BILL ANALYSIS                                                                                                                                                                                                    Ó






                                 SENATE HEALTH
                               COMMITTEE ANALYSIS
                       Senator Ed Hernandez, O.D., Chair


          BILL NO:       AB 922                                      
          A
          AUTHOR:        Monning                                     
          B
          AMENDED:       September 2, 2011                           
          HEARING DATE:  September 6, 2011                           
          9
          CONSULTANT:                                                
          2
          Chan-Sawin                                                 
          2                                                          

                                        
                              PURSUANT TO S.R. 29.10


                                    SUBJECT
                                         
                           Office of Patient Advocate
                                         

                                    SUMMARY  

          Transfers the Department of Managed Health Care (DMHC) from 
          the California Business, Transportation and Housing Agency 
          (BTH) to the California Health and Human Services Agency 
          (CHHS).  Transfers the Office of the Patient Advocate (OPA) 
          from DMHC to CHHS effective July 1, 2012.  Revises OPA's 
          current purpose and duties, and assigns new duties 
          consistent with requirements of the Patient Protection and 
          Affordable Care Act (PPACA).  


                             CHANGES TO EXISTING LAW  

          Existing federal law:
          Requires, under PPACA (Public Law 111-148), as amended by 
          the Health Care Education and Reconciliation Act of 2010 
          (Public Law 111-152), each state, by January 1, 2014, to 
          establish an American Health Benefit Exchange that makes 
          qualified health insurance products available to qualified 
                                                         Continued---



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          individuals and qualified employers.  If a state does not 
          establish an Exchange, the federal government administers 
          the Exchange.

          Requires the federal Secretary of Health and Human Services 
          Agency to award grants to states to enable states (or the 
          exchanges operating in such states) to establish, expand, 
          or provide support for offices of health insurance consumer 
          assistance or health insurance ombudsman programs.  

          Establishes criteria for states to meet in order to receive 
          a consumer assistance grant under the PPACA, and requires 
          the ombudsman to perform certain activities, including 
          assisting with the filing of complaints and appeals, 
          educating consumers on their rights and responsibilities, 
          assisting consumers with enrollment, and resolving problems 
          in obtaining premium tax credits made available by PPACA.  
          As a condition of receiving a federal ombudsman grant, an 
          office of health insurance consumer assistance or ombudsman 
          program is required to collect and report data to the 
          Secretary of HHS on the types of problems and inquiries 
          encountered by consumers.

          Existing state law:
          Provides for the regulation of health plans by DMHC under 
          the Knox-Keene Health Care Service Plan Act of 1975 
          (Knox-Keene Act), and for the regulation of health insurers 
          by the California Department of Insurance (CDI), under 
          provisions of the Insurance Code (collectively referred to 
          as regulators).

          Requires DMHC to establish and maintain a toll-free 
          telephone number for the purpose of receiving complaints 
          regarding health plans regulated by DMHC.  

          Establishes OPA within DMHC to represent the interests of 
          enrollees served by health plans regulated by DMHC and 
          establishes, as the goal of OPA, to help enrollees secure 
          health care services to which they are entitled under the 
          laws administered by DMHC.  Requires OPA to compile an 
          annual publication, to be made available on DMHC's website, 
          of a quality-of-care report card, including, but not 
          limited to, health plans.

          Requires the Insurance Commissioner to establish a program 




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          to investigate complaints, respond to inquiries, and to 
          bring enforcement actions regarding health insurers.  
          Requires the program to include, but not be limited to, a 
          toll-free telephone number dedicated to the handling of 
          complaints and inquiries, public service announcements to 
          inform consumers of the toll-free telephone number, 
          information as to how to register a complaint or make an 
          inquiry to the CDI, and a simple, standardized complaint 
          form designed to assure that complaints will be properly 
          registered and tracked.

          Establishes the Medi-Cal program, which is administered by 
          the State Department of Health Care Services (DHCS), under 
          which qualified low-income individuals receive health care 
          services.  

          Authorizes DHCS, for purposes of the Medi-Cal Program, on a 
          regional pilot project basis, to the extent authorized by 
          law, to enter into contracts with one or more nonprofit 
          organizations to perform the functions of the DHCS' Office 
          of the Ombudsman.  


          Establishes and specifies the duties and authority the 
          California Health Benefit Exchange (Exchange) within state 
          government in a manner that is consistent with PPACA.



          Establishes the Managed Care Fund and the Insurance Fund, 
          for the purposes of funding the regulatory activities of 
          DMHC and CDI, respectively. 

          This bill:
          Transfers DMHC from BTH to CHHS effective January 1, 2012.  
          Also transfers OPA from DMHC to CHHS effective July 1, 
          2012.  

          Delays the operative date of provisions affecting insureds 
          covered by CDI-regulated health insurers, and individuals 
          who receive or are eligible for coverage under the Medi-Cal 
          program, the Exchange, the Healthy Families Program, or any 
          other county or state health care program until January 1, 
          2013.  Further specifies that, for the period between July 
          1, 2012, and January 1, 2013, OPA will continue with any 




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          duties, responsibilities or activities in place as of July 
          1, 2011, in reference to those insureds and individuals. 

          Specifies that the duties of the OPA include, but are not 
          limited to:
                 Developing, in consultation with DMHC, CDI, the 
               Managed Risk Medical Insurance Board, DHCS, and 
               Exchange, consumer educational and information guides, 
               as specified.
                 Compiling an annual quality of care report card, as 
               specified.

          States that, because of the enactment of PPACA and the 
          implementation of various reform provisions by January 1, 
          2014, the Legislature recognizes that it is appropriate to 
          transfer and confer on OPA new responsibilities, including 
          assisting consumers in obtaining coverage and health care 
          through health coverage that is regulated by multiple 
          regulators, as specified.  

          Beginning January 1, 2013, makes the following additional 
          changes to the duties to OPA:
                 Receiving and responding to all inquiries, 
               complaints and requests for assistance from 
               individuals concerning health coverage available in 
               California;
                 Providing and assisting in the provision of, 
               outreach and education about coverage options, as 
               specified;
                 Coordinating and working with other government and 
               nongovernment patient assistance programs and health 
               care ombudsman programs.
                 Rendering assistance to, and advocating on behalf 
               of, consumers with problems related to health care 
               services, including care and service problems and 
               claims or payment problems.
                 Referring consumers to the appropriate regulator 
               for filing complaints, grievances, or claims or 
               payment problems.
                 Directing OPA to provide assistance regarding 
               coverage options if the consumer is not eligible for 
               coverage, as specified.
                 Requiring OPA to ensure that either OPA, or a state 
               agency contracting with OPA, provides such services.
                 Requiring OPA to operate a website, other social 




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               media, and up-to-date communication systems to provide 
               public information regarding consumer assistance 
               programs.

          Beginning January 1, 2013, requires OPA to track and 
          analyze data, as specified, on problems and complaints by, 
          and questions from, consumers about health care coverage 
          for the purpose of providing public information about 
          problems faced and information needed by consumers in 
          obtaining coverage and care.  

          Requires DMHC, DHCS, CDI, MRMIB, the Exchange, and other 
          public programs to provide OPA with aggregate data 
          concerning consumer complaints and grievances.   Removes 
          the provision allowing OPA to access to records of CDI, and 
          sunsets OPA's access of DMHC records on January 1, 2013.

          Requires OPA to collect and report data to the United 
          States Secretary of Health and Human Services on complaints 
          and consumer assistance as required to comply with 
          requirements of the PPACA.

          Allows OPA to contract with community-based consumer 
          assistance organizations to assist in any or all of certain 
          specified duties of OPA, in accordance with existing state 
          laws governing personal services contracts.  Allows OPA to 
          provide grants to such organizations for the provision of a 
          portion of OPA's duties, as specified.

          Requires OPA to adopt standards for the organizations with 
          which it contracts to ensure compliance with privacy and 
          confidentiality laws, as specified.  Also require OPA to 
          conduct privacy trainings as necessary, and regularly 
          verify that the organizations have measures in place to 
          ensure compliance with this provision.

          Requires OPA to develop the following: 
                 A procedure for referring complaints and grievances 
               to the appropriate regulator or coverage program for 
               resolution by the relevant regulator or public 
               program. 
                 A protocol or procedure for reporting to the 
               appropriate regulator and health coverage program 
               regarding complaints and grievances relevant to that 
               agency that OPA received and was able to resolve 




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               without further action or referral.

          Creates the OPA Trust Fund in the State Treasury, and upon 
          appropriation by the Legislature, requires moneys in the 
          fund to be made available for implementing the provisions 
          of this bill.  Requires funding for the actual and 
          necessary expenses of the OPA to be provided, subject to 
          appropriation by the Legislature, from the Managed Care 
          Fund and the Insurance Fund, as specified.

          Permits, rather than requires, OPA to apply to the United 
          States Secretary of Health and Human Services for a grant 
          made available under the federal health reform law, and to 
          the extent permitted by federal law, to seek federal 
          funding for assisting beneficiaries of the Medi-Cal 
          Program.

          Makes other technical and conforming changes.


                                  FISCAL IMPACT  

          According to the Senate Appropriations Committee analysis: 

                             Fiscal Impact (in thousands)

           Major Provisions      2011-12         2012-13       2013-14     Fund
           OPA expansion       Unknown, potentially in the hundredsSpecial*
          and shift           of thousands of dollars

          OPA additional duties and         likely in the millions of 
          dollars annually    Special*
          ongoing administration            commencing January 1, 2013

          DMHC data reporting $0            about $250  $500      Special**
          CDI data reporting  $0            $1,100      $550      
          Special***

          DHCS, MRMIB, and    Uknown, potentially significant     
          General/****
          Exchange data reporting           commencing January 1, 
          2013Federal/
                                                                  Special

          *Office of the Patient Advocate Trust Fund




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          **Managed Care Fund
          ***Insurance Fund
          ****MRMIB costs shared 35 percent General Fund; 65 percent 
          federal funds; Medi-Cal costs shared 50 percent General Fund, 50 
          percent federal funds; Exchange costs paid from the California 
          Health Trust Fund, to the extent federal financial participation 
          is available.


                            BACKGROUND AND DISCUSSION  

          According to the author, California currently has a 
          fragmented system for consumer assistance with health care 
          coverage complaints.  There are eight governmental entities 
          and several private, non-profit entities that provide a 
          number of services for assistance with public and private 
          health care coverage.  These services include advice on 
          coverage options, education about how to navigate the 
          system, assistance with complaints and grievances, 
          assistance in choosing a health plan and finding a 
          provider.  These entities also respond to complaints about, 
          among other things, eligibility, coverage of services, and 
          timely access to providers.  

          There has been extensive media coverage regarding PPACA.  
          However, the provisions are complex and have varying 
          effective dates.  The author believes that it is imperative 
          that Californians be provided with a single source of 
          correct and current information.  In addition to 
          information about coverage options, California health care 
          consumers need help when they have problems with their 
          health coverage including care denials, coverage 
          terminations and billing problems. Given California's 
          diverse population, assistance needs to be provided in 
          multiple languages.  In the present fiscal crisis climate, 
          there are no new state funds that could be used for this 
          purpose.  California must consolidate and coordinate 
          existing consumer assistance programs and combine funding 
          sources for more efficient use of funds.  

          According to the author, AB 922 also transfers OPA from BTH 
          to CHHS to better position California to receive federal 
          grants and to provide for much needed clear and 
          understandable consumer information and assistance by 
          expanding and strengthening current programs operating at 




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          the local level.  Data about consumers' problems would be 
          collected and compiled, allowing an important window into 
          the types of health care problems Californians face.

          The bill also moves DMHC from BTH to CHHS.  According to 
          the author, CHHS is focused on consumers and implementation 
          of PPACA (along with other aspects of healthcare delivery 
          and regulation), rather than BTH, which has a different 
          culture and focus, and has no expertise in federal health 
          care and its requirements.  In addition, the Secretary of 
          CHHS should be responsible for overseeing the state's 
          progress in implementation of federal health reform, 
          including the provisions that impact DMHC.  The author 
          argues that PPACA implementation necessitates collaboration 
          and a robust federal-state relationship that already exists 
          in other areas under CHHS (Medi-Cal, CalWORKs, SNAP, etc.). 
           Furthermore, since OPA's inception, OPA and DMHC have been 
          intertwined, with much of OPA's focus being on the vast 
          number of enrollees within DMHC's purview.  The author 
          believes that moving one alone may raise coordination 
          issues, and that logistically, both should be moved.  

          Patient assistance provisions in federal health reform
          On March 23, 2010, President Obama signed PPACA.  It is 
          estimated that 4.7 million California children and adults 
          who were uninsured during some part of 2009 will be 
          eligible for health coverage under PPACA.  Among other 
          provisions, the new law makes statutory changes affecting 
          the regulation of and payment for certain types of private 
          health insurance.  The law also significantly expands 
          health care coverage to currently uninsured individuals 
          through public program expansions, a mandate to purchase 
          coverage, a temporary high-risk pool program, and by 
          requiring guaranteed issue of coverage.  It is anticipated 
          that millions of currently uninsured persons in California 
          will obtain coverage under the provisions of PPACA.

          PPACA also contains provisions to provide funding for 
          states to establish health insurance consumer assistance 
          programs.  In order to be eligible to receive a grant, 
          states are required to designate an independent office of 
          health insurance consumer assistance that, directly or in 
          coordination with state health insurance regulators and 
          consumer assistance organizations, receives and responds to 
          inquiries and complaints concerning federal and state 




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          health insurance requirements.  DMHC, in partnership with 
          the OPA, has been awarded $3.4 million to:
                 Develop and promote a coordinated, 
               consumer-friendly website and corresponding toll-free 
               number that consumers can call with questions about 
               health care coverage, and to receive assistance with 
               the filing of complaints and appeals.
                 Conduct a statewide media campaign to educate 
               consumers about their rights and responsibilities, and 
               to provide assistance with enrollment in group health 
               plans or health insurance coverage.
                 Evaluate the effectiveness of the initiatives, and 
               track and quantify consumer problems and inquiries, 
               for reporting to state and federal policymakers.

          Implementation of the PPACA will lead to millions more 
          Californians enrolled in coverage, including expansions of 
          public programs.  Consumers will also have expanded choices 
          of coverage and different options to use, should they lose 
          a source of job-based coverage, have a child, divorce, or 
          have an increase in income.  All of these changes will 
          affect eligibility, making it all the more necessary to 
          establish one entity to help them with their health 
          coverage.  

          California's current system of consumer assistance
          California has a number of entities that provide services 
          for assistance with public and private health care 
          coverage, including:  
                 Government Entities:  HMO HelpLine, Medi-Cal 
               Managed Care (MCMC) Ombudsman, CDI Consumer Hotline 
               (applies to all types of insurance) Department of 
               Labor, the Employee Benefits Security Administration 
               (EBSA), 1-800-Medicare, county welfare offices, the 
               OPA, and the Exchange (forthcoming);
                 Nonprofit Entities:  Health Consumer Alliance 
               (HCA), Health Insurance Counseling and Advocacy 
               Program (HICAP), and Certified Application Assistors 
               (CAAs).

          These services include advice on coverage options, 
          education about how to navigate the system, assistance with 
          complaints and grievances, and assistance in choosing a 
          carrier and finding a provider.  These entities also 
          respond to complaints about, among other things, 




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          eligibility, coverage of services, and timely access to 
          providers.  

          Community-based consumer assistance programs
          There are a number of community-based organizations in 
          California that provide assistance to health care 
          consumers.  The HCA helps low-income Californians in 13 
          counties.  Each health consumer center runs a hotline to 
          assist consumers by telephone and provides in-person visits 
          as well as outstationed services in hospitals, courts, or 
          farm fields.  Consumers can also email an office for 
          assistance.  The HCA helps consumers regardless of their 
          type of coverage.  

          HICAP provides free and objective information and 
          counseling about Medicare.  Volunteer counselors help 
          Medicare beneficiaries understand their rights and health 
          care options. HICAP also offers free educational 
          presentations to groups of Medicare beneficiaries, their 
          families and/or providers on a variety of Medicare and 
          other health insurance-related topics.

          CAAs help families complete and submit the joint 
          HFP/Medi-Cal application.  These community-based entities 
          play a crucial role in providing information to thousands 
          of Californians (primarily low income, many with LEP) about 
          health coverage options and helping them to get enrolled 
          and properly use their insurance coverage.  CAAs are 
          trained and certified by MRMIB to help Californians 
          understand their coverage options and enroll in health 
          coverage.  CAAs are often bilingual, come from the 
          communities they serve, and can be employed by Federally 
          Qualified Health Centers, Rural Health Centers, regional 
          nonprofit organizations, and schools, etc. Throughout 
          California, these entities have developed strong and 
          trusting relationships within their communities and are 
          valued by local families needing information about health 
          coverage.

          Related legislation
          SB 615 (Calderon) requires, on and after January 1, 2013, 
          solicitors and solicitor firms, and principal persons 
          engaged in the supervision of solicitation for health care 
          service plan contracts to complete specified training, and 
          requires the Insurance Commissioner's (Commissioner) 




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          curriculum board to make recommendations to the 
          Commissioner for the instruction of accident and health 
          agents about the requirements imposed by PPACA.  Pending 
          hearing in Assembly Health Committee.
          
          AB 736 (Calderon), among other things, would have 
          authorized a person licensed to transact accident and 
          health insurance to be an agent, a broker, or both, and 
          would have removed the restriction that a life licensee 
          only be a life agent.  Held on suspense in Assembly 
          Appropriations Committee.

          

          Prior legislation
          SB 900 (Alquist), Chapter 659, Statutes of 2010, 
          establishes the California Health Benefit Exchange as an 
          independent public entity within state government.  
          Requires the Exchange to be governed by a board composed of 
          the Secretary of California Health and Human Services, or 
          his or her designee, and four other members appointed by 
          the Governor and the Legislature who meet specified 
          criteria.  

          AB 1602 (J. Perez), Chapter 655, Statutes of 2010, 
          specifies the powers and duties of the Exchange relative to 
          determining eligibility for enrollment in the Exchange and 
          arranging for coverage under qualified health plans.  
                                              Requires the Exchange to provide health plan products in 
          all five of the federal benefit levels (platinum, gold, 
          silver, bronze and catastrophic).  Requires health plans 
          participating in the Exchange to sell at least one product 
          in all five benefit levels in the Exchange, and to sell 
          their Exchange products outside of the Exchange.  Requires 
          health plans that do not participate in the Exchange to 
          sell at least one standardized product designated by the 
          Exchange in each of the four levels of coverage, if the 
          Exchange elects to standardize products.

          AB 2787 (Monning) of 2010 would have established the Office 
          of the California Health Ombudsman, governed by a chief 
          executive officer known as the California Health Ombudsman, 
          and would have required the Ombudsman to educate consumers 
          on their health care coverage rights and responsibilities, 
          assist consumers with enrollment in health care coverage, 




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          and resolve problems with obtaining federal premium tax 
          credits.  Held on suspense in the Senate Appropriations 
          Committee.

          AB 51 (Dymally) of 2006 would have required the OPA to 
          include in its annual health plan report card information 
          on quality of care and access provided by Medicare 
          prescription drug plans.  Failed passage out of Assembly 
          Appropriations Committee.

          AB 2170 (Chan) of 2006 was substantively similar to AB 51 
          (Dymally).  Vetoed. 

          AB 78 (Gallegos), Chapter 525, Statutes of 1999, 
          establishes the DMHC and transfers the regulation of health 
          care service plans (health plans) from the Department of 
          Corporations (DOC) to DMHC.

          Arguments in support
          Health Access California (HAC), a cosponsor of this bill, 
          writes that enactment of federal health reform means that 
          virtually every Californian will have access to quality, 
          affordable health care.  Existing programs, including the 
          HMOHelp Line, have done much of what is contemplated in 
          this bill, but not all.  HAC contends a state-level 
          ombudsman who serves as the first line of triage for 
          consumer complaints, while leaving the respective 
          regulators and sources of coverage the responsibility for 
          resolving specific complaints and grievances, is necessary. 
           HAC asserts that this bill will result in a robust 
          response to grievances and complaints about the health care 
          system.
          
          Western Center on Law & Poverty (WCLP), also a cosponsor, 
          writes that uninsured persons have different needs than 
          those who are consistently covered.  This includes people 
          who primarily speak a language other than English, those 
          who have never navigated a health insurance plan, and those 
          who have never consistently seen a health care provider.  
          For all those reasons, WCLP states that Californians need a 
          centralized hub when dealing with questions or problems 
          with their coverage.  WCLP argues that AB 922 leverages 
          existing consumer assistance programs by allowing OPA to 
          contract with community based organizations that already 
          provide consumer assistance services, many of which are 




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          experts in public programs, while ensuring that the most 
          qualified organizations can assist consumers in 
          community-based settings in a linguistically and culturally 
          appropriate manner.  WCLP asserts that this 
          "hub-and-spokes" approach has been effective in states like 
          New York, which allows one nonprofit organization to 
          coordinate with other community organizations to assist 
          health consumers.

          Consumers Union argues that AB 922 positions California to 
          maximize federal funds for ombudsman and consumer 
          navigation services, which is critically important to have 
          in place well in advance of the mandate for individual 
          coverage that takes effect in 2014.  The American 
          Federation of State, County and Municipal Employees states 
          that this bill would greatly facilitate California's 
          ability to comply and cope with federal health reform, and 
          that the state cannot offer its residents adequate 
          assistance in this matter currently.  The 100% Campaign, 
          PICO California and the California Coverage & Health 
          Initiatives state there is no one single place for families 
          to obtain clear and concise information and support.  This 
          bill not only builds toward future implementation of PPACA, 
          it provides a needed network to reach out to hundreds of 
          thousands of children who are currently uninsured but 
          eligible for California's public program coverage.

          The California Optometric Association writes in support, 
          stating that OPA will provide a "one-stop-shop" that 
          consolidates the existing fragmented system into one office 
          to provide clear, concise and up-to-date information to 
          consumers.  The California Chiropractic Association (CCA) 
          believes that it is essential to provide consumers support 
          in making coverage choices and for consumer coverage 
          complaints.  By operating as an independent state entity, 
          CCA believes that OPA will synthesize a fragmented health 
          care information coverage, outreach and complaint system.

          Arguments in opposition
          The California Association of Health Plans (CAHP) opposes 
          AB 922 on the grounds that California already has consumer 
          advocacy programs under each regulator that are funded by 
          the industry through assessments and taxes that cost the 
          industry and its consumers millions of dollars.  CAHP 
          states that this new entity does not provide any order to 




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          the myriad of assistance programs currently available to 
          consumers, and instead adds a new layer of government 
          bureaucracy designed largely to forward calls back to the 
          regulator.  CAHP supports consolidation of existing 
          consumer related functions, and argues that consolidation 
          could lead to more uniformity and clarity for consumers.

          The Association of California Life and Health Insurance 
          Companies (ACLHIC) concurs with CAHP, and argues that AB 
          922 has the potential to increase the cost of health care 
          by increasing the fees imposed on carriers.  ACLHIC points 
          out that the industry currently funds consumer assistance 
          programs at DMHC, OPA and CDI, and existing law requires 
          carriers to include their respective regulator's consumer 
          complaint number on claims forms, as well as other written 
          notices that go out to enrollees and insureds.  ACLHIC also 
          asserts that there is no real evidence supporting the 
          concept of adding an additional independent office for 
          consumer assistance.

          The California Right to Life Committee (CRLC), Inc. writes 
          that AB 922 advances the PPACA when there are serious 
          challenges to its constitutionality, and that it would be 
          better public policy not to depend on federal tax dollars 
          under these circumstances.  CRLC also contends that this 
          bill "is another attempt to promote family planning and 
          abortion services to low-income persons and non-English 
          speaking populations".
          

                                  PRIOR ACTIONS

           Assembly Health:    12- 6
          Assembly Appropriations:12- 5
          Assembly Floor:     51- 27
          Senate Appropriations:6- 3


                                     COMMENTS
           
          1.  Recent amendments.  Recent floor amendments make the 
          following significant changes to AB 922:
             a.   Transfer DMHC from BTH to CHHS.  
             b.   Remove a number of provisions including the 
               requirement that interpreters for limited-English 




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               proficiency callers be provided on the telephone 
               hotline and the provision allowing OPA to revoke the 
               contract of any organization with which it contracts 
               to provide patient assistance for violations of 
               specified standards.  
             c.   Make other technical and conforming changes in the 
               revision and recasting of OPA duties.
          
          2.  Location of DMHC.  According to the 2001 California 
          HealthCare Foundation report, Making Sense of Managed Care 
          Regulation in California, regulation of Knox-Keene licensed 
          health plans was originally established under the 
          Department of Corporations, which then became BTH.  In 
          1999, with the passage of AB 78 (Gallegos), DMHC was 
          established under BTH for the regulation of Knox-Keene 
          licensed health plans.  According to the author of AB 78, 
          the intent of the legislation is to establish a regulator 
          dedicated to consumer protection and quality of care.  
          Arguably, this could be achieved by locating DMHC under BTH 
          or any other agency, such as CHHS.  CHHS, with its health 
          expertise, is arguably better suited for coordination of 
          health reform related requirements.  A concern could be 
          raised that this has the effect of putting the regulation 
          of health plan and reimbursement to health plans (through 
          health plan purchasers such as DHCS) under the same agency.


                                    POSITIONS

          Prior version:
                                         
          Support:  Health Access California (cosponsor)
                    Western Center on Law and Poverty (cosponsor)
                    100% Campaign 
                    American Federation of State, County and 
                    Municipal Employees, AFL-CIO
                    Asian Pacific American Legal Center
                    California Association of Marriage and Family 
                    Therapists
                    California Children's Health Initiatives
                    California Chiropractic Association
                    California Coalition for Mental Health
                    California Coverage & Health Initiatives
                    California Family Resource Association
                    California Immigrant Policy Center




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                    California Optometric Association
                    California Pan-Ethnic Health Network
                    California Rural Legal Assistance Foundation
                    Children NOW
                    Children's Defense Fund-California
                    Children's Health Initiatives of Greater Los 
                    Angeles
                    Children's Partnership
                    Congress of California Seniors
                    Consumers Union
                    First 5 Association of California
                    Having Our Say
                    Health Consumer Center
                    Inland Empire United Way
                    Maternal and Child Health Access
                    Mental Health Association in California
                    National Alliance on Mental Illness California 
                    National Association of Social Workers - 
                    California Chapter 
                    National Health Law Program
                    Neighborhood Legal Services of Los Angeles County
                    PICO California
                    Santa Clara Board of Supervisors
                    SEIU California 
                    The 100% Campaign
                    Unitarian Universalist Legislative Ministry 
                    Action Network, CA
                    United Way of California
                    Youth Law Center

          Oppose:Association of California Life and Health Insurance 
          Companies
                    California Right to Life Committee, Inc. 
                    California Association of Health Plans
                    Insurance Commissioner (unless amended)


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