Monique Limón
- Democratic
- Senator
- District 19
Author
(1) Existing law, the Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene Act) 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 contract or health insurance policy issued, amended, delivered, or renewed on or after July 1, 2000, to provide coverage for all generally medically accepted cancer screening tests, and prohibits that contract or policy issued, amended, delivered, or renewed on or after July 1, 2022, from requiring prior authorization for biomarker testing for certain enrollees or insureds. Existing law applies the provisions relating to biomarker testing to Medi-Cal managed care plans, as prescribed. This bill would require a health care service plan contract or health insurance policy issued, amended, or renewed on or after July 1, 2024, to provide coverage for medically necessary biomarker testing, as prescribed, including whole genome sequencing, for the purposes of diagnosis, treatment, appropriate management, or ongoing monitoring of an enrollee's or insured's disease or condition to guide treatment decisions, as prescribed. The bill would specify that it does not require a health care service plan or health insurer to cover biomarker testing for screening purposes unless otherwise required by law. The bill would subject restricted or denied use of biomarker testing for the purpose of diagnosis, treatment, or ongoing monitoring of a medical condition to state and federal grievance and appeal processes. 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 provides for the Medi-Cal program, administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services pursuant to a schedule of benefits. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law includes Rapid Whole Genome Sequencing as a covered benefit for any Medi-Cal beneficiary who is one year of age or younger and is receiving inpatient hospital services in an intensive care unit. Subject to the extent that federal financial participation is available and not otherwise jeopardized, and any necessary federal approvals have been obtained, this bill, by July 1, 2024, would expand the Medi-Cal schedule of benefits to include biomarker testing, as prescribed, for the purposes of diagnosis, treatment, appropriate management, or ongoing monitoring of a Medi-Cal beneficiary's disease or condition to guide treatment decisions, as prescribed. The bill would authorize the department to implement these provisions by various means without taking regulatory action. (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.
Chaptered by Secretary of State. Chapter 401, Statutes of 2023.
Approved by the Governor.
Enrolled and presented to the Governor at 4 p.m.
Assembly amendments concurred in. (Ayes 40. Noes 0. Page 2844.) Ordered to engrossing and enrolling.
Read third time. Passed. (Ayes 79. Noes 0. Page 3432.) Ordered to the Senate.
In Senate. Concurrence in Assembly amendments pending.
Assembly Rule 69 suspended. (Ayes 62. Noes 15. Page 3010.)
Ordered to third reading.
Read third time and amended.
Read second time. Ordered to third reading.
From committee: Do pass as amended. (Ayes 11. Noes 0.) (September 1).
Read second time and amended. Ordered to second reading.
August 16 set for first hearing. Placed on suspense file.
Read second time and amended. Re-referred to Com. on APPR.
From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 15. Noes 0.) (July 11).
In Assembly. Read first time. Held at Desk.
Read third time. Passed. (Ayes 40. Noes 0. Page 1272.) Ordered to the Assembly.
Read second time. Ordered to third reading.
From committee: Do pass. (Ayes 6. Noes 0. Page 1172.) (May 18).
Set for hearing May 18.
May 8 hearing: Placed on APPR suspense file.
Set for hearing May 8.
Read second time and amended. Re-referred to Com. on APPR.
From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 11. Noes 0. Page 831.) (April 19).
Set for hearing April 19.
April 12 set for first hearing canceled at the request of author.
Set for hearing April 12.
From printer. May be acted upon on or after March 17.
Introduced. Read first time. To Com. on RLS. for assignment. To print.
| Bill Text Versions | Format |
|---|---|
| SB496 | HTML |
| 02/14/23 - Introduced | |
| 04/25/23 - Amended Senate | |
| 07/13/23 - Amended Assembly | |
| 09/01/23 - Amended Assembly | |
| 09/07/23 - Amended Assembly | |
| 09/18/23 - Enrolled | |
| 10/07/23 - Chaptered |
| Document | Format |
|---|---|
| 04/17/23- Senate Health | |
| 05/05/23- Senate Appropriations | |
| 05/22/23- Sen. Floor Analyses | |
| 07/07/23- Assembly Health | |
| 08/14/23- Assembly Appropriations | |
| 09/05/23- ASSEMBLY FLOOR ANALYSIS | |
| 09/07/23- ASSEMBLY FLOOR ANALYSIS | |
| 09/14/23- Sen. Floor Analyses |
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