BILL NUMBER: SB 1196 AMENDED
BILL TEXT
AMENDED IN SENATE MARCH 26, 2012
INTRODUCED BY Senator Hernandez
FEBRUARY 22, 2012
An act to amend Section 1381 of the Health and Safety
Code, relating to health care coverage. An act to add
Section 1367.50 to the Health and Safety Code, and to add Section
10117.52 to the Insurance Code, relating to health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
SB 1196, as amended, Hernandez. Health care service
plans: inspection of records. Claims data disclosure.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975,
provides for the licensing 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 insurers by the Insurance Commissioner. Except
as specified, existing law prohibits a provider of health care, a
health care service plan, or contractor from disclosing medical
information regarding a patient of the provider of health care or an
enrollee or subscriber of a health care service plan without first
obtaining an authorization.
Existing law, the federal Patient Protection and Affordable Care
Act (PPACA), requires the Secretary of Health and Human Services to
make available to qualified entities, as defined, specified claims
data relating to Medicare in order to evaluate the performance of
providers and suppliers.
This bill would provide that no contract or health insurance
policy issued, amended, or renewed on or after January 1, 2013,
between a health care service plan and a provider, as specified,
shall prohibit, condition, or in any way restrict the disclosure of
claims data related to health care services or coverage provided to
specified individuals to a qualified entity, as defined.
Because a willful violation of the act by a health care service
plan would constitute 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.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975,
provides for the licensing and regulation of health care service
plans by the Department of Managed Health Care. Under existing law,
the records, books, and papers of a health care service plan, and of
any provider or subcontractor providing health care services, must be
open for inspection, as specified, by the Director of the Department
of Managed Health Care.
This bill would make technical, nonsubstantive changes to these
provisions.
Vote: majority. Appropriation: no. Fiscal committee: no
yes . State-mandated local program: no
yes .
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 1367.50 is added to the
Health and Safety Code , to read:
1367.50. Notwithstanding Section 56.10 of the Civil Code, no
contract issued, amended, or renewed on or after January 1, 2013,
between a health care service plan and a provider, including a
provider of supplies, shall prohibit, condition, or in any way
restrict the disclosure of claims data related to health care
services provided to an enrollee or subscriber of the health care
service plan or beneficiaries of any self-funded health coverage
arrangement administered by the health care service plan to a
qualified entity, as defined in Section 1395kk of Title 42 of the
United States Code.
SEC. 2. Section 10117.52 is added to the
Insurance Code , to read:
10117.52. Notwithstanding any other provision of law, no health
insurance policy issued, amended, or renewed on or after January 1,
2013, between a health insurer and a provider, including a provider
of supplies, shall prohibit, condition, or in any way restrict the
disclosure of claims data related to coverage provided to insureds or
beneficiaries of any self-insured health coverage arrangement
administered by a carrier to a qualified entity, as defined in
Section 1395kk of Title 42 of the United States Code.
SEC. 3. 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.
SECTION 1. Section 1381 of the Health and
Safety Code is amended to read:
1381. (a) All records, books, and papers of a health care service
plan, management company, solicitor, solicitor firm, and any
provider or subcontractor providing health care or other services to
a health care service plan, management company, solicitor, or
solicitor firm shall be open to inspection during normal business
hours by the director.
(b) To the extent feasible, all records, books, and papers
described in subdivision (a) shall be located in this state. In
examining records outside this state, the director shall consider the
cost to the health care service plan, consistent with the
effectiveness of the director's examination, and may upon reasonable
notice require that the records, books and papers, or a specified
portion thereof, be made available for examination in this state, or
that a true and accurate copy of the records, books and papers, or a
specified portion thereof, be furnished to the director.