BILL NUMBER: AB 714 AMENDED
BILL TEXT
AMENDED IN SENATE JUNE 30, 2011
AMENDED IN SENATE JUNE 23, 2011
AMENDED IN ASSEMBLY MAY 27, 2011
AMENDED IN ASSEMBLY MAY 3, 2011
AMENDED IN ASSEMBLY APRIL 14, 2011
AMENDED IN ASSEMBLY MARCH 29, 2011
INTRODUCED BY Assembly Member Atkins
FEBRUARY 17, 2011
An act to amend Section 127420 of, and to add Sections 104164,
120971.5, and 120971.6 to, the Health and Safety Code, to add
Sections 12693.78, 12693.79, 12698.45, 12734, and 12739.615 to the
Insurance Code, and to add Sections 14029.9 and 14105.182 to the
Welfare and Institutions Code, relating to health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
AB 714, as amended, Atkins. Health care coverage: California
Health Benefit Exchange.
Existing law, the federal Patient Protection and Affordable Care
Act, requires each state to, by January 1, 2014, establish an
American Health Benefit Exchange that makes available qualified
health plans to qualified individuals and employers. Existing state
law establishes the California Health Benefit Exchange within state
government, specifies the powers and duties of the board governing
the Exchange relative to determining eligibility for enrollment in
the Exchange and arranging for coverage under qualified health plans,
and requires the board to facilitate the purchase of qualified
health plans through the Exchange by qualified individuals and small
employers by January 1, 2014.
Existing law establishes a program for the treatment of breast and
cervical cancer, administered by the State Department of Health Care
Services, and a program for cancer screening administered by the
State Department of Public Health. Existing law provides specified
health care coverage to eligible individuals under the Healthy
Families Program, the Access for Infants and Mothers Program, the
California Major Risk Medical Insurance Program, and the Federal
Temporary High Risk Pool, which are administered by the Managed Risk
Medical Insurance Board. Existing law provides specified health care
coverage to eligible individuals under the Medi-Cal program and the
Family PACT program, which are administered by the State Department
of Health Care Services. Existing law provides specified health care
coverage to individuals under the AIDS Drug Assistance Program (ADAP)
and the federal Ryan White HIV/AIDS Treatment Extension Act of 2009,
which are administered by the State Department of Public Health.
Existing law provides for the regulation and licensure of hospital
facilities by the State Department of Public Health.
This bill would, until June 30, 2013, require the State Department
of Health Care Services, the State Department of Public Health, and
the Managed Risk Medical Insurance Board, respectively, to disclose
information on health care coverage through the California Health
Benefit Exchange to every individual who has ceased to be enrolled
under the programs described above, except that, with respect to the
cancer treatment and screening programs, the Family PACT program, and
the programs for treatment of HIV/AIDS, the disclosure would be made
to each enrollee, and for the Family PACT Program, the disclosure
would be made by Family PACT providers and on and after July 1, 2013,
as specified. The bill would require certain hospitals, when
billing, to include additional disclosures regarding health care
coverage through the Exchange.
On and after January 1, 2013, this bill would require the State
Department of Health Care Services and the Managed Risk Medical
Insurance Board to provide to the California Health Benefit Exchange
specified information for each individual who has ceased to be
enrolled under those programs, except the cancer treatment and
screening programs, the Family PACT program, and the programs for
treatment of HIV/AIDS, in a manner to be prescribed by the Exchange,
for purposes of determining eligibility and completing enrollment in
the Exchange, and to disclose that enrollment to those individuals.
On and after January 1, 2013, with respect to the cancer treatment
and screening programs, the programs for the treatment of HIV/AIDS,
and the Family PACT program, this bill would require the State
Department of Health Care Services or the State Department of Public
Health to provide to the Exchange specified information for each
enrollee in a manner to be prescribed by the Exchange for purposes of
determining eligibility and completing enrollment in the Exchange.
The bill would make the automatic enrollment of those individuals in
the Exchange subject to the State Department of Health Care Services,
the State Department of Public Health, and the Managed Risk Medical
Insurance Board receiving approval from the United States Department
of Health and Human Services to transfer the minimum information
necessary to initiate an application for enrollment, as specified.
The bill would allow an individual who has been enrolled in
the Exchange by the departments or the board to opt out of that
coverage in a manner to be prescribed by the Exchange
require each affected individual to be given the opportunity to
provide informed consent to commence eligibility determination and
complete enrollment, but would provide that failure to consent or to
respond would be construed to mean the individual is declining
coverage .
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 104164 is added to the Health and Safety Code,
to read:
104164. (a) (1) Effective January 1, 2012, to June 30, 2013,
inclusive, the State Department of Health Care Services shall include
the following notice in materials otherwise provided to every
individual receiving services or treatment for cancer under this
chapter or Section 14007.71 of the Welfare and Institutions Code:
"Effective January 1, 2014, you may be eligible for reduced-cost,
comprehensive health care coverage through the California Health
Benefit Exchange. If your income is low, you may be eligible for
no-cost coverage through Medi-Cal. For more information, please visit
www.healthcare.ca.gov or call 1-888-Healthhelp (insert telephone
number)."
(2) Effective January 1, 2012, to June 30, 2013, inclusive, the
State Department of Public Health shall include the notice set forth
in paragraph (1) in materials otherwise provided to every individual
receiving cancer screening under Section 30461.8 of the Revenue and
Taxation Code.
(b) (1) Effective July 1, 2013, the State Department of Health
Care Services shall include the following notice in materials
otherwise provided to every individual receiving services or
treatment under this chapter or Section 14007.71 of the Welfare and
Institutions Code:
"Because you are enrolled in a cancer screening or treatment
program, an application for health care coverage through the
California Health Benefit Exchange will be made for you. Coverage
will not be effective until January 1, 2014. You are not required to
accept coverage from the Exchange. Your payment for coverage will be
based on your income last year. If you make significantly less or
more this year than you made last year, please tell the California
Health Benefit Exchange and your charges will be based on your
current income. If your income is low, you may qualify for no-cost
coverage through Medi-Cal. For more information, check
www.healthcare.ca.gov or call 1-888-Healthhelp (insert telephone
number)."
(2) Effective July 1, 2013, the State Department of Public Health
shall include the notice set forth in paragraph (1) in materials
otherwise provided to every individual receiving cancer screening
under Section 30461.8 of the Revenue and Taxation Code.
(c) (1) To maximize the number of individual Californians
complying with the requirements of the federal Patient Protection and
Affordable Care Act (Public Law 111-148) by obtaining coverage
consistent with the provisions of federal law, the departments shall
seek approval from the United States Department of Health and Human
Services to transfer the minimum information necessary to initiate an
application for enrollment under this section consistent with
Section 100503 of the Government Code.
(2) Effective January 1, 2013, for each enrollee, the departments
shall provide to the Exchange the name, most recent address, clinical
information, recent providers providers
within the last 12 months , and other information that is in
the possession of the program that the Exchange may require, in a
manner to be prescribed by the Exchange strictly necessary in order
to determine eligibility, complete enrollment, and maximize
continuity of care. The information shall be kept confidential in a
manner consistent with subsection (g) of Section 1411 of the federal
Patient Protection and Affordable Care Act (Public Law 111-148)
and other federal and state medical privacy laws .
(3) The information to the Exchange shall initiate an application
for enrollment in coverage within the meaning of Section 100503 of
the Government Code. Nothing in this section shall be construed to
alter the responsibility of the Exchange or other state and local
government entities with respect to the criteria and process for
eligibility and enrollment in the Exchange and other public health
care coverage programs.
(d) The individual shall have the opportunity to decline health
care coverage pursuant to this section in a manner to be prescribed
by the Exchange.
(d) An individual for whom an application has been initiated by
the transfer of information shall be given the opportunity to provide
informed consent for the use of the transferred information to
commence eligibility determination and complete enrollment as well as
the opportunity to correct any transferred information or provide
additional information before a final eligibility determination is
made. If the individual fails to consent or fails to respond to the
opportunity to provide informed consent within a reasonable period of
time, that failure to consent or respond shall be construed to mean
that the individual is declining coverage.
SEC. 2. Section 120971.5 is added to the Health and Safety Code,
to read:
120971.5. (a) Effective January 1, 2012, to June 30, 2013,
inclusive, the State Department of Public Health shall include the
following notice in materials otherwise provided to every individual
receiving care or services under the AIDS Drug Assistance Program
(ADAP), as provided in Section 120950:
"Effective January 1, 2014, you may be eligible for reduced-cost,
comprehensive health care coverage through the California Health
Benefit Exchange. If your income is low, you may be eligible for
no-cost coverage through Medi-Cal. For more information, please visit
www.healthcare.ca.gov or call 1-888-Healthhelp (insert telephone
number)."
(b) Effective July 1, 2013, the State Department of Public Health
shall include the following notice in materials otherwise provided to
every individual receiving care or services under ADAP as provided
in Section 120950:
"Because you are enrolled in a public health program, an
application for health care coverage through the California Health
Benefit Exchange will be made for you. Coverage will not be effective
until January 1, 2014. You are not required to accept coverage from
the Exchange. Your payment for coverage will be based on your income
last year. If you make significantly less or more this year than you
made last year, please tell the California Health Benefit Exchange
and your charges will be based on your current income. If your income
is low, you may qualify for no-cost coverage through Medi-Cal. For
more information, check www.healthcare.ca.gov or call
1-888-Healthhelp (insert telephone number)."
(c) (1) To maximize the number of individual Californians
complying with the requirements of the federal Patient Protection and
Affordable Care Act (Public Law 111-148) by obtaining coverage
consistent with the provisions of federal law, the State Department
of Public Health shall seek approval from the United States
Department of Health and Human Services to transfer the minimum
information necessary to initiate an application for enrollment under
this section consistent with Section 100503 of the Government Code.
(2) Effective January 1, 2013, for each enrollee, the State
Department of Public Health shall provide to the Exchange the name,
most recent address, clinical information, recent providers
providers within the last 12 months , and other
information that is in the possession of the program that the
Exchange may require, in a manner to be prescribed by the Exchange
strictly necessary in order to determine eligibility, complete
enrollment, and maximize continuity of care. The information shall be
kept confidential in a manner consistent with subsection (g) of
Section 1411 of the federal Patient Protection and Affordable Care
Act (Public Law 111-148) , the and other
federal and state medical privacy laws. The information shall
be provided consistent with Section 120980.
(3) The information provided to the Exchange shall initiate an
application for enrollment in coverage within the meaning of Section
100503 of the Government Code. Nothing in this section shall be
construed to alter the responsibility of the Exchange or other state
and local government entities with respect to the criteria and
process for eligibility and enrollment in the Exchange and other
public health care coverage programs.
(d) The individual shall have the opportunity to decline health
care coverage pursuant to this section in a manner to be prescribed
by the Exchange.
(d) An individual for whom an application has been initiated by
the transfer of information shall be given the opportunity to provide
informed consent for the use of the transferred information to
commence eligibility determination and complete enrollment as well as
the opportunity to correct any transferred information or provide
additional information before a final eligibility determination is
made. If the individual fails to consent or fails to respond to the
opportunity to provide informed consent within a reasonable period of
time, that failure to consent or respond shall be construed to mean
that the individual is declining coverage.
SEC. 3. Section 120971.6 is added to the Health and Safety Code,
to read:
120971.6. (a) Effective January 1, 2012, to June 30, 2013,
inclusive, the State Department of Public Health shall include the
following notice in materials otherwise provided to every individual
receiving care or services under the federal Ryan White HIV/AIDS
Treatment Extension Act of 2009 (Public Law 111-187):
"Effective January 1, 2014, you may be eligible for reduced-cost,
comprehensive health care coverage through the California Health
Benefit Exchange. If your income is low, you may be eligible for
no-cost coverage through Medi-Cal. For more information, please visit
www.healthcare.ca.gov or call 1-888-Healthhelp (insert telephone
number)."
(b) Effective July 1, 2013, the State Department of Public Health
shall include the following notice in materials otherwise provided to
every individual receiving care or services under the federal Ryan
White HIV/AIDS Treatment Extension Act of 2009 (Public Law 111-187):
"Because you are enrolled in a public health program, an
application for health care coverage through the California Health
Benefit Exchange will be made for you. Coverage will not be effective
until January 1, 2014. You are not required to accept coverage from
the Exchange. Your payment for coverage will be based on your income
last year. If you make significantly less or more this year than you
made last year, please tell the California Health Benefit Exchange
and your charges will be based on your current income. If your income
is low, you may qualify for no-cost coverage through Medi-Cal. For
more information, check www.healthcare.ca.gov or call
1-888-Healthhelp (insert telephone number)."
(c) (1) To maximize the number of individual Californians
complying with the requirements of the federal Patient Protection and
Affordable Care Act (Public Law 111-148) by obtaining coverage
consistent with the provisions of federal law, the State Department
of Public Health shall seek approval from the United States
Department of Health and Human Services to transfer the minimum
information necessary to initiate an application for enrollment under
this section consistent with Section 100503 of the Government Code.
(2) Effective January 1, 2013, for each enrollee, the State
Department of Public Health shall provide to the Exchange the name,
most recent address, clinical information, recent providers
providers within the last 12 months , and other
information that is in the possession of the program that the
Exchange may require, in a manner to be prescribed by the Exchange
strictly necessary in order to determine eligibility, complete
enrollment, and maximize continuity of care. The information shall be
kept confidential in a manner consistent with subsection (g) of
Section 1411 of the federal Patient Protection and Affordable Care
Act (Public Law 111-148) , the and other
federal and state medical privacy laws. The information shall
be provided consistent with Section 120980.
(3) The information provided to the Exchange shall initiate an
application for enrollment in coverage within the meaning of Section
100503 of the Government Code. Nothing in this section shall be
construed to alter the responsibility of the Exchange or other state
and local government entities with respect to the criteria and
process for eligibility and enrollment in the Exchange and other
public health care coverage programs.
(d) The individual shall have the opportunity to decline health
care coverage pursuant to this section in a manner to be prescribed
by the Exchange.
(d) An individual for whom an application has been initiated by
the transfer of information shall be given the opportunity to provide
informed consent for the use of the transferred information to
commence eligibility determination and complete enrollment as well as
the opportunity to correct any transferred information or provide
additional information before a final eligibility determination is
made. If the individual fails to consent or fails to respond to the
opportunity to provide informed consent within a reasonable period of
time, that failure to consent or respond shall be construed to mean
that the individual is declining coverage.
SEC. 4. Section 127420 of the Health and Safety Code is amended to
read:
127420. (a) Each hospital shall make all reasonable efforts to
obtain from the patient or his or her representative information
about whether private or public health insurance or sponsorship may
fully or partially cover the charges for care rendered by the
hospital to a patient, including, but not limited to, any of the
following:
(1) Private health insurance.
(2) Medicare.
(3) The Medi-Cal program, the Healthy Families Program, the
California Childrens' Services Program, or other state-funded
programs designed to provide health coverage.
(b) If a hospital bills a patient who has not provided proof of
coverage by a third party at the time the care is provided or upon
discharge, as a part of that billing, the hospital shall provide the
patient with a clear and conspicuous notice that includes all of the
following:
(1) A statement of charges for services rendered by the hospital.
(2) A request that the patient inform the hospital if the patient
has health insurance coverage, Medicare, Healthy Families, Medi-Cal,
or other coverage.
(3) A statement that if the consumer does not have health
insurance coverage, the consumer may be eligible for Medicare,
Healthy Families, Medi-Cal, California Childrens' Services Program,
or charity care. Effective January 1, 2013, the statement shall
include information about the availability of coverage through the
California Health Benefit Exchange and that such coverage shall be
available effective January 1, 2014.
(4) (A) A statement indicating how patients may obtain
applications for the Medi-Cal program and the Healthy Families
Program and that the hospital will provide these applications.
Effective January 1, 2013, the statement shall include information
about the availability of coverage through the California Health
Benefit Exchange and that such coverage shall be available effective
January 1, 2014. If the patient does not indicate coverage by a
third-party payer specified in subdivision (a), or requests a
discounted price or charity care then the hospital shall provide an
application for the Medi-Cal program, the Healthy Families Program,
or other governmental program to the patient. This application shall
be provided prior to discharge if the patient has been admitted or to
patients receiving emergency or outpatient care.
(B) Effective January 1, 2014, the California Health Benefit
Exchange shall be included as a government program under this
section, including for purposes of the notice and application
requirements under this subdivision.
(5) Information regarding the financially qualified patient and
charity care application, including the following:
(A) A statement that indicates that if the patient lacks, or has
inadequate, insurance, and meets certain low- and moderate-income
requirements, the patient may qualify for discounted payment or
charity care.
(B) The name and telephone number of a hospital employee or office
from whom or which the patient may obtain information about the
hospital's discount payment and charity care policies, and how to
apply for that assistance.
SEC. 5. Section 12693.78 is added to the Insurance Code, to read:
12693.78. (a) Effective January 1, 2012, to June 30, 2013,
inclusive, the board shall include the following notice in materials
otherwise provided to every individual who ceases to be enrolled in
the program:
"Effective January 1, 2014, you may be eligible for reduced-cost,
comprehensive health care coverage through the California Health
Benefit Exchange. If your income is low, you may be eligible for
no-cost coverage through Medi-Cal. For more information, please visit
www.healthcare.ca.gov or call 1-888-Healthhelp (insert telephone
number)."
(b) Effective July 1, 2013, the board shall include the following
notice in materials otherwise provided to every individual who ceases
to be enrolled in the program after that date :
"Because you are no longer enrolled in the Healthy Families
Program, an application for health care coverage through the
California Health Benefit Exchange will be made for you. Coverage
will not be effective until January 1, 2014. You are not required to
accept coverage from the Exchange. Your payment for coverage will be
based on your income last year. If you make significantly less or
more this year than you made last year, please tell the California
Health Benefit Exchange and your charges will be based on your
current income. If your income is low, you may qualify for no-cost
coverage through Medi-Cal. For more information, check
www.healthcare.ca.gov or call 1-888-Healthhelp (insert telephone
number)."
(c) (1) To maximize the number of individual Californians
complying with the requirements of the federal Patient Protection and
Affordable Care Act (Public Law 111-148) by obtaining coverage
consistent with the provisions of federal law, the board shall seek
approval from the United States Department of Health and Human
Services to transfer the minimum information necessary to initiate an
application for enrollment under this section consistent with
Section 100503 of the Government Code.
(2) Effective January 1, 2013, for each enrollee who has ceased to
be enrolled, the board shall provide to the Exchange the name, most
recent address, clinical information, recent providers
providers within the last 12 months , and other
information that is in the possession of the program that the
Exchange may require, in a manner to be prescribed by the Exchange
strictly necessary in order to determine eligibility, complete
enrollment, and maximize continuity of care. The information shall be
kept confidential in a manner consistent with subsection (g) of
Section 1411 of the federal Patient Protection and Affordable Care
Act (Public Law 111-148) and other federal and state medical
privacy laws .
(3) The information provided to the Exchange shall initiate an
application for enrollment in coverage within the meaning of Section
100503 of the Government Code. Nothing in this section shall be
construed to alter the responsibility of the Exchange or other state
and local government entities with respect to the criteria and
process for eligibility and enrollment in the Exchange and other
public health care coverage programs.
(d) The individual shall have the opportunity to decline health
care coverage pursuant to this section in a manner to be prescribed
by the Exchange.
(d) An individual for whom an application has been initiated by
the transfer of information shall be given the opportunity to provide
informed consent for the use of the transferred information to
commence eligibility determination and complete enrollment as well as
the opportunity to correct any transferred information or provide
additional information before a final eligibility determination is
made. If the individual fails to consent or fails to respond to the
opportunity to provide informed consent within a reasonable period of
time, that failure to consent or respond shall be construed to mean
that the individual is declining coverage.
SEC. 6. Section 12693.79 is added to the Insurance Code, to read:
12693.79. Effective January 1, 2012, the board shall include the
following notice in materials otherwise provided to every individual
enrolled in the Healthy Families Program:
"Effective January 1, 2014, if your parents or other family
members do not have health care coverage that costs less than 10% of
your income, your parents or other family members may be eligible for
reduced-cost, comprehensive health care coverage through the
California Health Benefit Exchange. If your income is low, you may be
eligible for no-cost coverage through Medi-Cal. For more
information, please visit www.healthcare.ca.gov or call
1-888-Healthhelp (insert telephone number)."
SEC. 7. Section 12698.45 is added to the Insurance Code, to read:
12698.45. (a) Effective January 1, 2012, to June 30, 2013,
inclusive, the board shall include the following notice in materials
otherwise provided to every individual who ceases to be enrolled in
the program:
"Effective January 1, 2014, you may be eligible for reduced-cost,
comprehensive health care coverage through the California Health
Benefit Exchange. If your income is low, you may be eligible for
no-cost coverage through Medi-Cal. For more information, please visit
www.healthcare.ca.gov or call 1-888-Healthhelp (insert telephone
number)."
(b) Effective July 1, 2013, the board shall include the following
notice in materials otherwise provided to every individual who ceases
to be enrolled in the program:
"Because you are no longer enrolled in AIM (Access for Infants and
Mothers Program), an application for health care coverage through
the California Health Benefit Exchange will be made for you. Coverage
will not be effective until January 1, 2014. You are not required to
accept coverage from the Exchange. Your payment for coverage will be
based on your income last year. If you make significantly less or
more this year than you made last year, please tell the California
Health Benefit Exchange and your charges will be based on your
current income. If your income is low, you may qualify for no-cost
coverage through Medi-Cal. For more information, check
www.healthcare.ca.gov or call 1-888-Healthhelp (insert telephone
number)."
(c) (1) To maximize the number of individual Californians
complying with the requirements of the federal Patient Protection and
Affordable Care Act (Public Law 111-148) by obtaining coverage
consistent with the provisions of federal law, the board shall seek
approval from the United States Department of Health and Human
Services to transfer the minimum information necessary to initiate an
application for enrollment under this section consistent with
Section 100503 of the Government Code.
(2) Effective January 1, 2013, for each enrollee who has ceased to
be enrolled, the board shall provide to the Exchange the name, most
recent address, clinical information, recent providers
providers within the last 12 months ,
and other information that is in the possession of the program that
the Exchange may require, in a manner to be prescribed by the
Exchange strictly necessary in order to determine eligibility,
complete enrollment, and maximize continuity of care. The information
shall be kept confidential in a manner consistent with subsection
(g) of Section 1411 of the federal Patient Protection and Affordable
Care Act (Public Law 111-148) and other federal and state
medical privacy laws .
(3) The information provided to the Exchange shall initiate an
application for enrollment in coverage within the meaning of Section
100503 of the Government Code. Nothing in this section shall be
construed to alter the responsibility of the Exchange or other state
and local government entities with respect to the criteria and
process for eligibility and enrollment in the Exchange and other
public health care coverage programs.
(d) The individual shall have the opportunity to decline health
care coverage pursuant to this section in a manner to be prescribed
by the Exchange.
(d) An individual for whom an application has been initiated by
the transfer of information shall be given the opportunity to provide
informed consent for the use of the transferred information to
commence eligibility determination and complete enrollment as well as
the opportunity to correct any transferred information or provide
additional information before a final eligibility determination is
made. If the individual fails to consent or fails to respond to the
opportunity to provide informed consent within a reasonable period of
time, that failure to consent or respond shall be construed to mean
that the individual is declining coverage.
SEC. 8. Section 12734 is added to the Insurance Code, to read:
12734. (a) Effective January 1, 2012, to June 30, 2013,
inclusive, the board shall include the following notice in materials
otherwise provided to every individual who ceases to be enrolled in
the program:
"Effective January 1, 2014, you may be eligible for reduced-cost,
comprehensive health care coverage through the California Health
Benefit Exchange. If your income is low, you may be eligible for
no-cost coverage through Medi-Cal. For more information, please visit
www.healthcare.ca.gov or call 1-888-Healthhelp (insert telephone
number)."
(b) Effective July 1, 2013, the board shall include the following
notice in materials otherwise provided to every individual who ceases
to be enrolled in the program:
"Because you are no longer enrolled in the California Major Risk
Medical Insurance Program, an application for health care coverage
through the California Health Benefit Exchange will be made for you.
Coverage will not be effective until January 1, 2014. You are not
required to accept
coverage from the Exchange. Your payment for coverage will be based
on your income last year. If you make significantly less or more this
year than you made last year, please tell the California Health
Benefit Exchange and your charges will be based on your current
income. If your income is low, you may qualify for no-cost coverage
through Medi-Cal. For more information, check www.healthcare.ca.gov
or call 1-888-Healthhelp (insert telephone number)."
(c) (1) To maximize the number of individual Californians
complying with the requirements of the federal Patient Protection and
Affordable Care Act (Public Law 111-148) by obtaining coverage
consistent with the provisions of federal law, the board shall seek
approval from the United States Department of Health and Human
Services to transfer the minimum information necessary to initiate an
application for enrollment under this section consistent with
Section 100503 of the Government Code.
(2) Effective January 1, 2013, for each enrollee who has ceased to
be enrolled, the board shall provide to the Exchange the name, most
recent address, clinical information, recent providers
providers within the last 12 months ,
and other information that is in the possession of the program that
the Exchange may require, in a manner to be prescribed by the
Exchange strictly necessary in order to determine eligibility,
complete enrollment, and maximize continuity of care. The information
shall be kept confidential in a manner consistent with subsection
(g) of Section 1411 of the federal Patient Protection and Affordable
Care Act (Public Law 111-148) and other federal and state
medical privacy laws .
(3) The information provided to the Exchange shall initiate an
application for enrollment in coverage within the meaning of Section
100503 of the Government Code. Nothing in this section shall be
construed to alter the responsibility of the Exchange or other state
and local government entities with respect to the criteria and
process for eligibility and enrollment in the Exchange and other
public health care coverage programs.
(d) The individual shall have the opportunity to decline health
care coverage pursuant to this section in a manner to be prescribed
by the Exchange.
(d) An individual for whom an application has been initiated by
the transfer of information shall be given the opportunity to provide
informed consent for the use of the transferred information to
commence eligibility determination and complete enrollment as well as
the opportunity to correct any transferred information or provide
additional information before a final eligibility determination is
made. If the individual fails to consent or fails to respond to the
opportunity to provide informed consent within a reasonable period of
time, that failure to consent or respond shall be construed to mean
that the individual is declining coverage.
SEC. 9. Section 12739.615 is added to the Insurance Code, to read:
12739.615. (a) Effective January 1, 2012, to June 30, 2013,
inclusive, the board shall include the following notice in materials
otherwise provided to every individual who ceases to be enrolled in
the program:
"Effective January 1, 2014, you may be eligible for reduced-cost,
comprehensive health care coverage through the California Health
Benefit Exchange. If your income is low, you may be eligible for
no-cost coverage through Medi-Cal. For more information, please visit
www.healthcare.ca.gov or call 1-888-Healthhelp (insert telephone
number)."
(b) Effective July 1, 2013, the board shall include the following
notice in materials otherwise provided to every individual who ceases
to be enrolled in the program:
"Because you are no longer enrolled in the Federal Temporary High
Risk Pool, an application for health care coverage through the
California Health Benefit Exchange will be made for you. Coverage
will not be effective until January 1, 2014. You are not required to
accept coverage from the Exchange. Your payment for coverage will be
based on your income last year. If you make significantly less or
more this year than you made last year, please tell the California
Health Benefit Exchange and your charges will be based on your
current income. If your income is low, you may qualify for no-cost
coverage through Medi-Cal. For more information, check
www.healthcare.ca.gov or call 1-888-Healthhelp (insert telephone
number)."
(c) (1) To maximize the number of individual Californians
complying with the requirements of the federal Patient Protection and
Affordable Care Act (Public Law 111-148) by obtaining coverage
consistent with the provisions of federal law, the board shall seek
approval from the United States Department of Health and Human
Services to transfer the minimum information necessary to initiate an
application for enrollment under this section consistent with
Section 100503 of the Government Code.
(2) Effective January 1, 2013, for each enrollee who has ceased to
be enrolled, the board shall provide to the Exchange the name, most
recent address, clinical information, recent providers
providers within the last 12 months ,
and other information that is in the possession of the program that
the Exchange may require, in a manner to be prescribed by the
Exchange strictly necessary in order to determine eligibility,
complete enrollment, and maximize continuity of care. The information
shall be kept confidential in a manner consistent with subsection
(g) of Section 1411 of the federal Patient Protection and Affordable
Care Act (Public Law 111-148) and other federal and state
medical privacy laws .
(3) The information provided to the Exchange shall initiate an
application for enrollment in coverage within the meaning of Section
100503 of the Government Code. Nothing in this section shall be
construed to alter the responsibility of the Exchange or other state
and local government entities with respect to the criteria and
process for eligibility and enrollment in the Exchange and other
public health care coverage programs.
(d) The individual shall have the opportunity to decline health
care coverage pursuant to this section in a manner to be prescribed
by the Exchange.
(d) An individual for whom an application has been initiated by
the transfer of information shall be given the opportunity to provide
informed consent for the use of the transferred information to
commence eligibility determination and complete enrollment as well as
the opportunity to correct any transferred information or provide
additional information before a final eligibility determination is
made. If the individual fails to consent or fails to respond to the
opportunity to provide informed consent within a reasonable period of
time, that failure to consent or respond shall be construed to mean
that the individual is declining coverage.
SEC. 10. Section 14029.9 is added to the Welfare and Institutions
Code, to read:
14029.9. (a) Effective January 1, 2012, to June 30, 2013,
inclusive, the department shall include the following notice in
materials otherwise provided to every individual who ceases to be
enrolled in the Medi-Cal program and received full-scope Medi-Cal
benefits for which there was federal financial participation:
"Effective January 1, 2014, you may be eligible for reduced-cost,
comprehensive health care coverage through the California Health
Benefit Exchange. If your income is low, you may be eligible for
no-cost coverage through Medi-Cal. For more information, please visit
www.healthcare.ca.gov or call 1-888-Healthhelp (insert telephone
number)."
(b) Effective July 1, 2013, the department shall include the
following notice in materials otherwise provided to every individual
who ceases to be enrolled in the Medi-Cal program and received
full-scope Medi-Cal benefits for which there was federal financial
participation:
"Because you are no longer enrolled in Medi-Cal, an application
for health care coverage through the California Health Benefit
Exchange will be made for you. Coverage will not be effective until
January 1, 2014. You are not required to accept coverage from the
Exchange. Your payment for coverage will be based on your income last
year. If you make significantly less or more this year than you made
last year, please tell the California Health Benefit Exchange and
your charges will be based on your current income. If your income is
low, you may qualify for no-cost coverage through Medi-Cal. For more
information, check www.healthcare.ca.gov or call 1-888-Healthhelp
(insert telephone number)."
(c) (1) To maximize the number of individual Californians
complying with the requirements of the federal Patient Protection and
Affordable Care Act (Public Law 111-148) by obtaining coverage
consistent with the provisions of federal law, the department shall
seek approval from the United States Department of Health and Human
Services to transfer the minimum information necessary to initiate an
application for enrollment under this section consistent with
Section 100503 of the Government Code.
(2) Effective January 1, 2013, for each enrollee who has ceased to
be enrolled, the department shall provide to the Exchange the name,
most recent address, clinical information, recent providers
providers within the last 12 months , and other
information that is in the possession of the program that the
Exchange may require, in a manner to be prescribed by the Exchange
strictly necessary in order to determine eligibility, complete
enrollment, and maximize continuity of care. The information shall be
kept confidential in a manner consistent with subsection (g) of
Section 1411 of the federal Patient Protection and Affordable Care
Act (Public Law 111-148) and other federal and state medical
privacy laws .
(3) The information provided to the Exchange shall initiate an
application for enrollment in coverage within the meaning of Section
100503 of the Government Code. Nothing in this section shall be
construed to alter the responsibility of the Exchange or other state
and local government entities with respect to the criteria and
process for eligibility and enrollment in the Exchange and other
public health care coverage programs.
(d) The individual shall have the opportunity to decline health
care coverage pursuant to this section in a manner to be prescribed
by the Exchange.
(d) An individual for whom an application has been initiated by
the transfer of information shall be given the opportunity to provide
informed consent for the use of the transferred information to
commence eligibility determination and complete enrollment as well as
the opportunity to correct any transferred information or provide
additional information before a final eligibility determination is
made. If the individual fails to consent or fails to respond to the
opportunity to provide informed consent within a reasonable period of
time, that failure to consent or respond shall be construed to mean
that the individual is declining coverage.
SEC. 11. Section 14105.182 is added to the Welfare and
Institutions Code, to read:
14105.182. (a) Effective January 1, 2012, to June 30, 2013,
inclusive, the Family PACT provider shall include the following
notice in materials otherwise provided to every individual receiving
care or services under the Family PACT program as provided in
subdivision (aa) of Section 14132:
"Effective January 1, 2014, you may be eligible for reduced-cost,
comprehensive health care coverage through the California Health
Benefit Exchange. If your income is low, you may be eligible for
no-cost coverage through Medi-Cal. For more information, please visit
www.healthcare.ca.gov or call 1-888-Healthhelp (insert telephone
number)."
(b) (1) Effective July 1, 2013, the Family
PACT provider shall include the following notice in materials
otherwise provided to every individual receiving care or services
under the Family PACT program as provided in subdivision (aa) of
Section 14132:
"Because you are enrolled in a public health program, an
application for health care coverage through the California Health
Benefit Exchange will be made for you. If you do not qualify for that
coverage or if you decline that coverage, your enrollment in Family
PACT will continue. Coverage will not be effective until January 1,
2014. You are not required to accept coverage from the Exchange. Your
payment for coverage will be based on your income last year. If you
make significantly less or more this year than you made last year,
please tell the California Health Benefit Exchange and your charges
will be based on your current income. If your income is low, you may
qualify for no-cost coverage through Medi-Cal. For more information,
check www.healthcare.ca.gov or call 1-888-Healthhelp (insert
telephone number)."
(2) The Family PACT provider shall seek written consent from every
individual receiving care or services under the program to initiate
an application for enrollment through the Exchange and shall provide
to the department the name and patient identifier for those
individuals who provide that consent.
(c) (1) To maximize the number of individual Californians
complying with the requirements of the federal Patient Protection and
Affordable Care Act (Public Law 111-148) by obtaining coverage
consistent with the provisions of federal law, the department shall
seek approval from the United States Department of Health and Human
Services to transfer the minimum information necessary to initiate an
application for enrollment under this section consistent with
Section 100503 of the Government Code.
(2) Effective January 1, 2013, for each enrollee from whom
the provider has obtained written consent , the department shall
provide to the Exchange the name, most recent address, other
information that is in the possession of the program, and providers
within the last 12 months, in a manner to be prescribed by the
Exchange strictly necessary in order to determine eligibility,
complete enrollment, and maximize continuity of care. The information
shall be kept confidential in a manner consistent with subsection
(g) of Section 1411 of the federal Patient Protection and Affordable
Care Act (Public Law 111-148) and other federal and state
medical privacy laws . To maximize continuity of care in
selecting a plan, enrollees shall be provided information about
participating providers based on an enrollee's existing or recent
utilization of providers, to the extent possible and consistent with
paragraph (9) of subdivision (a) of Section 100504 of the Government
Code.
(3) The information provided to the Exchange shall initiate an
application for enrollment in coverage within the meaning of Section
100503 of the Government Code. Nothing in this section shall be
construed to alter the responsibility of the Exchange or other state
and local government entities with respect to the criteria and
process for eligibility and enrollment in the Exchange and other
public health care coverage programs.
(d) The individual shall have the opportunity to decline health
care coverage pursuant to this section in a manner to be prescribed
by the Exchange.
(d) An individual for whom an application has been initiated by
the transfer of information shall be given the opportunity to provide
informed consent for the use of the transferred information to
commence eligibility determination and complete enrollment as well as
the opportunity to correct any transferred information or provide
additional information before a final eligibility determination is
made. If the individual fails to consent or fails to respond to the
opportunity to provide informed consent within a reasonable period of
time, that failure to consent or respond shall be construed to mean
that the individual is declining coverage.
SEC. 12. The State Public Health officer, with
respect to the notice required by Sections 104164, 120971.5,
120971.6, and 127420 of the Health and Safety Code, the Managed Risk
Medical Insurance Board, with respect to the notice required by
Sections 12693.78, 12693.79, 12734, and 12739.615 of the Insurance
Code, and the Director of Health Care Services, with respect to the
notice required by Sections 14029.9 and 14105.182 of the Welfare and
Institutions Code, may, by regulation, modify the wording of the
notice for purposes of clarity, readability, and accuracy, but may
not change the substantive meaning of the notice. Each notice shall
also be provided in threshold languages.