Health care coverage: scalp cooling., the official text

An act to add Section 1367.651 to the Health and Safety Code, to add Section 10123.811 to the Insurance Code, and to add Section 14132.65 to the Welfare and Institutions Code, relating to health care coverage.

LEGISLATIVE COUNSEL'S DIGEST

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 provides for the regulation of health insurers by the Department of Insurance. Existing law requires coverage by health care service plans and health insurers for various screening and treatment services with respect to cancer.
This bill would require a health care service plan contract or health insurance policy, except as specified, that is issued, amended, delivered, or renewed on or after January 1, 2027, to provide coverage for scalp cooling, as defined, as prescribed by a health care provider in connection with chemotherapy for persons with cancer. Because a violation of these provisions with respect to a health care service plan would be a crime, this bill would impose a state-mandated local program.
Existing law also provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services pursuant to a schedule of benefits, including various cancer screenings and benefits relating to cancer treatment.
Subject to the extent that federal financial participation is available and not otherwise jeopardized, and any necessary federal approvals have been obtained, this bill would expand the Medi-Cal schedule of benefits to include scalp cooling, as prescribed by a health care provider in connection with chemotherapy for persons with cancer.
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 1367.651 is added to the Health and Safety Code, to read:
1367.651.
(a) A health care service plan contract issued, amended, or renewed on and after January 1, 2027, shall provide coverage for scalp cooling, as prescribed by a health care provider in connection with chemotherapy for persons with cancer.
(b) Coverage required by this section may be subject to copayments, coinsurance, or deductibles, provided that the copayments, coinsurance, or deductibles applicable to scalp cooling are no less favorable to an enrollee than the copayments, coinsurance, or deductibles that apply to coverage for oncology supportive care services under the same contract.
(c) For purposes of this section, “scalp cooling’’ is defined as the use of a medical device or system cleared by the federal Food and Drug Administration (FDA) applied to the scalp before, during, or after the administration of chemotherapy to reduce the incidence or severity of chemotherapy-induced alopecia (hair loss). “Scalp cooling” does not include non-FDA-cleared cold caps or any non-FDA-cleared scalp cooling products, regardless of whether those products are described as “cold cap therapy” or similar terminology.
(d) This section shall not apply to specialized health care service plans.

SEC. 2.
Section 10123.811 is added to the Insurance Code, to read:
10123.811.
(a) A health insurance policy issued, amended, or renewed on and after January 1, 2027, shall provide coverage for scalp cooling, as prescribed by a health care provider in connection with chemotherapy for persons with cancer.
(b) Coverage required by this section may be subject to copayments, coinsurance, or deductibles, provided that the copayments, coinsurance, or deductibles applicable to scalp cooling are no less favorable to an insured than the copayments, coinsurance, or deductibles that apply to coverage for oncology supportive care services under the same policy.
(c) For purposes of this section, “scalp cooling’’ is defined as the use of a medical device or system cleared by the federal Food and Drug Administration (FDA) applied to the scalp before, during, or after the administration of chemotherapy to reduce the incidence or severity of chemotherapy induced alopecia (hair loss). “Scalp cooling” does not include non–FDA-cleared cold caps or any non–FDA-cleared scalp cooling products, regardless of whether such products are described as “cold cap therapy” or similar terminology.
(d) This section shall not apply to a specialized health insurance policy.

SEC. 3.
Section 14132.65 is added to the Welfare and Institutions Code, to read:
14132.65.
(a) Scalp cooling, as prescribed by a health care provider in connection with chemotherapy for persons with cancer, is a covered benefit under the Medi-Cal program.
(b) Coverage required by this section may be subject to copayments or deductibles, provided that the copayments or deductibles applicable to scalp cooling are no less favorable to a beneficiary than the copayments or deductibles that apply to oncology supportive care services that are covered benefits under the Medi-Cal program.
(c) For purposes of this section, “scalp cooling’’ is defined as the use of a medical device or system cleared by the federal Food and Drug Administration (FDA) applied to the scalp before, during, or after the administration of chemotherapy to reduce the incidence or severity of chemotherapy induced alopecia (hair loss). “Scalp cooling” does not include non–FDA-cleared cold caps or any non–FDA-cleared scalp cooling products, regardless of whether such products are described as “cold cap therapy” or similar terminology.
(d) This section shall be implemented in a manner consistent with federal law and only to the extent federal financial participation is available and not otherwise jeopardized.

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.