BILL NUMBER: AB 1296 CHAPTERED
BILL TEXT
CHAPTER 698
FILED WITH SECRETARY OF STATE OCTOBER 14, 2007
APPROVED BY GOVERNOR OCTOBER 14, 2007
PASSED THE SENATE SEPTEMBER 5, 2007
PASSED THE ASSEMBLY SEPTEMBER 5, 2007
AMENDED IN SENATE AUGUST 30, 2007
AMENDED IN SENATE JULY 12, 2007
AMENDED IN SENATE JULY 3, 2007
AMENDED IN ASSEMBLY MAY 31, 2007
AMENDED IN ASSEMBLY APRIL 19, 2007
AMENDED IN ASSEMBLY APRIL 9, 2007
INTRODUCED BY Assembly Member Torrico
FEBRUARY 23, 2007
An act to add Section 22854.5 to the Government Code, relating to
public employee health benefits.
LEGISLATIVE COUNSEL'S DIGEST
AB 1296, Torrico. Public employee health benefits: disclosures.
The Public Employees' Medical and Hospital Care Act requires the
Board of Administration of the Public Employees' Retirement System to
approve health benefit plans for certain public employees and
annuitants, and authorizes the board to contract with carriers
offering health benefit plans. The act sets forth certain criteria
the board may take into account when considering a contract with an
entity seeking to provide health care benefits or services, and
allows the board to require specified documents from that entity.
This bill would require a health benefit plan or contractor, or an
entity offering services relating to the administration of health
benefit plans to members and annuitants, to disclose to the Board of
Administration of the Public Employees' Retirement System, staff, and
any contractor or consultant of the system, the cost, utilization,
actual claim payments, and contract allowance amounts for health care
services rendered by participating hospitals, with specified
restrictions and disclosure limitations imposed upon the board,
staff, and any contractor or consultant of the system to whom the
information is disclosed. The bill would deem this information
confidential, subject to evidentiary trade secret protections, and
exempt from the California Public Records Act, as specified.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 22854.5 is added to the Government Code, to
read:
22854.5. (a) A health benefit plan or contractor, or an entity
offering services relating to the administration of health benefit
plans to members and annuitants, shall disclose to the board, staff,
and any contractor or consultant of the system, the cost,
utilization, actual claim payments, and contract allowance amounts
for health care services rendered by participating hospitals to each
member and annuitant.
(b) The information specified in subdivision (a) shall be deemed
confidential information and protected in accordance with the federal
Health Insurance Portability and Accountability Act of 1996 (42
U.S.C. Sec. 300gg), the final regulations issued pursuant to the act
by the United States Department of Health and Human Services (45
C.F.R. Parts 160 and 164), and the Confidentiality of Medical
Information Act (Part 2.6 (commencing with Section 56) of Division 1
of the Civil Code). Information provided to the board, staff, and any
contractor or consultant of the system shall not include individual
member or annuitant identifying information.
(c) The information specified in subdivision (a) shall be deemed
to be confidential trade secret information in accordance with
subdivision (d) of Section 3426.1 of the Civil Code and Section 1060
of the Evidence Code.
(d) The board shall not disclose the information specified in
subdivision (a) in either individual or aggregated form to any other
health care service plan or insurer or any entity offering services
relating to the administration of health benefit plans, and shall not
make this information available to the public, including, but not
limited to, any summaries, compilations, or rankings derived from
this information. This information shall be used only to make
decisions that materially affect the members and annuitants of the
health benefits program established by the board.
(e) Any staff, contractor, or consultant to whom information is
disclosed pursuant to subdivision (a) shall be subject to all the
restrictions in this section regarding the confidentiality and
nondisclosure of that information.
(f) The information specified in subdivision (a), in either
individual or aggregated form, shall be exempt from disclosure under
the California Public Records Act (Chapter 3.5 (commencing with
Section 6250) of Division 7 of Title 1) pursuant to subdivision (k)
of Section 6254.
(g) Upon request from a hospital, the board shall, on an annual
basis, provide the hospital a reasonable opportunity to validate the
data that has been provided to the board by a health insurer, health
care service plan, or entity pursuant to subdivision (a).
(h) For purposes of this section:
(1) "Actual claim payment" means the actual amount paid by the
health care plan or administrator to the participating hospital for a
health care service rendered to a member or annuitant, exclusive of
member or annuitant cost sharing and any other payment adjustments.
(2) "Contract allowance amounts" means the negotiated rate that
the participating hospital agrees to accept as payment for a health
care service rendered to a member or annuitant under the provider
agreement between the health plan or administrator and the
participating hospital.
(3) "Cost" means the full amount billed by the participating
hospital for a health care service rendered to a member or annuitant.