BILL NUMBER: SB 1913	CHAPTERED  09/22/02

	CHAPTER  793
	FILED WITH SECRETARY OF STATE  SEPTEMBER 22, 2002
	APPROVED BY GOVERNOR  SEPTEMBER 22, 2002
	PASSED THE SENATE  AUGUST 22, 2002
	PASSED THE ASSEMBLY  AUGUST 15, 2002
	AMENDED IN ASSEMBLY  JUNE 4, 2002
	AMENDED IN SENATE  APRIL 16, 2002

INTRODUCED BY   Committee on Insurance (Senators Speier (Chair),
Escutia, Figueroa, Johnson, Scott, and Soto)

                        FEBRUARY 22, 2002

   An act to add Section 1342.4 to the Health and Safety Code, and to
add Section 12923.5 to the Insurance Code, relating to health care.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 1913, Committee on Insurance.  Department of Managed Health
Care and Department of Insurance:  joint working group.
   Existing law requires the Director of Managed Health Care in the
Department of Managed Health Care to consult with the Insurance
Commissioner in the Department of Insurance to ensure consistency of
regulations relating to health care.
   This bill would require the Department of Managed Health Care and
the Department of Insurance to maintain a joint senior level working
group to ensure clarity in enforcement and consistency in
regulations.  The bill would require the joint working group to
review and examine certain procedures in the departments and to
report its findings to the Insurance Commissioner and the Director of
the Department of Managed Health Care to submit to the Legislature
by January 1 of every year for 5 years.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:


  SECTION 1.  Section 1342.4 is added to the Health and Safety Code,
to read:
   1342.4.  (a) The Department of Managed Health Care and the
Department of Insurance shall maintain a joint senior level working
group to ensure clarity for health care consumers about who enforces
their patient rights and consistency in the regulations of these
departments.
   (b) The joint working group shall undertake a review and
examination of the Health and Safety Code, the Insurance Code, and
the Welfare and Institutions Code as they apply to the Department of
Managed Health Care and the Department of Insurance to ensure
consistency in consumer protection.
   (c) The joint working group shall review and examine all of the
following processes in each department:
   (1) Grievance and consumer complaint processes, including, but not
limited to, outreach, standard complaints, including coverage and
medical necessity complaints, independent medical review, and
information developed for consumer use.
   (2) The processes used to ensure enforcement of the law,
including, but not limited to, the medical survey and audit process
in the Health and Safety Code and market conduct exams in the
Insurance Code.
   (3) The processes for regulating the timely payment of claims.
   (d) The joint working group shall report its findings to the
Insurance Commissioner and the Director of the Department of Managed
Health Care for review and approval.  The commissioner and the
director shall submit the approved final report under signature to
the Legislature by January 1 of every year for five years.
  SEC. 2.  Section 12923.5 is added to the Insurance Code, to read:
   12923.5.  (a) The Department of Managed Health Care and the
Department of Insurance shall maintain a joint senior level working
group to ensure clarity for health care consumers about who enforces
their patient rights and consistency in the regulations of these
departments.
   (b) The joint working group shall undertake a review and
examination of the Health and Safety Code, the Insurance Code, and
the Welfare and Institutions Code as they apply to the Department of
Managed Health Care and the Department of Insurance to ensure
consistency in consumer protection.
   (c) The joint working group shall review and examine all of the
following processes in each department:
   (1) Grievance and consumer complaint processes, including, but not
limited to, outreach, standard complaints, including coverage and
medical necessity complaints, independent medical review, and
information developed for consumer use.
   (2) The processes used to ensure enforcement of the law,
including, but not limited to, the medical survey and audit process
in the Health and Safety Code and market conduct exams in the
Insurance Code.
   (3) The processes for regulating the timely payment of claims.
   (d) The joint working group shall report its findings to the
Insurance Commissioner and the Director of the Department of Managed
Health Care for review and approval.  The commissioner and the
director shall submit the approved final report under signature to
the Legislature by January 1 of every year for five years.