BILL ANALYSIS                                                                                                                                                                                                    �






                             SENATE COMMITTEE ON HEALTH
                          Senator Ed Hernandez, O.D., Chair

          BILL NO:       AB 1428
          AUTHOR:        Conway
          AMENDED:       June 26, 2013
          HEARING DATE:  August 21, 2013
          CONSULTANT:    Bain

           SUBJECT  :  California Health Benefit Exchange: employees and  
          contractors.
           
          SUMMARY  : Requires the California Health Benefit Exchange board  
          criminal background check requirement for specified employees  
          and volunteers and vendors to be consistent with a specific  
          federal Centers for Medicare and Medicaid Services document or  
          further updates guidance or regulations. Requires fingerprint  
          images of specified individuals whose duties include access to  
          any information contained in the information systems and devices  
          of the California Health Benefit Exchange.

          Existing law:
          1.Establishes the California Health Benefit Exchange (known as  
            Covered California) in state government, which is governed by  
            a board composed of five members. Requires, under federal law,  
            Covered California to make available qualified health plans to  
            qualified individuals and qualified employers.

          2.Requires Covered California to inform individuals of  
            eligibility requirements for the Medi-Cal program, the Healthy  
            Families Program, or any applicable state or local public  
            program. Requires Covered California to enroll individuals in  
            any such program, if, through screening of the application,  
            Covered California determines that such an individual is  
            eligible.

          3.Requires the executive board of Covered California, consistent  
            with federal guidance applicable to state-based exchanges, to  
            submit to the Department of Justice (DOJ)  fingerprint images  
            and related information required by DOJ of all employees,  
            prospective employees, contractors, subcontractors,  
            volunteers, or vendors, whose duties include or would include  
            access to confidential information, personal identifying  
            information, personal health information, federal tax  
            information, financial information, or any other information  
            as required by federal law or guidance applicable to  
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            state-based exchanges for the purposes of obtaining  
            information on:

                  a.        The existence and content of a record of state  
                    or federal convictions; and, 
                  b.        The existence and content of a record of state  
                    or federal arrests for which DOJ establishes that the  
                    person is free on bail or on his or her recognizance  
                    pending trial or appeal.

          This bill:
          1.Requires fingerprint images for purposes of a criminal  
            background check of specified individuals whose duties include  
            access to any information contained in the information systems  
            and devices of Covered California, instead of existing law,  
            which requires a criminal background check of individuals  
            whose duties include or would include access to confidential  
            information, personal identifying information, personal health  
            information, federal tax information, financial information,  
            or any other information as required by federal law or  
            guidance applicable to state-based exchanges.

          2.Deletes an existing reference to "federal guidance applicable  
            to state-based exchanges" and replaces it with a specific  
            reference to the federal Centers for Medicare and Medicaid  
            Services (CMS), Catalog of Minimum Acceptable Risk Standards  
            for Exchanges (MARS-E), Exchange Reference Architecture  
            Supplement version 1.0, issued on August 12, 2012, or further  
            updates, guidance, or regulations.

           FISCAL EFFECT  :  According to the Assembly Appropriations  
          Committee, negligible state costs.

           PRIOR VOTES  :  
          Assembly Health:    18- 0
          Assembly Appropriations:17- 0
          Assembly Floor:     77- 0
           
          COMMENTS  :  
           1.Author's statement. According to the author, this bill is a  
            clean-up measure to SB 509 (DeSaulnier and Emmerson), Chapter 10,  
            Statutes of 2013, that would fix a flaw requiring private health  
            plan staff to undergo fingerprint and background checks. This bill  
            is needed to ensure that Covered California complies with the  
            federal background check guidance, Minimum Acceptable Risk  
            Standards for Exchanges (MARS-E), without imposing an unnecessary  




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            fingerprint burden on private health plan staff. In addition, this  
            bill ensures the fingerprint images and related information  
            submitted to the DOJ will only include that of specified  
            individuals whose duties include or would include access to any  
            personal information contained in the information systems and  
            devices of Covered California.
            
          2.Background. Covered California will be providing coverage to  
            small employers and individuals, including individuals  
            eligible for federal health insurance premium and cost-sharing  
            subsidies. Since some of the individuals applying for coverage  
            will be applying for coverage subsidies that are means-tested  
            (for example, federal premium and cost-sharing subsidies for  
            coverage through Covered California are based on the  
            individual's income), staff for Covered California will have  
            access to information about where the individual works,  
            financial (income, wage data) and personal identifying  
            information (Social Security Number, name, age, address,  
            dependents) about individuals seeking coverage. 

            SB 509 requires the Covered California board to submit to DOJ  
            fingerprint images and related information of employees,  
            prospective employees, contractors, subcontractors,  
            volunteers, or vendors whose duties include or would include  
            access to specified information for the purposes of obtaining  
            prescribed criminal history information. 

            SB 509 was signed into law on June 17, 2013 as an urgency  
            statute so Covered California could begin hiring call center  
            employees. As SB 509 moved through the legislative process,  
            its provisions did not mention the MARS-E but instead  
            referenced "federal guidance applicable to state-based  
            exchanges." Covered California's board determined compliance  
            with the MARS-E was important, but because SB 509's proponents  
            did not want to delay call center hiring, SB 509 moved forward  
            with an agreement that clarifying language, including specific  
            reference to the MARS-E, would follow in this bill.  
                  
            Covered California indicates the requirement for a fingerprint  
            check against federal and state arrest and comes from the  
            federal (MARS-E) Personnel Screening Requirements. MARS-E  
            requires organizations to screen individuals prior to  
            authorizing access to information systems, and rescreen  
            individuals periodically, consistent with the  
            criticality/sensitivity rating of the position. To meet these  




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            MARS-E requirements, Covered California must perform a  
            criminal history check for all persons prior to employment  
            and, require appropriate personnel to obtain and hold a  
            moderate-risk security clearance as defined in the federal  
            personnel security/suitability handbook.
          
          3.Prior legislation.
             a.   SB 900 (Alquist), Chapter 659, Statutes of 2010,  
               establishes Covered California as an independent public  
               entity within state government, and requires Covered  
               California to be governed by a board composed of the  
               Secretary of California Health and Human Services Agency,  
               or his or her designee, and four other members appointed by  
               the Governor and the Legislature who meet specified  
               criteria.  
             b.   AB 1602 (John A. P�rez), Chapter 655, Statutes of 2010,  
               specifies the powers and duties of Covered California  
               relative to determining eligibility for enrollment in  
               Covered California, and requires Covered Coverage to  
               arrange for coverage through Qualified Health Plans.
             c.   AB 2343 (Torres), Chapter 256, Statutes of 2012 requires  
               that, when state or federal summary criminal history  
               information is furnished, the authorized agency,  
               organization, or individual furnish a copy of the  
               information to the person to whom the information relates  
               if the information is a basis for an adverse employment,  
               licensing, or certification decision.

          4.Support. The California Association of Health Plans (CAHP)  
            writes in support that this bill contains important technical  
            amendments to the recently passed SB 509 (DeSaulnier and  
            Emmerson) including adding a specific reference to federal law  
            and limiting the fingerprinting and background check  
            requirements of that bill to individuals who have access to  
            the Covered California computer system for eligibility and  
            enrollment.

          5.Drafting issue. This bill is intended to avoid imposing an  
            unnecessary burden on health plan staff by limiting the  
            fingerprinting and criminal background check requirements to  
            individuals who have access to confidential information,  
            personal identifying information, personal health information,  
            federal tax information, financial information, or any other  
            information as required by federal law or guidance applicable  
            to state-based exchanges. However, as drafted, this bill  
            broadens the scope of the background check requirement by  




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            requiring individuals with access to "any information"  
            contained in information systems and devices of Covered  
            California be subject to the background check requirement.  
            Staff recommends the author clarify this provision of this  
            bill.

           SUPPORT AND OPPOSITION  :
          Support:  California Association of Health Plans

          Oppose:   None received.

                                          
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