BILL NUMBER: AB 788	INTRODUCED
	BILL TEXT


INTRODUCED BY   Assembly Member Pan

                        FEBRUARY 17, 2011

   An act to amend Section 10133.5 of the Insurance Code, relating to
health insurance.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 788, as introduced, Pan. Health insurance.
   Existing law provides for the regulation of health insurers by the
Department of Insurance. Existing law requires the Insurance
Commissioner, on or before January 1, 2004, to promulgate regulations
meeting specified standards applicable to health insurers that
contract with providers for alternative rates. Existing law requires
the department to report to specified committees of the Legislature
on March 1, 2003, and March 1, 2004, regarding the implementation of
the regulations.
   This bill would delete the provisions requiring the department to
report to the Legislature on those dates.
   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 10133.5 of the Insurance Code is amended to
read:
   10133.5.  (a) The commissioner shall, on or before January 1,
2004, promulgate regulations applicable to health insurers which
contract with providers for alternative rates pursuant to Section
10133 to ensure that insureds have the opportunity to access needed
health care services in a timely manner.
   (b) These regulations shall be designed to assure accessibility of
provider services in a timely manner to individuals comprising the
insured or contracted group, pursuant to benefits covered under the
policy or contract. The regulations shall insure: 
    1. 
    (1)  Adequacy of number and locations of institutional
facilities and professional providers, and consultants in
relationship to the size and location of the insured group and that
the services offered are available at reasonable times. 
    2. 
    (2)  Adequacy of number of professional providers, and
license classifications of such providers, in relationship to the
projected demands for services covered under the group policy or
plan. The department shall consider the nature of the specialty in
determining the adequacy of professional providers. 
    3. 
    (3)  The policy or contract is not inconsistent with
standards of good health care and clinically appropriate care.

    4. 
   (4)  All contracts including contracts with providers,
and other persons furnishing services, or facilities shall be fair
and reasonable.
   (c) In developing standards under subdivision (a), the department
shall also consider requirements under federal law; requirements
under other state programs and law, including utilization review; and
standards adopted by other states, national accrediting
organizations and professional associations. The department shall
further consider the accessability to provider services in rural
areas.
   (d) In designing the regulations the commissioner shall consider
the regulations in Title 28, of the California Administrative Code of
Regulations, commencing with Section 1300.67.2, which are applicable
to Knox-Keene plans, and all other relevant guidelines in an effort
to accomplish maximum accessibility within a cost efficient system of
indemnification. The department shall consult with the Department of
Managed Health Care concerning regulations developed by that
department pursuant to Section 1367.03 of the Health and Safety Code
and shall seek public input from a wide range of interested parties.
   (e) Health insurers that contract for alternative rates of payment
with providers shall report annually on complaints received by the
insurer regarding timely access to care. The department shall review
these complaints and any complaints received by the department
regarding timeliness of care and shall make public this information.

   (f) The department shall report to the Assembly Committee on
Health and the Senate Committee on Insurance of the Legislature on
March 1, 2003, and on March 1, 2004, regarding the progress towards
the implementation of this section.  
   (g) 
    (f)  Every three years, the commissioner shall review
the latest version of the regulations adopted pursuant to subdivision
(a) and shall determine if the regulations should be updated to
further the intent of this section.