BILL NUMBER: AB 2400	INTRODUCED
	BILL TEXT


INTRODUCED BY   Assembly Member Ridley-Thomas

                        FEBRUARY 21, 2014

   An act to add Section 1375.65 to the Health and Safety Code, and
to add Section 10133.651 to the Insurance Code, relating to health
care coverage.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 2400, as introduced, Ridley-Thomas. Health care coverage:
physician contracts.
   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 prescribes restrictions on the types of contractual
provisions that may be included in agreements between health care
service plans or health insurers and health care providers.
   This bill would prohibit a contract between a physician or
physician group with a health care service plan or health insurer,
that is issued, amended, delivered, or renewed in this state on or
after January 1, 2015, from including any provision that requires a
physician, as a condition of entering into the contract, to
participate in any product that provides different rates, methods of
payment, or lines of business unless that participation is negotiated
and agreed to between the health care service plan or health insurer
and the physician. The bill would require any contract that contains
a provision attempting to obligate the physician to participate in
any product that provides different rates, methods of payment, or
lines of business to contain a provision for each product permitting
the physician to affirmatively agree to participate in each product.
The bill would state findings and declarations of the Legislature
with respect to these provisions.
   By expanding the scope of a crime, this bill would create 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: yes.
State-mandated local program: yes.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 1375.65 is added to the Health and Safety Code,
to read:
   1375.65.  (a) The Legislature finds and declares that prohibiting
health care service plans from executing agreements with physicians
that contain provisions requiring physicians to participate in all
networks or products that are currently offered or that may be
offered by the health plan without allowing physicians to
affirmatively agree and opt-in to participate in each network or
product will assist in maintaining patient access to adequate
physician networks. The Legislature further finds and declares that
the ability of physicians to exercise this choice will further
protect patients as physicians will be able to decide on the merits
of the product being offered and whether participation, in their
reasonable professional judgment, would further patients' access to
continuous quality of medical care.
   (b) A contract between a physician or physician group and a health
care service plan that is issued, amended, delivered, or renewed in
this state on or after January 1, 2015, shall not include any
provision that requires a physician, as a condition of entering into
the contract, to participate in any product that provides different
rates, methods of payment, or lines of business unless that
participation is negotiated and agreed to between the health care
service plan and the physician. Any contract that contains a
provision attempting to obligate the physician to participate in any
product that provides different rates, methods of payment, or lines
of business shall contain a provision for each product permitting the
physician to affirmatively agree to participate in each product. The
status of a physician as a member of, or as being eligible for,
other existing or new provider panels shall not be adversely affected
by the physician's exercise of his or her right to not participate
pursuant to this section.
  SEC. 2.  Section 10133.651 is added to the Insurance Code, to read:

   10133.651.  (a) The Legislature finds and declares that
prohibiting health insurers from executing agreements with physicians
or physician groups that contain provisions requiring physicians to
participate in all networks or products that are currently offered or
that may be offered by the health insurer without allowing
physicians to affirmatively agree and opt-in to participate in each
network or product will assist in maintaining patient access to
adequate physician networks. The Legislature further finds and
declares that the ability of physicians to exercise this choice will
further protect patients as physicians will be able to decide on the
merits of the product being offered and whether participation, in
their reasonable professional judgment, would further patients'
access to continuous quality of medical care.
   (b) A contract between a physician or physician group and a health
insurer that is issued, amended, delivered, or renewed in this state
on or after January 1, 2015, shall not include any provision that
requires a physician, as a condition of entering into the contract,
to participate in any product that provides different rates, methods
of payment, or lines of business unless that participation is
negotiated and agreed to between the health insurer and the
physician. Any contract that contains a provision attempting to
obligate the physician to participate in any product that provides
different rates, methods of payment, or lines of business shall
contain a provision for each product permitting the physician to
affirmatively agree to participate in each product. The status of a
physician as a member of, or as being eligible for, other existing or
new provider panels shall not be adversely affected by the physician'
s exercise of his or her right to not participate pursuant to this
section.
  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.