Health care coverage: acquired brain injuries.

(1) Existing law provides for licensing and regulation of health care service plans by the Department of Managed Health Care. A willful violation of these provisions is a crime. Existing law provides for licensing and regulation of health insurers by the Insurance Commissioner. Existing law requires health care service plan contracts and health insurance policies to provide coverage for specified matters. This bill would provide that health care service plan contracts and health insurance policies may not deny coverage for medically necessary treatment of acquired brain injuries at any of various facilities that are properly licensed and accredited, as specified. The bill would also prohibit denial of coverage because the treating facility is not in or near the home of the enrollee or insured. Because the bill would change the definition of a crime with respect to health care service plans, it would thereby impose a state-mandated local program. (2) 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.