An act to add Section 1367.58 to the Health and Safety Code, and to add Section 10123.78 to the Insurance Code, relating to health care coverage.
SB 1309 would require most health care service plans and health insurance policies issued, amended, or renewed on or after January 1, 2027, to cover followup screening or diagnostic services for lung cancer when recommended by a health care provider. The bill defines these services as tests and procedures performed after an initial abnormal or indeterminate lung cancer screening result, including diagnostic CT scans, PET/CT scans, tissue sampling, biopsy, bronchoscopy, pathology, and surgical consultation.
The bill also bars insurers and health plans from applying copayments, coinsurance, deductibles, or other cost sharing to this coverage. For high deductible health plans, the bill allows cost sharing only if eliminating it would conflict with federal high-deductible plan requirements. Specialized health care service plan contracts are excluded from the mandate.
In state law, SB 1309 would add a new section to both the Health and Safety Code and the Insurance Code, extending the coverage requirement to both managed care plans regulated by the Department of Managed Health Care and health insurance policies regulated by the Department of Insurance. Because a willful violation by a health care service plan can be treated as a crime under existing law, the bill is described as creating a state-mandated local program, though it also states that no reimbursement is required.
The general sentiment reflected in the available vote history is favorable. The bill passed the April 22 committee vote unanimously, 10-0, and later was placed on the suspense file by a 7-0 vote, suggesting broad policy support but concern about fiscal effects. No committee transcript is available, so there is no recorded floor or committee debate to indicate opposition arguments in detail.
The main point of contention appears to be fiscal rather than policy-based: the mandate would require plans and insurers to absorb the cost of additional followup diagnostics without patient cost sharing, which likely contributed to the suspense-file referral. Any tension over the bill would also center on how the new mandate interacts with federal rules for high deductible health plans and whether the coverage expansion could increase premiums or administrative costs.
SB 1309 would create new coverage mandates in California for lung cancer followup screening and diagnostic services, requiring both health care service plans and health insurance policies to cover those services without patient cost sharing, subject to a limited exception for high deductible health plans under federal law. It would amend the Health and Safety Code and Insurance Code, expanding the scope of required cancer-related benefits for regulated plans and insurers beginning with policies and contracts issued, amended, or renewed on or after January 1, 2027. The bill could also expose health care service plans to existing enforcement consequences for willful violations, including criminal liability under the Knox-Keene framework.
The available legislative history suggests the bill was received positively in committee, with unanimous support in the recorded votes. Its movement to the suspense file indicates that, while the policy goal of improving access to lung cancer followup care appears broadly acceptable, lawmakers or fiscal committees likely viewed the cost implications as significant enough to warrant further review. No committee transcript is available, so the record does not show organized opposition or detailed debate.
The likely contention is over cost and mandate scope. Opponents or fiscal reviewers may be concerned that requiring no-cost followup diagnostics for lung cancer will increase utilization, premiums, or plan expenses, especially because the bill applies to both managed care plans and health insurance policies. A secondary issue is the interaction with federal high deductible health plan rules, since the bill must preserve compliance with federal tax requirements while still limiting cost sharing. The exclusion of specialized health care service plans may also be a point of technical discussion, but the record provided does not show explicit opposition on that basis.