BILL NUMBER: SB 283 CHAPTERED 09/18/02 CHAPTER 667 FILED WITH SECRETARY OF STATE SEPTEMBER 18, 2002 APPROVED BY GOVERNOR SEPTEMBER 17, 2002 PASSED THE SENATE AUGUST 30, 2002 PASSED THE ASSEMBLY AUGUST 26, 2002 AMENDED IN ASSEMBLY AUGUST 23, 2002 AMENDED IN ASSEMBLY AUGUST 1, 2002 AMENDED IN ASSEMBLY JULY 3, 2002 AMENDED IN ASSEMBLY JUNE 12, 2002 INTRODUCED BY Senator Speier (Coauthor: Assembly Members Alquist and Cohn) FEBRUARY 16, 2001 An act to amend Section 12693.325 of the Insurance Code, relating to the Healthy Families Program. LEGISLATIVE COUNSEL'S DIGEST SB 283, Speier. Healthy Families Program. Existing law establishes the Healthy Families Program, administered by the Managed Risk Medical Insurance Board, to arrange for the provision of health services to eligible children based upon applications submitted by applicants to the program. Existing law authorizes the board to establish a list of designated eligible individuals or categories of individuals and organizations that may be compensated for assisting an applicant in completing a program application. Existing law authorizes a plan participating in the program to provide application assistance in specific situations directly to an applicant acting on behalf of an eligible child who requests application assistance or to an applicant who is completing the program's annual eligibility review package on behalf of a subscriber enrolled with a participating plan. Under existing law, these provisions will be repealed on January 1, 2003. This bill would, until January 1, 2006, authorize a plan participating in the program, after completing a state-sponsored or approved training course, to provide application assistance directly to an applicant who is acting on behalf of an eligible person, subject to specified conditions. The bill would provide that a participating plan that directly provides application assistance to an applicant or subscriber is not eligible to receive the application assistance fee. The bill would delete the repealing provision. The bill would require the board to provide the Legislature with a specified report on the impact of the bill's provisions on or before March 1 of every other year. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. Section 12693.325 of the Insurance Code is amended to read: 12693.325. (a) (1) Notwithstanding any provision of this chapter, a participating health, dental, or vision plan that is licensed and in good standing as required by subdivision (b) of Section 12693.36 may provide application assistance directly to an applicant acting on behalf of an eligible person who telephones, writes, or contacts the plan in person at the plan's place of business, or at a community public awareness event that is open to all participating plans in the county, or at any other site approved by the board, and who requests application assistance. (2) Until January 1, 2006, a participating health, dental, or vision plan may also provide application assistance directly to an applicant only under the following conditions: (A) The assistance is provided upon referral from a government agency, school, or school district. (B) The applicant has authorized the government agency, school, or school district to allow a health, dental, or vision plan to contact the applicant with additional information on enrolling in free or low-cost health care. (C) The State Department of Health Services approves the applicant authorization form in consultation with the board. (D) The plan may not actively solicit referrals and may not provide compensation for the referrals. (E) If a family is already enrolled in a health plan, the plan that contacts the family cannot encourage the family to change health plans. (F) The board amends its marketing guidelines to require that when a government agency, school, or school district requests assistance from a participating health, dental, or vision plan to provide application assistance, that all plans in the area shall be invited to participate. (G) The plan abides by the board's marketing guidelines. (b) A participating health, dental, or vision plan may provide application assistance to an applicant who is acting on behalf of an eligible or potentially eligible child in any of the following situations: (1) The child is enrolled in a Medi-Cal managed care plan and the participating plan becomes aware that the child's eligibility status has or will change and that the child will no longer be eligible for Medi-Cal. In those instances, the plan shall inform the applicant of the differences in benefits and requirements between the Healthy Families Program and the Medi-Cal program. (2) The child is enrolled in a Healthy Families Program managed care plan and the participating plan becomes aware that the child's eligibility status has changed or will change and that the child will no longer be eligible for Healthy Families. When it appears a child may be eligible for Medi-Cal benefits, the plan shall inform the applicant of the differences in benefits and requirements between the Medi-Cal program and the Healthy Families Program. (3) The participating plan provides employer-sponsored coverage through an employer and an employee of that employer who is the parent or legal guardian of the eligible or potentially eligible child. (4) The child and his or her family are participating through the participating plan in COBRA continuation coverage or other group continuation coverage required by either state or federal law and the group continuation coverage will expire within 60 days, or has expired within the past 60 days. (5) The child's family, but not the child, is participating through the participating plan in COBRA continuation coverage or other group continuation coverage required by either state or federal law, and the group continuation coverage will expire within the past 60 days, or has expired within the past 60 days. (c) A participating health, dental, or vision plan employee or other representative that provides application assistance shall complete a certified application assistant training class approved by the State Department of Health Services in consultation with the board. The employee or other representative shall in all cases inform an applicant verbally of his or her relationship with the participating health plan. In the case of an in-person contact, the employee or other representative shall provide in writing to the applicant the nature of his or her relationship with the participating health plan and obtain written acknowledgement from the applicant that the information was provided. (d) A participating health, dental, or vision plan that provides application assistance may not do any of the following: (1) Directly, indirectly, or through its agents, conduct door-to-door marketing or phone solicitation. (2) Directly, indirectly, or through its agents, select a health plan or provider for a potential applicant. Instead, the plan shall inform a potential applicant of the choice of plans available within the applicant's county of residence and specifically name those plans and provide the most recent version of the program handbook. (3) Directly, indirectly, or through its agents, conduct mail or in-person solicitation of applicants for enrollment, except as specified in subdivision (b), using materials approved by the board. (e) A participating health, dental, or vision plan that provides application assistance pursuant to this section is not eligible for an application assistance fee otherwise available pursuant to Section 12693.32, and may not sponsor a person eligible for the program by paying his or her family contribution amounts or copayments, and may not offer applicants any inducements to enroll, including, but not limited to, gifts or monetary payments. (f) A participating health, dental, or vision plan may assist applicants acting on behalf of subscribers who are enrolled with the participating plan in completing the program's annual eligibility review package in order to allow those applicants to retain health care coverage. (g) Each participating health, dental, or vision plan shall submit to the board a plan for application assistance. All scripts and materials to be used during application assistance sessions shall be approved by the board and the State Department of Health Services. (h) Each participating health, dental, or vision plan shall provide each applicant with the toll-free telephone number for the Healthy Families Program. (i) When deemed appropriate by the board, the board may refer a participating health, dental, or vision plan to the Department of Managed Health Care or the State Department of Health Services, as applicable, for the review or investigation of its application assistance practices. (j) The board shall evaluate the impact of the changes required by this section and shall provide a biennial report to the Legislature on or before March 1 of every other year. To prepare these reports, the State Department of Health Services, in cooperation with the board, shall code all the application packets used by a managed care plan to record the number of applications received that originated from managed care plans. The number of applications received that originated from managed care plans shall also be reported on the board's Web site. In addition, the board shall periodically survey those families assisted by plans to determine if the plans are meeting the requirements of this section, and if families are being given ample information about the choice of health, dental, or vision plans available to them. (k) Nothing in this section shall be seen as mitigating a participating health, dental, or vision plan's responsibility to comply with all federal and state laws, including, but not limited to, Section 1320a-7b of Title 42 of the United States Code. (l) Paragraph (2) of subdivision (a) shall become inoperative on January 1, 2006.