BILL NUMBER: SB 751	INTRODUCED
	BILL TEXT


INTRODUCED BY   Senator Gaines

                        FEBRUARY 18, 2011

   An act to add Section 1367.49 to the Health and Safety Code, and
to add Section 10133.64 to the Insurance Code, relating to health
care coverage.



	LEGISLATIVE COUNSEL'S DIGEST


   SB 751, as introduced, Gaines. Health care coverage: provider
contracts.
   Existing law, the Knox-Keene Health Care Service Plan Act of 1975,
provides for the licensure and regulation of health care service
plans by the Department of Managed Health Care. Existing law also
provides for the regulation of health insurers by the Department of
Insurance. Existing law prohibits a contract between a plan or
insurer and a health care provider from containing certain terms.
   This bill would prohibit a contract by or on behalf of a plan or
insurer and a licensed hospital, as defined, or any other licensed
health care facility, as defined, owned by a licensed hospital to
provide inpatient hospital services or ambulatory care services to
subscribers and enrollees of the plan or policyholders and insureds
of the insurer from containing a provision that restricts the ability
of the plan or insurer to furnish information to subscribers or
enrollees of the plan or policyholders or insureds of the insurer
concerning the cost range of procedures at the hospital or licensed
health care facility or the quality of services performed by the
hospital or facility. The bill would make a contractural provision
inconsistent with this requirement void and unenforceable.
   Vote: majority. Appropriation: no. Fiscal committee: no.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 1367.49 is added to the Health and Safety Code,
to read:
   1367.49.  (a) A contract issued, amended, renewed, or delivered on
or after January 1, 2012, by or on behalf of a health care service
plan and a licensed hospital or any other licensed health care
facility owned by a licensed hospital to provide inpatient hospital
services or ambulatory care services to subscribers and enrollees of
the plan shall not contain any provision that restricts the ability
of the health care service plan to furnish information to subscribers
or enrollees of the plan concerning the cost range of procedures at
the hospital or the licensed health care facility or the quality of
services performed by the hospital or facility.
   (b) Any contractural provision inconsistent with this section
shall be void and unenforceable.
   (c) For purposes of this section, the following definitions apply:

   (1) "Licensed hospital" has the same meaning as set forth in
Section 4028 of the Business and Professions Code.
   (2) "Licensed health care facility" means any institution or
health facility, other than a long-term health care facility as
defined pursuant to Section 1418, licensed by the State Department of
Public Health to deliver or furnish health care services.
   (d) Section 1390 shall not apply for purposes of this section.
  SEC. 2.  Section 10133.64 is added to the Insurance Code, to read:
   10133.64.  (a) A contract issued, amended, renewed, or delivered
on or after January 1, 2012, by or on behalf of a health insurer and
a licensed hospital or any other licensed health care facility owned
by a licensed hospital to provide inpatient hospital services or
ambulatory care services to policyholders and insureds of the insurer
shall not contain any provision that restricts the ability of the
health insurer to furnish information to policyholders or insureds
concerning the cost range of procedures at the hospital or the
licensed health care facility or the quality of services provided by
the hospital or facility.
   (b) Any contractural provision inconsistent with this section
shall be void and unenforceable.
   (c) For purposes of this section, the following definitions apply:

   (1) "Licensed hospital" has the same meaning as set forth in
Section 4028 of the Business and Professions Code.
   (2) "Licensed health care facility" means any institution or
health facility, other than a long-term health care facility as
defined pursuant to Section 1418 of the Health and Safety Code,
licensed by the State Department of Public Health to deliver or
furnish health care services.