BILL NUMBER: AB 2350 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY APRIL 11, 2012
INTRODUCED BY Assembly Member Monning
FEBRUARY 24, 2012
An act to add Section 1348.95 to the Health and Safety Code, and
to add Section 10127.19 to the Insurance Code, relating to health
care coverage.
LEGISLATIVE COUNSEL'S DIGEST
AB 2350, as amended, Monning. Health care coverage.
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 and makes a
willful violation of the act a crime. Existing law provides for the
regulation of health carriers insurers
by the Department of Insurance.
This bill would require every health care service plan except
those providing coverage for specialized health care services, to
provide the number of enrollees that receive health care coverage
from the service plan as of December 31st of each year, as well as
other specified information, to the Department of Managed Health
Care, in a form and manner specified by the department in
consultation with the Department of Insurance to ensure that the data
reported is comparable and consistent.
This bill would likewise require a health insurer, except those
providing coverage for specialized health care services, to provide
the number of covered lives as of December 31st of each year, as well
as other specified information, to the Department of Insurance in a
form and manner specified by the department in consultation with the
Department of Managed Health Care.
This bill would require health care service plans and health
insurers to annually, commencing March 31, 2013, provide specified
information regarding their plan contracts or policies to the
Department of Managed Health Care or the Department of Insurance, as
applicable, including claims payment policies and practices, periodic
financial disclosures, and data on enrollment and disenrollment, as
specified.
Because a willful violation of the bill's provisions
relative to this reporting requirement by a
health care service plans plan would be
a crime, the bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
This bill would provide that no reimbursement is required by this
act for a specified reason.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. It is the intent of the Legislature by
enacting this act that the reporting requirements for health care
service plans and health insurers be consistent with the reporting
requirements, including form and manner, imposed on qualified health
plans pursuant to Section 156.220 of Title 45 of the Code of Federal
Regulations.
SECTION 1. SEC. 2. Section 1348.95 is
added to the Health and Safety Code, to read:
1348.95. (a) Commencing March 1, 2013, and
at least annually thereafter, every health care service plan, not
including a health care service plan offering specialized health care
service plan contracts, shall provide to the department, in a form
and manner determined by the department in consultation with the
Department of Insurance, the following information:
(1) Claims payment policies and practices.
(2) Periodic financial disclosures.
(3) Data on enrollment.
(4) Data on disenrollment.
(5) Data on the number of claims that are denied.
(6) Data on rating practices.
(7) Information on cost-sharing and payments with respect to any
out-of-network coverage.
(8) Information on enrollee rights.
(9) Enrollee cost-sharing transparency.
(b) The data on enrollment specified in
paragraph (3) of subdivision (a) shall include the number of
enrollees as of December 31 of the prior year, that receive health
care coverage under a health care service plan contract that covers
individuals, small groups, groups of 51-100, groups of 101
or more, or a small group health care service plan
contract as defined in Section 1385.01, or a large group health care
service plan contract as defined in Section 1385.01, or under
administrative services only business lines. Health care service
plans shall include the unduplicated enrollment data in specific
product lines as determined by the department, including, but not
limited to, HMO, point-of-service, PPO, Medicare excluding Medicare
supplement, Medi-Cal managed care, and traditional indemnity non-PPO
health insurance. The department shall publicly report the data
provided by each health care service plan pursuant to this section,
including, but not limited to, posting the data on the department's
Internet Web site. The department shall consult with the Department
of Insurance to ensure that the data reported is comparable and
consistent.
SEC. 2. SEC. 3. Section 10127.19 is
added to the Insurance Code, to read:
10127.19. (a) Commencing March 1, 2013, and
at least annually thereafter, every health
insurer, that issues policies of health insurance, not
including a health insurer offering specialized
health insurance policies, shall provide to the department, in a form
and manner determined by the department in consultation with the
Department of Managed Health Care, the following information:
(1) Claims payment policies and practices.
(2) Periodic financial disclosures.
(3) Data on enrollment.
(4) Data on disenrollment.
(5) Data on the number of claims that are denied.
(6) Data on rating practices.
(7) Information on cost-sharing and payments with respect to any
out-of-network coverage.
(8) Information on rights of insureds.
(9) Insured cost-sharing transparency.
(b) The data on enrollment specified in
paragraph (3) of subdivision (a) shall include the number of
covered lives, as of December 31 of the prior year, that receive
health care coverage under a health insurance policy that covers
individuals, a small groups, groups of 51-100,
groups of 101 or more, group health
insurance policy as defined in Section 10181, or a large group
health insurance policy as defined in Section 10181,
or under administrative services only business lines.
Health insurers Insurers
shall include the unduplicated enrollment data in specific
product lines as determined by the department,
commissioner, including, but not limited to HMO,
point-of-service, PPO, Medicare excluding Medicare supplement,
Medi-Cal managed care, and traditional indemnity non-PPO health
insurance. The department shall publicly report the data provided by
each health insurer pursuant to this section,
including, but not limited to, posting the data on the department's
Internet Web site. The department shall consult with the Department
of Managed Health Care to ensure that the data reported is comparable
and consistent.
SEC. 3. SEC. 4. No reimbursement is
required by this act pursuant to Section 6 of Article XIII B of the
California Constitution because the only costs that may be incurred
by a local agency or school district will be incurred because this
act creates a new crime or infraction, eliminates a crime or
infraction, or changes the penalty for a crime or infraction, within
the meaning of Section 17556 of the Government Code, or changes the
definition of a crime within the meaning of Section 6 of Article XIII
B of the California Constitution.