SECTIONS 12695-12695.24 - California Statutes

INSURANCE CODE

SECTION 12695-12695.24

12695. This part shall be known and may be cited as the Access for
Infants and Mothers Program.

12695.02. For purposes of this part, the definitions contained in
this article shall govern the construction of this part, unless the
context requires otherwise.

12695.03. "AIM-linked infant" means any infant born to a woman
whose enrollment in the Access for Infants and Mothers Program begins
after June 30, 2004.

12695.04. "Advisory panel" means the Managed Risk Medical Insurance
Board Access for Infants and Mothers Advisory Panel created pursuant
to Section 12696.5.

12695.06. "Applicant" means an individual who applies for coverage
through the program.

12695.08. "Board" means the Managed Risk Medical Insurance Board
created pursuant to Section 12710.

12695.10. "Case management" means the management of all physician
services, both primary and specialty, and arrangements for
hospitalization, post-discharge care, and followup care.

12695.12. "Comprehensive primary care services" include, but are
not limited to, all of the following:
(a) Preventive, screening, diagnostic, and treatment services
furnished directly by a licensed clinic, either onsite or by formal
written contract, on a case-managed basis, to patients who remain
less than 24 hours at the clinic for an illness or injury, advice,
counseling, outreach, and translation as needed.
(b) Physician services.
(c) Emergency first aid, perinatal, obstetric, radiology,
laboratory, and nutrition services.
(d) Services of advanced practice nurses or mid-level
practitioners who are authorized to perform any of the services
listed in this subdivision within the scope of their licensure.
(e) Health education, including education regarding the harmful
results of tobacco use, and information and referral services.

12695.14. "Fund" means the Perinatal Insurance Fund.

12695.16. "Health education services relating to tobacco use" means
tobacco use prevention and education services, including, when
appropriate, tobacco use cessation services, in accordance with
protocols established by the board in coordination with the Tobacco
Control Section of the State Department of Health Services.

12695.18. "Participating health plan" means any of the following
plans that are lawfully engaged in providing, arranging, paying for,
or reimbursing the cost of personal health care services under
insurance policies or contracts, medical and hospital service
arrangements, or membership contracts, in consideration of premiums
or other periodic charges payable to it, and that contracts with the
program to provide coverage to program subscribers:
(a) A private insurer holding a valid outstanding certificate of
authority from the Insurance Commissioner.
(b) A nonprofit membership corporation lawfully operating under
the Nonprofit Corporation Law (Division 2 (commencing with Section
5000) of the Corporations Code).
(c) A health care service plan as defined under subdivision (f) of
Section 1345 of the Health and Safety Code.
(d) A county or a city and county, in which case no license or
approval from the Department of Insurance or the Department of
Managed Health Care shall be required to meet the requirements of
this part.
(e) A comprehensive primary care licensed community clinic that is
an organized outpatient freestanding health facility and is not part
of a hospital that delivers comprehensive primary care services, in
which case, no license or approval from the Department of Insurance
or the Department of Managed Health Care shall be required to meet
the requirements of this part.

12695.20. "Program" means the Access for Infants and Mothers
Program.

12695.22. "Subscriber" means an individual who is eligible for and
enrolled in the program.

12695.24. "Subscriber contribution" means the cost to the
subscriber to participate in the program.