BILL NUMBER: AB 2389 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY APRIL 8, 2010
INTRODUCED BY Assembly Member Gaines
FEBRUARY 19, 2010
An act to amend Section 1569.70 of add
Section 1367.49 to the Health and Safety Code,
relating to care facilities. and to add Section
10133.64 to the Insurance Code, relating to health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
AB 2389, as amended, Gaines. Residential care for the
elderly. Health care coverage: provider contracts.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975,
provides for the licensure and regulation of health care service
plans by the Department of Managed Health Care. Existing law also
provides for the regulation of health insurers by the Department of
Insurance. Existing law prohibits a contract between a plan or
insurer and a health care provider from containing certain terms.
This bill would prohibit a contract between a plan or insurer and
a health care facility to provide inpatient hospital services or
ambulatory care services to subscribers and enrollees of the plan or
policyholders and insureds of the insurer from containing a provision
that restricts the ability of the plan or insurer to furnish
information to subscribers or enrollees of the plan or policyholders
or insureds of the insurer concerning the cost of procedures at the
facility or the quality of services provided by the facility. The
bill would make a contractural provision inconsistent with this
requirement void and unenforceable.
Existing law requires the State Department of Social Services to
license and regulate residential care facilities for the elderly.
This bill would make a technical, nonsubstantive change in those
provisions.
Vote: majority. Appropriation: no. Fiscal committee: no.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 1367.49 is added to the
Health and Safety Code , to read:
1367.49. (a) A contract issued, amended, renewed, or delivered on
or after January 1, 2011, between a health care service plan and a
health care facility to provide inpatient hospital services or
ambulatory care services to subscribers and enrollees of the plan
shall not contain any provision that restricts the ability of the
health care service plan to furnish information to subscribers or
enrollees of the plan concerning the cost of procedures at the
facility or the quality of services provided by the facility.
(b) Any contractural provision inconsistent with this section
shall be void and unenforceable.
(c) Section 1390 shall not apply for purposes of this section.
SEC. 2. Section 10133.64 is added to the
Insurance Code , to read:
10133.64. (a) A contract issued, amended, renewed, or delivered
on or after January 1, 2011, between a health insurer and a health
care facility to provide inpatient hospital services or ambulatory
care services to policyholders and insureds of the insurer shall not
contain any provision that restricts the ability of the health
insurer to furnish information to policyholders or insureds
concerning the cost of procedures at the facility or the quality of
services provided by the facility.
(b) Any contractural provision inconsistent with this section
shall be void and unenforceable.
SECTION 1. Section 1569.70 of the Health and
Safety Code is amended to read:
1569.70. It is the intent of the Legislature to develop and
implement a plan to establish three levels of care under the
residential care facility for the elderly license, subject to future
Budget Act appropriations and statutory authorization to implement
levels of care.
(a) The guidelines for the development of these levels of care
are:
(1) Level I--Base care and supervision. Residents at this level
are able to maintain a higher degree of independence and need only
minimum care and supervision, as defined, and minimal personal care
assistance.
(2) Level II--Nonmedical personal care. Residents at this level
have functional limitations and psychosocial needs requiring not only
care and supervision but frequent assistance with personal
activities of daily living and active intervention to help them
maintain their potential for independent living.
(3) Level III--Health related assistance. Residents at this level
require the services of lower levels and rely on the facility for
extensive assistance with personal activities of daily living. This
level may include residents who also require the occasional services
of an appropriate skilled professional due to chronic health problems
and returning residents recovering from illness, injury, or
treatment that required placement in facilities providing higher
levels of care.
These levels are to be based on the services required by residents
at each level due to their functional limitations.
(b) The levels of care plan shall include:
(1) Guidelines for meeting requirements at each level of care by
utilizing appropriate community and professional services. Options
shall be provided to allow facilities to meet resident needs by
accessing community services or hiring appropriate staff.
(2) Assessment procedures for facility evaluation of residents'
level of care needs.
(3) Process for ensuring the individual facility's ability to
serve clients at each level of care they intend to provide.
(4) Recommendations for a supplemental rate structure based on the
services required at Levels II and III to be provided for residents
who need those levels of care and are recipients of SSI/SSP. These
rates shall be in addition to the basic SSI/SSP rate for providing
care supervision and shall reflect actual costs of operation for
residential care facilities for the elderly.
(5) Procedures for assessment and certification of SSI/SSP
recipients, by county social services departments to allow for
administration of the supplemental rate structure.
(6) Procedures for evaluating and monitoring the appropriateness
of the levels of care determined for SSI/SSP recipients.
(c) Implementation of the levels of care system shall consider the
applicability of the 1985 level of care report developed by the
California Health and Human Services Agency to ensure continuity in
the residential care facility for the elderly program as outlined
under this chapter.