Amended  IN  Senate  April 30, 2019

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Senate Bill No. 600

Introduced by Senator Portantino

February 22, 2019

An act to add Sections 1374.551 and 1374.552 to the Health and Safety Code, and to add Sections 10119.61 and 10119.62 to the Insurance Code, relating to healthcare coverage. Section 1374.551 to the Health and Safety Code, to add Section 10119.61 to the Insurance Code, and to add Section 14132.43 to the Welfare and Institutions Code, relating to health care coverage.


LEGISLATIVE COUNSEL'S DIGEST


SB 600, as amended, Portantino. Healthcare Health care coverage: fertility preservation.
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 every group health care service plan contract and health insurance policy issued, amended, or renewed on or after January 1, 2017, to include, at a minimum, coverage for essential health benefits, including medically necessary basic health care services, as defined.
This bill would clarify that an individual or group health care service plan contract or health insurance policy that covers hospital, medical, or surgical expenses includes coverage for standard fertility preservation services when a medically necessary treatment may cause iatrogenic infertility to an enrollee or insured. The bill would state that these provisions are declaratory of existing law.

This bill would also prohibit a health care service plan or health insurer from denying coverage for standard fertility preservation services based on medical necessity when a provider of a treatment of a medical condition authorized by the plan or policy states that the treatment may cause iatrogenic infertility to an enrollee or insured. 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.

Existing law provides for the Medi-Cal program, administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law provides for a schedule of benefits under the Medi-Cal program, which includes comprehensive perinatal services, subject to utilization controls.
This bill would add to the schedule of benefits standard fertility preservation services when a medically necessary treatment may cause iatrogenic infertility to a beneficiary.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: YESNO  

The people of the State of California do enact as follows:


SECTION 1.

 Section 1374.551 is added to the Health and Safety Code, to read:

1374.551.
 (a) An individual or group A health care service plan contract that covers hospital, medical, or surgical expenses includes coverage for medically necessary expenses for standard fertility preservation services when a medically necessary treatment may directly or indirectly cause iatrogenic infertility to an enrollee.
(b) For purposes of this section and Section 1374.552, section, the following definitions apply:
(1) “Iatrogenic infertility” means an impairment of fertility caused directly or indirectly by surgery, chemotherapy, radiation, or other medical treatment.
(2) Medical treatment that “may directly or indirectly cause iatrogenic infertility” means medical treatment with a possible side effect of impaired fertility, as established by the American Society of Clinical Oncology, the American Society for Reproductive Medicine, or other reputable professional association or organization. Oncology or the American Society for Reproductive Medicine.
(3) “Standard fertility preservation services” means procedures consistent with the established medical practices and professional guidelines published by the American Society of Clinical Oncology, the American Society for Reproductive Medicine, or other reputable professional medical organization. Oncology or the American Society for Reproductive Medicine.
(c) This section applies to a health care service plan contract with the State Department of Health Care Services pursuant to the Medi-Cal program (Chapter 7 (commencing with Section 14000) of Part 3 of the Welfare and Institutions Code).

SEC. 2.Section 1374.552 is added to the Health and Safety Code, to read:
1374.552.

(a)Standard fertility preservation services shall be deemed medically necessary when a provider of treatment of a medical condition authorized by a health care service plan states that there is a substantial likelihood that the treatment may directly or indirectly cause iatrogenic infertility to the enrollee.

(b)When a provider states that standard fertility preservation services are medically necessary pursuant to subdivision (a), a health care service plan shall not deny coverage for those services based on medical necessity.

SEC. 3.SEC. 2.

 Section 10119.61 is added to the Insurance Code, to read:

10119.61.
 (a) An individual or group health insurance policy that covers hospital, medical, or surgical expenses includes coverage for medically necessary expenses for standard fertility preservation services when a medically necessary treatment may directly or indirectly cause iatrogenic infertility to an insured.
(b) For purposes of this section and Section 10119.62, section, the following definitions apply:
(1) “Iatrogenic infertility” means an impairment of fertility caused directly or indirectly by surgery, chemotherapy, radiation, or other medical treatment.
(2) Medical treatment that “may directly or indirectly cause iatrogenic infertility” means medical treatment with a possible side effect of impaired fertility, as established by the American Society of Clinical Oncology, the American Society for Reproductive Medicine, or other reputable professional association or organization. Oncology or the American Society for Reproductive Medicine.
(3) “Standard fertility preservation services” means procedures consistent with the established medical practices and professional guidelines published by the American Society of Clinical Oncology, the American Society for Reproductive Medicine, or other reputable professional medical organization. Oncology or the American Society for Reproductive Medicine.

SEC. 4.Section 10119.62 is added to the Insurance Code, to read:
10119.62.

(a)Standard fertility preservation services shall be deemed medically necessary when a provider of treatment of a medical condition authorized by a health insurance policy states that there is a substantial likelihood that the treatment may cause iatrogenic infertility to the insured.

(b)When a provider states that standard fertility preservation services are medically necessary pursuant to subdivision (a), an insurer shall not deny coverage for those services based on medical necessity.

SEC. 3.

 Section 14132.43 is added to the Welfare and Institutions Code, immediately following Section 14132.42, to read:

14132.43.
 (a) Medically necessary expenses for standard fertility preservation services are covered under this chapter when a medically necessary treatment may directly or indirectly cause iatrogenic infertility to a beneficiary.
(b) For purposes of this section, the following definitions apply:
(1) “Iatrogenic infertility” means an impairment of fertility caused directly or indirectly by surgery, chemotherapy, radiation, or other medical treatment.
(2) Medical treatment that “may directly or indirectly cause iatrogenic infertility” means medical treatment with a possible side effect of impaired fertility, as established by the American Society of Clinical Oncology or the American Society for Reproductive Medicine.
(3) “Standard fertility preservation services” means procedures consistent with the established medical practices and professional guidelines published by the American Society of Clinical Oncology or the American Society for Reproductive Medicine.

SEC. 5.SEC. 4.

 The addition of Section 1374.551 to the Health and Safety Code and Section 10119.61 to the Insurance Code by this act does not constitute a change in, but is declaratory of, existing law.
SEC. 6.

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.