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SB-406 Health care coverage.(2019-2020)

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Date Published: 01/06/2020 02:00 PM
SB406:v98#DOCUMENT

Corrected  January 06, 2020
Amended  IN  Senate  January 06, 2020

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Senate Bill
No. 406


Introduced by Senator Pan

February 20, 2019


An act to amend repeal and add Section 1348.96 1367.002 of the Health and Safety Code, and to amend Section 10127.21 of the Insurance Code, relating to health care coverage.


LEGISLATIVE COUNSEL'S DIGEST


SB 406, as amended, Pan. Health care coverage.
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 requires a group or individual health care service plan contract 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 requires a plan to comply with those provisions to the extent required by federal law.
This bill would delete the requirement that a plan 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 to, at a minimum, provide coverage for specified preventive services without any cost-sharing requirements for those preventive services, thereby indefinitely extending those requirements. 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.
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.

Existing federal law, the federal Patient Protection and Affordable Care Act (PPACA), enacts various health care coverage market reforms. The PPACA requires a state, using criteria and methods developed by the United States Secretary of Health and Human Services, to implement a risk adjustment program under which a charge is assessed on low actuarial risk plans and a payment is made to high actuarial risk plans. Existing federal law requires a qualified health plan to submit data relating to the risk adjustment program to the secretary. Existing state law requires any data submitted by a health care service plan or health insurer to the secretary for purposes of the risk adjustment program to also be concurrently submitted to the Department of Managed Health Care or the Department of Insurance in the same format.

This bill would require the Department of Managed Health Care and the Department of Insurance to each prepare, in coordination with the other department, an annual summary report that describes the impact of the risk adjustment program on premium rates in this state. The bill would also require the reports to be posted on the departments’ respective internet websites no later than 7 months after the risk adjustment year.

Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NOYES  

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


SECTION 1.

 Section 1367.002 of the Health and Safety Code is repealed.
1367.002.

To the extent required by federal law, a group or individual health care service plan contract issued, amended, renewed, or delivered on or after September 23, 2010, shall comply with Section 2713 of the federal Public Health Service Act (42 U.S.C. Sec. 300gg-13), as added by Section 1001 of the federal Patient Protection and Affordable Care Act (P.L. 111-148), and any rules or regulations issued under that section.

SEC. 2.

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

1367.002.
 (a) A group or individual 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.
(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.

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.
SECTION 1.Section 1348.96 of the Health and Safety Code is amended to read:
1348.96.

Any data submitted by a health care service plan to the United States Secretary of Health and Human Services, or the secretary’s designee, for purposes of the risk adjustment program described in Section 1343 of the federal Patient Protection and Affordable Care Act (42 U.S.C. Sec. 18063) shall be concurrently submitted to the department in the same format. The department shall use the information to monitor federal implementation of risk adjustment in the state and to ensure that health care service plans are in compliance with federal requirements related to risk adjustment. The department, in coordination with the Department of Insurance, shall prepare an annual summary report that describes the impact of the risk adjustment program on premium rates in this state. The report shall be posted on the department’s internet website no later than seven months after the risk adjustment year.

SEC. 2.Section 10127.21 of the Insurance Code is amended to read:
10127.21.

Any data submitted by a health insurer to the United States Secretary of Health and Human Services, or the secretary’s designee, for purposes of the risk adjustment program described in Section 1343 of the federal Patient Protection and Affordable Care Act (42 U.S.C. Sec. 18063) shall be concurrently submitted to the department and in the same format. The department shall use the information to monitor federal implementation of risk adjustment in the state and to ensure that insurers are in compliance with federal requirements related to risk adjustment. The department, in coordination with the Department of Managed Health Care, shall prepare an annual summary report that describes the impact of the risk adjustment program on premium rates in this state. The report shall be posted on the department’s internet website no later than seven months after the risk adjustment year.

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CORRECTIONS:
Heading—Last amended date.
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