Amended in Senate August 19, 2016

Amended in Senate August 4, 2016

Amended in Senate August 1, 2016

Amended in Senate June 15, 2016

Amended in Senate September 9, 2015

Amended in Senate September 4, 2015

California Legislature—2015–16 Regular Session

Assembly BillNo. 72


Introduced by Assembly Members Bonta, Bonilla, Dahle, Gonzalez, Maienschein, Santiago, and Wood

December 18, 2014


An act to add Sections 1371.30, 1371.31, and 1371.9 to the Health and Safety Code, and to add Sections 10112.8, 10112.81, and 10112.82 to the Insurance Code, relating to health care coverage.

LEGISLATIVE COUNSEL’S DIGEST

AB 72, as amended, Bonta. Health care coverage: out-of-network coverage.

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. A willful violation of the act is a crime. Existing law requires a health care service plan to reimburse providers for emergency services and care provided to its enrollees, until the care results in stabilization of the enrollee. Existing law prohibits a health care service plan from requiring a provider to obtain authorization prior to the provision of emergency services and care necessary to stabilize the enrollee’s emergency medical care, as specified.

Existing law also provides for the regulation of health insurers by the Insurance Commissioner. Existing law requires a health insurance policy issued, amended, or renewed on or after January 1, 2014, that provides or covers benefits with respect to services in an emergency department of a hospital to cover emergency services without the need for prior authorization, regardless of whether the provider is a participating provider, and subject to the same cost sharing required if the services were provided by a participating provider, as specified.

This bill would require a health care service plan contract or health insurance policy issued, amended, or renewed on or after July 1, 2017, to provide that if an enrollee or insured receives covered services from a contracting health facility, as defined, at which, or as a result of which, the enrollee or insured receives covered services provided by a noncontracting individual health professional, as defined, the enrollee or insured would be required to pay the noncontracting individual health professional only the same cost sharing required if the services were provided by a contracting individual health professional, which would be referred to as the “in-network cost-sharing amount.” The bill would prohibit an enrollee or insured from owing the noncontracting individual health professional at the contracting health facility more than the in-network cost-sharing amount if the noncontracting individual health professional receives reimbursement for services provided to the enrollee or insured at a contracting health facility from the health care service plan or health insurer. However, the bill would make an exception from this prohibition if the enrollee or insured provides written consent that satisfies specified criteria. The bill would require a noncontracting individual health professional who collects more than the in-network cost-sharing amount from the enrollee or insured to refund any overpayment to the enrollee or insured, as specified, and would provide that interest on any amount not refunded to the enrollee or insured shall accrue at 15% per annum, as specified.

Existing law requires a contract between a health care service plan and a provider, or a contract between an insurer and a provider, to contain provisions requiring a fast, fair, and cost-effective dispute resolution mechanism under which providers may submit disputes to the plan or insurer. Existing law requires that dispute resolution mechanism also be made accessible to a noncontracting provider for the purpose of resolving billing and claims disputes.

This bill would require the department and the commissioner to eachbegin delete establishend deletebegin insert establish, by September 1, 2017,end insert an independent dispute resolution process that would allow a noncontracting individual health professional who rendered services at a contracting health facility, or a plan or insurer, to appeal a claim payment dispute, as specified. The bill would authorize the department and the commissioner to contract with one or more independent dispute resolution organizations to conduct the independent dispute resolution process, as specified.begin insert Contracts entered into pursuant to these provisions would be exempt from specified statutory provisions and related state agency review and approval requirements.end insert The bill would provide that the decision of the organization would be binding on the parties. The bill would require a plan or insurer to base reimbursement for covered services on the amount the individual health professional would have been reimbursed by Medicare for the same or similar services in the general geographic area in which the services were rendered pursuant to a specifiedbegin delete methodology.end deletebegin insert methodology and would specify, among other responsibilities, the duties of health care service plans, their delegated entities, and health insurers in identifying and calculating the applicable reimbursement rates, as well as various related duties of the department and the commissioner.end insert The bill would require the department and the commissioner to reportbegin delete the above informationend deletebegin insert on the data and information provided in the independent dispute resolution processend insert to the Governor and other specified recipients by January 1,begin delete 2020.end deletebegin insert 2019.end insert The bill would require a noncontracting individual healthbegin delete professional whoend deletebegin insert professional, health care service plan or delegated entity, or health insurer thatend insert disputes that claim reimbursement to utilize the independent dispute resolution process. The bill would provide that these provisions do not apply to emergency services and care, as defined.

Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest.

This bill would make legislative findings to that effect.

Because a willful violation of the bill’s provisions relative to a health care service plan would be a crime, the 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:

P4    1

SECTION 1.  

Section 1371.30 is added to the Health and Safety
2Code, immediately following Section 1371.3
, to read:

3

1371.30.  

(a) (1) begin deleteTheend deletebegin insert By September 1, 2017, theend insert department
4shall establish an independent dispute resolution process for the
5purpose of processing and resolving a claim dispute between a
6health care service plan and a noncontracting individual health
7professional for services subject to subdivision (a) of Section
81371.9.

9(2) Prior to initiating the independent dispute resolution process,
10the parties shall complete the plan’s internal process.

11(3) If either the noncontracting individual health professional
12or the plan appeals a claim to the department’s independent dispute
13resolution process, the other party shall participate in the appeal
14process as described in this section.

15(b) (1) The department shall establish uniform written
16procedures for the submission, receipt, processing, and resolution
17of claim payment disputes pursuant to this section and any other
18guidelines for implementing this section.

19(2) The department shall establish reasonable and necessary
20fees for the purpose of administering this section, to be paid by
21both parties.

22(3) In establishing the independent dispute resolution process,
23the department shall permit the bundling of claims submitted to
24the same plan or the same delegated entity for the same or similar
25services by the same noncontracting individual health professional.

26(4) The department shall permit a physician group, independent
27practice association, or other entity authorized to act on behalf of
28a noncontracting individual health professional to initiate and
29participate in the independent dispute resolution process.

P5    1(5) In deciding the dispute, the independent organization shall
2base its decision regarding the appropriate reimbursement on all
3relevantbegin delete information, including, but not limited to, the
4reimbursement amount suggested by either party.end delete
begin insert information.end insert

5(c) (1) The department may contract with one or more
6independent organizations to conduct the proceedings. The
7independent organization handling a dispute shall be independent
8of either party to the dispute.

9(2) The department shall establish conflict-of-interest standards,
10consistent with the purposes of this section, that an organization
11shall meet in order to qualify to administer the independent dispute
12resolution program. The conflict-of-interest standards shall be
13consistent with the standards pursuant to subdivisions (c) and (d)
14of Section 1374.32.

15(3) The department may contract with the same independent
16organization or organizations as the Department of Insurance.

17(4) The department shall provide, upon the request of an
18interested person, a copy of all nonproprietary information, as
19determined by the director, filed with the department by an
20independent organization seeking to contract with the department
21to administer the independent dispute resolution process pursuant
22to this section. The department may charge a nominal fee to cover
23the costs of providing a copy of the information pursuant to this
24paragraph.

25(5) The independent organization retained to conduct
26proceedings shall be deemed to be consultants for purposes of
27Section 43.98 of the Civil Code.

begin insert

28
(6) Contracts entered into pursuant to the authority in this
29subdivision shall be exempt from Part 2 (commencing with Section
3010100) of Division 2 of the Public Contract Code, Section 19130
31of the Government Code, and Chapter 6 (commencing with Section
3214825) of Part 5.5 of Division 3 of the Government Code and shall
33be exempt from the review or approval of any division of the
34Department of General Services.

end insert

35(d) The decision obtained through the department’s independent
36dispute resolution process shall be binding on both parties. The
37plan shall implement the decision obtained through the independent
38dispute resolution process. If dissatisfied, either party may pursue
39any right, remedy, or penalty established under any other applicable
40law.

P6    1(e) This section shall not apply to a Medi-Cal managed health
2care service plan or any entity that enters into a contract with the
3State Department of Health Care Services pursuant to Chapter 7
4(commencing with Section 14000), Chapter 8 (commencing with
5Section 14200), and Chapter 8.75 (commencing with Section
614591) of Part 3 of Division 9 of the Welfare and Institutions Code.

7(f) If a health care service plan delegates payment functions to
8a contracted entity, including, but not limited to, a medical group
9or independent practice association, then the delegated entity shall
10comply with this section.

11(g) This section shall not apply to emergency services and care,
12as defined in Sectionbegin delete 1317.1, or services required to be covered
13by a health care service plan pursuant to Section 1371.4.end delete
begin insert 1317.1.end insert

14(h) The definitions in subdivision (f) of Section 1371.9 shall
15apply for purposes of this section.

begin insert

16
(i) This section shall not be construed to alter a health care
17service plan’s obligations pursuant to Sections 1371 and 1371.4.

end insert
begin insert

18
(j) Notwithstanding Chapter 3.5 (commencing with Section
1911340) of Part 1 of Division 3 of Title 2 of the Government Code,
20the department may implement, interpret, or make specific this
21section by means of all-plan letters or similar instructions, without
22taking regulatory action, until the time regulations are adopted.

end insert
begin insert

23
(k) By January 1, 2019, the department shall provide a report
24to the Governor, the President pro Tempore of the Senate, the
25Speaker of the Assembly, and the Senate and Assembly Committees
26on Health of the data and information provided in the independent
27dispute resolution process in a manner and format specified by
28the Legislature.

end insert
29

SEC. 2.  

Section 1371.31 is added to the Health and Safety
30Code
, to read:

31

1371.31.  

(a) (1) For services rendered subject to Section
321371.9,begin insert effective July 1, 2017,end insert unless otherwise agreed to by the
33noncontracting individual health professional and the plan, the
34plan shall reimburse the greater of the average contracted rate or
35125 percent of the amount Medicare reimburses on a fee-for-service
36basis for the same or similar services in the general geographic
37region in which the services were rendered. For the purposes of
38this section, “average contracted rate” means the average of the
39contracted commercial rates paid by the health plan or delegated
40entity for the same or similar services in the geographic region.
P7    1This subdivision does not apply to subdivision (c) of Section
21371.9 or subdivision (b) of this section.

begin insert

3
(2) (A) By July 1, 2017, each health care service plan and its
4delegated entities shall provide to the department all of the
5following:

end insert
begin insert

6
(i) Data listing its average contracted rates for the plan for
7services most frequently subject to Section 1371.9 in each
8geographic region in which the services are rendered for the
9calendar year 2015.

end insert
begin insert

10
(ii) Its methodology for determining the average contracted rate
11for the plan for services subject to Section 1371.9. The methodology
12to determine an average contracted rate shall ensure that the plan
13includes the highest and lowest contracted rates for the calendar
14year 2015.

end insert
begin insert

15
(iii) The policies and procedures used to determine the average
16contracted rates under this subdivision.

end insert
begin insert

17
(B) For each calendar year after the plan’s initial submission
18of the average contracted rate as specified in subparagraph (A)
19and until the standardized methodology under paragraph (3) is
20specified, a health care service plan and the plan’s delegated
21entities shall adjust the rate initially established pursuant to this
22subdivision by the Consumer Price Index for Medical Care
23Services, as published by the United States Bureau of Labor
24Statistics.

end insert
begin delete

25(2) (A) The

end delete

26begin insert(3)end insertbegin insertend insertbegin insert(A)end insertbegin insertend insertbegin insertBy January 1, 2019, theend insert department shall specify a
27methodology that plans and delegated entities shall use to
28determine the average contracted rates for services most frequently
29subject to Section 1371.9. This methodology shall take into
30account, at a minimum,begin insert information from the independent dispute
31resolution process,end insert
the specialty of the individual health
32begin delete professionalend deletebegin insert professional,end insert and the geographic region in which the
33services are rendered. The methodology to determine an average
34contracted rate shall ensure that the plan includes the highest and
35lowest contracted rates.

36(B) Health care service plans and delegated entities shall
37begin delete annuallyend delete provide to the department the policies and procedures
38used to determine the average contracted rates in compliance with
39subparagraph (A).

P8    1(C) If, based on the health care service plan’s model, a health
2care service plan does not pay a statistically significant number or
3dollar amount of claims for services covered under Section 1371.9,
4the health care service plan shall demonstrate to the department
5that it has access to a statistically credible database reflecting rates
6paid to noncontracting individual health professionals for services
7provided in a geographicbegin delete region.end deletebegin insert region and shall use that database
8to determine an average contracted rate required pursuant to
9paragraph (1).end insert

begin delete

10(D) For each year after 2015, the health care service plan and
11the plan’s delegated entities shall adjust the rate initially established
12pursuant to this subdivision by the Consumer Price Index for
13Medical Care Services, as published by the United States Bureau
14 of Labor Statistics.

15(E)

end delete

16begin insert(D)end insert The department shall review the information filed pursuant
17to this subdivision as part of its examination of fiscal and
18administrative affairs pursuant to Section 1382.

begin delete

19(F)

end delete

20begin insert(E)end insert The average contracted rate data submitted pursuant to this
21begin delete paragraphend deletebegin insert sectionend insert shall be confidential and not subject to disclosure
22under the California Public Records Act (Chapter 3.5 (commencing
23with Section 6250) of Division 7 of Title 1 of the Government
24Code).

begin delete

25(G) By January 1, 2020, the department shall provide a report
26to the Governor, the President pro Tempore of the Senate, the
27Speaker of the Assembly, and the Senate and Assembly
28Committees on Health of the data and information provided in
29subparagraphs (A) and (B) in a manner and format specified by
30the Legislature.

end delete
begin insert

31
(F) In developing the standardized methodology under this
32subdivision, the department shall consult with interested parties
33throughout the process of developing the standards, including the
34Department of Insurance, representatives of health plans, insurers,
35health care providers, hospitals, consumer advocates, and other
36stakeholders it deems appropriate. The department shall hold the
37first stakeholder meeting no later than July 1, 2017.

end insert
begin delete

38(3)

end delete

39begin insert(4)end insert A health care service plan shall include in its reports
40submitted to the department pursuant to Section 1367.035 and
P9    1regulations adopted pursuant to that section, in a manner specified
2by the department, the number ofbegin delete out-of-network payments made
3for services subject to Section 1371.9, as well as other data
4sufficient to determine the prevalence of out-of-network individual
5health professionals at specific facilities for the types of facilities
6listed in subdivision (f) of Section 1371.9.end delete
begin insert payments made to
7noncontracting individual health professionals for services at a
8contracting health facility and subject to Section 1371.9, as well
9as other data sufficient to determine the proportion of
10noncontracting individual health professionals to contracting
11individual health professionals at contracting health facilities, as
12defined in subdivision (f) of Section 1371.9. The department shall
13include a summary of this information in its January 1, 2019,
14report required pursuant to subdivision (k) of Section 1371.30end insert
begin insert and
15its findings regarding the impact of the act that added this section
16on health care service plan contracting and network adequacy.end insert

begin insert

17
(5) A health care service plan that provides services subject to
18 Section 1371.9 shall meet the network adequacy requirements set
19forth in subdivisions (d) and (e) of Section 1367 of this code and
20in Exhibits (H) and (I) of subdivision (d) of Section 1300.51 of,
21and Section 1300.67.2 of, Title 28 of the California Code of
22Regulations, including, but not limited to, inpatient hospital
23services and specialist physician services, and if necessary, the
24department may adopt additional regulations related to those
25services.

end insert
begin delete

26(4)

end delete

27begin insert(6)end insert For purposes of this section for Medicare fee-for-service
28reimbursement, geographic regions shall be the geographic regions
29specified for physician reimbursement for Medicare fee-for-service
30 by the United States Department of Health and Human Services.

begin delete

31(5)

end delete

32begin insert(7)end insert A health care service plan shall authorize and permit
33assignment of the enrollee’s right, if any, to any reimbursement
34for health care services covered under the plan contract to a
35noncontracting individual health professional who furnishes the
36health care services rendered subject to Section 1371.9. Lack of
37assignment pursuant to this paragraph shall not be construed to
38limit the applicability of this section, Section 1371.30, or Section
391371.9.

begin delete

40(6)

end delete

P10   1begin insert(8)end insert A noncontracting individual healthbegin delete professionalend deletebegin insert professional,
2health care service plan, or health care service plan’s delegated
3entityend insert
who disputes the claim reimbursement under this section
4shall utilize the independent dispute resolution process described
5in Section 1371.30.

6(b) If nonemergency services are provided by a noncontracting
7individual health professional consistent with subdivision (c) of
8Section 1371.9 to an enrollee who has voluntarily chosen to use
9his or her out-of-network benefit for services covered by a plan
10that includes coverage for out-of-network benefits, unless otherwise
11agreed to by the plan and the noncontracting individual health
12professional, the amount paid by the health care service plan shall
13be the amount set forth in the enrollee’s evidence of coverage.
14This payment is not subject to the independent dispute resolution
15process described in Section 1371.30.

16(c) If a health care service plan delegates the responsibility for
17payment of claims to a contracted entity, including, but not limited
18to, a medical group or independent practice association, then the
19entity to which that responsibility is delegated shall comply with
20the requirements of this section.

21(d) (1) A payment made by the health care service plan to the
22noncontracting health care professional for nonemergency services
23as required by Section 1371.9 and this section, in addition to the
24applicable cost sharing owed by the enrollee, shall constitute
25payment in full for nonemergency services rendered unless either
26party uses the independent dispute resolution process or other
27lawful means pursuant to Section 1371.30.

28(2) Notwithstanding any other law, the amounts paid by a plan
29for services under this section shall not constitute the prevailing
30or customary charges, the usual fees to the general public, or other
31charges for other payers for an individual health professional.

32(3) This subdivision shall not preclude the use of the independent
33dispute resolution process pursuant to Section 1371.30.

34(e) This section shall not apply to a Medi-Cal managed health
35care service plan or any other entity that enters into a contract with
36the State Department of Health Care Services pursuant to Chapter
377 (commencing with Section 14000), Chapter 8 (commencing with
38Section 14200), and Chapter 8.75 (commencing with Section
3914591) of Part 3 of Division 9 of the Welfare and Institutions Code.

P11   1(f) This section shall not apply to emergency services and care,
2as defined in Sectionbegin delete 1317.1, or to those services required to be
3covered by a health care service plan pursuant to Section 1371.4.end delete

4
begin insert 1317.1.end insert

5(g) The definitions in subdivision (f) of Section 1371.9 shall
6apply for purposes of this section.

begin insert

7
(h) This section shall not be construed to alter a health care
8service plan’s obligations pursuant to Sections 1371 and 1371.4.

end insert
9

SEC. 3.  

Section 1371.9 is added to the Health and Safety Code,
10to read:

11

1371.9.  

(a) (1) Except as provided in subdivision (c), a health
12care service plan contract issued, amended, or renewed on or after
13July 1, 2017, shall provide that if an enrollee receives covered
14services from a contracting health facility at which, or as a result
15of which, the enrollee receives services provided by a
16noncontracting individual health professional, the enrollee shall
17pay no more than the same cost sharing that the enrollee would
18pay for the same covered services received from a contracting
19individual health professional. This amount shall be referred to as
20the “in-network cost-sharing amount.”

21(2) An enrollee shall not owe the noncontracting individual
22health professional more than the in-network cost-sharing amount
23 for services subject to this section. At the time of payment by the
24plan to the noncontracting individual health professional, the plan
25shall inform the enrollee and the noncontracting individual health
26professional of the in-network cost-sharing amount owed by the
27enrollee.

28(3) A noncontracting individual health professional shall not
29bill or collect any amount from the enrollee for services subject
30to this section except for the in-network cost-sharing amount. Any
31communication from the noncontracting individual health
32professional to the enrollee prior to the receipt of information about
33the in-network cost-sharing amount pursuant to paragraph (2) shall
34include a notice in 12-point bold type stating that the
35communication is not a bill and informing the enrollee that the
36enrollee shall not pay until he or she is informed by his or her
37health care service plan of any applicable cost sharing.

begin delete

38(4) In submitting a claim to the plan, the noncontracting
39individual health professional shall affirm to the plan that he or
40she has not attempted to collect any payment from the enrollee.

end delete
begin delete

P12   1(5)

end delete

2begin insert(4)end insert (A) If the noncontracting individual health professional has
3received more than the in-network cost-sharing amount from the
4enrollee for services subject to this section, the noncontracting
5individual health professional shall refund any overpayment to the
6enrollee within 30 calendar days after receivingbegin delete notice from the
7plan of the in-network cost-sharing amount owed by the enrollee
8pursuant to paragraph (2).end delete
begin insert payment from the enrollee.end insert

9(B) If the noncontracting individual health professional does
10not refund any overpayment to the enrollee within 30begin delete businessend delete
11begin insert calendarend insert days after being informed of the enrollee’s in-network
12cost-sharing amount, interest shall accrue at the rate of 15 percent
13per annum beginning with thebegin delete first day after the 30-business-day
14period has elapsed.end delete
begin insert date payment was received from the enrollee.end insert

15(C) A noncontracting individual health professional shall
16automatically include in his or her refund to the enrollee all interest
17that has accrued pursuant to this section without requiring the
18enrollee to submit a request for the interest amount.

19(b) Except for services subject to subdivision (c), the following
20shall apply:

21(1) Any cost sharing paid by the enrollee for the services subject
22to this section shall count toward the limit on annual out-of-pocket
23expenses established under Section 1367.006.

24(2) Cost sharing arising from services subject to this section
25shall be counted toward any deductible in the same manner as cost
26sharing would be attributed to a contracting individual health
27professional.

28(3) The cost sharing paid by the enrollee pursuant to this section
29shall satisfy the enrollee’s obligation to pay cost sharing for the
30health service and shall constitute “applicable cost sharing owed
31by the enrollee.”

32(c) For services subject to this section, if an enrollee has a health
33care service plan that includes coverage for out-of-network benefits,
34a noncontracting individual health professional may bill or collect
35from the enrollee the out-of-network cost sharing, if applicable,
36only when the enrollee consents in writing and that written consent
37demonstrates satisfaction of all the following criteria:

38(1) At least 24 hours in advance of care, the enrollee shall
39consent in writing to receive services from the identified
40noncontracting individual health professional.

P13   1(2) The consent shall be obtained by the noncontracting
2individual health professional in a document that is separate from
3the document used to obtain the consent for any other part of the
4care or procedure. The consent shall not be obtained by the facility
5or any representative of the facility. The consent shall not be
6obtained at the time of admission or at any time when the enrollee
7is being prepared for surgery or any other procedure.

8(3) At the time consent is provided, the noncontracting
9individual health professional shall give the enrollee a written
10estimate of the enrollee’s total out-of-pocket cost of care. The
11written estimate shall be based on the professional’s billed charges
12for the service to be provided. The noncontracting individual health
13professional shall not attempt to collect more than the estimated
14amount without receiving separate written consent from the
15enrollee or the enrollee’s authorized representative, unless
16circumstances arise during delivery of services that were
17unforeseeable at the time the estimate was given that would require
18the provider to change the estimate.

19(4) The consent shall advise the enrollee that he or she may
20elect to seek care from a contracted provider or may contact the
21enrollee’s health care service plan in order to arrange to receive
22the health service from a contracted provider for lower
23out-of-pocket costs.

24(5) The consent and estimate shall be provided to the enrollee
25in the language spoken by the enrollee, if the language is a
26Medi-Cal threshold language, as defined in subdivision (d) of
27Section 128552.

28(6) The consent shall also advise the enrollee that any costs
29incurred as a result of the enrollee’s use of the out-of-network
30benefit shall be in addition to in-network cost-sharing amounts
31and may not count toward the annual out-of-pocket maximum on
32in-network benefits or a deductible, if any, for in-network benefits.

33(d) A noncontracting individual health professional who fails
34to comply with the requirements of subdivision (c) has not obtained
35written consent for purposes of this section. Under those
36circumstances, subdivisions (a) and (b) shall apply and subdivision
37(c) shall not apply.

38(e) (1) A noncontracting individual health professional may
39advance to collections only the in-network cost-sharing amount,
40as determined by the plan pursuant to subdivision (a) or the
P14   1out-of-network cost-sharing amount owed pursuant to subdivision
2(c), that the enrollee has failed to pay.

3(2) The noncontracting individual health professional, or any
4entity acting on his or her behalf, including any assignee of the
5debt, shall not report adverse information to a consumer credit
6reporting agency or commence civil action against the enrollee for
7a minimum of 150 days after the initial billing regarding amounts
8owed by the enrollee under subdivision (a) or (c).

9(3) With respect to an enrollee, the noncontracting individual
10health professional, or any entity acting on his or her behalf,
11including any assignee of the debt, shall not use wage garnishments
12or liens on primary residences as a means of collecting unpaid bills
13under this section.

14(f) For purposes of this section and Sections 1371.30 and
151371.31, the following definitions shall apply:

16(1) “Contracting health facility” means a health facility that is
17contracted with the enrollee’s health care service plan to provide
18services under the enrollee’s plan contract. A contracting health
19care facility includes, but is not limited to, the following providers:

20(A) A licensed hospital.

21(B) An ambulatory surgery or other outpatient setting, as
22described in subdivision (a), (d), (e), (g), or (h) of Section 1248.1.

23(C) A laboratory.

24(D) A radiology or imaging center.

25(2) “Cost sharing” includes any copayment, coinsurance, or
26deductible, or any other form of cost sharing paid by the enrollee
27other than premium or share of premium.

28(3) “Individual health professional” means a physician and
29surgeon or other professional who is licensed by this state to deliver
30or furnish health care services. For this purpose, an “individual
31health professional” shall not include a dentist, licensed pursuant
32to the Dental Practice Act (Chapter 4 (commencing with Section
331600) of Division 2 of the Business and Professions Code).

34(4) “In-network cost-sharing amount” means an amount no more
35than the same cost sharing the enrollee would pay for the same
36covered service received from a contracting health professional.
37The in-network cost-sharing amount with respect to an enrollee
38with coinsurance shall be based on the amount paid by the plan
39pursuant to paragraph (1) of subdivision (a) of Section 1371.31.

P15   1(5) “Noncontracting individual health professional” means a
2physician and surgeon or other professional who is licensed by the
3state to deliver or furnish health care services and who is not
4contracted with the enrollee’s health care service product. For this
5purpose, a “noncontracting individual health professional” shall
6not include a dentist, licensed pursuant to the Dental Practice Act
7(Chapter 4 (commencing with Section 1600) of Division 2 of the
8Business and Professions Code). Application of this definition is
9not precluded by a noncontracting individual health professional’s
10affiliation with a group.

11(g) This section shall not be construed to require a health care
12service plan to cover services not required by law or by the terms
13and conditions of the health care service plan contract.

14(h) This section shall not be construed to exempt a plan or
15provider from the requirements under Section 1371.4 or 1373.96,
16nor abrogate the holding in Prospect Medical Group, Inc. v.
17Northridge Emergency Medical Group (2009) 45 Cal.4th 497.

18(i) If a health care service plan delegates payment functions to
19a contracted entity, including, but not limited to, a medical group
20or independent practice association, the delegated entity shall
21comply with this section.

22(j) This section shall not apply to a Medi-Cal managed health
23care service plan or any other entity that enters into a contract with
24the State Department of Health Care Services pursuant to Chapter
257 (commencing with Section 14000), Chapter 8 (commencing with
26Section 14200), and Chapter 8.75 (commencing with Section
2714591) of Part 3 of Division 9 of the Welfare and Institutions Code.

28(k) This section shall not apply to emergency services and care,
29as defined in Section begin delete 1317.1, or to those services required to be
30covered by a health care service plan pursuant to Section 1371.4.end delete

31
begin insert 1317.1.end insert

32

SEC. 4.  

Section 10112.8 is added to the Insurance Code, to
33read:

34

10112.8.  

(a) (1) Except as provided in subdivision (c), a health
35insurance policy issued, amended, or renewed on or after July 1,
362017, that provides benefits through contracts with providers at
37alternative rates of payment pursuant to Section 10133, shall
38provide that if an insured receives covered services from a
39contracting health facility at which, or as a result of which, the
40insured receives services provided by a noncontracting individual
P16   1health professional, the insured shall pay no more than the same
2cost sharing that the insured would pay for the same covered
3services received from a contracting individual health professional.
4This amount shall be referred to as the “in-network cost-sharing
5amount.”

6(2) Except as provided in subdivision (c), an insured shall not
7owe the noncontracting individual health professional more than
8the in-network cost-sharing amount for services subject to this
9section. At the time of payment by the insurer to the noncontracting
10individual health professional, the insurer shall inform the insured
11and the noncontracting individual health professional of the
12in-network cost-sharing amount owed by the insured.

13(3) A noncontracting individual health professional shall not
14bill or collect any amount from the insured for services subject to
15this section except the in-network cost-sharing amount. Any
16communication from the noncontracting individual health
17professional to the insured prior to the receipt of information about
18the in-network cost-sharing amount pursuant to paragraph (2) shall
19include a notice in 12-point bold type stating that the
20communication is not a bill and informing the insured that the
21insured shall not pay until he or she is informed by his or her
22insurer of any applicable cost sharing.

begin delete

23(4) In submitting a claim to the insurer, the noncontracting
24individual health professional shall affirm to the insurer that he or
25she has not attempted to collect any payment from the insured.

end delete
begin delete

26(5)

end delete

27begin insert(4)end insert (A) If the noncontracting individual health professional has
28received more than the in-network cost-sharing amount from the
29insured for services subject to this section, the noncontracting
30individual health professional shall refund any overpayment to the
31 insured within 30 calendar days after receivingbegin delete notice from the
32insurer of the in-network cost-sharing amount owed by the insured
33pursuant to paragraph (2).end delete
begin insert payment from the insured.end insert

34(B) If the noncontracting individual health professional does
35not refund any overpayment to the insured within 30begin delete businessend delete
36begin insert calendarend insert days after being informed of the insured’s in-network
37cost-sharing amount, interest shall accrue at the rate of 15 percent
38per annum beginning with thebegin delete first day after the 30-business-day
39period has elapsed.end delete
begin insert date payment was received from the insured.end insert

P17   1(C) A noncontracting individual health professional shall
2automatically include in his or her refund to the insured all interest
3that has accrued pursuant to this section without requiring the
4insured to submit a request for the interest amount.

5(b) Except for services subject to subdivision (c), the following
6shall apply:

7(1) Any cost sharing paid by the insured for the services subject
8to this section shall count toward the limit on annual out-of-pocket
9expenses established under Section 10112.28.

10(2) Cost sharing arising from services subject to this section
11shall be counted toward any deductible in the same manner as cost
12sharing would be attributed to a contracting individual health
13professional.

14(3) The cost sharing paid by the insured pursuant to this section
15shall satisfy the insured’s obligation to pay cost sharing for the
16health service and shall constitute “applicable cost sharing owed
17by the insured.”

18(c) For services subject to this section, if an insured has an
19insurance contract that includes coverage for out-of-network
20benefits, a noncontracting individual health professional may bill
21or collect from the insured the out-of-network cost sharing, if
22applicable, only when the insured consents in writing and that
23written consent demonstrates satisfaction of all the following
24criteria:

25(1) At least 24 hours in advance of care, the insured shall consent
26in writing to receive services from the identified noncontracting
27individual health professional.

28(2) The consent shall be obtained by the noncontracting
29individual health professional in a document that is separate from
30the document used to obtain the consent for any other part of the
31care or procedure. The consent shall not be obtained by the facility
32or any representative of the facility. The consent shall not be
33obtained at the time of admission or at any time when the enrollee
34is being prepared for surgery or any other procedure.

35(3) At the time consent is provided the noncontracting individual
36health professional shall give the insured a written estimate of the
37insured’s total out-of-pocket cost of care. The written estimate
38shall be based on the professional’s billed charges for the service
39to be provided. The noncontracting individual health professional
40shall not attempt to collect more than the estimated amount without
P18   1receiving separate written consent from the insured or the insured’s
2authorized representative, unless circumstances arise during
3delivery of services that were unforeseeable at the time the estimate
4was given that would require the provider to change the estimate.

5(4) The consent shall advise the insured that he or she may elect
6to seek care from a contracted provider or may contact the insured’s
7begin delete health care service planend deletebegin insert insurerend insert in order to arrange to receive the
8health service from a contracted provider for lower out-of-pocket
9costs.

10(5) The consent and estimate shall be provided to the insured
11in the language spoken by the insured, if the language is a Medi-Cal
12threshold language, as defined in subdivision (d) of Section 128552
13of the Health and Safety Code.

14(6) The consent shall also advise the insured that any costs
15incurred as a result of the insured’s use of the out-of-network
16benefit shall be in addition to in-network cost-sharing amounts
17and may not count toward the annual out-of-pocket maximum on
18in-network benefits or a deductible, if any, for in-network benefits.

19(d) A noncontracting individual health professional who fails
20to comply with provisions of this subdivision has not obtained
21written consent for purposes of this section. Under those
22circumstances, subdivisions (a) and (b) shall apply and subdivision
23(c) shall not apply.

24(e) (1) A noncontracting individual health professional may
25advance to collections only the in-network cost-sharing amount,
26as determined by the insurer pursuant to subdivision (a) or the
27 out-of-network cost-sharing amount owed pursuant to subdivision
28(c), that the insured has failed to pay.

29(2) The noncontracting individual health professional, or any
30entity acting on his or her behalf, including any assignee of the
31debt, shall not report adverse information to a consumer credit
32reporting agency or commence civil action against the insured for
33a minimum of 150 days after the initial billing regarding amounts
34owed by the insured under subdivision (a) or (c).

35(3) With respect to an insured, a noncontracting individual health
36professional, or any entity acting on his or her behalf, including
37any assignee of the debt, shall not use wage garnishments or liens
38on primary residences as a means of collecting unpaid bills under
39this section.

P19   1(f) For purposes of this section and Sections 10112.81 and
210112.82, the following definitions shall apply:

3(1) “Contracting health facility” means a health facility that is
4contracted with the insured’s health insurer to provide services
5under the insured’s policy. A contracting health care facility
6includes, but is not limited to, the following providers:

7(A) A licensed hospital.

8(B) An ambulatory surgery or other outpatient setting, as
9described in subdivision (a), (d), (e), (g), or (h) of Section 1248.1
10of the Health and Safety Code.

11(C) A laboratory.

12(D) A radiology or imaging center.

13(2) “Cost sharing” includes any copayment, coinsurance, or
14deductible, or any other form of cost sharing paid by the insured
15other than premium or share of premium.

16(3) “Individual health professional” means a physician and
17surgeon or other professional who is licensed by the state to deliver
18or furnish health care services. For this purpose, an “individual
19health professional” shall not include a dentist, licensed pursuant
20to the Dental Practice Act (Chapter 4 (commencing with Section
211600) of Division 2 of the Business and Professions Code).

22(4) “In-network cost-sharing amount” means an amount no more
23than the same cost sharing the insured would pay for the same
24covered service received from a contracting health professional.
25The in-network cost-sharing amount with respect to an insured
26with coinsurance shall be based on the amount paid by the insurer
27pursuant to paragraph (1) of subdivision (a) of Section 10112.82.

28(5) “Noncontracting individual health professional” means a
29physician and surgeon or other professional who is licensed by the
30state to deliver or furnish health care services and who is not
31contracted with the insured’s health insurance product. For this
32purpose, a “noncontracting individual health professional” shall
33not include a dentist, licensed pursuant to the Dental Practice Act
34(Chapter 4 (commencing with Section 1600) of Division 2 of the
35Business and Professions Code). Application of this definition is
36not precluded by a noncontracting individual health professional’s
37affiliation with a group.

38(g) This section shall not be construed to require an insurer to
39cover services not required by law or by the terms and conditions
40of the health insurance policy.

P20   1(h) If a health insurer delegates payment functions to a
2contracted entity, including, but not limited to, a medical group or
3independent practice association, the delegated entity shall comply
4with this section.

5(i) This section shall not apply to emergency services and care,
6as defined in Section 1317.1 of the Health and Safety Code.

7

SEC. 5.  

Section 10112.81 is added to the Insurance Code, to
8read:

9

10112.81.  

(a) (1) begin deleteThe end deletebegin insertBy September 1, 2017, the end insertcommissioner
10shall establish an independent dispute resolution process for the
11purpose of processing and resolving a claim dispute between a
12health insurer and a noncontracting individual health professional
13for services subject to subdivision (a) of Section 10112.8.

14(2) Prior to initiating the independent dispute resolution process,
15the parties shall complete the insurer’s internal process.

16(3) If either the noncontracting individual health professional
17or the insurer appeals a claim to the department’s independent
18dispute resolution process, the other party shall participate in the
19appeal process as described in this section.

20(b) (1) The commissioner shall establish uniform written
21procedures for the submission, receipt, processing, and resolution
22of claim payment disputes pursuant to this section and any other
23guidelines for implementing this section.

24(2) The commissioner shall establish reasonable and necessary
25fees for the purpose of administering this section, to be paid by
26both parties.

27(3) In establishing the independent dispute resolution process,
28the commissioner shall permit the bundling of claims submitted
29to the same insurer or the same delegated entity for the same or
30similar services by the same noncontracting individual health
31professional.

32(4) The commissioner shall permit a physician group,
33independent practice association, or other entity authorized to act
34on behalf of a noncontracting individual health professional to
35initiate and participate in the independent dispute resolution
36process.

37(5) In deciding the dispute, the independent organization shall
38base its decision regarding the appropriate reimbursement on all
39relevantbegin delete information, including, but not limited to, the
40reimbursement amount suggested by either party.end delete
begin insert information.end insert

P21   1(c) (1) The commissioner may contract with one or more
2independent organizations to conduct the proceedings. The
3independent organization handling a dispute shall be independent
4of either party to the dispute.

5(2) The commissioner shall establish conflict-of-interest
6standards, consistent with the purposes of this section, that an
7organization shall meet in order to qualify to administer the
8independent dispute resolution program. The conflict-of-interest
9standards shall be consistent with the standards pursuant to
10subdivisions (c) and (d) of Section 10169.2.

11(3) The commissioner may contract with the same independent
12organization or organizations as the State Department of Managed
13Health Care.

14(4) The commissioner shall provide, upon the request of an
15interested person, a copy of all nonproprietary information, as
16determined by the commissioner, filed with the department by an
17independent organization seeking to contract with the department
18to administer the independent dispute resolution process pursuant
19to this section. The department may charge a nominal fee to cover
20the costs of providing a copy of the information pursuant to this
21paragraph.

begin delete

22(5) The independent organization retained to conduct
23proceedings shall be deemed to be consultants for purposes of
24Section 43.98 of the Civil Code.

end delete
begin insert

25
(5) Contracts entered into pursuant to the authority in this
26subdivision shall be exempt from Part 2 (commencing with Section
2710100) of Division 2 of the Public Contract Code, Section 19130
28of the Government Code, and Chapter 6 (commencing with Section
2914825) of Part 5.5 of Division 3 of the Government Code and shall
30be exempt from the review or approval of any division of the
31Department of General Services.

end insert

32(d) The decision obtained through the commissioner’s
33independent dispute resolution process shall be binding on both
34parties. The insurer shall implement the decision obtained through
35the independent dispute resolution process. If dissatisfied, either
36party may pursue any right, remedy, or penalty established under
37any other applicable law.

38(e) If a health insurer delegates payment functions to a
39contracted entity, including, but not limited to, a medical group or
P22   1independent practice association, then the delegated entity shall
2comply with this section.

3(f) This section shall not apply to emergency services and care,
4as defined in Section 1317.1 of the Health and Safety Code.

5(g) The definitions in subdivision (f) of Section 10112.8 shall
6apply for purposes of this section.

begin insert

7
(h) This section shall not be construed to alter a health insurer’s
8obligations pursuant to Section 10123.13.

end insert
begin insert

9
(i) Notwithstanding Chapter 3.5 (commencing with Section
1011340) of Part 1 of Division 3 of Title 2 of the Government Code,
11the commissioner may implement, interpret, or make specific this
12section by issuing guidance, without taking regulatory action, until
13the time regulations are adopted.

end insert
begin insert

14
(j) By January 1, 2019, the commissioner shall provide a report
15to the Governor, the President pro Tempore of the Senate, the
16Speaker of the Assembly, and the Senate and Assembly Committees
17on Health of the data and information provided in the independent
18dispute resolution process in a manner and format specified by
19the Legislature.

end insert
20

SEC. 6.  

Section 10112.82 is added to the Insurance Code, to
21read:

22

10112.82.  

(a) (1) For services rendered subject to Section
2310112.8,begin insert effective July 1, 2017,end insert unless otherwise agreed to by the
24noncontracting individual health professional and the insurer, the
25insurer shall reimburse the greater of the average contracted rate
26or 125 percent of the amount Medicare reimburses on a
27fee-for-service basis for the same or similar services in the general
28geographic region in which the services were rendered. For the
29purposes of this section, “average contracted rate” means the
30average of the contracted commercial rates paid by the health
31insurer for the same or similar services in the geographic region.
32This subdivision does not apply to subdivision (c) of Section
3310112.8 or subdivision (b) of this section.

begin insert

34
(2) (A) By July 1, 2017, each health insurer shall provide to
35the commissioner all of the following:

end insert
begin insert

36
(i) Data listing its average contracted rates for the insurer for
37services most frequently subject to Section 10112.8 in each
38geographic region in which the services are rendered for the
39calendar year 2015.

end insert
begin insert

P23   1
(ii) Its methodology for determining the average contracted rate
2for the insurer for services subject to Section 10112.8. The
3methodology to determine an average contracted rate shall ensure
4that the insurer includes the highest and lowest contracted rates
5for the calendar year 2015.

end insert
begin insert

6
(iii) The policies and procedures used to determine the average
7contracted rates under this subdivision.

end insert
begin insert

8
(B) For each calendar year after the health insurer’s initial
9submission of the average contracted rate as specified in
10subparagraph (A) and until the standardized methodology under
11paragraph (3) is specified, a health insurer shall adjust the rate
12initially established pursuant to this subdivision by the Consumer
13Price Index for Medical Care Services, as published by the United
14States Bureau of Labor Statistics.

end insert
begin delete

15(2) (A) The

end delete

16begin insert(3)end insertbegin insertend insertbegin insert(A)end insertbegin insertend insertbegin insertBy January 1, 2019, theend insert commissioner shall specify a
17methodology that insurers shall use to determine the average
18contracted rates for services most frequently subject to Section
1910112.8. This methodology shall take into account, at a minimum,
20begin insert information from the independent dispute resolution process,end insert the
21specialty of the individual healthbegin delete professionalend deletebegin insert professional,end insert and
22the geographic region in which the services are rendered. The
23methodology to determine an average contracted rate shall ensure
24that the insurer includes the highest and lowest contracted rates.

25(B) Insurers shallbegin delete annuallyend delete provide to the commissioner the
26policies and procedures used to determine the average contracted
27rates in compliance with subparagraph (A).

begin delete

28(C) For each year after 2015, the health insurer and its delegated
29entities shall adjust the rate initially established pursuant to this
30subdivision by the Consumer Price Index for Medical Care
31Services, as published by the United States Bureau of Labor
32Statistics.

33(D)

end delete

34begin insert(C)end insert The average contracted rate data submitted pursuant to this
35begin delete paragraphend deletebegin insert sectionend insert shall be confidential and not subject to disclosure
36under the California Public Records Act (Chapter 3.5 (commencing
37with Section 6250) of Division 7 of Title 1 of the Government
38Code).

begin delete

39(E) By January 1, 2020, the department shall provide a report
40to the Governor, the President pro Tempore of the Senate, the
P24   1Speaker of the Assembly, and the Senate and Assembly
2Committees on Health of the data and information provided in
3subparagraphs (A) and (B) in a manner and format specified by
4the Legislature.

end delete
begin insert

5
(D) In developing the standardized methodology under this
6subdivision, the commissioner shall consult with interested parties
7throughout the process of developing the standards, including the
8Department of Managed Health Care, representatives of health
9plans, insurers, health care providers, hospitals, consumer
10advocates, and other stakeholders it deems appropriate. The
11commissioner shall hold the first stakeholder meeting no later than
12July 1, 2017.

end insert
begin insert

13
(4) A health insurer shall include in its reports submitted to the
14commissioner pursuant to Section 10133.5 and regulations adopted
15pursuant to that section, in a manner specified by the department,
16the number of payments made to noncontracting individual health
17professionals for services at a contracting health facility and
18subject to Section 10112.8, as well as other data sufficient to
19determine the proportion of noncontracting individual health
20professionals to contracting individual health professionals at
21contracting health facilities, as defined in subdivision (f) of Section
2210112.8. The commissioner shall include a summary of this
23information in its January 1, 2019, report required pursuant to
24subdivision (j) of Section 10112.81 and its findings regarding the
25impact of the act that added this section on health insurer
26contracting and network adequacy.

end insert
begin insert

27
(5) A health insurer that provides services subject to Section
2810112.8 shall meet the network adequacy requirements set forth
29in Section 10133.5 of the Insurance Code and Section 2240.1 of
30Title 10 of the California Code of Regulations, including, but not
31limited to, inpatient hospital services and specialist physician
32services, and if necessary, the commissioner may adopt additional
33regulations related to those services.

end insert
begin delete

34(3)

end delete

35begin insert(6)end insert For the purposes of this section, for average contracted rates
36for individual and small group coverage, geographic region shall
37be the geographic regions listed in subparagraph (A) of paragraph
38(2) of subdivision (a) of Sectionbegin delete 1357.512 of the Health and Safety
39Code.end delete
begin insert 10753.14.end insert For purposes of this section for Medicare
40fee-for-service reimbursement, geographic regions shall be the
P25   1geographic regions specified for physician reimbursement for
2Medicare fee-for-service by the United States Department of Health
3and Human Services.

begin delete

4(4)

end delete

5begin insert(7)end insert A health insurer shall authorize and permit assignment of
6the insured’s right, if any, to any reimbursement for health care
7services covered under the health insurance policy to a
8noncontracting individual health professional who furnishes the
9health care services rendered subject to Section 10112.8. Lack of
10assignment pursuant to this paragraph shall not be construed to
11limit the applicability of this section, Section 10112.8, or Section
1210112.81.

begin delete

13(5)

end delete

14begin insert(8)end insert A noncontracting individual health professionalbegin insert or health
15insurerend insert
who disputes the claim reimbursement under this section
16shall utilize the independent dispute resolution process described
17in Section 10112.81.

18(b) If nonemergency services are provided by a noncontracting
19individual health professional consistent with subdivision (c) of
20Section 10112.8 to an insured who has voluntarily chosen to use
21his or her out-of-network benefit for services covered by an insurer
22that includes coverage for out-of-network benefits, unless otherwise
23agreed to by the insurer and the noncontracting individual health
24professional, the amount paid by the insurer shall be the amount
25set forth in the insured’sbegin delete evidence of coverage.end deletebegin insert policy.end insert This
26payment is not subject to the independent dispute resolution process
27described in Section 10112.81.

28(c) If a health insurer delegates the responsibility for payment
29of claims to a contracted entity, including, but not limited to, a
30medical group or independent practice association, then the entity
31to which that responsibility is delegated shall comply with the
32requirements of this section.

33(d) (1) A payment made by the health insurer to the
34noncontracting health care professional for nonemergency services
35as required by Section 10112.8 and this section, in addition to the
36applicable cost sharing owed by the insured, shall constitute
37payment in full for nonemergency services rendered unless either
38party uses the dispute resolution process or other lawful means
39pursuant to Section 10112.81.

P26   1(2) Notwithstanding any other law, the amounts paid by an
2insurer for services under this section shall not constitute the
3prevailing or customary charges, the usual fees to the general
4public, or other charges for other payers for an individual health
5professional.

6(3) This subdivision shall not preclude the use of the independent
7dispute resolution process pursuant to Section 10112.81.

8(e)  This section shall not apply to emergency services and care,
9as defined in Section 1317.1 of the Health and Safety Code.

10(f)  The definitions in subdivision (f) of Section 10112.8 shall
11apply for purposes of this section.

begin insert

12
(g) This section shall not be construed to alter a health insurer’s
13obligations pursuant to Section 10123.13.

end insert
14

SEC. 7.  

The Legislature finds and declares that Sections 2 and
156 of this act, which add Section 1371.31 to the Health and Safety
16Code and Section 10112.82 to the Insurance Code, respectively,
17impose a limitation on the public’s right of access to the meetings
18of public bodies or the writings of public officials and agencies
19within the meaning of Section 3 of Article I of the California
20Constitution. Pursuant to that constitutional provision, the
21Legislature makes the following findings to demonstrate the interest
22protected by this limitation and the need for protecting that interest:

23In order to protect confidential rate information used by health
24care service plans and health insurers and to protect the integrity
25of the competitive market, it is necessary that this act limit the
26public’s right of access to that information.

27

SEC. 8.  

No reimbursement is required by this act pursuant to
28Section 6 of Article XIII B of the California Constitution because
29the only costs that may be incurred by a local agency or school
30district will be incurred because this act creates a new crime or
31infraction, eliminates a crime or infraction, or changes the penalty
32for a crime or infraction, within the meaning of Section 17556 of
33the Government Code, or changes the definition of a crime within
34the meaning of Section 6 of Article XIII B of the California
35Constitution.



O

    93