as set forth by regulations promulgated by the NOP, when applicable, or as follows: by producers for not less than three years and by handlers for not less than two years from the date that the product is sold, and shall be maintained by retailers for not less than one year from the date that the product is sold, and shall be maintained by the retailers for not less than one year from the date that the product is received by the retailer. These records shall be made available for inspection at any time by the director or the secretary and by each certification organization that certifies the product, if any, for purposes of carrying out this article and Chapter 10 (commencing with Section 46000) of Division 17 of the Food and Agricultural Code.

SEC. 6.

 Section 11833.05 of the Health and Safety Code is amended to read:

11833.05.
 (a) All programs certified by the department pursuant to Chapter 7 (commencing with Section 11830) or facilities licensed by the department pursuant to Chapter 7.5 (commencing with Section 11834.01) shall disclose to the department the following information:
(1) Ownership or control of, or financial interest in, a recovery residence.
(2) Any contractual relationship with an entity that regularly provides professional services or addiction treatment or recovery services to clients of programs licensed or certified certified or facilities licensed by the department, if the entity is not part of the program licensed or certified certified or facility licensed by the department.
(b) All programs licensed or certified certified or facilities licensed by the department shall make the disclosures pursuant to subdivision (a) upon initial licensure or certification, upon renewal of licensure or certification, and upon a licensed facility or certified program acquiring or starting a relationship that meets paragraph (1) or (2) of subdivision (a). The department may suspend or revoke the license or certification of a program for failing to disclose the information required in subdivision (a).
(c) The department may suspend or revoke the certification of a program or license of a facility for failing to disclose the information required in subdivision (a).
(d) The department shall take action pursuant to Section 11834.31 against an unlicensed facility that is disclosed as a recovery residence pursuant to paragraph (1) of subdivision (a).
(e) The department may refer a substantiated complaint against a recovery residence to other enforcement entities as appropriate under state or federal law, including the Department of Insurance, the Department of Managed Health Care, the Attorney General, and the United States Attorney General.

(c)

(f) For the purposes of this section, “recovery residence” means a residential dwelling that provides primary housing for individuals who seek a cooperative living arrangement that supports personal recovery from a substance use disorder and that does not require licensure by the department or does not provide licensable services, pursuant to Chapter 7.5 (commencing with Section 11834.01). A recovery residence may include, but is not limited to, residential dwellings commonly referred to as “sober living homes,” “sober living environments,” or “unlicensed alcohol and drug free residences.”

SEC. 7.

 Section 127662 of the Health and Safety Code is amended to read:

127662.
 (a) In order to effectively support the University of California and its work in implementing this chapter, there is hereby established in the State Treasury, the Health Care Benefits Fund. The university’s work in providing the bill analyses shall be supported from the fund.
(b) For the 2017–18 to 2019–20 2021–22 fiscal years, inclusive, each health care service plan, except a specialized health care service plan, and each health insurer offering health insurance, as defined in Section 106 of the Insurance Code, shall be assessed an annual fee in an amount determined through regulation. The amount of the fee shall be determined by the Department of Managed Health Care and the Department of Insurance in consultation with the university and shall be limited to the amount necessary to fund the actual and necessary expenses of the university and its work in implementing this chapter. The total annual assessment on health care service plans and health insurers shall not exceed two million dollars ($2,000,000).
(c) The Department of Managed Health Care and the Department of Insurance, in coordination with the university, shall assess the health care service plans and health insurers, respectively, for the costs required to fund the university’s activities pursuant to subdivision (b).
(1) Health care service plans shall be notified of the assessment on or before June 15 of each year with the annual assessment notice issued pursuant to Section 1356. The assessment pursuant to this section is separate and independent of the assessments in Section 1356.
(2) Health insurers shall be noticed of the assessment in accordance with the notice for the annual assessment or quarterly premium tax revenues.
(3) The assessed fees required pursuant to subdivision (b) shall be paid on an annual basis no later than August 1 of each year. The Department of Managed Health Care and the Department of Insurance shall forward the assessed fees to the Controller for deposit in the Health Care Benefits Fund immediately following their receipt.
(4) “Health insurance,” as used in this subdivision, does not include Medicare supplement, vision-only, dental-only, or CHAMPUS supplement insurance, or hospital indemnity, accident-only, or specified disease insurance that does not pay benefits on a fixed benefit, cash payment only basis.

SEC. 8.

 Section 127665 of the Health and Safety Code is repealed.
127665.

This chapter shall become inoperative on July 1, 2020, and, as of January 1, 2021, is repealed.

SEC. 9.

 Section 127665 is added to the Health and Safety Code, to read:

127665.
 This chapter shall become inoperative on July 1, 2022, and, as of January 1, 2023, is repealed.

SEC. 7.SEC. 10.

 Section 10112.1 of the Insurance Code is repealed.

SEC. 8.SEC. 11.

 Section 10112.1 is added to the Insurance Code, to read:

10112.1.
 (a) An individual or group health insurance policy shall not establish either of the following:
(1) Lifetime limits on the dollar value of benefits for an insured.
(2) Annual limits on the dollar value of benefits for an insured.
(b) Subdivision (a) does not prevent a group health insurance policy from placing annual or lifetime per-insured limits on specific covered benefits that are not essential health benefits, as defined under Section 10112.27, to the extent that those limits are otherwise permitted under federal or state law.

SEC. 9.SEC. 12.

 Section 10112.2 of the Insurance Code is repealed.

SEC. 10.SEC. 13.

 Section 10112.2 is added to the Insurance Code, to read:

10112.2.
 (a) A group or individual nongrandfathered health insurance policy shall, at a minimum, provide coverage for and shall not impose any cost-sharing requirements for all of the following:
(1) Evidence-based items or services that have in effect a rating of “A” or “B” in the recommendations of the United States Preventive Services Task Force, as periodically updated.
(2) Immunizations that have in effect a recommendation, as periodically updated, from the Advisory Committee on Immunization Practices of the federal Centers for Disease Control and Prevention with respect to the individual involved.
(3) With respect to infants, children, and adolescents, evidence-informed preventive care and screenings provided in the comprehensive guidelines, as periodically updated, supported by the United States Health Resources and Services Administration.
(4) With respect to women, those additional preventive care and screenings not described in paragraph (1) as provided for in comprehensive guidelines supported by the United States Health Resources and Services Administration for purposes of this paragraph.
(5) For the purposes of this section, the current recommendations of the United States Preventive Services Task Force regarding breast cancer screening, mammography, and prevention shall be considered the most current other than those issued in or around November 2009.
(b) This section does not prohibit a health insurance policy from providing coverage for services in addition to those recommended by the United States Preventive Services Task Force or to deny coverage for services that are not recommended by the United States Preventive Services Task Force.
(c) The department shall establish through regulations a minimum interval of no less than one year between the date on which a recommendation described in paragraph (1) or paragraph (2) of subdivision (a) or a guideline under paragraph (3) of subdivision (a) is issued and the plan year with respect to which the requirement described in subdivision (a) is effective with respect to the service described in such recommendation or guideline. The department shall coordinate with the State Department of Health Care Services Department of Managed Health Care to align these requirements.
(d) This section shall only apply to a health savings account-eligible health insurance policy to the extent it does not fail to be treated as a high deductible health insurance policy under Section 223 of Title 26 of the United States Code.

SEC. 11.SEC. 14.

 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.