BILL NUMBER: AB 321 CHAPTERED 09/09/04 CHAPTER 411 FILED WITH SECRETARY OF STATE SEPTEMBER 9, 2004 APPROVED BY GOVERNOR SEPTEMBER 9, 2004 PASSED THE ASSEMBLY AUGUST 16, 2004 PASSED THE SENATE AUGUST 9, 2004 AMENDED IN SENATE JULY 7, 2004 AMENDED IN SENATE APRIL 13, 2004 AMENDED IN ASSEMBLY JANUARY 22, 2004 AMENDED IN ASSEMBLY JANUARY 5, 2004 AMENDED IN ASSEMBLY APRIL 22, 2003 INTRODUCED BY Assembly Member Cogdill (Coauthor: Assembly Member Frommer) FEBRUARY 7, 2003 An act to add Section 1366.2 to the Health and Safety Code, relating to health care, and declaring the urgency thereof, to take effect immediately. LEGISLATIVE COUNSEL'S DIGEST AB 321, Cogdill. Health care service plans: contract termination dates. Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the regulation of health care service plans by the Department of Managed Health Care. A violation of the act's provisions is a crime. Existing law requires health care service plans to provide affected enrollees with written notice of certain information prior to the termination date of its contract with a provider group or general acute care hospital. This bill would require a full health care service plan, as defined, to make available to group subscribers the termination date of all major health care provider contracts, as defined, for services in the geographic area for which the group subscriber has secured coverage, when the contract specifies a termination date. Because the bill would create an additional requirement for health care service plans, the violation of which would be a crime, the bill would impose a state-mandated local program. The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that no reimbursement is required by this act for a specified reason. The bill would declare that it is to take effect immediately as an urgency statute. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. Section 1366.2 is added to the Health and Safety Code, to read: 1366.2. (a) A full health care service plan shall make available to a group subscriber, upon request, the termination date of all major health care provider contracts that are for services in the geographic area for which the group subscriber has secured coverage and that include a specified termination date. (b) For purposes of this section, the following terms have the following meanings: (1) "Enrollee" means a person who is enrolled in a health care service plan and who is a recipient of services from the plan. (2) "Full health care service plan" means a plan that meets the definition set forth in subdivision (f) of Section 1345, and that has a total enrolled membership exceeding 499,999 enrollees. (3) "Hospital" means a general acute care hospital. (4) "Major health care provider contract" means a contract between a full service plan and provider group or hospital covering more than 25,000 of that plan's enrollees. "Major health care provider contract" does not mean a provider contract between a specialized health care service plan and a provider group or hospital. (5) "Provider group" means a medical group, independent practice association, or other similar group of providers with a total enrolled membership exceeding 99,999 enrollees. SEC. 2. No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution. SEC. 3. This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the Constitution and shall go into immediate effect. The facts constituting the necessity are: In order for group subscribers to obtain information regarding the availability of certain health care provider groups under a health care service plan at the earliest possible time to assist their health care coverage decisions, it is necessary that this act take effect immediately.