Bill Text

PDF |Add To My Favorites |Track Bill | print page

AB-1534 Health care coverage: HIV specialists.(2017-2018)

SHARE THIS:share this bill in Facebookshare this bill in Twitter
Date Published: 06/26/2017 02:00 PM
AB1534:v97#DOCUMENT

Amended  IN  Senate  June 26, 2017
Amended  IN  Assembly  April 06, 2017

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Assembly Bill No. 1534


Introduced by Assembly Member Nazarian

February 17, 2017


An act to add Section 1367.693 to the Health and Safety Code, and to add Section 10123.833 to the Insurance Code, relating to health care coverage.


LEGISLATIVE COUNSEL'S DIGEST


AB 1534, as amended, Nazarian. Health care coverage: HIV specialists.
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. A willful violation of the act is a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires the Department of Managed Health Care to adopt regulations to ensure that enrollees have access to needed health care services in a timely manner. Existing law requires the Department of Managed Health Care to develop indicators of timeliness of access to care, including waiting times for appointments with physicians, including primary care and speciality specialty physicians. Existing law requires health care service plans to report annually to the Department of Managed Health Care on compliance with the standards developed pursuant to these provisions. Existing law requires the Insurance Commissioner to promulgate regulations applicable to health insurers that contract with providers for alternative rates to ensure that insureds have the opportunity to access needed health care services in a timely manner.
This bill would require a health care service plan contract or health insurance policy that is issued, amended, or renewed on or after January 1, 2018, to permit an HIV specialist, as defined, to be an eligible primary care provider, as defined, if the provider requests primary care provider status and meets the plan’s or the health insurer’s eligibility criteria for all specialists seeking primary care provider status. The bill would provide that these provisions do not apply to a health insurance policy that does not require an insured to obtain a referral from his or her primary care physician prior to seeking covered health care services from a specialist. The bill would provide that these provisions shall not be construed to include an HIV specialist as a primary care physician for the purposes of network adequacy requirements. Because a willful violation of these requirements by a health care service plan 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   Local Program: YES  

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


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, 2018, 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 shall not be construed to include an HIV specialist as a primary care physician for the purposes of network adequacy requirements under this chapter.

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, 2018, 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 shall not be construed to include an HIV specialist as a primary care physician for the purposes of the department’s network adequacy requirements.
(e) This section shall not apply to a health insurance policy that does not require an insured to obtain a referral from his or her primary care physician prior to seeking covered health care services from a specialist.

SEC. 2.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.