BILL NUMBER: SB 964	INTRODUCED
	BILL TEXT


INTRODUCED BY   Senator Hernandez

                        FEBRUARY 10, 2014

   An act to amend Section 1380.3 of, and to add Sections 1380.4,
1380.5, and 1380.6 to, the Health and Safety Code, relating to health
care coverage.



	LEGISLATIVE COUNSEL'S DIGEST


   SB 964, as introduced, Hernandez. Health care service plans:
medical surveys.
   Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Care Services, under
which qualified low-income individuals receive health care services.
Existing law establishes the California Health Benefit Exchange for
the purpose of facilitating the enrollment of qualified individuals
and small employers in qualified health plans.
   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. Existing law requires
the department to periodically conduct an onsite medical survey of
the health delivery system of each plan. Existing law exempts a plan
that provides services solely to Medi-Cal beneficiaries from the
survey upon submission to the department the medical survey audit
conducted by the State Department of Health Care Services as part of
the Medi-Cal contracting process.
   This bill would specify that a plan that provides services solely
to Medi-Cal beneficiaries is not exempt from the medical survey with
respect to quality management, utilization review, timely access,
network adequacy, and any other requirements related to access and
availability, except as specified. The bill would require a plan that
provides services to Medi-Cal beneficiaries, except for a plan that
serves Medi-Cal beneficiaries exclusively, and a plan that provides
services to enrollees in the California Health Benefit Exchange to be
surveyed separately with respect to those products. The bill would
also require a plan that provides services to Medi-Cal beneficiaries
through specified programs to be surveyed annually with respect to
those products until 5 years after completion of initial enrollment
in those products, as specified.
   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 1380.3 of the Health and Safety Code is amended
to read:
   1380.3.   (a)    Notwithstanding Section 1380,
 any   and except as provided in subdivision
(b), a  plan that provides services solely to Medi-Cal
beneficiaries pursuant to Chapter 8 (commencing with Section 14200)
of Part 3 of Division 9 of the Welfare and Institutions Code shall
not be subject to the requirements of Section 1380 upon the
submission to the director of the medical survey audit for the same
period conducted by the State Department of Health  Care 
Services as part of the Medi-Cal contracting process, unless the
director determines that an additional medical survey audit is
required. 
   (b) A plan that provides services solely to Medi-Cal beneficiaries
pursuant to Chapter 8 (commencing with Section 14200) of Part 3 of
Division 9 of the Welfare and Institutions Code shall not be exempt
from Section 1380 with respect to quality management, utilization
review, timely access, network adequacy, and any other requirements
related to access and availability unless the department and the
State Department of Health Care Services jointly make a public
determination that the medical survey audit for the same period
conducted by the State Department of Health Care Services as part of
the Medi-Cal contracting process assures compliance with the access
and availability requirements of this chapter. 
  SEC. 2.  Section 1380.4 is added to the Health and Safety Code, to
read:
   1380.4.  (a) A plan that provides services to Medi-Cal
beneficiaries pursuant to Chapter 8 (commencing with Section 14200)
of Part 3 of Division 9 of the Welfare and Institutions Code shall be
surveyed under Section 1380 separately with respect to those
products in order to determine whether the services received by
Medi-Cal beneficiaries through those products comply with the
requirements of this chapter.
   (b) If a plan provides services solely to Medi-Cal beneficiaries
pursuant to Chapter 8 (commencing with Section 14200) of Part 3 of
Division 9 of the Welfare and Institutions Code, compliance with
Section 1380.3 shall satisfy the requirements of this section.
  SEC. 3.  Section 1380.5 is added to the Health and Safety Code, to
read:
   1380.5.  A plan that provides services to enrollees in the
California Health Benefit Exchange pursuant to Title 22 (commencing
with Section 100500) of the Government Code shall be surveyed
separately under Section 1380 with respect to those products in order
to determine whether the services received by those enrollees
through the products comply with the requirements of this chapter.
  SEC. 4.  Section 1380.6 is added to the Health and Safety Code, to
read:
   1380.6.  Notwithstanding Section 1380.3, a plan that enrolls
Medi-Cal beneficiaries as a result of any of the following shall be
surveyed annually under Section 1380 with respect to those products
until five years after the completion of initial enrollment under
those products:
   (a) The transition of Healthy Families Program enrollees to the
Medi-Cal program pursuant to Chapter 16.2 (commencing with Section
12694.1) of Part 6.2 of Division 2 of the Insurance Code.
   (b) Article 2.82 (commencing with Section 14087.98) of Chapter 7
of Part 3 of Division 9 of the Welfare and Institutions Code.
   (c) Section 14182 of the Welfare and Institutions Code.
   (d) Section 14182.16 or 14232.275 of the Welfare and Institutions
Code.