Bill Text: CA AB1946 | 2009-2010 | Regular Session | Introduced

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Victims of sexual assault: child molestation.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced - Dead) 2010-04-07 - Re-referred to Com. on PUB. S. [AB1946 Detail]

Download: California-2009-AB1946-Introduced.html

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BILL NUMBER: AB 1946	INTRODUCED
	BILL TEXT


INTRODUCED BY   Assembly Member Fletcher

                        FEBRUARY 17, 2010

   An act to amend Section 1367.36 of the Health and Safety Code,
relating to health care coverage.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 1946, as introduced, Fletcher. Health care service plans:
immunizations.
   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 that act a crime. Existing law requires every health
care service plan that covers hospital, medical, or surgical expenses
on a group basis to provide certain preventive health care benefits
for children, including immunizations. Existing law specifies the
reimbursement rate with respect to immunizations that are not part of
the current contract between a health care service plan and a
physician or physician group.
   This bill would make a technical, nonsubstantive change to that
provision.
   Vote: majority. Appropriation: no. Fiscal committee: no.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 1367.36 of the Health and Safety Code is
amended to read:
   1367.36.  (a)  A risk-based contract between a health care service
plan and a physician or physician group that is issued, amended,
delivered, or renewed in this state on or after January 1, 2001,
shall not include a provision that requires a physician or a
physician group to assume financial risk for the acquisition costs of
required immunizations for children as a condition of accepting the
risk-based contract. A physician or physician group shall not be
required to assume financial risk for immunizations that are not part
of the current contract.
   (b)  Beginning January 1, 2001, with respect to immunizations for
children that are not part of the current contract between a health
care service plan and a physician or physician group, the health care
service plan shall reimburse a physician or physician group at the
lowest of the following, until the contract is renegotiated: (1) the
physician's actual acquisition cost, (2) the "average wholesale price"
as published in the Drug Topics Red Book, or (3) the lowest
acquisition cost through sources made available to the physician by
the health care service plan. Reimbursements shall be made within 45
days of receipt by the plan of documents from the physician
demonstrating that the immunizations were performed, consistent with
Section 1371 or through an alternative funding mechanism mutually
agreed to by the health care service plan and the physician or
physician group. The alternative funding mechanism shall be based on
reimbursements consistent with this subdivision.
   (c)  Physicians and physician groups may assume financial risk for
providing required immunizations  ,  if the
immunizations have experiential data that has been negotiated and
agreed upon by the health care service plan and the physician
risk-bearing organization. However, a health care service plan shall
not require a physician risk-bearing organization to accept financial
risk or impose additional risk on a physician risk-bearing
organization in violation of subdivision (a).
   (d)  A health care service plan shall not include the acquisition
costs associated with required immunizations for children in the
capitation rate of a physician who is individually capitated.