BILL NUMBER: AB 910 CHAPTERED
BILL TEXT
CHAPTER 617
FILED WITH SECRETARY OF STATE OCTOBER 13, 2007
APPROVED BY GOVERNOR OCTOBER 13, 2007
PASSED THE SENATE SEPTEMBER 7, 2007
PASSED THE ASSEMBLY SEPTEMBER 11, 2007
AMENDED IN SENATE AUGUST 28, 2007
AMENDED IN SENATE JULY 2, 2007
AMENDED IN SENATE JUNE 27, 2007
AMENDED IN SENATE JUNE 12, 2007
AMENDED IN ASSEMBLY MAY 21, 2007
AMENDED IN ASSEMBLY APRIL 30, 2007
AMENDED IN ASSEMBLY APRIL 18, 2007
AMENDED IN ASSEMBLY APRIL 12, 2007
INTRODUCED BY Assembly Member Karnette
FEBRUARY 22, 2007
An act to amend Sections 3751 and 3752.5 of the Family Code, to
amend Section 1373 of the Health and Safety Code, and to amend
Sections 10277 and 10278 of the Insurance Code, relating to disabled
persons.
LEGISLATIVE COUNSEL'S DIGEST
AB 910, Karnette. Disabled persons: support and health care
coverage.
(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 also
provides for the regulation of health insurers by the Department of
Insurance. Under existing law, a plan and a health insurer are
required to provide that coverage for a dependent child who attains a
limiting age specified in the plan or policy shall not terminate if
the child is and continues to be both incapable of self-sustaining
employment by reason of mental retardation or a physical handicap and
chiefly dependent upon the subscriber or insured for support,
provided that proof of those facts is furnished within 31 days of the
request for the information or the child's attainment of the
limiting age, as specified.
This bill would change the first criterion, requiring a health
care service plan and a health insurer to provide that coverage of a
dependent child shall not terminate upon attaining the limiting age
if, in addition to meeting the 2nd criterion, as specified, the child
is and continues to be incapable of self-sustaining employment by
reason of a physically or mentally disabling injury, illness, or
condition. The bill would require the plan and insurer to notify the
subscriber or insured at least 90 days before the dependent child
attains the limiting age and would require the subscriber or insured
to submit proof, within 60 days of receiving that notice, that the
child meets the criteria. The bill would require the plan or insurer
upon request from the subscriber, group member, or policyholder and
proof the child meets the criteria for continued coverage, to
determine whether the child meets that criteria before the date the
child attains the limiting age. The bill would also require, after a
change in carriers, that the new plan or insurer continue coverage of
the dependent child and would authorize that new plan or insurer to
request information about the dependent child initially and not more
frequently than annually thereafter in order to determine if the
child continues to meet the criteria. The bill would require the
subscriber, group member, or policyholder to submit the information
requested by the new plan or insurer within 60 days of receiving the
request.
Because the bill would specify additional requirements under the
Knox-Keene Act, the willful violation of which would be a crime, it
would impose a state-mandated local program.
(2) Existing law requires health insurance coverage, as defined,
for a supported child to be included in a court's order for support
if that insurance is available at no cost or at a reasonable cost to
the parents. Existing law also requires a child support order to
include a provision requiring the child support obligor and obligee
to inform each other of the availability of health insurance
coverage, as specified, and requires the Judicial Council to modify
the form of the order to include those provisions.
The bill would require a support order to direct the parent or
parents who, at the time of the order or subsequently, provide health
insurance coverage for a supported child to seek continuation of
coverage for the child upon his or her attaining the limiting age
under the coverage if the child is incapable of self-sustaining
employment and otherwise meets the criteria described in paragraph
(1). The bill would require a child support order to include a
provision for the obligor and obligee to provide information about
the availability of health insurance coverage for a child or an adult
who meets that criteria and would not require the Judicial Council
to modify the order's form for this purpose until January 1, 2010.
(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.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 3751 of the Family Code is amended to read:
3751. (a) (1) Support orders issued or modified pursuant to this
chapter shall include a provision requiring the child support obligor
to keep the agency designated under Title IV-D of the Social
Security Act (42 U.S.C. Sec. 651 et seq.) informed of whether the
obligor has health insurance coverage at a reasonable cost and, if
so, the health insurance policy information.
(2) In any case in which an amount is set for current support, the
court shall require that health insurance coverage for a supported
child shall be maintained by either or both parents if that insurance
is available at no cost or at a reasonable cost to the parent.
Health insurance coverage shall be rebuttably presumed to be
reasonable in cost if it is employment-related group health insurance
or other group health insurance, regardless of the service delivery
mechanism. The actual cost of the health insurance to the obligor
shall be considered in determining whether the cost of insurance is
reasonable. If the court determines that the cost of health insurance
coverage is not reasonable, the court shall state its reasons on the
record.
(b) If the court determines that health insurance coverage is not
available at no cost or at a reasonable cost, the court's order for
support shall contain a provision that specifies that health
insurance coverage shall be obtained if it becomes available at no
cost or at a reasonable cost. Upon health insurance coverage at no
cost or at a reasonable cost becoming available to a parent, the
parent shall apply for that coverage.
(c) The court's order for support shall require the parent who, at
the time of the order or subsequently, provides health insurance
coverage for a supported child to seek continuation of coverage for
the child upon attainment of the limiting age for a dependent child
under the health insurance coverage if the child meets the criteria
specified under Section 1373 of the Health and Safety Code or Section
10277 or 10278 of the Insurance Code and that health insurance
coverage is available at no cost or at a reasonable cost to the
parent or parents, as applicable.
SEC. 2. Section 3752.5 of the Family Code is amended to read:
3752.5. (a) A child support order issued or modified pursuant to
this division shall include a provision requiring the child support
obligor to keep the obligee informed of whether the obligor has
health insurance made available through the obligor's employer or has
other group health insurance and, if so, the health insurance policy
information. The support obligee under a child support order shall
inform the support obligor of whether the obligee has health
insurance made available through the employer or other group health
insurance and, if so, the health insurance policy information.
(b) A child support order issued or modified pursuant to this
division shall include a provision requiring the child support
obligor and obligee to provide the information described in
subdivision (a) for a child or an adult who meets the criteria for
continuation of health insurance coverage upon attaining the limiting
age pursuant to Section 1373 of the Health and Safety Code or
Section 10277 or 10278 of the Insurance Code.
(c) The Judicial Council shall modify the form of the order for
health insurance coverage (family law) to notify child support
obligors of the requirements of this section and of Section 3752.
Notwithstanding any other provision of law, the Judicial Council
shall not be required to modify the form of the order for health
insurance coverage (family law) to include the provisions described
in subdivision (b) until January 1, 2010.
SEC. 3. Section 1373 of the Health and Safety Code is amended to
read:
1373. (a) A plan contract may not provide an exception for other
coverage if the other coverage is entitlement to Medi-Cal benefits
under Chapter 7 (commencing with Section 14000) or Chapter 8
(commencing with Section 14200) of Part 3 of Division 9 of the
Welfare and Institutions Code, or Medicaid benefits under Subchapter
19 (commencing with Section 1396) of Chapter 7 of Title 42 of the
United States Code.
Each plan contract shall be interpreted not to provide an
exception for the Medi-Cal or Medicaid benefits.
A plan contract shall not provide an exemption for enrollment
because of an applicant's entitlement to Medi-Cal benefits under
Chapter 7 (commencing with Section 14000) or Chapter 8 (commencing
with Section 14200) of Part 3 of Division 9 of the Welfare and
Institutions Code, or Medicaid benefits under Subchapter 19
(commencing with Section 1396) of Chapter 7 of Title 42 of the United
States Code.
A plan contract may not provide that the benefits payable
thereunder are subject to reduction if the individual insured has
entitlement to the Medi-Cal or Medicaid benefits.
(b) A plan contract that provides coverage, whether by specific
benefit or by the effect of general wording, for sterilization
operations or procedures shall not impose any disclaimer, restriction
on, or limitation of, coverage relative to the covered individual's
reason for sterilization.
As used in this section, "sterilization operations or procedures"
shall have the same meaning as that specified in Section 10120 of the
Insurance Code.
(c) Every plan contract that provides coverage to the spouse or
dependents of the subscriber or spouse shall grant immediate accident
and sickness coverage, from and after the moment of birth, to each
newborn infant of any subscriber or spouse covered and to each minor
child placed for adoption from and after the date on which the
adoptive child's birth parent or other appropriate legal authority
signs a written document, including, but not limited to, a health
facility minor release report, a medical authorization form, or a
relinquishment form, granting the subscriber or spouse the right to
control health care for the adoptive child or, absent this written
document, on the date there exists evidence of the subscriber's or
spouse's right to control the health care of the child placed for
adoption. No plan may be entered into or amended if it contains any
disclaimer, waiver, or other limitation of coverage relative to the
coverage or insurability of newborn infants of, or children placed
for adoption with, a subscriber or spouse covered as required by this
subdivision.
(d) (1) Every plan contract that provides that coverage of a
dependent child of a subscriber shall terminate upon attainment of
the limiting age for dependent children specified in the plan, shall
also provide that attainment of the limiting age shall not operate to
terminate the coverage of the child while the child is and continues
to meet both of the following criteria:
(A) Incapable of self-sustaining employment by reason of a
physically or mentally disabling injury, illness, or condition.
(B) Chiefly dependent upon the subscriber for support and
maintenance.
(2) The plan shall notify the subscriber that the dependent child'
s coverage will terminate upon attainment of the limiting age unless
the subscriber submits proof of the criteria described in
subparagraphs (A) and (B) of paragraph (1) to the plan within 60 days
of the date of receipt of the notification. The plan shall send this
notification to the subscriber at least 90 days prior to the date
the child attains the limiting age. Upon receipt of a request by the
subscriber for continued coverage of the child and proof of the
criteria described in subparagraphs (A) and (B) of paragraph (1), the
plan shall determine whether the child meets that criteria before
the child attains the limiting age. If the plan fails to make the
determination by that date, it shall continue coverage of the child
pending its determination.
(3) The plan may subsequently request information about a
dependent child whose coverage is continued beyond the limiting age
under this subdivision but not more frequently than annually after
the two-year period following the child's attainment of the limiting
age.
(4) If the subscriber changes carriers to another plan or to a
health insurer, the new plan or insurer shall continue to provide
coverage for the dependent child. The new plan or insurer may request
information about the dependent child initially and not more
frequently than annually thereafter to determine if the child
continues to satisfy the criteria in subparagraphs (A) and (B) of
paragraph (1). The subscriber shall submit the information requested
by the new plan or insurer within 60 days of receiving the request.
(e) A plan contract that provides coverage, whether by specific
benefit or by the effect of general wording, for both an employee and
one or more covered persons dependent upon the employee and provides
for an extension of the coverage for any period following a
termination of employment of the employee shall also provide that
this extension of coverage shall apply to dependents upon the same
terms and conditions precedent as applied to the covered employee,
for the same period of time, subject to payment of premiums, if any,
as required by the terms of the policy and subject to any applicable
collective bargaining agreement.
(f) A group contract shall not discriminate against handicapped
persons or against groups containing handicapped persons. Nothing in
this subdivision shall preclude reasonable provisions in a plan
contract against liability for services or reimbursement of the
handicap condition or conditions relating thereto, as may be allowed
by rules of the director.
(g) Every group contract shall set forth the terms and conditions
under which subscribers and enrollees may remain in the plan in the
event the group ceases to exist, the group contract is terminated or
an individual subscriber leaves the group, or the enrollees'
eligibility status changes.
(h) (1) A health care service plan or specialized health care
service plan may provide for coverage of, or for payment for,
professional mental health services, or vision care services, or for
the exclusion of these services. If the terms and conditions include
coverage for services provided in a general acute care hospital or an
acute psychiatric hospital as defined in Section 1250 and do not
restrict or modify the choice of providers, the coverage shall extend
to care provided by a psychiatric health facility as defined in
Section 1250.2 operating pursuant to licensure by the State
Department of Mental Health. A health care service plan that offers
outpatient mental health services but does not cover these services
in all of its group contracts shall communicate to prospective group
contractholders as to the availability of outpatient coverage for the
treatment of mental or nervous disorders.
(2) No plan shall prohibit the member from selecting any
psychologist who is licensed pursuant to the Psychology Licensing Law
(Chapter 6.6 (commencing with Section 2900) of Division 2 of the
Business and Professions Code), any optometrist who is the holder of
a certificate issued pursuant to Chapter 7 (commencing with Section
3000) of Division 2 of the Business and Professions Code or, upon
referral by a physician and surgeon licensed pursuant to the Medical
Practice Act (Chapter 5 (commencing with Section 2000) of Division 2
of the Business and Professions Code), (i) any marriage and family
therapist who is the holder of a license under Section 4980.50 of the
Business and Professions Code, (ii) any licensed clinical social
worker who is the holder of a license under Section 4996 of the
Business and Professions Code, (iii) any registered nurse licensed
pursuant to Chapter 6 (commencing with Section 2700) of Division 2 of
the Business and Professions Code, who possesses a master's degree
in psychiatric-mental health nursing and is listed as a
psychiatric-mental health nurse by the Board of Registered Nursing,
or (iv) any advanced practice registered nurse certified as a
clinical nurse specialist pursuant to Article 9 (commencing with
Section 2838) of Chapter 6 of Division 2 of the Business and
Professions Code who participates in expert clinical practice in the
specialty of psychiatric-mental health nursing, to perform the
particular services covered under the terms of the plan, and the
certificate holder is expressly authorized by law to perform these
services.
(3) Nothing in this section shall be construed to allow any
certificate holder or licensee enumerated in this section to perform
professional mental health services beyond his or her field or fields
of competence as established by his or her education, training and
experience.
(4) For the purposes of this section, "marriage and family
therapist" means a licensed marriage and family therapist who has
received specific instruction in assessment, diagnosis, prognosis,
and counseling, and psychotherapeutic treatment of premarital,
marriage, family, and child relationship dysfunctions that is
equivalent to the instruction required for licensure on January 1,
1981.
(5) Nothing in this section shall be construed to allow a member
to select and obtain mental health or psychological or vision care
services from a certificate or licenseholder who is not directly
affiliated with or under contract to the health care service plan or
specialized health care service plan to which the member belongs. All
health care service plans and individual practice associations that
offer mental health benefits shall make reasonable efforts to make
available to their members the services of licensed psychologists.
However, a failure of a plan or association to comply with the
requirements of the preceding sentence shall not constitute a
misdemeanor.
(6) As used in this subdivision, "individual practice association"
means an entity as defined in subsection (5) of Section 1307 of the
federal Public Health Service Act (42 U.S.C. Sec. 300e-1 (5)).
(7) Health care service plan coverage for professional mental
health services may include community residential treatment services
that are alternatives to inpatient care and that are directly
affiliated with the plan or to which enrollees are referred by
providers affiliated with the plan.
(i) If the plan utilizes arbitration to settle disputes, the plan
contracts shall set forth the type of disputes subject to
arbitration, the process to be utilized, and how it is to be
initiated.
(j) A plan contract that provides benefits that accrue after a
certain time of confinement in a health care facility shall specify
what constitutes a day of confinement or the number of consecutive
hours of confinement that are requisite to the commencement of
benefits.
SEC. 4. Section 10277 of the Insurance Code is amended to read:
10277. (a) A group health insurance policy that provides that
coverage of a dependent child of an employee or other member of the
covered group shall terminate upon attainment of the limiting age for
dependent children specified in the policy, shall also provide that
attainment of the limiting age shall not operate to terminate the
coverage of the child while the child is and continues to meet both
of the following criteria:
(1) Incapable of self-sustaining employment by reason of a
physically or mentally disabling injury, illness, or condition.
(2) Chiefly dependent upon the employee or member for support and
maintenance.
(b) The insurer shall notify the employee or member that the
dependent child's coverage will terminate upon attainment of the
limiting age unless the employee or member submits proof of the
criteria described in paragraphs (1) and (2) of subdivision (a) to
the insurer within 60 days of the date of receipt of the
notification. The insurer shall send this notification to the
employee or member at least 90 days prior to the date the child
attains the limiting age. Upon receipt of a request by the employee
or member for continued coverage of the child and proof of the
criteria described in paragraphs (1) and (2) of subdivision (a), the
insurer shall determine whether the dependent child meets that
criteria before the child attains the limiting age. If the insurer
fails to make the determination by that date, it shall continue
coverage of the child pending its determination.
(c) The insurer may subsequently request information about a
dependent child whose coverage is continued beyond the limiting age
under subdivision (a), but not more frequently than annually after
the two-year period following the child's attainment of the limiting
age.
(d) If the employee or member changes carriers to another insurer
or to a health care service plan, the new insurer or plan shall
continue to provide coverage for the dependent child. The new plan or
insurer may request information about the dependent child initially
and not more frequently than annually thereafter to determine if the
child continues to satisfy the criteria in paragraphs (1) and (2) of
subdivision (a). The employee or member shall submit the information
requested by the new plan or insurer within 60 days of receiving the
request.
SEC. 5. Section 10278 of the Insurance Code is amended to read:
10278. (a) An individual health insurance policy that provides
that coverage of a dependent child shall terminate upon attainment of
the limiting age for dependent children specified in the policy,
shall also provide that attainment of the limiting age shall not
operate to terminate the coverage of the child while the child is and
continues to meet both of the following criteria:
(1) Incapable of self-sustaining employment by reason of a
physically or mentally disabling injury, illness, or condition.
(2) Chiefly dependent upon the policyholder or subscriber for
support and maintenance.
(b) The insurer shall notify the policyholder or subscriber that
the dependent child's coverage will terminate upon attainment of the
limiting age unless the policyholder or subscriber submits proof of
the criteria described in paragraphs (1) and (2) of subdivision (a)
to the insurer within 60 days of the date of receipt of the
notification. The insurer shall send this notification to the
policyholder or subscriber at least 90 days prior to the date the
child attains the limiting age. Upon receipt of a request by the
policyholder or subscriber for continued coverage of the child and
proof of the criteria described in paragraphs (1) and (2) of
subdivision (a), the insurer shall determine whether the dependent
child meets that criteria before the child attains the limiting age.
If the insurer fails to make the determination by that date, it shall
continue coverage of the child pending its determination.
(c) The insurer may subsequently request information about a
dependent child whose coverage is continued beyond the limiting age
under subdivision (a), but not more frequently than annually after
the two-year period following the child's attainment of the limiting
age.
(d) If the subscriber or policyholder changes carriers to another
insurer or to a health care service plan, the new insurer or plan
shall continue to provide coverage for the dependent child. The new
plan or insurer may request information about the dependent child
initially and not more frequently than annually thereafter to
determine if the child continues to satisfy the criteria in
paragraphs (1) and (2) of subdivision (a). The subscriber or
policyholder shall submit the information requested by the new plan
or insurer within 60 days of receiving the request.
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.