| 1 | 1 | | CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION Assembly Bill No. 2640Introduced by Assembly Member GonzalezFebruary 20, 2020 An act to amend Section 1367.665 of the Health and Safety Code, and to amend Section 10123.20 of the Insurance Code, relating to health care coverage. LEGISLATIVE COUNSEL'S DIGESTAB 2640, as introduced, Gonzalez. Health care coverage: genetic biomarker testing.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 an individual or group health care service plan contract or health insurance policy issued, amended, delivered, or renewed on or after July 1, 2000, to provide coverage for all generally medically accepted cancer screening tests.This bill would prohibit an individual or group health care service plan contract or health insurance policy issued, amended, delivered, or renewed on or after January 1, 2021, from requiring prior authorization for genetic biomarker testing for an enrollee or insured with metastatic or advanced stage 3 or 4 cancer. 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.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES Bill TextThe people of the State of California do enact as follows:SECTION 1. Section 1367.665 of the Health and Safety Code is amended to read:1367.665. Every (a) An individual or group health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after July 1, 2000, shall be deemed to provide coverage for all generally medically accepted cancer screening tests, subject to all terms and conditions that would otherwise apply.(b) An individual or group health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after January 1, 2021, shall not require prior authorization for genetic biomarker testing for an enrollee with metastatic or advanced stage 3 or 4 cancer.SEC. 2. Section 10123.20 of the Insurance Code is amended to read:10123.20. (a) Every An individual or group disability health insurance policy that covers hospital, medical, or surgical expenses that is issued, amended, delivered, or renewed on or after July 1, 2000, shall be deemed to provide coverage for all generally medically accepted cancer screening tests, subject to all other terms and conditions that would otherwise apply.(b) An individual or group health insurance policy that is issued, amended, delivered, or renewed on or after January 1, 2021, shall not require prior authorization for genetic biomarker testing for an insured with metastatic or advanced stage 3 or 4 cancer.(b)(c) This section shall does not apply to vision-only, dental-only, accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, or disability income insurance, except that for accident-only, specified disease, or hospital indemnity insurance, coverage for benefits under this section shall apply to the extent that the benefits are covered under the general terms and conditions that apply to all other benefits under the policy or contract. Nothing in this section shall be construed as imposing This section does not impose a new benefit mandate on accident-only, specified disease, or hospital indemnity insurance.SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution. |
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| 3 | 3 | | CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION Assembly Bill No. 2640Introduced by Assembly Member GonzalezFebruary 20, 2020 An act to amend Section 1367.665 of the Health and Safety Code, and to amend Section 10123.20 of the Insurance Code, relating to health care coverage. LEGISLATIVE COUNSEL'S DIGESTAB 2640, as introduced, Gonzalez. Health care coverage: genetic biomarker testing.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 an individual or group health care service plan contract or health insurance policy issued, amended, delivered, or renewed on or after July 1, 2000, to provide coverage for all generally medically accepted cancer screening tests.This bill would prohibit an individual or group health care service plan contract or health insurance policy issued, amended, delivered, or renewed on or after January 1, 2021, from requiring prior authorization for genetic biomarker testing for an enrollee or insured with metastatic or advanced stage 3 or 4 cancer. 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.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES |
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| 9 | 9 | | CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION |
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| 11 | 11 | | Assembly Bill |
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| 12 | 12 | | |
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| 13 | 13 | | No. 2640 |
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| 15 | 15 | | Introduced by Assembly Member GonzalezFebruary 20, 2020 |
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| 17 | 17 | | Introduced by Assembly Member Gonzalez |
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| 18 | 18 | | February 20, 2020 |
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| 19 | 19 | | |
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| 20 | 20 | | An act to amend Section 1367.665 of the Health and Safety Code, and to amend Section 10123.20 of the Insurance Code, relating to health care coverage. |
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| 21 | 21 | | |
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| 22 | 22 | | LEGISLATIVE COUNSEL'S DIGEST |
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| 23 | 23 | | |
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| 24 | 24 | | ## LEGISLATIVE COUNSEL'S DIGEST |
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| 25 | 25 | | |
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| 26 | 26 | | AB 2640, as introduced, Gonzalez. Health care coverage: genetic biomarker testing. |
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| 27 | 27 | | |
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| 28 | 28 | | 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 an individual or group health care service plan contract or health insurance policy issued, amended, delivered, or renewed on or after July 1, 2000, to provide coverage for all generally medically accepted cancer screening tests.This bill would prohibit an individual or group health care service plan contract or health insurance policy issued, amended, delivered, or renewed on or after January 1, 2021, from requiring prior authorization for genetic biomarker testing for an enrollee or insured with metastatic or advanced stage 3 or 4 cancer. 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. |
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| 29 | 29 | | |
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| 30 | 30 | | 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 an individual or group health care service plan contract or health insurance policy issued, amended, delivered, or renewed on or after July 1, 2000, to provide coverage for all generally medically accepted cancer screening tests. |
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| 31 | 31 | | |
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| 32 | 32 | | This bill would prohibit an individual or group health care service plan contract or health insurance policy issued, amended, delivered, or renewed on or after January 1, 2021, from requiring prior authorization for genetic biomarker testing for an enrollee or insured with metastatic or advanced stage 3 or 4 cancer. 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. |
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| 33 | 33 | | |
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| 34 | 34 | | 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. |
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| 35 | 35 | | |
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| 36 | 36 | | This bill would provide that no reimbursement is required by this act for a specified reason. |
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| 37 | 37 | | |
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| 38 | 38 | | ## Digest Key |
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| 39 | 39 | | |
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| 40 | 40 | | ## Bill Text |
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| 41 | 41 | | |
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| 42 | 42 | | The people of the State of California do enact as follows:SECTION 1. Section 1367.665 of the Health and Safety Code is amended to read:1367.665. Every (a) An individual or group health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after July 1, 2000, shall be deemed to provide coverage for all generally medically accepted cancer screening tests, subject to all terms and conditions that would otherwise apply.(b) An individual or group health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after January 1, 2021, shall not require prior authorization for genetic biomarker testing for an enrollee with metastatic or advanced stage 3 or 4 cancer.SEC. 2. Section 10123.20 of the Insurance Code is amended to read:10123.20. (a) Every An individual or group disability health insurance policy that covers hospital, medical, or surgical expenses that is issued, amended, delivered, or renewed on or after July 1, 2000, shall be deemed to provide coverage for all generally medically accepted cancer screening tests, subject to all other terms and conditions that would otherwise apply.(b) An individual or group health insurance policy that is issued, amended, delivered, or renewed on or after January 1, 2021, shall not require prior authorization for genetic biomarker testing for an insured with metastatic or advanced stage 3 or 4 cancer.(b)(c) This section shall does not apply to vision-only, dental-only, accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, or disability income insurance, except that for accident-only, specified disease, or hospital indemnity insurance, coverage for benefits under this section shall apply to the extent that the benefits are covered under the general terms and conditions that apply to all other benefits under the policy or contract. Nothing in this section shall be construed as imposing This section does not impose a new benefit mandate on accident-only, specified disease, or hospital indemnity insurance.SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution. |
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| 44 | 44 | | The people of the State of California do enact as follows: |
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| 46 | 46 | | ## The people of the State of California do enact as follows: |
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| 48 | 48 | | SECTION 1. Section 1367.665 of the Health and Safety Code is amended to read:1367.665. Every (a) An individual or group health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after July 1, 2000, shall be deemed to provide coverage for all generally medically accepted cancer screening tests, subject to all terms and conditions that would otherwise apply.(b) An individual or group health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after January 1, 2021, shall not require prior authorization for genetic biomarker testing for an enrollee with metastatic or advanced stage 3 or 4 cancer. |
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| 50 | 50 | | SECTION 1. Section 1367.665 of the Health and Safety Code is amended to read: |
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| 52 | 52 | | ### SECTION 1. |
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| 53 | 53 | | |
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| 54 | 54 | | 1367.665. Every (a) An individual or group health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after July 1, 2000, shall be deemed to provide coverage for all generally medically accepted cancer screening tests, subject to all terms and conditions that would otherwise apply.(b) An individual or group health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after January 1, 2021, shall not require prior authorization for genetic biomarker testing for an enrollee with metastatic or advanced stage 3 or 4 cancer. |
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| 56 | 56 | | 1367.665. Every (a) An individual or group health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after July 1, 2000, shall be deemed to provide coverage for all generally medically accepted cancer screening tests, subject to all terms and conditions that would otherwise apply.(b) An individual or group health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after January 1, 2021, shall not require prior authorization for genetic biomarker testing for an enrollee with metastatic or advanced stage 3 or 4 cancer. |
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| 58 | 58 | | 1367.665. Every (a) An individual or group health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after July 1, 2000, shall be deemed to provide coverage for all generally medically accepted cancer screening tests, subject to all terms and conditions that would otherwise apply.(b) An individual or group health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after January 1, 2021, shall not require prior authorization for genetic biomarker testing for an enrollee with metastatic or advanced stage 3 or 4 cancer. |
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| 62 | 62 | | 1367.665. Every (a) An individual or group health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after July 1, 2000, shall be deemed to provide coverage for all generally medically accepted cancer screening tests, subject to all terms and conditions that would otherwise apply. |
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| 64 | 64 | | (b) An individual or group health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after January 1, 2021, shall not require prior authorization for genetic biomarker testing for an enrollee with metastatic or advanced stage 3 or 4 cancer. |
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| 65 | 65 | | |
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| 66 | 66 | | SEC. 2. Section 10123.20 of the Insurance Code is amended to read:10123.20. (a) Every An individual or group disability health insurance policy that covers hospital, medical, or surgical expenses that is issued, amended, delivered, or renewed on or after July 1, 2000, shall be deemed to provide coverage for all generally medically accepted cancer screening tests, subject to all other terms and conditions that would otherwise apply.(b) An individual or group health insurance policy that is issued, amended, delivered, or renewed on or after January 1, 2021, shall not require prior authorization for genetic biomarker testing for an insured with metastatic or advanced stage 3 or 4 cancer.(b)(c) This section shall does not apply to vision-only, dental-only, accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, or disability income insurance, except that for accident-only, specified disease, or hospital indemnity insurance, coverage for benefits under this section shall apply to the extent that the benefits are covered under the general terms and conditions that apply to all other benefits under the policy or contract. Nothing in this section shall be construed as imposing This section does not impose a new benefit mandate on accident-only, specified disease, or hospital indemnity insurance. |
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| 68 | 68 | | SEC. 2. Section 10123.20 of the Insurance Code is amended to read: |
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| 70 | 70 | | ### SEC. 2. |
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| 72 | 72 | | 10123.20. (a) Every An individual or group disability health insurance policy that covers hospital, medical, or surgical expenses that is issued, amended, delivered, or renewed on or after July 1, 2000, shall be deemed to provide coverage for all generally medically accepted cancer screening tests, subject to all other terms and conditions that would otherwise apply.(b) An individual or group health insurance policy that is issued, amended, delivered, or renewed on or after January 1, 2021, shall not require prior authorization for genetic biomarker testing for an insured with metastatic or advanced stage 3 or 4 cancer.(b)(c) This section shall does not apply to vision-only, dental-only, accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, or disability income insurance, except that for accident-only, specified disease, or hospital indemnity insurance, coverage for benefits under this section shall apply to the extent that the benefits are covered under the general terms and conditions that apply to all other benefits under the policy or contract. Nothing in this section shall be construed as imposing This section does not impose a new benefit mandate on accident-only, specified disease, or hospital indemnity insurance. |
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| 74 | 74 | | 10123.20. (a) Every An individual or group disability health insurance policy that covers hospital, medical, or surgical expenses that is issued, amended, delivered, or renewed on or after July 1, 2000, shall be deemed to provide coverage for all generally medically accepted cancer screening tests, subject to all other terms and conditions that would otherwise apply.(b) An individual or group health insurance policy that is issued, amended, delivered, or renewed on or after January 1, 2021, shall not require prior authorization for genetic biomarker testing for an insured with metastatic or advanced stage 3 or 4 cancer.(b)(c) This section shall does not apply to vision-only, dental-only, accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, or disability income insurance, except that for accident-only, specified disease, or hospital indemnity insurance, coverage for benefits under this section shall apply to the extent that the benefits are covered under the general terms and conditions that apply to all other benefits under the policy or contract. Nothing in this section shall be construed as imposing This section does not impose a new benefit mandate on accident-only, specified disease, or hospital indemnity insurance. |
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| 76 | 76 | | 10123.20. (a) Every An individual or group disability health insurance policy that covers hospital, medical, or surgical expenses that is issued, amended, delivered, or renewed on or after July 1, 2000, shall be deemed to provide coverage for all generally medically accepted cancer screening tests, subject to all other terms and conditions that would otherwise apply.(b) An individual or group health insurance policy that is issued, amended, delivered, or renewed on or after January 1, 2021, shall not require prior authorization for genetic biomarker testing for an insured with metastatic or advanced stage 3 or 4 cancer.(b)(c) This section shall does not apply to vision-only, dental-only, accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, or disability income insurance, except that for accident-only, specified disease, or hospital indemnity insurance, coverage for benefits under this section shall apply to the extent that the benefits are covered under the general terms and conditions that apply to all other benefits under the policy or contract. Nothing in this section shall be construed as imposing This section does not impose a new benefit mandate on accident-only, specified disease, or hospital indemnity insurance. |
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| 80 | 80 | | 10123.20. (a) Every An individual or group disability health insurance policy that covers hospital, medical, or surgical expenses that is issued, amended, delivered, or renewed on or after July 1, 2000, shall be deemed to provide coverage for all generally medically accepted cancer screening tests, subject to all other terms and conditions that would otherwise apply. |
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| 82 | 82 | | (b) An individual or group health insurance policy that is issued, amended, delivered, or renewed on or after January 1, 2021, shall not require prior authorization for genetic biomarker testing for an insured with metastatic or advanced stage 3 or 4 cancer. |
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| 83 | 83 | | |
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| 84 | 84 | | (b) |
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| 88 | 88 | | (c) This section shall does not apply to vision-only, dental-only, accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, or disability income insurance, except that for accident-only, specified disease, or hospital indemnity insurance, coverage for benefits under this section shall apply to the extent that the benefits are covered under the general terms and conditions that apply to all other benefits under the policy or contract. Nothing in this section shall be construed as imposing This section does not impose a new benefit mandate on accident-only, specified disease, or hospital indemnity insurance. |
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| 89 | 89 | | |
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| 90 | 90 | | SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution. |
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| 92 | 92 | | SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution. |
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| 94 | 94 | | SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution. |
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| 96 | 96 | | ### SEC. 3. |
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