BILL NUMBER: AB 2301 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY APRIL 30, 2014
AMENDED IN ASSEMBLY MARCH 28, 2014
INTRODUCED BY Assembly Member Mansoor
FEBRUARY 21, 2014
An act to amend Section 100503 of the Government Code, relating to
health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
AB 2301, as amended, Mansoor. California Health Benefit Exchange:
individual market reports.
Existing law establishes the California Health Benefit 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. Existing law requires the board of
the Exchange to annually prepare a written report on the
implementation and performance of the Exchange functions during the
preceding fiscal year, as specified, and requires that this report be
submitted to the Legislature and the Governor and be made available
to the public on the Internet Web site of the Exchange. Existing law
requires the board to require carriers participating in the Exchange
to immediately notify the Exchange when an individual is or will be
disenrolled from a qualified health plan offered by the carrier.
This bill would also require the board to prepare a written report
on a quarterly basis that identifies the number of covered
lives under individuals enrolled in qualified
health plans purchased through the individual market of the Exchange
by specified categories demographics, level
of coverage, and geographic region, and the number of applications
filed through the individual market of the Exchange for each quarter,
as specified . The bill would also require this report to
identify the number of individuals who have been disenrolled from
those plans due to nonpayment of the premiums, as specified
by total number, demographics, level of coverage,
geographic region, and reason for disenrollment . The bill
would require this report to be submitted to the Legislature and the
Governor and to be made available to the public on the Internet Web
site of the Exchange.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 100503 of the Government Code, as amended by
Section 4 of Chapter 5 of the 1st Extraordinary Session of the
Statutes of 2013, 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
subsections (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 subsections (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) Except as otherwise provided in this section and Section
100504.5, 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. "Product"
also does not include a bridge plan product offered pursuant to
Section 100504.5.
(3) Except as required by Section 1301(a)(1)(C)(ii) of the federal
act, a carrier offering a bridge plan product in the Exchange may
limit the products it offers in the Exchange solely to a bridge plan
product contract.
(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) Notwithstanding Section 10231.5, 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. The report shall
also include data provided by health care service plans and health
insurers offering bridge plan products regarding the extent of health
care provider and health facility overlap in their Medi-Cal networks
as compared to the health care provider and health facility networks
contracting with the plan or insurer in their bridge plan contracts.
(2) The Exchange shall prepare, or contract for the preparation
of, an evaluation of the bridge plan program using the first three
years of experience with the program. The evaluation shall be
provided to the health policy and fiscal committees of the
Legislature in the fourth year following federal approval of the
bridge plan option. The evaluation shall include, but not be limited
to, all of the following:
(A) The number of individuals eligible to participate in the
bridge plan program each year by category of eligibility.
(B) The number of eligible individuals who elect a bridge plan
option each year by category of eligibility.
(C) The average length of time, by region and statewide, that
individuals remain in the bridge plan option each year by category of
eligibility.
(D) The regions of the state with a bridge plan option, and the
carriers in each region that offer a bridge plan, by year.
(E) The premium difference each year, by region, between the
bridge plan and the first and second lowest cost plan
plans for individuals in the Exchange who are
not eligible for the bridge plan.
(F) The effect of the bridge plan on the premium subsidy amount
for bridge plan eligible individuals each year by each region.
(G) Based on a survey of individuals enrolled in the bridge plan:
(i) Whether individuals enrolling in the bridge plan product are
able to keep their existing health care providers.
(ii) Whether individuals would want to retain their bridge plan
product, buy a different Exchange product, or decline to purchase
health insurance if there was no bridge plan product available. The
Exchange may include questions designed to elicit the information in
this subparagraph as part of an existing survey of individuals
receiving coverage in the Exchange.
(3) In addition to the evaluation required by paragraph (2), the
Exchange shall post the items in subparagraphs (A) to (F), inclusive,
on its Internet Web site each year.
(4) (A) In addition to the report described in paragraph (1), and
notwithstanding Section 10231.5, the board shall quarterly
prepare a written report that identifies the
number of covered lives under qualified health plans purchased
through the individual market of the Exchange by the following
categories: on a quarterly basis regarding the status
of the individual market of the Exchange. The report shall be made
available, as described in paragraph (5), within 30 days following
the end of each quarter and shall, at a minimum, include all of the
following information:
(i) Total number overall.
(ii) Age.
(iii) Ethnicity.
(iv) Gender.
(v) Income level.
(i) Demographic information regarding the number of individuals
enrolled in qualified health plans purchased through the individual
market of the Exchange, including, but not limited to, gender, age,
race, ethnicity, primary language, and income level.
(ii) The number of individuals enrolled in qualified health plans
purchased through the individual market of the Exchange in each of
the levels of coverage identified in Section 1367.008 of the Health
and Safety Code and Section 10112.295 of the Insurance Code.
(vi)
(iii) The number of individuals enrolled in
qualified health plans purchased through the individual market of the
Exchange in each of the geographic regions listed in Section
1357.512 1399.855 of the Health and
Safety Code and Section 10965.9 of the Insurance Code.
(iv) The number of applications that were filed through the
individual market of the Exchange since the end of the previous
quarter.
(v) The number of applications that were filed through the
individual market of the Exchange since the end of the previous
quarter with the help of an agent, a certified enrollment counselor,
as defined in Section 6650 of Title 10 of the California Code of
Regulations, or any other person or entity.
(vi) The number of applications that were filed through the
individual market of the Exchange using the Internet Web site of the
Exchange maintained under subdivision (c) of Section 100502.
(B) The report required by this paragraph shall also identify the
number of individuals , by the categories listed in
subparagraph (A), who, since the end of the last
previous quarter, or since January 1, 2014, in
the case of the first report, have been disenrolled from a qualified
health plan purchased through the individual market of the Exchange
due to nonpayment of the premiums. by the
following categories:
(C) The report required by this paragraph shall be completed
within 30 days of the end of a quarter.
(i) Total number.
(ii) Demographics, including, but not limited to, gender, age,
race, ethnicity, primary language, and income level.
(iii) The levels of coverage described in Section 1367.008 of the
Health and Safety Code and Section 10112.295 of the Insurance Code.
(iv) The geographic regions listed in Section 1399.855 of the
Health and Safety Code and Section 10965.9 of the Insurance Code.
(v) Reasons for disenrollment.
(5) The reports required by this subdivision 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. The reports made
to the Legislature pursuant to this subdivision shall be submitted
pursuant to Section 9795.
(6) In addition to the reports described in paragraphs
(1) and (2) this subdivision , 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
act 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 December 1, 2018, on whether to adopt the option
in Section 1312(c)(3) 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.
(z) This section shall become inoperative on the October 1 that is
five years after the date that federal approval of the bridge plan
option occurs, and, as of the second January 1 thereafter, is
repealed, unless a later enacted statute that is enacted before that
date deletes or extends the dates on which it becomes inoperative and
is repealed.
SEC. 2. Section 100503 of the Government Code, as added by Section
5 of Chapter 5 of the 1st Extraordinary Session of the Statutes of
2013, 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
subsections (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 subsections (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) Notwithstanding Section 10231.5, 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.
(2) (A) In addition to the report described in paragraph (1), and
notwithstanding Section 10231.5, the board shall quarterly
prepare a written report that identifies the
number of covered lives under qualified health plans purchased
through the individual market of the Exchange by the following
categories: on a quarterly basis regarding the status
of the individual market of the Exchange. The report shall be made
available, as described in paragraph (3), within 30 days following
the end of each quarter and shall, at a minimum, include all of the
following information:
(i) Total number overall.
(ii) Age.
(iii) Ethnicity.
(iv) Gender.
(v) Income level.
(i) Demographic information regarding the number of individuals
enrolled in qualified health plans purchased through the individual
market of the Exchange, including, but not limited to, gender, age,
race, ethnicity, primary language, and income level.
(ii) The number of individuals enrolled in qualified health plans
purchased through the individual market of the Exchange in each of
the levels of coverage
identified in Section 1367.008 of the Health and Safety Code and
Section 10112.295 of the Insurance Code.
(vi)
(iii) The number of individuals enrolled in
qualified health plans purchased through the individual market of the
Exchange in each of the geographic regions listed in Section
1357.512 1399.855 of the Health and
Safety Code and Section 10965.9 of the Insurance Code.
(iv) The number of applications that were filed through the
individual market of the Exchange since the end of the previous
quarter.
(v) The number of applications that were filed through the
individual market of the Exchange since the end of the previous
quarter with the help of an agent, a certified enrollment counselor,
as defined in Section 6650 of Title 10 of the California Code of
Regulations, or any other person or entity.
(vi) The number of applications that were filed through the
individual market of the Exchange using the Internet Web site of the
Exchange maintained under subdivision (c) of Section 100502.
(B) The report required by this paragraph shall also identify the
number of individuals , by the categories listed in
subparagraph (A), who, since the end of the last
previous quarter, or since January 1, 2014, in
the case of the first report, have been disenrolled from a qualified
health plan purchased through the individual market of the Exchange
was canceled due to nonpayment of the premiums.
by the following categories:
(C) The report required by this paragraph shall be completed
within 30 days of the end of each quarter.
(i) Total number.
(ii) Demographics, including, but not limited to, gender, age,
race, ethnicity, primary language, and income level.
(iii) The levels of coverage described in Section 1367.008 of the
Health and Safety Code and Section 10112.295 of the Insurance Code.
(iv) The geographic regions listed in Section 1399.855 of the
Health and Safety Code and Section 10965.9 of the Insurance Code.
(v) Reasons for disenrollment.
(3) The reports required by this subdivision 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. The reports made
to the Legislature pursuant to this subdivision shall be submitted
pursuant to Section 9795.
(4) In addition to the reports described in paragraphs (1) and
(2), 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
act 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 December 1, 2018, on whether to adopt the option
in Section 1312(c)(3) 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.
(z) This section shall become operative only if Section 4 of the
act that added this section becomes inoperative pursuant to
subdivision (z) of that Section 4.