BILL NUMBER: AB 1946 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY APRIL 6, 2010
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. An act to
amend Section 13823.9 of the Penal Code, relating to crime victims.
LEGISLATIVE COUNSEL'S DIGEST
AB 1946, as amended, Fletcher. Health care service plans:
immunizations. Victims of sexual assault: child
molestation.
Under existing law, each county with a population of more than
100,000 is required to arrange to have professional personnel trained
in the examination of victims of sexual assault, including child
molestation, to be present or on call either in the county hospital
or a general acute care hospital.
This bill would revise these provisions to require that each
county with a population of more than 50,000 would be required to
arrange to have these professional personnel in either the county
hospital or a general acute care hospital.
By requiring additional counties to arrange for this service, this
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, if the Commission on State Mandates
determines that the bill contains costs mandated by the state,
reimbursement for those costs shall be made pursuant to these
statutory provisions.
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
yes . State-mandated local program: no
yes .
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 13823.9 of the Penal
Code is amended to read:
13823.9. (a) Every public or private general acute care hospital
that examines a victim of sexual assault or attempted sexual assault,
including child molestation, shall comply with the standards
specified in Section 13823.11 and the protocol and guidelines adopted
pursuant to Section 13823.5.
(b) Each county with a population of more than 100,000
50,000 shall arrange that professional personnel
trained in the examination of victims of sexual assault, including
child molestation, shall be present or on call either in the county
hospital which provides emergency medical services or in any general
acute care hospital which has contracted with the county to provide
emergency medical services. In counties with a population of
1,000,000 or more, the presence of these professional personnel shall
be arranged in at least one general acute care hospital for each
1,000,000 persons in the county.
(c) Each county shall designate at least one general acute care
hospital to perform examinations on victims of sexual assault,
including child molestation.
(d) (1) The protocol published by the agency or agencies
designated by the Director of Finance pursuant to Section 13820 shall
be used as a guide for the procedures to be used by every public or
private general acute care hospital in the state for the examination
and treatment of victims of sexual assault and attempted sexual
assault, including child molestation, and the collection and
preservation of evidence therefrom.
(2) The informational guide developed by the agency or agencies
designated by the Director of Finance pursuant to Section 13820 shall
be consulted where indicated in the protocol, as well as to gain
knowledge about all aspects of examination and treatment of victims
of sexual assault and child molestation.
SEC. 2. If the Commission on State Mandates
determines that this act contains costs mandated by the state,
reimbursement to local agencies and school districts for those costs
shall be made pursuant to Part 7 (commencing with Section 17500) of
Division 4 of Title 2 of the Government Code.
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.