Health care coverage: home test kits.

The coverage mandate was broadened from requiring only 'an annual cervical cancer screening home test kit' to requiring coverage for 'cervical cancer screening' generally, which includes FDA-authorized or cleared self-collected cervical screening kits as a subset rather than the sole requirement.

New explicit exclusions for vision-only, dental-only, and Medicare supplement contracts or policies were added to both the Health and Safety Code (health care service plans) and Insurance Code (health insurance policies) sections.

The Insurance Code section changed the covered policy type from 'disability insurance policy' to 'health insurance policy,' and simplified the exclusion list by removing accident-only, specified disease, hospital indemnity, CHAMPUS supplement, long-term care, and disability income insurance from the exclusions, thereby expanding which policies must comply.

A new exclusion was added in the Health and Safety Code section for Medi-Cal managed care plan contracts with the State Department of Health Care Services, clarifying that those plans are governed by separate statutory chapters rather than this mandate.

The clinical guideline reference was expanded from 'nationally recognized clinical guidelines' alone to also include 'any relevant recommendations published pursuant to Section 120164' for health care service plans and 'specified recommendations published by the State Department of Public Health' in the Medi-Cal provisions.

A new condition was added for Medi-Cal coverage of cervical cancer home test kits: federal financial participation must be available and not otherwise jeopardized, and any necessary federal approvals must have been obtained.

The referral/ordering requirement was broadened from specific provider types (physician and surgeon, nurse practitioner, or certified nurse-midwife) to any in-network provider operating within their permitted scope of practice, for both service plans and insurance policies.

A new exception was added: the no-cost-sharing rule only applies to health savings account-eligible plans to the extent the plan does not fail to be treated as a high deductible health plan under Section 223 of Title 26 of the United States Code. This means HSA-eligible plans that are NOT high deductible health plans may still impose cost-sharing.

A new requirement that cervical cancer screening coverage must be consistent with nationally recognized clinical guidelines was added to both the Health and Safety Code (service plans) and Insurance Code (policies) provisions.

FDA-authorized or cleared self-collected cervical screening kits that allow patients to self-collect samples outside a clinical setting are now explicitly named as included in covered cervical cancer screening tests, for both service plans and insurance policies.

The Medi-Cal benefit was expanded from simply adding home test kits to including all cervical cancer tests for screening ordered by a patient's health care provider and consistent with nationally recognized clinical guidelines, in addition to FDA-authorized or cleared home test kits specifically.

New subdivisions (c) and (d) were added to both Section 1367.66 and Section 10123.18 creating a blanket prohibition on deductibles, coinsurance, copayments, or any other cost-sharing for all coverage provided under those sections, not just home test kits.

New savings clause subdivisions (e) were added: Section 1367.66 does not limit the application of Section 1367.002, and Section 10123.18 does not limit the application of Section 10112.2.

The bill now amends Section 14132 of the Welfare and Institutions Code (the Medi-Cal schedule of benefits) and Section 24007, expanding its reach beyond just cervical cancer screening to broader home test kit coverage in family planning programs.

The legislative digest was retitled from 'Cervical cancer screening' to 'Health care coverage: home test kits,' reflecting the expanded purpose of the bill.

The requirement that home test kit coverage under the Family PACT Program and State-Only Family Planning Program be contingent upon the addition of billing codes specific to home test kits in the Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) was removed.

Section 1367.66 (Health and Safety Code) was restructured: the home test kit mandate moved from a standalone paragraph to paragraph (2) of subdivision (a), existing coverage language (Pap test, HPV screening) moved to paragraph (3), and the 'not a new mandated benefit' clarification moved to paragraph (4).

Section 10123.18 (Insurance Code) was similarly restructured with renumbered paragraphs to align with the Health and Safety Code changes.