Fiscal Summary

NOT SIGNIFICANT

Bill Summary

This bill prohibits certain healthcare entities and insurers from discriminating based on disability in regard to transplantation services or coverage, as described below.

HEALTHCARE ENTITIES

This bill prohibits a covered entity from doing any of the following solely on the basis of the disability of a qualified recipient:

(1) Consider a qualified recipient ineligible for transplantation or receipt of an anatomical gift;

(2) Deny medical or other services related to transplantation;

(3) Refuse to refer a qualified recipient to a transplant center or specialist;

(4) Refuse to place a qualified recipient on an organ or tissue waiting list; or

(5) Place a qualified recipient at a position on an organ or tissue waiting list that is lower than the position at which the qualified recipient would have been placed if not for the qualified recipient's disability.

This bill defines a "covered entity" as a healthcare provider, hospital, ambulatory surgical treatment center, home care organization, or any other entity responsible for matching anatomical gifts or organ donors to potential recipients. This bill defines "qualified recipient" as a recipient who has a disability and meets the eligibility requirements for receipt of transplantation or anatomical gift regardless of the use of the following:

(A) Individuals or entities available to support and assist the recipient of an anatomical gift or transplantation;

(B) Auxiliary aids and services; or

(C) Reasonable modifications to the policies, practices, or procedures of a covered entity, including modifications that allow for communication with one or more individuals or entities available to support or assist with the recipient's care after surgery or transplantation; or consideration of the availability of those individuals or entities when determining whether the recipient is able to comply with medical requirements following surgery or transplantation.

Under this bill, if a healthcare provider has examined an individual and determined that the individual has a disability, then a covered entity may consider, when making recommendations or decisions related to receipt of an anatomical gift or transplantation, the disability of the individual to be medically significant to the receipt of an anatomical gift or transplantation.

This bill prohibits a covered entity from considering a qualified recipient's inability to comply with medical requirements following transplantation to be medically significant if a qualified recipient has individuals or entities available to assist in complying with the medical requirements. This bill requires a covered entity to make reasonable modifications to its policies, practices, or procedures to allow individuals with disabilities access to transplantation related treatment and services, except when the covered entity demonstrates that the modifications would fundamentally alter the nature of the transplantation-related treatment and services.

HEALTH INSURANCE

This bill prohibits a health insurance entity that offers plans in this state that provide coverage for transplantation to individuals or groups on an expense-incurred basis from denying coverage for transplantation solely on the basis of the covered person's disability.

This bill states that it does not require a health insurance entity to provide coverage for transplantation if the transplantation is not medically necessary.

CIVIL ACTION

This bill authorizes an individual who reasonably believes that a covered entity has violated the provisions described above under HEALTHCARE ENTITIES to bring a civil action for injunctive or other equitable relief against the covered entity for the purpose of enforcing compliance with this bill. In such a civil action, the court must:

(1) Schedule a hearing as soon as practicable; and

(2) Apply the same standards when rendering judgment as would be applied in an action brought in federal court.

This bill states that it does not create a right to compensatory or punitive damages against a covered entity.