BILL NUMBER: SB 266	AMENDED
	BILL TEXT

	AMENDED IN SENATE  MARCH 18, 2013

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 amended, 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 
    This  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  or provider network, or the provider
group acknowledges to the patient in writing or verbally that
individual providers within the provider group may be outside the
patient's plan network or provider network and the provider group
recommends that the patient contact his or her health care service
plan or health insurer for information about providers who are within
the patient's plan network or   provider network. Those
provisions would not apply to emergency services and care  . 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   patient's  plan
network or  the insured's  provider network  and
the provider group recommends that the patient contact his or her
health care service plan or health insurer for information about
providers who are within the patient's plan network or provider netwo
  rk  .
   (b) For purposes of this section,  "provider 
 the following definitions shall apply:  
   (1) "Hold itself out" means advertise, refer to, use materials to
indicate, let itself be known, assume the appearance of, act as if it
is by claiming or presenting to accept payments from, or represent
itself as continuing to be in.  
   (2) "Plan network" means any entity, group of providers, or
individual providers contracted with a preferred provider
organization plan contract or point-of-service plan contract. 

   (3) Provider network" means any entity, group of providers, or
provider contacted with a preferred provider organization health
insurance policy. 
    (   4)     "   Provider
 group" means a medical group, independent practice association,
or any other similar organization. 
   (c) This section shall not apply to emergency services and care.

  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  
patient's  plan network  or provider network and the health
facility recommends that the patient contact his or her health care
service plan or health insurer for information about providers who
are within the patient's plan network or   provider network
 .
   (b) For purposes of this section,  "health  
the following definitions shall apply: 
    (1)     "   Health  facility"
means a health facility as defined in subdivision (a) of Section
1250. 
   (2) "Hold itself out" means advertise, refer to, use materials to
indicate, let itself be known, assume the appearance of, act as if it
is by claiming or presenting to accept payments from, or represent
itself as continuing to be in.  
   (3) "Plan network" means any entity, group of providers, or
individual providers contracted with a preferred provider
organization plan contract or point-of-service plan contract. 

   (4) Provider network" means any entity, group of providers, or
provider contacted with a preferred provider organization health
insurance policy.  
   (c) This section shall not apply to emergency services and care.

  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.