BILL NUMBER: SB 266	INTRODUCED
	BILL TEXT


INTRODUCED BY   Senator Lieu

                        FEBRUARY 13, 2013

   An act to add Section 687 to the Business and Professions Code,
and to add Section 1250.04 to the Health and Safety Code, relating to
health care coverage.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 266, as introduced, Lieu. Health care coverage: out-of-network
coverage.
   Existing law provides for the licensure and regulation of health
care practitioners by various healing arts boards within the
Department of Consumer Affairs. Existing law also provides for the
licensure and regulation of health facilities by the State Department
of Public Health. A violation of these provisions is a crime.
   The bill would prohibit a health facility or a provider group from
holding itself out as being within a plan network or a provider
network unless all of the individual providers providing services at
the facility or with the provider group are within the plan network.
By expanding the scope of 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: yes.
State-mandated local program: yes.


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

  SECTION 1.  Section 687 is added to the Business and Professions
Code, to read:
   687.  (a) A provider group shall not hold itself out as being
within a plan network or a provider network unless one of the
following applies:
   (1) All of the individual providers providing services with the
provider group are within that plan network or provider network.
   (2) The provider group acknowledges to the patient in writing or
verbally that individual providers within the provider group may be
outside the enrollee's plan network or the insured's provider
network.
   (b) For purposes of this section, "provider group" means a medical
group, independent practice association, or any other similar
organization.
  SEC. 2.  Section 1250.04 is added to the Health and Safety Code, to
read:
   1250.04.  (a) A health facility shall not hold itself out as being
within a plan network or a provider network unless one of the
following applies:
   (1) All of the individual providers providing services within the
health facility are within that plan network or provider network.
   (2) The health facility acknowledges to the patient in writing or
verbally that individual providers providing services within the
health facility may be outside the enrollee's plan network.
   (b) For purposes of this section, "health facility" means a health
facility as defined in subdivision (a) of Section 1250.
  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.