Amended in Assembly January 6, 2014

California Legislature—2013–14 Regular Session

Assembly Bill No. 369

Introduced by Assembly Member Pan

February 14, 2013

An act to amend Section begin delete 100503 of the Government Code, end delete begin insert 1373.96 of the Health and Safety Code, and to amend Section 10133.56 of the Insurance Code, end insert relating to health care coverage.

LEGISLATIVE COUNSEL’S DIGEST

AB 369, as amended, Pan. begin delete California Health Benefit Exchange: report. end delete begin insert Continuity of care. end insert

begin insert

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 also provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan, with some exceptions, to provide for the completion of covered services by a terminated provider or a nonparticipating provider for enrollees who were receiving services from the provider for one of the specified conditions at the time of the contract termination or at the time a newly covered enrollee’s coverage became effective. Existing law requires a health insurer, with some exceptions, to provide for the completion of covered services by a terminated provider for insureds who were receiving services from the provider for one of the specified conditions at the time of the policy termination.

end insert

Under the federal Patient Protection and Affordable Care Act (PPACA), each state is required, by January 1, 2014, to establish an American Health Benefit Exchange that makes available qualified health plans to qualified individuals and small employers. Existing state law establishes the California Health Benefit Exchange (Exchange) within state government, specifies the powers and duties of the board governing the Exchange, and requires the board to facilitate the purchase of qualified health plans through the Exchange by qualified individuals and small employers by January 1, 2014. begin delete Existing law requires the board to report, or contract with an independent entity to report, to the Legislature by December 1, 2018, on whether to adopt the option under the PPACA to merge the individual and small employer insurance markets. end delete

begin delete

This bill would instead require the board or the independent entity to make this report to the Legislature by March 1, 2019.

end delete begin insert

This bill would require a health insurer to arrange for the completion of covered services by a nonparticipating provider at the request of a newly covered insured under a group insurance policy. The bill would require a health care service plan and a health insurer to arrange for the completion of covered services by a nonparticipating provider for a newly covered enrollee and a newly covered insured under an individual health care service plan contract or insurance policy whose prior coverage was terminated between January 1, 2013, and March 31, 2014, inclusive.

end insert begin insert

Because a willful violation of these provisions by a health care service plan would, in part, be a crime, this bill would impose a state-mandated local program.

end insert begin insert

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.

end insert begin insert

This bill would provide that no reimbursement is required by this act for a specified reason.

end insert

Vote: majority. Appropriation: no. Fiscal committee:  begin delete no end delete begin insert yes end insert . State-mandated local program:  begin delete no end delete begin insert yes end insert .

The people of the State of California do enact as follows:

begin insert

begin insert SECTION 1. end insert   

end insert

begin insert Section 1373.96 of the end insert begin insert Health and Safety Code end insert
begin insert is amended to read: end insert

1373.96.  

(a) A health care service plan shall at the request of
an enrollee, provide the completion of covered services as set forth
in this section by a terminated provider or by a nonparticipating
provider.

(b) (1) The completion of covered services shall be provided
by a terminated provider to an enrollee who at the time of the
contract’s termination, was receiving services from that provider
for one of the conditions described in subdivision (c).

(2) The completion of covered services shall be provided by a
nonparticipating provider to a newly covered enrollee who, at the
time his or her coverage became effective, was receiving services
from that provider for one of the conditions described in
subdivision (c).

(c) The health care service plan shall provide for the completion
of covered services for the following conditions:

(1) An acute condition. An acute condition is a medical
condition that involves a sudden onset of symptoms due to an
illness, injury, or other medical problem that requires prompt
medical attention and that has a limited duration. Completion of
covered services shall be provided for the duration of the acute
condition.

(2) A serious chronic condition. A serious chronic condition is
a medical condition due to a disease, illness, or other medical
problem or medical disorder that is serious in nature and that
persists without full cure or worsens over an extended period of
time or requires ongoing treatment to maintain remission or prevent
deterioration. Completion of covered services shall be provided
for a period of time necessary to complete a course of treatment
and to arrange for a safe transfer to another provider, as determined
by the health care service plan in consultation with the enrollee
and the terminated provider or nonparticipating provider and
consistent with good professional practice. Completion of covered
services under this paragraph shall not exceed 12 months from the
contract termination date or 12 months from the effective date of
coverage for a newly covered enrollee.

(3) A pregnancy. A pregnancy is the three trimesters of
pregnancy and the immediate postpartum period. Completion of
covered services shall be provided for the duration of the
pregnancy.

(4) A terminal illness. A terminal illness is an incurable or
irreversible condition that has a high probability of causing death
within one year or less. Completion of covered services shall be
provided for the duration of a terminal illness, which may exceed
12 months from the contract termination date or 12 months from
the effective date of coverage for a new enrollee.

(5) The care of a newborn child between birth and age 36
months. Completion of covered services under this paragraph shall
not exceed 12 months from the contract termination date or 12
months from the effective date of coverage for a newly covered
enrollee.

(6) Performance of a surgery or other procedure that is
authorized by the plan as part of a documented course of treatment
and has been recommended and documented by the provider to
occur within 180 days of the contract’s termination date or within
180 days of the effective date of coverage for a newly covered
enrollee.

(d) (1) The plan may require the terminated provider whose
services are continued beyond the contract termination date
pursuant to this section to agree in writing to be subject to the same
contractual terms and conditions that were imposed upon the
provider prior to termination, including, but not limited to,
credentialing, hospital privileging, utilization review, peer review,
and quality assurance requirements. If the terminated provider
does not agree to comply or does not comply with these contractual
terms and conditions, the plan is not required to continue the
provider’s services beyond the contract termination date.

(2) Unless otherwise agreed by the terminated provider and the
plan or by the individual provider and the provider group, the
services rendered pursuant to this section shall be compensated at
rates and methods of payment similar to those used by the plan or
the provider group for currently contracting providers providing
similar services who are not capitated and who are practicing in
the same or a similar geographic area as the terminated provider.
Neither the plan nor the provider group is required to continue the
services of a terminated provider if the provider does not accept
the payment rates provided for in this paragraph.

(e) (1) The plan may require a nonparticipating provider whose
services are continued pursuant to this section for a newly covered
enrollee to agree in writing to be subject to the same contractual
terms and conditions that are imposed upon currently contracting
providers providing similar services who are not capitated and
who are practicing in the same or a similar geographic area as the
nonparticipating provider, including, but not limited to,
credentialing, hospital privileging, utilization review, peer review,
and quality assurance requirements. If the nonparticipating provider
does not agree to comply or does not comply with these contractual
terms and conditions, the plan is not required to continue the
provider’s services.

(2) Unless otherwise agreed upon by the nonparticipating
provider and the plan or by the nonparticipating provider and the
provider group, the services rendered pursuant to this section shall
be compensated at rates and methods of payment similar to those
used by the plan or the provider group for currently contracting
providers providing similar services who are not capitated and
who are practicing in the same or a similar geographic area as the
nonparticipating provider. Neither the plan nor the provider group
is required to continue the services of a nonparticipating provider
if the provider does not accept the payment rates provided for in
this paragraph.

(f) The amount of, and the requirement for payment of,
copayments, deductibles, or other cost sharing components during
the period of completion of covered services with a terminated
provider or a nonparticipating provider are the same as would be
paid by the enrollee if receiving care from a provider currently
contracting with or employed by the plan.

(g) If a plan delegates the responsibility of complying with this
section to a provider group, the plan shall ensure that the
requirements of this section are met.

(h) This section shall not require a plan to provide for
completion of covered services by a provider whose contract with
the plan or provider group has been terminated or not renewed for
reasons relating to a medical disciplinary cause or reason, as
defined in paragraph (6) of subdivision (a) of Section 805 of the
Business and Profession Code, or fraud or other criminal activity.

(i) This section shall not require a plan to cover services or
provide benefits that are not otherwise covered under the terms
and conditions of the plan contract. begin delete This end delete begin insert Except as provided in
subdivision (k), this end insert begin insert end insert section shall not apply to a newly covered
enrollee covered under an individual subscriber agreement who is
undergoing a course of treatment on the effective date of his or
her coverage for a condition described in subdivision (c).

begin delete

(j) This section shall not apply to a newly covered enrollee who
is offered an out-of-network option or to a newly covered enrollee
who had the option to continue with his or her previous health plan
or provider and instead voluntarily chose to change health plans.

(k)

end delete

begin insert (j) end insert  The provisions contained in this section are in addition to
any other responsibilities of a health care service plan to provide
continuity of care pursuant to this chapter. Nothing in this section
shall preclude a plan from providing continuity of care beyond the
requirements of this section.

begin insert

(k) (1) A health care service plan shall, at the request of a newly
covered enrollee under an individual health care service plan
contract, arrange for the completion of covered services by a
nonparticipating provider for one of the conditions described in
subdivision (c) if the newly covered enrollee meets both of the
following:

end insert begin insert

(A) The newly covered enrollee’s prior coverage was terminated
between January 1, 2013, and March 31, 2014, inclusive.

end insert begin insert

(B) At the time his or her coverage became effective, the newly
covered enrollee was receiving services from that provider for one
of the conditions described in subdivision (c).

end insert begin insert

(2) A violation of this subdivision does not constitute a crime
under Section 1390.

end insert

(l) The following definitions apply for the purposes of this
section:

(1) “Individual provider” means a person who is a licentiate, as
defined in Section 805 of the Business and Professions Code, or
a person licensed under Chapter 2 (commencing with Section
1000) of Division 2 of the Business and Professions Code.

(2) “Nonparticipating provider” means a provider who is not
contracted with a health care service plan. begin insert A nonparticipating
provider does not include a terminated provider. end insert

(3) “Provider” shall have the same meaning as set forth in
subdivision (i) of Section 1345.

(4) “Provider group” means a medical group, independent
practice association, or any other similar organization.

begin insert

(5) “Terminated provider” means a provider whose contract
to provide services to enrollees is terminated or not renewed by
the plan or one of the plan’s contracting provider groups.

end insert

begin insert

begin insert SEC. 2. end insert   

end insert

begin insert Section 10133.56 of the end insert begin insert Insurance Code end insert begin insert is amended
to read: end insert

10133.56.  

(a) A health insurer that enters into a contract with
a professional or institutional provider to provide services at
alternative rates of payment pursuant to Section 10133 shall, at
the request of an insured, arrange for the completion of covered
services by a terminated provider, if the insured is undergoing a
course of treatment for any of the following conditions:

(1) An acute condition. An acute condition is a medical
condition that involves a sudden onset of symptoms due to an
illness, injury, or other medical problem that requires prompt
medical attention and that has a limited duration. Completion of
covered services shall be provided for the duration of the acute
condition.

(2) A serious chronic condition. A serious chronic condition is
a medical condition due to a disease, illness, or other medical
problem or medical disorder that is serious in nature and that
persists without full cure or worsens over an extended period of
time or requires ongoing treatment to maintain remission or prevent
deterioration. Completion of covered services shall be provided
for a period of time necessary to complete a course of treatment
and to arrange for a safe transfer to another provider, as determined
by the health insurer in consultation with the insured and the
terminated provider and consistent with good professional practice.
Completion of covered services under this paragraph shall not
exceed 12 months from the contract termination date.

(3) A pregnancy. A pregnancy is the three trimesters of
pregnancy and the immediate postpartum period. Completion of
covered services shall be provided for the duration of the
pregnancy.

(4) A terminal illness. A terminal illness is an incurable or
irreversible condition that has a high probability of causing death
within one year or less. Completion of covered services shall be
provided for the duration of a terminal illness, which may exceed
12 months from the contract termination date.

(5) The care of a newborn child between birth and age 36
months. Completion of covered services under this paragraph shall
not exceed 12 months from the contract termination date.

(6) Performance of a surgery or other procedure that has been
recommended and documented by the provider to occur within
180 days of the contract’s termination date.

(b) The insurer may require the terminated provider whose
services are continued beyond the contract termination date
pursuant to this section, to agree in writing to be subject to the
same contractual terms and conditions that were imposed upon
the provider prior to termination, including, but not limited to,
credentialing, hospital privileging, utilization review, peer review,
and quality assurance requirements. If the terminated provider
does not agree to comply or does not comply with these contractual
terms and conditions, the insurer is not required to continue the
provider’s services beyond the contract termination date.

(c) Unless otherwise agreed upon between the terminated
provider and the insurer or between the terminated provider and
the provider group, the agreement shall be construed to require a
rate and method of payment to the terminated provider, for the
services rendered pursuant to this section, that are the same as the
rate and method of payment for the same services while under
contract with the insurer and at the time of termination. The
provider shall accept the reimbursement as payment in full and
shall not bill the insured for any amount in excess of the
reimbursement rate, with the exception of copayments and
deductibles pursuant to subdivision (e).

(d) Notice as to the process by which an insured may request
completion of covered services pursuant to this section shall be
provided in any insurer evidence of coverage and disclosure form
issued after March 31, 2004. An insurer shall provide a written
copy of this information to its contracting providers and provider
groups. An insurer shall also provide a copy to its insureds upon
request.

(e) The payment of copayments, deductibles, or other
cost-sharing components by the insured during the period of
completion of covered services with a terminated provider shall
be the same copayments, deductibles, or other cost-sharing
components that would be paid by the insured when receiving care
from a provider currently contracting with the insurer.

(f) If an insurer delegates the responsibility of complying with
this section to its contracting entities, the insurer shall ensure that
the requirements of this section are met.

(g) For the purposes of this section, the following terms have
the following meanings:

(1) “Provider” means a person who is a licentiate as defined in
Section 805 of the Business and Professions Code or a person
licensed under Chapter 2 (commencing with Section 1000) of
Division 2 of the Business and Professions Code.

begin insert

(2) “Provider group” includes a medical group, independent
practice association, or any other similar organization.

end insert begin insert

(3) “Nonparticipating provider” means a provider who does
not have a contract with an insurer to provide services to insureds.
A nonparticipating provider does not include a terminated
provider.

end insert begin delete

(2)

end delete

begin insert (4) end insert  “Terminated provider” means a provider whose contract to
provide services to insureds is terminated or not renewed by the
insurer or one of the insurer’s contracting provider groups. begin delete A
terminated provider is not a provider who voluntarily leaves the
insurer or contracting provider group. end delete

begin delete

(3) “Provider group” includes a medical group, independent
practice association, or any other similar organization.

end delete

(h) This section shall not require an insurer or provider group
to provide for the completion of covered services by a provider
whose contract with the insurer or provider group has been
terminated or not renewed for reasons relating to medical
disciplinary cause or reason, as defined in paragraph (6) of
subdivision (a) of Section 805 of the Business and Professions
Code, or fraud or other criminal activity.

(i) This section shall not require an insurer to cover services or
provide benefits that are not otherwise covered under the terms
and conditions of the insurer contract.

(j) The provisions contained in this section are in addition to
any other responsibilities of insurers to provide continuity of care
pursuant to this chapter. Nothing in this section shall preclude an
insurer from providing continuity of care beyond the requirements
of this section.

begin insert

(k) (1) A health insurer shall, at the request of a newly covered
insured under a group insurance policy, arrange for the completion
of covered services by a nonparticipating provider for one of the
conditions described in subdivision (a).

end insert begin insert

(2) A health insurer shall, at the request of a newly covered
insured under an individual insurance policy, arrange for the
completion of covered services by a nonparticipating provider for
one of the conditions described in subdivision (a) if the newly
covered insured meets both of the following:

end insert begin insert

(A) The newly covered insured’s prior coverage was terminated
between January 1, 2013, and March 31, 2014.

end insert begin insert

(B) At the time his or her coverage became effective, the newly
covered insured was receiving services from that provider for one
of the conditions described in subdivision (a).

end insert begin insert

(3) (A)    The insurer may require a nonparticipating provider
whose services are continued pursuant to this section for a newly
covered insured to agree in writing to be subject to the same
contractual terms and conditions that are imposed upon currently
participating providers providing similar services who are
practicing in the same or a similar geographic area as the
nonparticipating provider, including, but not limited to,
credentialing, hospital privileging, utilization review, peer review,
and quality assurance requirements. If the nonparticipating
provider does not agree to comply or does not comply with these
contractual terms and conditions, the insurer is not required to
continue the provider’s services.

end insert begin insert

(B) Unless otherwise agreed upon by the nonparticipating
provider and the insurer or by the nonparticipating provider and
the provider group, the services rendered pursuant to this section
shall be compensated at rates and methods of payment similar to
those used by the insurer or the provider group for currently
participating providers providing similar services who are
practicing in the same or a similar geographic area as the
nonparticipating provider. Neither the insurer nor the provider
group is required to continue the services of a nonparticipating
provider if the provider does not accept the payment rates provided
for in this paragraph. The provider shall accept the reimbursement
as payment in full and shall not bill the insured for any amount in
excess of the reimbursement rate, with the exception of copayments
and deductibles pursuant to subdivision (e).

end insert

begin insert

begin insert SEC. 3. end insert   

end insert begin insert

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.

end insert

begin delete

SECTION 1.  

Section 100503 of the Government Code is
amended to read:

100503.  

In addition to meeting the minimum requirements of
Section 1311 of the federal act, the board shall do all of the
following:

(a) Determine the criteria and process for eligibility, enrollment,
and disenrollment of enrollees and potential enrollees in the
Exchange and coordinate that process with the state and local
government entities administering other health care coverage
programs, including the State Department of Health Care Services,
the Managed Risk Medical Insurance Board, and California
counties, in order to ensure consistent eligibility and enrollment
processes and seamless transitions between coverage.

(b) Develop processes to coordinate with the county entities
that administer eligibility for the Medi-Cal program and the entity
that determines eligibility for the Healthy Families Program,
including, but not limited to, processes for case transfer, referral,
and enrollment in the Exchange of individuals applying for
assistance to those entities, if allowed or required by federal law.

(c) Determine the minimum requirements a carrier must meet
to be considered for participation in the Exchange, and the
standards and criteria for selecting qualified health plans to be
offered through the Exchange that are in the best interests of
qualified individuals and qualified small employers. The board
shall consistently and uniformly apply these requirements,
standards, and criteria to all carriers. In the course of selectively
contracting for health care coverage offered to qualified individuals
and qualified small employers through the Exchange, the board
shall seek to contract with carriers so as to provide health care
coverage choices that offer the optimal combination of choice,
value, quality, and service.

(d) Provide, in each region of the state, a choice of qualified
health plans at each of the five levels of coverage contained in
subdivisions (d) and (e) of Section 1302 of the federal act.

(e) Require, as a condition of participation in the Exchange,
carriers to fairly and affirmatively offer, market, and sell in the
Exchange at least one product within each of the five levels of
coverage contained in subdivisions (d) and (e) of Section 1302 of
the federal act. The board may require carriers to offer additional
products within each of those five levels of coverage. This
subdivision shall not apply to a carrier that solely offers
supplemental coverage in the Exchange under paragraph (10) of
subdivision (a) of Section 100504.

(f) (1) Require, as a condition of participation in the Exchange,
carriers that sell any products outside the Exchange to do both of
the following:

(A) Fairly and affirmatively offer, market, and sell all products
made available to individuals in the Exchange to individuals
purchasing coverage outside the Exchange.

(B) Fairly and affirmatively offer, market, and sell all products
made available to small employers in the Exchange to small
employers purchasing coverage outside the Exchange.

(2) For purposes of this subdivision, “product” does not include
contracts entered into pursuant to Part 6.2 (commencing with
Section 12693) of Division 2 of the Insurance Code between the
Managed Risk Medical Insurance Board and carriers for enrolled
Healthy Families beneficiaries or contracts entered into pursuant
to Chapter 7 (commencing with Section 14000) of, or Chapter 8
(commencing with Section 14200) of, Part 3 of Division 9 of the
Welfare and Institutions Code between the State Department of
Health Care Services and carriers for enrolled Medi-Cal
beneficiaries.

(g) Determine when an enrollee’s coverage commences and the
extent and scope of coverage.

(h) Provide for the processing of applications and the enrollment
and disenrollment of enrollees.

(i) Determine and approve cost-sharing provisions for qualified
health plans.

(j) Establish uniform billing and payment policies for qualified
health plans offered in the Exchange to ensure consistent
enrollment and disenrollment activities for individuals enrolled in
the Exchange.

(k) Undertake activities necessary to market and publicize the
availability of health care coverage and federal subsidies through
the Exchange. The board shall also undertake outreach and
enrollment activities that seek to assist enrollees and potential
enrollees with enrolling and reenrolling in the Exchange in the
least burdensome manner, including populations that may
experience barriers to enrollment, such as the disabled and those
with limited English language proficiency.

(l) Select and set performance standards and compensation for
navigators selected under subdivision (l) of Section 100502.

(m) Employ necessary staff.

(1) The board shall hire a chief fiscal officer, a chief operations
officer, a director for the SHOP Exchange, a director of Health
Plan Contracting, a chief technology and information officer, a
general counsel, and other key executive positions, as determined
by the board, who shall be exempt from civil service.

(2) (A) The board shall set the salaries for the exempt positions
described in paragraph (1) and subdivision (i) of Section 100500
in amounts that are reasonably necessary to attract and retain
individuals of superior qualifications. The salaries shall be
published by the board in the board’s annual budget. The board’s
annual budget shall be posted on the Internet Web site of the
Exchange. To determine the compensation for these positions, the
board shall cause to be conducted, through the use of independent
outside advisors, salary surveys of both of the following:

(i) Other state and federal health insurance exchanges that are
most comparable to the Exchange.

(ii) Other relevant labor pools.

(B) The salaries established by the board under subparagraph
(A) shall not exceed the highest comparable salary for a position
of that type, as determined by the surveys conducted pursuant to
subparagraph (A).

(C) The Department of Human Resources shall review the
methodology used in the surveys conducted pursuant to
subparagraph (A).

(3) The positions described in paragraph (1) and subdivision (i)
of Section 100500 shall not be subject to otherwise applicable
provisions of the Government Code or the Public Contract Code
and, for those purposes, the Exchange shall not be considered a
state agency or public entity.

(n) Assess a charge on the qualified health plans offered by
carriers that is reasonable and necessary to support the
development, operations, and prudent cash management of the
Exchange. This charge shall not affect the requirement under
Section 1301 of the federal act that carriers charge the same
premium rate for each qualified health plan whether offered inside
or outside the Exchange.

(o) Authorize expenditures, as necessary, from the California
Health Trust Fund to pay program expenses to administer the
Exchange.

(p) Keep an accurate accounting of all activities, receipts, and
expenditures, and annually submit to the United States Secretary
of Health and Human Services a report concerning that accounting.
Commencing January 1, 2016, the board shall conduct an annual
audit.

(q) (1) Annually prepare a written report on the implementation
and performance of the Exchange functions during the preceding
fiscal year, including, at a minimum, the manner in which funds
were expended and the progress toward, and the achievement of,
the requirements of this title. This report shall be transmitted to
the Legislature and the Governor and shall be made available to
the public on the Internet Web site of the Exchange. A report made
to the Legislature pursuant to this subdivision shall be submitted
pursuant to Section 9795.

(2) In addition to the report described in paragraph (1), the board
shall be responsive to requests for additional information from the
Legislature, including providing testimony and commenting on
proposed state legislation or policy issues. The Legislature finds
and declares that activities including, but not limited to, responding
to legislative or executive inquiries, tracking and commenting on
legislation and regulatory activities, and preparing reports on the
implementation of this title and the performance of the Exchange,
are necessary state requirements and are distinct from the
promotion of legislative or regulatory modifications referred to in
subdivision (d) of Section 100520.

(r) Maintain enrollment and expenditures to ensure that
expenditures do not exceed the amount of revenue in the fund, and
if sufficient revenue is not available to pay estimated expenditures,
institute appropriate measures to ensure fiscal solvency.

(s) Exercise all powers reasonably necessary to carry out and
comply with the duties, responsibilities, and requirements of this
title and the federal act.

(t) Consult with stakeholders relevant to carrying out the
activities under this title, including, but not limited to, all of the
following:

(1) Health care consumers who are enrolled in health plans.

(2) Individuals and entities with experience in facilitating
enrollment in health plans.

(3) Representatives of small businesses and self-employed
individuals.

(4) The State Medi-Cal Director.

(5) Advocates for enrolling hard-to-reach populations.

(u) Facilitate the purchase of qualified health plans in the
Exchange by qualified individuals and qualified small employers
no later than January 1, 2014.

(v) Report, or contract with an independent entity to report, to
the Legislature by March 1, 2019, on whether to adopt the option
in paragraph (3) of subdivision (c) of Section 1312 of the federal
act to merge the individual and small employer markets. In its
report, the board shall provide information, based on at least two
years of data from the Exchange, on the potential impact on rates
paid by individuals and by small employers in a merged individual
and small employer market, as compared to the rates paid by
individuals and small employers if a separate individual and small
employer market is maintained. A report made pursuant to this
subdivision shall be submitted pursuant to Section 9795.

(w) With respect to the SHOP Program, collect premiums and
administer all other necessary and related tasks, including, but not
limited to, enrollment and plan payment, in order to make the
offering of employee plan choice as simple as possible for qualified
small employers.

(x) Require carriers participating in the Exchange to immediately
notify the Exchange, under the terms and conditions established
by the board, when an individual is or will be enrolled in or
disenrolled from any qualified health plan offered by the carrier.

(y) Ensure that the Exchange provides oral interpretation
services in any language for individuals seeking coverage through
the Exchange and makes available a toll-free telephone number
for the hearing and speech impaired. The board shall ensure that
written information made available by the Exchange is presented
in a plainly worded, easily understandable format and made
available in prevalent languages.

end delete