BILL NUMBER: AB 369 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY JANUARY 6, 2014
INTRODUCED BY Assembly Member Pan
FEBRUARY 14, 2013
An act to amend Section 100503 of the Government Code,
1373.96 of the Health and Safety Code, and to amend
Section 10133.56 of the Insurance Code, relating to health
care coverage.
LEGISLATIVE COUNSEL'S DIGEST
AB 369, as amended, Pan. California Health Benefit
Exchange: report. Continuity of care.
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.
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. 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.
This bill would instead require the board or the independent
entity to make this report to the Legislature by March 1, 2019.
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.
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.
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: no
yes . State-mandated local program: no
yes .
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 1373.96 of the
Health and Safety Code is amended to read:
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. This Except
as provided in subdivision (k), this 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).
(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)
(j) 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.
(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:
(A) The newly covered enrollee's prior coverage was terminated
between January 1, 2013, and March 31, 2014, inclusive.
(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).
(2) A violation of this subdivision does not constitute a crime
under Section 1390.
( 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. A nonparticipating
provider does not include a terminated provider.
(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.
(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.
SEC. 2. Section 10133.56 of the
Insurance Code is amended to read:
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.
(2) "Provider group" includes a medical group, independent
practice association, or any other similar organization.
(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.
(2)
(4) "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.
A terminated provider is not a provider who voluntarily
leaves the insurer or contracting provider group.
(3) "Provider group" includes a medical group, independent
practice association, or any other similar organization.
(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.
(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).
(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:
(A) The newly covered insured's prior coverage was terminated
between January 1, 2013, and March 31, 2014.
(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).
(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.
(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).
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 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.