Senate Bills 974 and 987, authored by Senator Anthony J. Portantino that address the delay and absence of live-saving treatments for cancer patients, passed the Assembly Health Committee. 

SB 974 expands health care coverage for diagnostic breast imaging following an abnormal mammography and SB 987 aims to address significant disparities in cancer patient access by expanding Medi-Cal patient eligibility for necessary clinical expertise and resources.

“With SB 974, we are highlighting the importance of follow-up diagnostic testing for breast cancer screenings,” said Senator Portantino. “Health insurance only covers the initial screening mammogram and it should extend to these crucial follow-up diagnostics, which will save lives and significantly impact health outcomes for women. I am thankful to my constituent Gayaneh Pezeshkian Avanes for suggesting this bill idea. Her activism will help thousands of women.”

SB 974 would require that a health insurance policy, which is issued, amended, or renewed on or after Jan. 1, 2023, must provide coverage for a medically necessary diagnostic breast imaging, including diagnostic breast imaging following an abnormal mammography result. Diagnostic breast imaging includes breast magnetic resonance imaging and breast ultrasound.

SB 987, the California Cancer Care Equity Act, which also passed the Senate Health Committee, aims to improve cancer care access, cancer survival, and patient experience by enhancing Medi-Cal patient access to necessary clinical expertise and resources at NCI-Designated Comprehensive Cancer Centers. The bill parallels the current Medi-Cal coverage model that allows Medi-Cal beneficiaries to have access to certain life-saving care services at a Center of Excellence, even if that center is not included in the member’s provider network. Specifically, SB 987 expands the existing set of care diagnoses for which such enhanced access is provided and includes clinically necessary cancer care services such as genomic/genetic/transcriptomic/proteomic testing, clinical trials participation, and all necessary cancer-related outpatient and inpatient clinical care, defined episode of care.

SB 987 would also require Medi-Cal managed care providers to inform enrollees of their eligibility to receive enhanced care and ensures primary care doctors in contract with those managed care providers inform enrollees with any information they need to decide between relevant treatment options. The bill also requires that decisions to approve, deny, or modify a patient’s request for optimal care are made within a 72-hour time window to shorten the window between diagnosis and treatment.

“This year, more than 189,000 Californians will hear the terrifying words ‘You have cancer,’” said Dr. Harlan Levine, president of Health Innovation and Policy at City of Hope. “While innovation has dramatically impacted survival, many patients, particularly those from underserved communities, are unable to access the highly specialized treatments, clinical trials and care from the subspecialists most likely to help save their lives. This is particularly true for Medi-Cal beneficiaries, and SB 987 says that we will not leave them behind.”