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AB-598 Hearing aids: minors.(2019-2020)

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Date Published: 07/02/2019 09:00 PM
AB598:v97#DOCUMENT

Amended  IN  Senate  July 02, 2019
Amended  IN  Assembly  May 16, 2019

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Assembly Bill
No. 598


Introduced by Assembly Member Bloom
(Principal coauthor: Senator Allen)
(Coauthors: Assembly Members Aguiar-Curry, Bonta, Carrillo, Friedman, Gabriel, Gallagher, Kamlager-Dove, McCarty, Mullin, Nazarian, Petrie-Norris, Rodriguez, and Wood)
(Coauthor: Senator Stone)

February 14, 2019


An act to add Section 1367.72 to the Health and Safety Code, and to add Section 10123.72 to the Insurance Code, relating to health care coverage.


LEGISLATIVE COUNSEL'S DIGEST


AB 598, as amended, Bloom. Hearing aids: minors.
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 also provides for the regulation of health insurers by the Department of Insurance. Existing law requires health care service plan contracts and health insurance policies to provide coverage for specified benefits.
This bill would require a health care service plan contract or a health insurance policy issued, amended, or renewed on or after January 1, July 1, 2020, to include coverage for hearing aids, as defined, for an enrollee or insured under 18 years of age, as specified. age. The bill would require the coverage to be performed by contracted providers, except as specified. The bill would require the contracted providers to include a pediatric audiologist for children under 5 years of age. The bill would require hearing aids covered under the bill to be subject to the cost sharing imposed by the plan contract or health insurance policy for durable medical equipment, as specified. Because a willful violation of these requirements by a health care service plan would be a crime, this 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.

 The Legislature finds and declares as follows:
(a) In the United States, approximately 3.5 percent of adolescents 12 to 19 years of age are deaf or hard of hearing. This includes those who were born deaf or hard of hearing as well as those who later acquired that hearing status.
(b)  Studies have shown that early diagnosis of a child’s hearing status and quick intervention is critical to developing language and improving speech outcomes. Research supported by the National Institutes of Health identify identifies the first three years of life as the most intensive period of speech and language development in children.

(c) Studies have shown that the earlier a deaf or hard of hearing child has access to interventions, the better the child’s spoken language outcomes are.

(c) A review of literature by the California Health Benefits Review Program on the effects of hearing aids on children with hearing loss suggests that early treatment of hearing loss is associated with improvement in language, verbal, nonverbal, and social development outcomes.
(d)  In 2006, California passed Assembly Bill 2651, implementing a comprehensive newborn hearing screening program to identify the hearing status of newborns and guide parents to appropriate services. The program’s stated goal is to identify hearing status in infants before three months of age and subsequently link those events to intervention services by six months of age.
(e) The National Institutes of Health, Centers for Disease Control and Prevention, and American Academy of Pediatrics all stress that newborns should have their hearing status identified by age one month, diagnosed by three months, and should receive early interventions by six months of age.
(f)  California, however, does not require insurance companies to cover hearing aids, making an important intervention financially inaccessible or burdensome to many parents.
(g)  Hearing aids provide a significant financial burden to many California families. A 2013 survey found cost to be the most significant challenge to obtaining timely hearing aid fittings, with 30 percent of parents reporting problems paying for hearing aids and 17 percent reporting problems with paying for earmolds.
(h)  Hearing aids are expensive, costing on average between $1,500 and $4,000 per ear, and up to $6,000 in many cases. Additionally, these devices have to be replaced frequently to accommodate a child’s growth. Families also incur additional costs from hearing aid services, including fittings and repairs.
(i) Fewer than one in 10 Californian children on privately funded plans have coverage for pediatric hearing aids and hearing aid services. As a result, thousands of families are forced to pay the steep costs for these devices out of pocket or forego hearing aids for their children.
(j) It is the intent of the Legislature to ensure that deaf and hard of hearing children have a continuous pathway from screening to diagnosis to intervention. The lack of insurance coverage remains a significant obstacle to that pathway and must be addressed.

SEC. 2.

 Section 1367.72 is added to the Health and Safety Code, to read:

1367.72.
 (a) (1) (A) A health care service plan contract issued, amended, or renewed on or after January 1, July 1, 2020, shall include coverage for hearing aids for all enrollees under 18 years of age when medically necessary. Coverage shall be provided by contracted providers unless the plan allows for out-of-network coverage. For children under five years of age, a contracted provider shall include a pediatric audiologist.
(B) The maximum coverage amount under this section is three thousand dollars ($3,000) per individual hearing aid. An insured enrollee may choose to purchase a hearing aid that exceeds the maximum coverage amount, and shall be responsible for the difference between the cost of the hearing aid and the maximum coverage amount. Hearing aids covered pursuant to this section shall be subject to the cost sharing imposed by the plan contract for durable medical equipment and shall not be subject to more restrictive limitations on coverage or higher cost sharing than other items of durable medical equipment covered by the plan contract.
(2) Coverage for hearing aids includes an initial assessment, new hearing aids at least every four years, new earmolds, new hearing aids if alterations to existing hearing aids cannot meet the needs of the child, a new hearing aid if the existing one is no longer working, fittings, adjustments, auditory training, and maintenance of the hearing aids.
(b) For purposes of this section, “hearing aid” means an electronic device designed to aid or compensate for impaired human hearing and any parts, attachments, or accessories, including earmolds, but excluding batteries and cords. This includes both hearing aids traditionally worn behind the ear and auditory osseointegrated devices, whether implanted or worn externally.
(c) This section shall not apply to Medicare supplement, dental-only, or vision-only supplement or specialized health care service plan contracts.

SEC. 3.

 Section 10123.72 is added to the Insurance Code, to read:

10123.72.
 (a) (1) (A) A health insurance policy issued, amended, or renewed on or after January 1, July 1, 2020, shall include coverage for hearing aids for all insureds under 18 years of age when medically necessary. Coverage shall be provided by contracted providers unless the plan allows for out-of-network coverage. For children under five years of age, a contracted provider shall include a pediatric audiologist.
(B) The maximum coverage amount under this section is three thousand dollars ($3,000) per individual hearing aid. An insured may choose to purchase a hearing aid that exceeds the maximum coverage amount, and shall be responsible for the difference between the cost of the hearing aid and the maximum coverage amount. Hearing aids covered pursuant to this section shall be subject to the cost sharing imposed by the policy for durable medical equipment and shall not be subject to more restrictive limitations on coverage or higher cost sharing than other items of durable medical equipment covered by the policy.
(2) Coverage for hearing aids includes an initial assessment, new hearing aids at least every four years, new earmolds, new hearing aids if alterations to existing hearing aids cannot meet the needs of the child, a new hearing aid if the existing one is no longer working, fittings, adjustments, auditory training, and maintenance of the hearing aids.
(b) For purposes of this section, “hearing aid” means an electronic device designed to aid or compensate for impaired human hearing and any parts, attachments, or accessories, including earmolds, but excluding batteries and cords. This includes both hearing aids traditionally worn behind the ear and auditory osseointegrated devices, whether implanted or worn externally.
(c) This section shall not apply to accident-only, specified disease, hospital indemnity, Medicare supplement, dental-only, or vision-only supplement, or specialized health insurance policies.

SEC. 4.

  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.