BILL ANALYSIS                                                                                                                                                                                                    �



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          SENATE THIRD READING
          SB 509 (DeSaulnier and Emmerson)
          As Amended May 24, 2013
          2/3 vote. Urgency

           SENATE VOTE  :39-0  
           
           HEALTH              18-0        APPROPRIATIONS      14-0        
           
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          |Ayes:|Pan, Logue, Ammiano,      |Ayes:|Gatto, Harkey, Bigelow,   |
          |     |Atkins, Bonilla, Bonta,   |     |Bocanegra, Ian Calderon,  |
          |     |Chesbro, Gomez, Roger     |     |Campos, Eggman, Gomez,    |
          |     |Hern�ndez, Lowenthal,     |     |Hall, Linder, Pan, Quirk, |
          |     |Maienschein, Mansoor,     |     |Wagner, Weber             |
          |     |Nazarian, Nestande, V.    |     |                          |
          |     |Manuel P�rez, Wagner,     |     |                          |
          |     |Wieckowski, Wilk          |     |                          |
          |     |                          |     |                          |
           ----------------------------------------------------------------- 
           SUMMARY  :  Requires the Executive Board (Board) of the California  
          Health Benefit Exchange (Exchange), known as Covered California,  
          to require fingerprint images and related information of all  
          employees, prospective employees, contractors, subcontractors,  
          volunteers, or vendors whose duties include or would include  
          access to confidential information, personal identifying  
          information (PII), personal health information (PHI), federal  
          tax information (FTI), financial information, as required by  
          federal law or guidance, for the purposes of obtaining  
          information of the existence and content of a record of state or  
          federal criminal history and information as to the existence and  
          content of pending state or federal arrests, as specified.   
          Contains an urgency clause in order to become effective  
          immediately upon enactment.  

           FISCAL EFFECT  :  According to the Assembly Appropriations  
          Committee:  
           
          1)About $60,000 costs for 2013, which includes background checks  
            of approximately 900 Covered California employees, and ongoing  
            annual costs of approximately $38,000.

          2)About $1.2 million for assister background checks during the  
            first year of operation, and unknown but significantly  








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            decreasing ongoing costs.

          3)Federal grant money received by Covered California is expected  
            to cover these costs for employees and assisters through  
            December 2014.
           
          COMMENTS  :  According to the author, in order to provide  
          eligibility and enrollment assistance, the Exchange service  
          center employees, as well as assisters who provide in-person  
          assistance will need to ask consumers for a variety of highly  
          sensitive and confidential personal information.  This includes  
          an enrollees' name, address, contact information, Social  
          Security Number (SSN), employer, annual income, number of  
          dependents, and more.  To receive the authorization from the  
          federal government to operate a state-based exchange, federal  
          guidelines require state exchanges to perform criminal history  
          checks prior to hiring any person whose position will have  
          access to the PII and FTI of Exchange applicants and enrollees. 

          Based on federal guidance, Covered California has determined the  
          Exchange must meet Minimum Acceptable Risk Standards for  
          Exchanges (MARS-E), one of three on Exchange privacy and  
          security standards.  According to documents provided by Covered  
          California, the MARS-E requires all individuals associated with  
          the Exchange who would have access to sensitive information such  
          as PII, PHI, and FTI to be screened before they may be  
          authorized to obtain access to the information system and  
          devices containing such information.  To meet these  
          requirements, Covered California must perform a background check  
          for all persons prior to authorizing access and require  
          appropriate personnel to obtain and hold a moderate-risk  
          security clearance as defined in the federal Department of  
          Health and Human Services Personnel Security/Suitability  
          Handbook.  The MARS-E also requires periodic rescreening of  
          individuals, consistent with the criticality or sensitivity  
          rating of the position.  Furthermore, according to Covered  
          California, the Internal Revenue Service Publication 1075, Tax  
          Information Security Guidelines requires screening and  
          consideration of an individual's background and security  
          clearance when designating personnel who are authorized to  
          access FTI.  

          The Board and staff have determined that Covered California must  
          have explicit statutory authority in order to receive criminal  








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          record information from the Department of Justice (DOJ) and the  
          Federal Bureau of Investigation, and subsequent criminal arrest  
          and conviction information from DOJ.  Covered California will  
          then promulgate emergency regulations to further specify  
          background check requirements including disqualifying crimes and  
          affected positions.  At the May 23, 2013, Board meeting, the  
          Board approved for submission to the Office of Administrative  
          Law, Draft Covered California Fingerprinting Implementation  
          Regulations (Draft Regulations), to require fingerprint images  
          and associated criminal history information from individuals  
          whose duties include or would include any of the following:  1)  
          access to FTI; 2) access to PII; 3) access to PHI; 4) access to  
          confidential or sensitive information provided by a member of  
          the public including, but not limited to, a credit card account  
          number or SSN; 5) access to cash, checks, or other forms of  
          payment and accountable items; 6) responsibility for the  
          development or maintenance of the California Healthcare  
          Eligibility, Enrollment, and Retention System and other critical  
          automated systems of the Exchange; or 7) access to information  
          technology systems of the Exchange.  The Draft Regulations  
          further provide that if the state or federal level criminal  
          records contain a conviction of a felony, misdemeanor, or  
          pending criminal charge related to a crime of moral turpitude  
          that is substantially related to the qualifications, functions,  
          or duties of the specific employment sought by the applicant or  
          employee, it shall be justification for denial to an individual  
          to serve in an Exchange role that requires fingerprinting.  
           
           Covered California is also in the process of establishing an  
          Assisters Program that will include assister enrollment entities  
          (AEE) and individual entities.  AEEs are entities and  
          organizations eligible to be trained and registered to provide  
          in-person assistance to consumers and help them apply for  
          Covered California programs, particularly entities that have  
          access to Covered California's targeted population.  Individual  
          AEEs are employed, trained, certified, and linked to AEEs to  
          provide in-person assistance to consumers and help them apply  
          for Covered California programs and are individuals who can  
          provide assistance in a culturally and linguistically  
          appropriate manner to consumers.  The proposed compensation for  
          AEEs is $58.00 per new enrollment into Covered California,  
          including a person who was a modified adjusted gross  
          income-eligible Medi-Cal enrollee but upon redetermination  
          qualifies for Covered California and when a currently enrolled  








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          person adds a new dependent.  Compensation for annual renewal is  
          $25.00.  The funding source for the initial application is the  
          federal funding from the Level II Establishment Federal Grant  
          and renewals will be funded as operating costs from  
          self-sustainability funds.  There is no compensation for an  
          enrollment into Medi-Cal.  The Board is expected to address  
          Draft Regulations regarding AEE fingerprinting and records  
          checks at the June 20, 2013, meeting.  The Draft Regulations  
          applying to AEEs will provide for notification to the applicant  
          of disqualifying information and allow for an appeal.  These  
          Draft Regulations will also provide for an opportunity to  
          correct inaccurate or incomplete information and request a new  
          determination of fitness for employment.  

          The California Association of Health Plans has raised some  
          concerns regarding the breadth of the requirement that applies  
          to contractors and have asked for clarifying amendments to  
          ensure that it is not interpreted to apply to their contracting  
          providers or employees that process claims.  AB 1428 (Conway) of  
          this legislative year, is an urgency bill that enacts this  
          clarification, as there was a concern that amending this bill  
          would delay the Exchange's ability to start hiring call center  
          staff. 


           Analysis Prepared by  :    Marjorie Swartz / HEALTH / (916)  
          319-2097 


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