Amended  IN  Assembly  March 21, 2023
Amended  IN  Assembly  February 17, 2023

CALIFORNIA LEGISLATURE— 2023–2024 REGULAR SESSION

Assembly Bill
No. 659

Introduced by Assembly Member Aguiar-Curry
(Coauthors: Assembly Members Wendy Carrillo, Friedman, Kalra, Ortega, Papan, and Blanca Rubio)
(Coauthor: Senator Wiener)

February 09, 2023

An act to amend Sections 1367.66, 120325, 120335, and 120338 of 1367.66 and 120390 of, and to add Sections 120336 and 120390.6 to, the Health and Safety Code, to amend Section 10123.18 of the Insurance Code, and to add Section 14132.04 to the Welfare and Institutions Code Code, relating to human papillomavirus.


LEGISLATIVE COUNSEL'S DIGEST

AB 659, as amended, Aguiar-Curry. Cancer Prevention Act.
Existing law prohibits the governing authority of a school or other institution from unconditionally admitting any person as a pupil of any private or public elementary or secondary school, childcare center, day nursery, nursery school, family daycare home, or development center, unless prior to their admission to that institution they have been fully immunized. Existing law requires the documentation of immunizations for certain diseases, including, among others, measles, mumps, pertussis, and any other disease deemed appropriate by the State Department of Public Health, as specified. Existing law authorizes certain exemptions from these provisions subject to specified conditions.

Existing law requires the department to adopt and enforce regulations for these provisions and authorizes the department to specify the immunizing agents that may be utilized and the manner in which immunizations are administered.

This bill, the Cancer Prevention Act, would add human papillomavirus (HPV) to the above-described list of diseases for which immunization documentation is required. The bill would specifically prohibit the governing authority from unconditionally admitting or advancing any pupil to the 8th grade level of any private or public elementary or secondary school if the pupil has not been fully immunized against HPV. The bill would clarify the department’s authority to adopt HPV-related regulations for grades below the 8th grade level. declare the public policy of the state that pupils are expected to be fully immunized against human papillomavirus (HPV) before admission or advancement to the 8th grade level of any private or public elementary or secondary school. The bill would, upon a pupil’s admission or advancement to the 6th grade level, require the governing authority to submit to the pupil and their parent or guardian a notification containing a statement about that public policy and advising that the pupil be fully immunized against HPV before admission or advancement to the 8th grade level. By creating new notification duties for school districts, the bill would impose a state-mandated local program.
Existing law requires the Trustees of the California State University and, subject to a resolution, the Regents of the University of California to require the first-time enrollees at those institutions who are 18 years of age or younger to provide proof of full immunization against the hepatitis B virus prior to enrollment. Existing law authorizes an extension with conditional enrollment, and sets forth exemptions from the immunization requirement on the basis of contrary beliefs, or physical condition or medical circumstances, as specified.
This bill would require the Trustees of the California State University, the Regents of the University of California subject to a resolution, and the Board of Governors of the California Community Colleges to require the first-time enrollees at those institutions who are 26 years of age or younger to provide proof of full immunization against HPV prior to enrollment. The bill would authorize an extension with conditional enrollment, and would set forth a medical exemption from the immunization requirement, as specified. The bill would make a conforming change to a consultation-related provision. By creating new duties for community college districts, the bill would impose a state-mandated local program.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care, and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2002, as specified, to provide coverage for an annual cervical cancer screening test, including a human papillomavirus (HPV) an HPV screening test that is approved by the United States Food and Drug Administration (FDA).
Existing law provides for the Medi-Cal program, administered by the State Department of Health Care Services and under which health care services are provided to low-income individuals pursuant to a schedule of benefits. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law also establishes the Family Planning, Access, Care, and Treatment (Family PACT) Waiver Program, administered by the Office of Family Planning within the department, under which comprehensive clinical family planning services are provided to a person who has a family income at or below 200% of the federal poverty level, and who is eligible to receive these services.
This bill would expand the coverage requirement for an annual cervical cancer screening test to disability insurance policies that provide coverage for hospital, medical, or surgical benefits and would require a health care service plan contract or contract, or a disability insurance policy that provides coverage for hospital, medical, or surgical benefits benefits, issued, amended, or renewed on or after January 1, 2024, to provide coverage without cost sharing for the HPV vaccine for persons for whom the vaccine is FDA approved. Because a willful violation of the bill’s requirements relative to health care service plans would be a crime, the bill would impose a state-mandated local program. The bill would also expand comprehensive clinical family planning services under the Family PACT Waiver Program to include the HPV vaccine for persons for whom it is FDA approved.
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 with regard to certain mandates no reimbursement is required by this act for a specified reason.
With regard to any other mandates, this bill would provide that, if the Commission on State Mandates determines that the bill contains costs so mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.
Digest Key Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: YES  
Bill Text
The people of the State of California do enact as follows:
SECTION 1. This act shall be known, and may be cited, as the Cancer Prevention Act.
SEC. 2. Section 1367.66 of the Health and Safety Code is amended to read:
1367.66. (a) A health care service plan contract, except for a specialized health care service plan, issued, amended, or renewed on or after January 1, 2002, shall provide coverage for an annual cervical cancer screening test upon the referral of the patient’s physician and surgeon, a nurse practitioner, or a certified nurse midwife, nurse-midwife, providing care to the patient and operating within the scope of practice otherwise permitted for the licensee.
(1) The coverage for an annual cervical cancer screening test provided pursuant to this section shall include the conventional Pap test, a human papillomavirus screening test that is approved by the United States Food and Drug Administration (FDA), and the option of any cervical cancer screening test approved by the FDA, upon the referral of the patient’s health care provider.
(2) This subdivision does not establish a new mandated benefit or to prevent application of deductible or copayment provisions in an existing plan contract. The Legislature intends in this section to provide that cervical cancer screening services are deemed to be covered if the plan contract includes coverage for cervical cancer treatment or surgery.
(b) A health care service plan contract, except for a specialized health care service plan, issued, amended, or renewed on or after January 1, 2024, shall provide coverage for the human papillomavirus vaccine for enrollees for whom the vaccine is approved by the FDA. A health care service plan contract shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage provided pursuant to this subdivision.
SEC. 3.Section 120325 of the Health and Safety Code is amended to read:120325.

In enacting this chapter, but excluding Section 120380, and in enacting Sections 120400, 120405, 120410, and 120415, it is the intent of the Legislature to provide all of the following:

(a)A means for the eventual achievement of total immunization of appropriate age groups against the following childhood diseases:

(1)Diphtheria.

(2)Hepatitis B.

(3)Haemophilus influenzae type b.

(4)Measles.

(5)Mumps.

(6)Pertussis (whooping cough).

(7)Poliomyelitis.

(8)Rubella.

(9)Tetanus.

(10)Varicella (chickenpox).

(11)Human papillomavirus (HPV).

(12)Any other disease deemed appropriate by the department, taking into consideration the recommendations of the Advisory Committee on Immunization Practices of the United States Department of Health and Human Services, the American Academy of Pediatrics, and the American Academy of Family Physicians.

(b)That the persons required to be immunized be allowed to obtain immunizations from whatever medical source they so desire, subject only to the condition that the immunization be performed in accordance with the regulations of the department and that a record of the immunization is made in accordance with the regulations.

(c)Exemptions from immunization for medical reasons.

(d)For the keeping of adequate records of immunization so that health departments, schools, and other institutions, parents or guardians, and the persons immunized will be able to ascertain that a child is fully or only partially immunized, and so that appropriate public agencies will be able to ascertain the immunization needs of groups of children in schools or other institutions.

(e)Incentives to public health authorities to design innovative and creative programs that will promote and achieve full and timely immunization of children.

SEC. 4.Section 120335 of the Health and Safety Code is amended to read:120335.

(a)As used in this chapter, “governing authority” means the governing board of each school district or the authority of each other private or public institution responsible for the operation and control of the institution or the principal or administrator of each school or institution.

(b)The governing authority shall not unconditionally admit any person as a pupil of any private or public elementary or secondary school, childcare center, day nursery, nursery school, family daycare home, or development center, unless, prior to their first admission to that institution, they have been fully immunized. The following are the diseases for which immunizations shall be documented:

(1)Diphtheria.

(2)Haemophilus influenzae type b.

(3)Measles.

(4)Mumps.

(5)Pertussis (whooping cough).

(6)Poliomyelitis.

(7)Rubella.

(8)Tetanus.

(9)Hepatitis B.

(10)Varicella (chickenpox).

(11)Human papillomavirus (HPV), as specified in subdivision (e).

(12)Any other disease deemed appropriate by the department, taking into consideration the recommendations of the Advisory Committee on Immunization Practices of the United States Department of Health and Human Services, the American Academy of Pediatrics, and the American Academy of Family Physicians.

(c)Notwithstanding subdivision (b), full immunization against hepatitis B shall not be a condition by which the governing authority shall admit or advance any pupil to the 7th grade level of any private or public elementary or secondary school.

(d)The governing authority shall not unconditionally admit or advance any pupil to the 7th grade level of any private or public elementary or secondary school unless the pupil has been fully immunized against pertussis, including all pertussis boosters appropriate for the pupil’s age.

(e)(1)The governing authority shall not unconditionally admit or advance any pupil to the 8th grade level of any private or public elementary or secondary school if the pupil has not been fully immunized against HPV.

(2)Paragraph (1) shall not be construed as prohibiting the department from adopting, and subdivision (b) shall not be construed as requiring the department to adopt, regulations imposing an immunization schedule against HPV for admission or advancement of pupils to grades below the 8th grade level for purposes of this section.

(f)The department may specify the immunizing agents that may be utilized and the manner in which immunizations are administered.

(g)This section does not apply to a pupil in a home-based private school or a pupil who is enrolled in an independent study program pursuant to Article 5.5 (commencing with Section 51744) of Chapter 5 of Part 28 of Division 4 of Title 2 of the Education Code and does not receive classroom-based instruction.

(h)(1)A pupil who, prior to January 1, 2016, submitted a letter or affidavit on file at a private or public elementary or secondary school, child daycare center, day nursery, nursery school, family daycare home, or development center stating beliefs opposed to immunization shall be allowed enrollment to any private or public elementary or secondary school, child daycare center, day nursery, nursery school, family daycare home, or development center within the state until the pupil enrolls in the next grade span.

(2)For purposes of this subdivision, “grade span” means each of the following:

(A)Birth to preschool.

(B)Kindergarten and grades 1 to 6, inclusive, including transitional kindergarten.

(C)Grades 7 to 12, inclusive.

(3)Except as provided in this subdivision, on and after July 1, 2016, the governing authority shall not unconditionally admit to any of those institutions specified in this subdivision for the first time, or admit or advance any pupil to 7th grade level, unless the pupil has been immunized for their age as required by this section.

(i)This section does not prohibit a pupil who qualifies for an individualized education program, pursuant to federal law and Section 56026 of the Education Code, from accessing any special education and related services required by their individualized education program.

SEC. 5.Section 120338 of the Health and Safety Code is amended to read:120338.

Notwithstanding Sections 120325 and 120335, any immunizations deemed appropriate by the department pursuant to paragraph (12) of subdivision (a) of Section 120325 or paragraph (12) of subdivision (b) of Section 120335, may be mandated before a pupil’s first admission to any private or public elementary or secondary school, childcare center, day nursery, nursery school, family daycare home, or development center, only if exemptions are allowed for both medical reasons and personal beliefs.

SEC. 3. Section 120336 is added to the Health and Safety Code, to read:

120336. (a) It is the public policy of the state that pupils are expected to be fully immunized against human papillomavirus (HPV) before admission or advancement to the 8th grade level of any private or public elementary or secondary school.
(b) Upon a pupil’s admission or advancement to the 6th grade level, the governing authority shall submit to the pupil and their parent or guardian a notification containing a statement about the state’s public policy described in subdivision (a) and advising that the pupil be fully immunized against HPV before admission or advancement to the 8th grade level.
SEC. 4. Section 120390 of the Health and Safety Code is amended to read:
120390. The department, in consultation with the Trustees of the California State University, and the Regents of the University of California, and the Board of Governors of the California Community Colleges, as applicable, shall adopt and enforce all regulations necessary to carry out this chapter.
SEC. 5. Section 120390.6 is added to the Health and Safety Code, to read:

120390.6. (a) Except as provided in subdivisions (b) and (c), the Trustees of the California State University, the Regents of the University of California, and the Board of Governors of the California Community Colleges shall require the first-time enrollees at those institutions who are 26 years of age or younger to provide proof of full immunization against the human papillomavirus (HPV) prior to enrollment.
(b) A person who has not been fully immunized against HPV, as required by subdivision (a), may be admitted by the governing body of any of the institutions of higher education to which subdivision (a) is applicable on condition that, within a designated time period, the person will provide proof of full immunization against HPV.
(c) Immunization of a person shall not be required for admission to an institution of higher education to which subdivision (a) is applicable if any of the following persons files with the governing body of the educational institution a medical exemption:
(1) The parent, guardian, or adult who has assumed responsibility for the care and custody of the person seeking admission, if that applicant is a minor who is not emancipated.
(2) The person seeking admission, if that applicant is an emancipated minor or is 18 years of age or older.
SEC. 6. Section 10123.18 of the Insurance Code is amended to read:
10123.18. (a) A disability insurance policy issued, amended, or renewed on or after January 1, 2024, and that provides coverage for hospital, medical, or surgical benefits shall provide coverage, upon the referral of a patient’s physician and surgeon, a nurse practitioner, or a certified nurse midwife, nurse-midwife, providing care to the patient and operating within the scope of practice otherwise permitted for the licensee, for an annual cervical cancer screening test.
(1) The coverage for an annual cervical cancer screening test provided pursuant to this section shall include the conventional Pap test, a human papillomavirus screening test that is approved by the United States Food and Drug Administration (FDA) and the option of any cervical cancer screening test approved by the FDA, upon the referral of the patient’s health care provider.
(2) This subdivision does not require an individual or group policy to cover treatment or surgery for cervical cancer or to prevent application of deductible or copayment provisions contained in the policy or certificate, and does not require that coverage under an individual or group policy be extended to any other procedures.
(b) A disability insurance policy issued, amended, or renewed on or after January 1, 2024, that provides coverage for hospital, medical, or surgical benefits shall provide coverage for the human papillomavirus vaccine for insureds for whom the vaccine is approved by the FDA. The policy shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage provided pursuant to this subdivision.
(c) This section shall not apply to vision only, dental only, accident only, vision-only, dental-only, accident-only, specified disease, hospital indemnity, Medicare supplement, CHAMPUS supplement, long-term care, or disability income insurance. For accident only, accident-only, hospital indemnity, or specified disease insurance, coverage for benefits under this section shall apply only to the extent that the benefits are covered under the general terms and conditions that apply to all other benefits under the policy or certificate. This section does not impose a new benefit mandate on accident only, accident-only, hospital indemnity, or specified disease insurance.
SEC. 7. Section 14132.04 is added to the Welfare and Institutions Code, to read:
14132.04. For purposes of subdivision (aa) of Section 14132, “comprehensive clinical family planning services” includes the human papillomavirus vaccine for persons for whom it is approved by the United States Food and Drug Administration.
SEC. 8. No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution for certain costs that may be incurred by a local agency or school district because, in that regard, this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.
However, if the Commission on State Mandates determines that this act contains other costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code.