Bill Text: CA AB2004 | 2015-2016 | Regular Session | Amended
Bill Title: Hearing aids: minors.
Spectrum: Moderate Partisan Bill (Democrat 4-1)
Status: (Failed) 2016-11-30 - From Senate committee without further action. [AB2004 Detail]
Download: California-2015-AB2004-Amended.html
BILL NUMBER: AB 2004 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY MAY 31, 2016
AMENDED IN ASSEMBLY APRIL 26, 2016
AMENDED IN ASSEMBLY MARCH 9, 2016
INTRODUCED BY Assembly Member Bloom
(Coauthors: Assembly Members Dodd, Gallagher, Cristina Garcia, and
Mullin)
FEBRUARY 16, 2016
An act to add and repeal Section 1367.72 to
of the Health and Safety Code, and to add
and repeal Section 10123.72 to of
the Insurance Code, relating to health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
AB 2004, as amended, Bloom. Hearing aids: minors.
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 also provides for the
regulation of health insurers by the Department of Insurance.
Existing law requires health care service plan contracts and health
insurance policies to provide coverage for specified benefits.
This bill bill, until January 1, 2019,
would require a health care service plan contract or a health
insurance policy issued, amended, or renewed on or after January 1,
2017, to include coverage for hearing aids for an enrollee or insured
under 18 years of age, as specified. These provisions would
become inoperative if the Department of Managed Health Care and the
Department of Insurance receive a notification from the federal
Centers for Medicare and Medicaid Services or any other applicable
federal agency that these provisions constitute a discriminatory age
limitation under federal law and the state is required to defray the
costs of requiring a plan contract or policy to include coverage for
hearing aids on behalf of enrollees or insureds who are 18 years of
age or older pursuant to a specified federal law. Because a
willful violation of these requirements by a health care service plan
would be a crime, 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 no reimbursement is required by this
act for a specified reason.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. It is the intent of the Legislature to
explore alternate approaches to ensure the continuation of broad
coverage of pediatric hearing benefits upon expiration of this
mandate, including exploring ways to add pediatric hearing as an
essential health benefit, without incurring ongoing state costs.
SECTION 1. SEC. 2. Section 1367.72
is added to the Health and Safety Code, to read:
1367.72. (a) (1) A health care service plan contract issued,
amended, or renewed on or after January 1, 2017, shall include
coverage for hearing aids for all enrollees under 18 years of age
when medically necessary.
(2) Coverage for hearing aids includes an initial assessment, new
hearing aids at least every five years, new ear molds, new hearing
aids if alterations to existing hearing aids cannot meet the needs of
the child, a new hearing aid if the existing one is no longer
working, fittings, adjustments, auditory training, and maintenance of
the hearing aids.
(b) For purposes of this section, "hearing aid" means an
electronic device usually worn in or behind the ear of a deaf and
hard of hearing person for the purpose of amplifying sound.
(c) This section shall not apply to Medicare supplement,
dental-only, or vision-only health care service plan contracts.
(d) (1) This section shall become inoperative if the department
receives a notification from the federal Centers for Medicare and
Medicaid Services or any other applicable federal agency that this
section constitutes a discriminatory age limitation under federal law
and the state is required to defray the costs of requiring a plan
contract to include coverage for hearing aids on behalf of enrollees
who are 18 years of age or older pursuant to Section 1311 of the
Patient Protection and Affordable Care Act (42 U.S.C. Sec. 18031(d)
(3)).
(2) This section shall become inoperative 30 days after the
director executes a declaration, which shall be retained by the
director, stating that the department received the notification
described in paragraph (1). The director shall post the declaration
on the department's Internet Web site, and the director shall send
the declaration to the appropriate policy committees of the
Legislature and to the Legislative Counsel.
(e) This section shall remain in effect only until January 1,
2019, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2019, deletes or extends
that date.
SEC. 2. SEC. 3. Section 10123.72 is
added to the Insurance Code, to read:
10123.72. (a) (1) A health insurance policy issued, amended, or
renewed on or after January 1, 2017, shall include coverage for
hearing aids for all insureds under 18 years of age when medically
necessary.
(2) Coverage for hearing aids includes an initial assessment, new
hearing aids at least every five years, new ear molds, new hearing
aids if alterations to existing hearing aids cannot meet the needs of
the child, a new hearing aid if the existing one is no longer
working, fittings, adjustments, auditory training, and maintenance of
the hearing aids.
(b) For purposes of this section, "hearing aid" means an
electronic device usually worn in or behind the ear of a deaf and
hard of hearing person for the purpose of amplifying sound.
(c) This section shall not apply to accident-only, specified
disease, hospital indemnity, Medicare supplement, dental-only, or
vision-only health insurance policies.
(d) (1) This section shall become inoperative if the department
receives a notification from the federal Centers for Medicare and
Medicaid Services or any other applicable federal agency that this
section constitutes a discriminatory age limitation under federal law
and the state is required to defray the costs of requiring a health
insurance policy to include coverage for hearing aids on behalf of
insureds who are 18 years of age or older pursuant to Section 1311 of
the Patient Protection and Affordable Care Act (42 U.S.C. Sec. 18031
(d)(3)).
(2) This section shall become inoperative 30 days after the
commissioner executes a declaration, which shall be retained by the
commissioner, stating that the department received the notification
described in paragraph (1). The commissioner shall post the
declaration on the department's Internet Web site, and the
commissioner shall send the declaration to the appropriate policy
committees of the Legislature and to the Legislative Counsel.
(e) This section shall remain in effect only until January 1,
2019, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2019, deletes or extends
that date.
SEC. 3. SEC. 4. 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.
