§ 1367.06
357 words·~2 min read·
/ca/health-and-safety-code/1367-06A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
(a)A health care service plan contract, except a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after January 1, 2005, that covers outpatient prescription drug benefits shall include coverage for inhaler spacers when medically necessary for the management and treatment of pediatric asthma.
(b)If a subscriber has coverage for outpatient prescription drugs, a health care service plan contract, except a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after January 1, 2005, shall include coverage for the following equipment and supplies when medically necessary for the management and treatment of pediatric asthma:
(1)Nebulizers, including face masks and tubing.
(2)Peak flow meters.
(c)The quantity of the equipment and supplies required to be covered pursuant to subdivisions
(a)and
(b)may be limited by the health care service plan if the limitations do not inhibit appropriate compliance with treatment as prescribed by the enrollee’s physician and surgeon. A health care service plan shall provide for an expeditious process for approving additional or replacement inhaler spacers, nebulizers, and peak flow meters when medically necessary for an enrollee to maintain compliance with his or her treatment regimen. The process required by Section 1367.24 may be used to satisfy the requirements of this section for an inhaler spacer.
(d)Education for pediatric asthma, including education to enable an enrollee to properly use the device identified in subdivisions
(a)and (b), shall be consistent with current professional medical practice.
(e)The coverage required by this section shall be provided under the same general terms and conditions, including copayments and deductibles, applicable to all other benefits provided by the plan.
(f)A health care service plan shall disclose the benefits under this section in its evidence of coverage and disclosure forms.
(g)A health care service plan may not reduce or eliminate coverage as a result of the requirements of this section.
(h)Nothing in this section shall be construed to deny or restrict in any way the department’s authority to ensure plan compliance with this chapter, if a plan provides coverage for prescription drugs.