Amended in Assembly March 26, 2015

California Legislature—2015–16 Regular Session

Assembly Bill No. 1027

Introduced by Assembly Member Gatto

February 26, 2015

An act to begin delete amend Section 11580.010 of end delete begin insert add Section 1367.48 to the Health and Safety Code, and to add Section 10133.62 end insert the Insurance Code, relating to begin delete automobile insurance. end delete begin insert health care coverage. end insert

LEGISLATIVE COUNSEL’S DIGEST

AB 1027, as amended, Gatto. begin delete Automobile insurance coverage: medical transportation services. end delete begin insert Health care coverage: contracted rates: disclosure to consumers. end insert

begin insert

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 and makes a willful violation of that act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan or a health insurer to submit to the Department of Managed Health Care or the Department of Insurance, as applicable, specified rate information, including information regarding the contracted rate between a health care service plan or health insurer and a provider of health care services. Existing law deems that contracted rate confidential information that is exempt from disclosure under the California Public Records Act and prohibits the Department of Managed Health Care or the Department of Insurance, as applicable, from making that information public.

end insert begin insert

This bill would require, notwithstanding the provisions described above deeming contracted rate information confidential and exempt from public disclosure, a health care service plan or a health insurer to disclose, upon request, to a consumer, as defined, information regarding the contracted rate for a procedure or a full course of treatment between the plan or insurer and a provider or supplier, as defined.

end insert begin insert

Because a willful violation of the bill’s requirements relative to health care service plans would be a crime, this bill would impose a state-mandated local program.

end insert begin insert

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.

end insert begin insert

This bill would provide that no reimbursement is required by this act for a specified reason.

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Existing law provides that an automobile liability insurer that is responsible for coverage for ordinary, reasonable, and necessary medical transportation services to an insured, or to a valid claimant on behalf of an insured, is liable to the person performing those services. Existing law provides that the insurer may discharge the obligation by making payment to the person performing those services, to the insured, or to the claimant on behalf of the insured. Existing law provides that an insured or claimant who receives that payment, as specified, from the insurer is liable for those charges to the person performing those services.

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This bill would make technical, nonsubstantive changes to those provisions.

end delete

Vote: majority. Appropriation: no. Fiscal committee:  begin delete no end delete begin insert yes end insert . State-mandated local program:  begin delete no end delete begin insert yes end insert .

The people of the State of California do enact as follows:

begin insert

begin insert SECTION 1. end insert   

end insert

begin insert Section 1367.48 is added to the end insert begin insert Health and Safety
Code end insert begin insert , end insert immediately following Section 1367.46 begin insert , to read: end insert

begin insert

begin insert 1367.48. end insert   

(a) Notwithstanding Section 1385.07, upon the
request of a consumer, a health care service plan shall provide to
the consumer information regarding the contracted rate between
the health care service plan and a provider or supplier for a
procedure or course of treatment, including, but not limited to,
facility, professional, and diagnostic services, prescription drugs,
durable medical equipment, and other items and services related
to the treatment.

(b) The health care service plan shall use the information
available to it at the time of the request in responding to a request
made pursuant to subdivision (a).

(c) The health care service plan shall respond to a request made
pursuant to subdivision (a) no later than 30 calendar days after
receipt of the request.

(d) For the purposes of this section, the following definitions
shall apply:

(1) “Consumer” means an enrollee or subscriber of the health
care service plan or a beneficiary of a self-funded health coverage
arrangement administered by the health care service plan, or a
person entitled to access services through a network established
by the health care service plan.

(2) “Provider” has the same meaning as that term is defined
in Section 1367.50.

(3) “Supplier” has the same meaning as that term is defined in
Section 1367.50.

end insert

begin insert

begin insert SEC. 2. end insert   

end insert

begin insert Section 10133.62 is added to the end insert begin insert Insurance Code end insert begin insert , end insert immediately following Section 10133.6 begin insert , to read: end insert

begin insert

begin insert 10133.62. end insert   

(a) Notwithstanding Section 10181.7, upon the
request of a consumer, a health insurer shall provide to the
consumer information regarding the contracted rate between the
health insurer and a provider or supplier for a procedure or course
of treatment, including, but not limited to, facility, professional,
and diagnostic services, prescription drugs, durable medical
equipment, and other items and services related to the treatment.

(b) The health insurer shall use the information available to it
at the time of the request in responding to a request made pursuant
to subdivision (a).

(c) The health insurer shall respond to a request made pursuant
to subdivision (a) no later than 30 calendar days after receipt of
the request.

(d) For the purposes of this section, the following definitions
shall apply:

(1) “Consumer” means a policyholder or insured of the health
insurer or the beneficiary of a self-funded health coverage
arrangement administered by the health insurer, or other persons
entitled to access services through a network established by the
health insurer.

(2) “Provider” has the same meaning as that term is defined
in Section 10117.52.

(3) “Supplier” has the same meaning as that term is defined in
Section 10117.52.

end insert

begin insert

begin insert SEC. 3. end insert   

end insert begin insert

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.

end insert

begin delete

SECTION 1.  

Section 11580.010 of the Insurance Code is
amended to read:

11580.010.  

(a) An automobile liability insurer that is
responsible for coverage for ordinary, reasonable, and necessary
medical transportation services provided to an insured, or a valid
claimant on behalf of an insured, is liable for those charges to the
person performing those services. The insurer may discharge this
obligation by making payment to the person performing the
medical transportation services or to the insured or to the claimant
on behalf of the insured.

(b) An insured or claimant who has received payment from an
insurer for a loss relating to a vehicle that includes charges for
medical transportation services is liable for those charges to the
person performing those services.

end delete