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SB-568 Deductibles: chronic disease management.(2021-2022)

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Date Published: 02/19/2021 04:00 AM
SB568:v99#DOCUMENT


CALIFORNIA LEGISLATURE— 2021–2022 REGULAR SESSION

Senate Bill
No. 568


Introduced by Senator Pan

February 18, 2021


An act to add Section 1342.75 to the Health and Safety Code, and to add Section 10123.1934 to the Insurance Code, relating to health care coverage.


LEGISLATIVE COUNSEL'S DIGEST


SB 568, as introduced, Pan. Deductibles: chronic disease management.
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, in accordance with the federal Patient Protection and Affordable Care Act, requires a health care service plan or health insurance issuer offering coverage in the individual or small group market to ensure that the coverage includes the essential health benefits package and defines this package to mean coverage that, among other requirements, includes preventive and wellness services and chronic disease management. Existing law, with respect to those individual or group health care service plan contracts and health insurance policies, prohibits the copayment, coinsurance, or any other form of cost sharing for a covered outpatient prescription drug for an individual prescription from exceeding $250, as specified. Existing law requires a health care service plan contract that covers hospital, medical, or surgical expenses to include coverage for certain equipment and supplies for the management and treatment of various types of diabetes as medically necessary, even if those items are available without a prescription.
This bill would prohibit a health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2022, from imposing a deductible requirement for a covered prescription drug and the above equipment and supplies, and would limit the amount paid for the benefit by an enrollee, subscriber, policyholder, or insured to no more than the amount of copayment or coinsurance specified in the applicable summary of benefits and coverage, as specified. This bill would prohibit a health care service plan contract or health insurance policy that meets the definition of a “high deductible health plan” under specified federal law from imposing a deductible requirement with respect to any covered benefit for preventive care, in accordance with that law. Because a violation of the requirements of the bill 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 1342.75 is added to the Health and Safety Code, to read:

1342.75.
 (a)  Notwithstanding subdivision (a) of Section 1342.73 with respect to deductibles, an individual or group health care service plan contract issued, amended, or renewed on or after January 1, 2022, shall not impose a deductible requirement for a covered prescription drug and for a benefit described in subdivision (a) of Section 1367.51 used to treat a chronic disease. The amount of cost sharing, if any, paid by an enrollee or a subscriber for those drugs and benefits shall not exceed the amount of copayment or coinsurance specified in the summary of benefits and coverage and shall be consistent with other applicable provisions of this article.
(b) A state-regulated “high deductible health plan,” under the definition set forth in Section 223 of Title 26 of the United States Code, shall not impose a deductible requirement with respect to any covered benefit for preventive care identified by the Internal Revenue Service, in accordance with Section 223(c)(2)(C)of Title 26 of the United States Code.
(c) This section does not require cost sharing for care that state or federal law otherwise requires to be provided without cost sharing.
(d) For purposes of this section, “chronic disease” means a condition that lasts one year or longer and requires ongoing medical attention, limits activities of daily living, or both.

SEC. 2.

 Section 10123.1934 is added to the Insurance Code, to read:

10123.1934.
 (a)  Notwithstanding subdivision (a) of Section 10123.1932 with respect to deductibles, an individual or group health insurance policy issued, amended, or renewed on or after January 1, 2022, shall not impose a deductible requirement for any covered prescription drug and for a benefits described in subdivision (a) of Section 10176.61 used to treat a chronic disease. The amount of cost sharing, if any, paid by a policyholder or an insured for those drugs and benefits shall not exceed the amount of copayment or coinsurance specified in the summary of benefits and coverage and shall be consistent with other applicable provisions of this article.
(b) A state-regulated “high deductible health plan,” under the definition set forth in Section 223 of Title 26 of the United States Code, shall not impose a deductible requirement with respect to any covered benefit for preventive care identified by the Internal Revenue Service, in accordance with Section 223(c)(2)(C)of Title 26 of the United States Code.
(c) This section does not require cost sharing for care that state or federal law otherwise requires to be provided without cost sharing.
(d) For purposes of this section, “chronic disease” means a condition that lasts one year or longer and requires ongoing medical attention, limits activities of daily living, or both.

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.