In addition to meeting the requirements of Section
2100532, the board shall do all of the following:
3(a) Determine the criteria and process for eligibility, enrollment,
4and disenrollment of enrollees and potential enrollees in the
5program and coordinate that process with the state and local
6government entities administering other health care coverage
7programs, including the Exchange, the State Department of Health
8Care Services, and California counties, in order to ensure
9consistent eligibility and enrollment processes and seamless
10transitions between coverage.
11(b) Develop processes to coordinate with the county entities
12that administer eligibility for the Medi-Cal program.
13(c) Determine the minimum requirements a carrier must meet
14to be considered for participation in the program, and the
15standards and criteria for selecting qualified health plans to be
16offered through the program that are in the best interests of
17qualified individuals. The board shall consistently and uniformly
18apply these requirements, standards, and criteria to all carriers.
19In the course of selectively contracting for health care coverage
20offered to qualified individuals through the program, the board
21shall seek to contract with carriers so as to provide health care
22coverage choices that offer the optimal combination of choice,
23value, quality, and service.
24(d) Provide, in each region of the state, a choice of qualified
25health plans at each of the five levels of coverage contained in
26Section 1302(d) and (e) of the federal act.
27(e) Require, as a condition of participation in the program,
28carriers to fairly and affirmatively offer, market, and sell in the
29program at least one product within each of the five levels of
30coverage contained in Section 1302(d) and (e) of the federal act.
31The board may require carriers to offer additional products within
32each of those five levels of coverage. This subdivision shall not
33apply to a carrier that solely offers supplemental coverage in the
34program under paragraph (10) of subdivision (a) of Section
36(f) (1) Except as otherwise provided in this section, require, as
37a condition of participation in the program, carriers that sell any
38products outside the program to fairly and affirmatively offer,
39market, and sell all products made available to individuals in the
40program to individuals purchasing coverage outside the program.
P10 1(2) For purposes of this subdivision, “product” does not include
2contracts entered into pursuant to Chapter 7 (commencing with
3Section 14000) or Chapter 8 (commencing with Section 14200) of
4Part 3 of Division 9 of the Welfare and Institutions Code between
5the State Department of Health Care Services and carriers for
6enrolled Medi-Cal beneficiaries. “Product” also does not include
7a bridge plan product offered pursuant to Section 100504.5.
8(g) Determine when an enrollee’s coverage commences and the
9extent and scope of coverage.
10(h) Provide for the processing of applications and the enrollment
11and disenrollment of enrollees.
12(i) Determine and approve cost-sharing provisions for qualified
14(j) Establish uniform billing and payment
policies for qualified
15health plans offered in the program to ensure consistent enrollment
16and disenrollment activities for individuals enrolled in the
18(k) Undertake activities necessary to market and publicize the
19availability of health care coverage and subsidies through the
20program. The board shall also undertake outreach and enrollment
21activities that seek to assist enrollees and potential enrollees with
22enrolling and reenrolling in the program in the least burdensome
23manner, including populations that may experience barriers to
24enrollment, such as the disabled and those with limited English
26(l) Select and set performance standards and compensation for
27navigators selected under subdivision (j) of Section 100532.
28(m) Employ necessary staff. The board shall employ staff
with the applicable requirements imposed under
30subdivision (m) of Section 100503.
31(n) Assess a charge on the qualified health plans offered by
32carriers that is reasonable and necessary to support the
33development, operations, and prudent cash management of the
35(o) Authorize expenditures, as necessary, from the fund to pay
36program expenses to administer the program.
37(p) Keep an accurate accounting of all activities, receipts, and
38expenditures. Commencing January 1, 2017, the board shall
39conduct an annual audit.
P11 1(q) (1) Notwithstanding Section 10231.5, annually prepare a
2written report on the implementation and performance of the
3program functions during the preceding fiscal year, including, at
4a minimum, the manner in which
funds were expended and the
5progress toward, and the achievement of, the requirements of this
6title. The report shall also include data provided by health care
7service plans and health insurers offering bridge plan products
8regarding the extent of health care provider and health facility
9overlap in their Medi-Cal networks as compared to the health care
10provider and health facility networks contracting with the plan or
11insurer in their bridge plan contracts. This report shall be
12transmitted to the Legislature and the Governor and shall be made
13available to the public on the Internet Web site of the program. A
14report made to the Legislature pursuant to this subdivision shall
15be submitted pursuant to Section 9795.
16(2) In addition to the report described in paragraph (1), the
17board shall be responsive to requests for additional information
18from the Legislature, including providing testimony and
19commenting on proposed state legislation or policy
20Legislature finds and declares that activities, including, but not
21limited to, responding to legislative or executive inquiries, tracking
22and commenting on legislation and regulatory activities, and
23preparing reports on the implementation of this title and the
24performance of the program, are necessary state requirements
25and are distinct from the promotion of legislative or regulatory
26modifications referred to in subdivision (c) of Section 100540.
27(r) Maintain enrollment and expenditures to ensure that
28expenditures do not exceed the amount of revenue in the fund, and
29if sufficient revenue is not available to pay estimated expenditures,
30institute appropriate measures to ensure fiscal solvency.
31(s) Exercise all powers reasonably necessary to carry out and
32comply with the duties, responsibilities, and requirements of this
34(t) Consult with stakeholders relevant to carrying out the
35activities under this title, including, but not limited to, all of the
37(1) Health care consumers who are enrolled in health plans.
38(2) Individuals and entities with experience in facilitating
39enrollment in health plans.
40(3) The executive director of the Exchange.
P12 1(4) The State Medi-Cal Director.
2(5) Advocates for enrolling hard-to-reach populations.
3(u) Facilitate the purchase of qualified health plans in the
4program by qualified individuals no later than January 1, 2016.
5(v) Require carriers participating in the program to immediately
6notify the program, under the terms and conditions established by
7the board when an individual is or will be enrolled in or disenrolled
8from any qualified health plan offered by the carrier.
9(w) Ensure that the program provides oral interpretation
10services in any language for individuals seeking coverage through
11the program and makes available a toll-free telephone number for
12the hearing and speech impaired. The board shall ensure that
13written information made available by the program is presented
14in a plainly worded, easily understandable format and made
15available in prevalent languages.