SB 1473 — Health care coverage.

Summary

(1) Existing federal law, the Patient Protection and Affordable Care Act (PPACA) , requires each state to establish an American Health Benefit Exchange to facilitate the purchase of qualified health benefit plans by qualified individuals and qualified small employers. Existing state law creates the California Health Benefit Exchange (Exchange) , also known as Covered California, to facilitate the enrollment of qualified individuals and qualified small employers in qualified health plans as required under PPACA. 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 a health care service plan or health insurer to provide a special enrollment period for individual health benefit plans offered through the Exchange from December 16 of the preceding calendar year to January 31 of the benefit year, inclusive, for policy years beginning on or after January 1, 2020. Under existing law, February 1 of the benefit year is the effective coverage date for individual health benefit plans offered outside and through the Exchange that are selected from December 16 to January 31, inclusive. This bill would eliminate the above-described special enrollment period for individual health benefit plans offered through the Exchange for policy years on or after January 1, 2023, and would instead create an annual enrollment period from November 1 of the preceding calendar year to January 31 of the benefit year, inclusive. The bill would specify that the effective date of coverage for individual health benefit plans offered outside and through the Exchange would be no later than January 1 of the benefit year for plan selection made from November 1 to December 31 of the preceding calendar year, inclusive, and would be no later than February 1 of the benefit year for plan selection made from January 1 to January 31 of the benefit year, inclusive. 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. (2) Existing law requires a health care service plan contract or a disability insurance policy that provides coverage for hospital, medical, or surgical benefits, excluding a specialized health care service plan contract or health insurance policy, to cover the costs of testing and immunization for COVID-19, or a future disease when declared a public health emergency by the Governor, and prohibits the contract or policy from imposing cost sharing or prior authorization requirements for that coverage. Under existing law, the requirement to cover COVID-19 testing and immunizations delivered by an out-of-network provider without cost sharing does not apply to testing and immunizations furnished on or after the expiration of the federal public health emergency. A violation of these provisions by a health care service plan is a crime. This bill would provide that a health care service plan, including a Medi-Cal managed care plan, or disability insurer is not required to cover the cost sharing for COVID-19 testing and immunizations delivered by an out-of-network provider beginning 6 months after the federal public health emergency expires. The bill would prohibit a provider from reporting adverse information to a consumer credit reporting agency or commence civil action against an enrollee or insured for payment of COVID-19-related items, services, or immunizations. If a contract or policy covers therapeutics for COVID-19, as specified, the bill would extend these and the above-described provisions to therapeutics approved or granted emergency use authorization by the federal Food and Drug Administration for treatment of COVID-19 when prescribed or furnished by a licensed health care provider acting within their scope of practice and the standard of care. The bill would require a contract, including a Medi-Cal managed care plan contract, or policy to cover therapeutics approved or granted emergency use authorization by the federal Food and Drug Administration for a disease that the Governor has declared a public health emergency. The bill would extend existing duties for health care service plans during a declared public health emergency to Medi-Cal managed care plans. The bill would eliminate a health care service plan's criminal liability for a violation of COVID-19 testing and immunization coverage requirements that occurred before January 1, 2022. (3) 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. (4) This bill would declare that it is to take effect immediately as an urgency statute.

Bill Text

• Chaptered 09/25/22 - Chaptered Current pdf September 25, 2022
• Enrolled 09/08/22 - Enrolled pdf September 08, 2022
• Amended 08/25/22 - Amended Assembly pdf August 25, 2022
• Amended 08/15/22 - Amended Assembly pdf August 15, 2022
• Amended 06/30/22 - Amended Assembly pdf June 30, 2022
• Amended 06/06/22 - Amended Assembly pdf June 06, 2022
• Amended 03/10/22 - Amended Senate pdf March 10, 2022
• Introduced 02/18/22 - Introduced pdf February 18, 2022
• SB1473 View text html

Action History

1. September 25, 2022

   Chaptered by Secretary of State. Chapter 545, Statutes of 2022.

2. September 25, 2022

   Approved by the Governor.

3. September 13, 2022

   Enrolled and presented to the Governor at 3 p.m.

4. August 31, 2022

   Assembly amendments concurred in. (Ayes 32. Noes 0. Page 5390.) Ordered to engrossing and enrolling.

5. August 31, 2022

   Urgency clause adopted.

6. August 31, 2022

   In Senate. Concurrence in Assembly amendments pending.

7. August 31, 2022

   Read third time. Urgency clause adopted. Passed. Ordered to the Senate.

8. August 25, 2022

   Ordered to third reading.

9. August 25, 2022

   Read third time and amended.

10. August 16, 2022

    Read second time. Ordered to third reading.

11. August 15, 2022

    Read second time and amended. Ordered to second reading.

12. August 11, 2022

    From committee: Do pass as amended. (Ayes 12. Noes 4.) (August 11).

13. August 11, 2022

    Joint Rule 62(a) suspended.

14. August 10, 2022

    August 10 set for first hearing. Placed on suspense file.

15. July 29, 2022

    August 3 hearing postponed by committee.

16. June 30, 2022

    Read second time and amended. Re-referred to Com. on APPR.

17. June 29, 2022

    From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 11. Noes 3.) (June 28).

18. June 06, 2022

    From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH.

19. May 05, 2022

    Referred to Com. on HEALTH.

20. April 21, 2022

    In Assembly. Read first time. Held at Desk.

21. April 21, 2022

    Read third time. Passed. (Ayes 39. Noes 0. Page 3476.) Ordered to the Assembly.

22. April 19, 2022

    Read second time. Ordered to consent calendar.

23. April 18, 2022

    From committee: Be ordered to second reading pursuant to Senate Rule 28.8 and ordered to consent calendar.

24. April 05, 2022

    Set for hearing April 18.

25. March 31, 2022

    From committee: Do pass and re-refer to Com. on APPR with recommendation: To consent calendar. (Ayes 11. Noes 0. Page 3273.) (March 30). Re-referred to Com. on APPR.

26. March 16, 2022

    Set for hearing March 30.

27. March 10, 2022

    From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH.

28. March 09, 2022

    Referred to Com. on HEALTH.

29. February 22, 2022

    From printer.

30. February 18, 2022

    Article IV Section 8(a) of the Constitution and Joint Rule 55 dispensed with February 7, 2022, suspending the 30 calendar day requirement.

31. February 18, 2022

    Introduced. Read first time. To Com. on RLS. for assignment. To print.

Sponsors

• Pan · Primary

Votes

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