BILL NUMBER: AB 1027	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  MARCH 26, 2015

INTRODUCED BY   Assembly Member Gatto

                        FEBRUARY 26, 2015

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



	LEGISLATIVE COUNSEL'S DIGEST


   AB 1027, as amended, Gatto.  Automobile insurance
coverage: medical transportation services.   Health care
coverage: contracted rates: disclosure to consumers.  
    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.  
   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.  
   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.  
   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.  
   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.  
   This bill would make technical, nonsubstantive changes to those
provisions. 
   Vote: majority. Appropriation: no. Fiscal committee:  no
  yes  . State-mandated local program:  no
  yes  .


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

   SECTION 1.    Section 1367.48 is added to the 
 Health and Safety Code   ,  immediately following
Section 1367.46  , to read:  
   1367.48.  (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. 
   SEC. 2.    Section 10133.62 is added to the 
 Insurance Code   ,  immediately following Section
10133.6  , to read:  
   10133.62.  (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. 
   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.  
  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.