SENIOR ASSEMBLY PROPOSAL NO. 8

INTRODUCED BY ASSEMBLY MEMBER CHOATE

(COAUTHOR:  ASSEMBLY MEMBER PERSON)

(COAUTHOR:  SENATOR MUNOZ)

LEGISLATIVE COUNSEL'S DIGEST

AP 8:  HEALTH CARE SERVICE PLANS.

UNDER EXISTING LAW, A HEALTH CARE SERVICE PLAN MAY REQUIRE THAT PLAN ENROLLEES WHO NEED MEDICAL CARE FROM A SPECIALIST MUST FIRST OBTAIN A REFERRAL FROM THEIR PRIMARY CARE PHYSICIAN TO SPECIALISTS UNDER CONTRACT TO THE PLAN.

THIS MEASURE WOULD MEMORIALIZE THE LEGISLATURE AND THE GOVERNOR TO ENACT LEGISLATION THAT WOULD REQUIRE ALL HEALTH CARE SERVICE PLANS TO ALLOW PATIENTS AGES 60 YEARS AND OLDER ACCESS TO MEDICAL TREATMENT FROM ANY SPECIALIST LICENSED BY THE STATE OF CALIFORNIA, INCLUDING THOSE SPECIALISTS WHO ARE NOT UNDER CONTRACT TO THE PLAN, AND THAT WOULD REQUIRE THE PLAN TO PAY FOR SERVICES OF A PROFESSIONAL NOT UNDER CONTRACT TO THE PLAN, UP TO THE AMOUNT SPECIFIED FOR A PROFESSIONAL UNDER CONTRACT.

VOTE:  MAJORITY.

AP 8:  RELATING TO HEALTH CARE SERVICE PLANS

WHEREAS, SENIORS WHO NEED SPECIALIZED MEDICAL TREATMENT OFTEN ENCOUNTER DELAYS OR OUTRIGHT DENIAL OF ACCESS TO QUALIFIED HEALTH CARE PROFESSIONALS DUE TO HEALTH CARE SERVICE PLAN REQUIREMENTS RESTRICTING REFERRALS TO THOSE PROFESSIONALS UNDER CONTRACT TO THE PLAN; AND

WHEREAS, DELAYS OR DENIALS OF ACCESS TO THE SERVICES OF QUALIFIED HEALTH CARE PROFESSIONALS MAY CAUSE SERIOUS ADVERSE CONSEQUENCES TO THE HEALTH OF OLDER PATIENTS; AND

WHEREAS, THE NUMBER OF OLDER PATIENTS NEEDING SPECIALIZED MEDICAL CARE IS GROWING, BUT THE NUMBER OF HEALTH CARE PROFESSIONALS TRAINED IN GERIATRIC-RELATED MEDICAL PROBLEMS IS LIMITED; NOW, THEREFORE, BE IT

RESOLVED, BY THE SENIOR ASSEMBLY AND THE SENIOR SENATE, JOINTLY, THAT THE SENIOR LEGISLATURE OF THE STATE OF CALIFORNIA AT ITS 2002 REGULAR SESSION, A MAJORITY OF THE MEMBERS VOTING THEREFOR, HEREBY PROPOSES THAT ALL HEALTH CARE SERVICE PLANS BE REQUIRED TO DO THE FOLLOWING:

(1] ALLOW PATIENTS AGES 60 YEARS AND OLDER ACCESS TO THE MEDICAL SERVICES OF ANY STATE-LICENSED HEALTH CARE PROFESSIONAL OF THEIR CHOICE, WITHOUT REQUIRING THAT THE PROFESSIONAL BE UNDER CONTRACT TO THE PLAN.

(2) PAY FOR PROFESSIONAL SERVICES PROVIDED BY A STATE-LICENSED HEALTH CARE PROFESSIONAL NOT UNDER CONTRACT TO THE PLAN, UP TO THE AMOUNT SPECIFIED FOR A PROFESSIONAL UNDER CONTRACT, WITH ANY BALANCE DUE TO BE PAID BY THE RECIPIENT OF THE CARE PROVIDED; AND BE IT FURTHER

RESOLVED, THAT THE SENIOR LEGISLATURE OF THE STATE OF CALIFORNIA RESPECTFULLY MEMORIALIZES THE LEGISLATURE AND THE GOVERNOR TO ENACT APPROPRIATE LEGISLATION THAT WOULD ADDRESS TEE CONCERNS SET FORTH IN THIS MEASURE; AND BE IT FURTHER

RESOLVED, THAT A COPY OF THIS MEASURE BE TRANSMITTED TO THE SPEAKER OF THE ASSEMBLY, THE PRESIDENT PRO TEMPORE OF THE SENATE, AMD THE GOVERNOR OF THE STATE OF CALIFORNIA .

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