Health care coverage: scalp cooling.

Removed the requirement that small group health care service plan contracts issued, amended, or renewed on or after January 1, 2027 must offer scalp cooling coverage (former Section 1367.651(b)). Small group plans are no longer subject to any obligation under this bill.

Removed the requirement that small group health insurance policies issued, amended, or renewed on or after January 1, 2027 must offer scalp cooling coverage (former Section 10123.811(b)). Small group insurers are no longer subject to any obligation under this bill.

Subdivision letters were renumbered in Sections 1 and 2 to reflect the removal of the small group provisions (e.g., former (c) became (b), former (d) became (c), etc.).

Header changed from 'Amended in Senate' to enrolled bill format with Assembly and Senate passage dates (both August 26, 2026) and a Governor's approval line. The coauthor credit for Senator Rubio was removed from the enrolled version.

Removed the provision in Section 14132.65 (Medi-Cal) that required copayments or deductibles for scalp cooling to be no less favorable to a beneficiary than those applying to oncology supportive care services under Medi-Cal.

Changed 'chemotherapy induced' to 'chemotherapy-induced' (added hyphen) in the definition of scalp cooling across all three code sections.

Removed the phrase 'under the Medi-Cal program' from Section 14132.65(a), which is redundant since the section is located in the Welfare and Institutions Code governing Medi-Cal.

Large group health care service plan contracts and large group health insurance policies must provide scalp cooling coverage. Small group plans and policies need only offer coverage, and the bill explicitly states this shall not be construed to require them to actually provide it. This is a major softening of the mandate for small employers.

A new exemption was added: Medi-Cal managed care plan contracts are excluded from the Health and Safety Code section (Section 1367.651) and instead governed by the Welfare and Institutions Code section (Section 14132.65). This prevents duplicate or conflicting requirements on Medi-Cal managed care plans.

Senator Rubio was added as a co-author, indicating bipartisan or cross-chamber support for the amendment.

The definition of when scalp cooling coverage is required was narrowed from 'in connection with chemotherapy for persons with cancer' to 'to reduce the incidence or severity of alopecia before, during, or after chemotherapy in which alopecia-inducing chemotherapeutic agents are used.' This limits coverage to chemotherapy regimens that actually cause hair loss.

Medi-Cal coverage for scalp cooling is now explicitly subject to utilization controls and medical necessity, giving the state tools to limit when the benefit is paid.

The federal compliance condition for Medi-Cal was strengthened from 'federal financial participation is available and not otherwise jeopardized' to 'any necessary federal approvals have been obtained and federal financial participation is available and not otherwise jeopardized,' adding an explicit requirement that federal approvals must actually be secured before the benefit takes effect.

A new provision allows the department to implement, interpret, and make specific the Medi-Cal scalp cooling section through all-county letters, plan letters, plan or provider bulletins, or similar instructions without taking further regulatory action, notwithstanding Administrative Procedure Act requirements. This gives the state faster implementation authority.