Amended in Senate April 6, 2015

Senate BillNo. 4


Introduced by Senator Lara

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(Principal coauthor: Assembly Member Bonta)

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(Coauthors: Senators Hancock, Hueso, Mitchell, Monning, and Pan)

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(Coauthor: Assembly Member Levine)

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December 1, 2014


begin deleteAn act relating to health care coverage. end deletebegin insertAn act to add and repeal Section 100522 of, and to add and repeal Title 22.5 (commencing with Section 100530) of, the Government Code, to add and repeal Section 1366.7 of the Health and Safety Code, to add and repeal Section 10112.31 of the Insurance Code, and to add Sections 14102.1 and 14102.2 to the Welfare and Institutions Code, relating to health care coverage, and making an appropriation therefor.end insert

LEGISLATIVE COUNSEL’S DIGEST

SB 4, as amended, Lara. Health care coverage: immigration status.

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Existing law, the federal Patient Protection and Affordable Care Act (PPACA), requires each state to establish an American Health Benefit Exchange that facilitates the purchase of qualified health plans by qualified individuals and qualified small employers, and meets certain other requirements. PPACA specifies that an individual who is not a citizen or national of the United States or an alien lawfully present in the United States shall not be treated as a qualified individual and may not be covered under a qualified health plan offered through an exchange. Existing law creates the California Health Benefit Exchange for the purpose of facilitating the enrollment of qualified individual and qualified small employers in qualified health plans as required under PPACA.

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Existing law governs health care service plans and insurers. A willful violation of the provisions governing health care service plans is a crime.

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This bill would require the Secretary of California Health and Human Services to apply to the United States Department of Health and Human Services for a waiver to allow individuals who are not eligible to obtain health coverage because of their immigration status to obtain coverage from the California Health Benefit Exchange. The bill would require the California Health Benefit Exchange to offer qualified health benefit plans, as specified, to these individuals. The bill would require that individuals eligible to purchase California qualified health plans pay the cost of coverage without federal assistance. These requirements would become operative when federal approval of the waiver is granted. If federal approval is not granted on or before January 1, 2017, the bill would create the California Health Exchange Program for all Californians within state government.

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The bill would require that the California Health Exchange Program for All Californians (Program) be governed by the executive board that governs the California Health Benefit Exchange. The bill would specify the duties of the board relative to the Program and would require the board to, by a specified date, facilitate the enrollment into qualified health plans of individuals who are not eligible for full-scope Medi-Cal coverage and would have been eligible to purchase coverage through the Exchange but for their immigration status. The bill would require the board to provide premium subsidies and cost-sharing reductions to eligible individuals that are the same as the premium assistance and cost-sharing reductions the individuals would have received through the Exchange. The bill would create the California Health Trust Fund For All Californians as a continuously appropriated fund, thereby making an appropriation, would require the board to assess a charge on qualified health plans, and would make the implementation of the Program’s provisions contingent on a determination by the board that sufficient financial resources exist or will exist in the fund. The bill would enact other related provisions.

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The bill would require health care services plans and health insurers to fairly and affirmatively offer, market, and sell in the Program at least one product within each of the 5 levels of coverage, as specified. Because a violation of the requirements imposed on health care service plans would be a crime, the bill would impose a state-mandated local program.

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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. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. The federal Medicaid Program provisions prohibit payment to a state for medical assistance furnished to an alien who is not lawfully admitted for permanent residence or otherwise permanently residing in the United States under color of law.

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This bill would extend eligibility for full-scope Medi-Cal benefits to individuals who are otherwise eligible for those benefits but for their immigration status. The bill would require these individuals to enroll into Medi-Cal managed care health plans, and to pay copayments and premium contributions, to the extent required of otherwise eligible Medi-Cal recipients who are similarly situated. The bill would require that benefits for those services be provided with state-only funds only if federal financial participation is not available. Because counties are required to make Medi-Cal eligibility determinations and this bill would expand Medi-Cal eligibility, the bill would impose a state-mandated local program.

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The bill would require the State Department of Health Care Services to develop a transition plan for individuals who are enrolled in restricted-scope Medi-Cal as of a specified date, and who are otherwise eligible for full-scope Medi-Cal coverage but for their immigration status, to transition directly to full-scope Medi-Cal coverage. The bill would require the department to notify these individuals, as specified.

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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.

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This bill would provide that with regard to certain mandates no reimbursement is required by this act for a specified reason.

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With regard to any other mandates, this bill would provide that, if the Commission on State Mandates determines that the bill contains costs so mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.

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Existing law creates the California Health Benefit Exchange for the purpose of facilitating the enrollment of qualified individuals and small employers in qualified health care plans. Existing law also provides for the Medi-Cal program, under which qualified low-income individuals receive health care services.

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This bill would declare the intent of the Legislature all Californians, regardless of immigration status, have access to affordable health coverage and care.

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Vote: majority. Appropriation: begin deleteno end deletebegin insertyesend insert. Fiscal committee: begin deleteno end deletebegin insertyesend insert. State-mandated local program: begin deleteno end deletebegin insertyesend insert.

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

P4    1begin insert

begin insertSECTION 1.end insert  

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begin insert(a)end insertbegin insertend insertbegin insert(1)end insertbegin insertend insertbegin insertThe Legislature finds and declares that
2longstanding California law provides full-scope Medi-Cal to
3United States citizens, lawful permanent residents, and individuals
4permanently residing in the United States under color of law,
5including those granted deferred action.end insert

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6(2) It is the intent of the Legislature in enacting this act to extend
7full-scope Medi-Cal eligibility to California residents who are
8currently ineligible for Medi-Cal due to their immigration status,
9as long as they meet the other requirements of the Medi-Cal
10program.

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11(b) It is the intent of the Legislature that all Californians,
12regardless of immigration status, have access to health coverage
13and care.

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14(c) It is the intent of the Legislature that all Californians who
15are otherwise eligible for Medi-Cal, a qualified health plan offered
16through the California Health Benefits Exchange, or affordable
17employer-based health coverage, enroll in that coverage and obtain
18the care that they need.

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19(d) It is further the intent of the Legislature to ensure that all
20Californians be included in eligibility for coverage without regard
21to immigration status.

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22begin insert

begin insertSEC. 2.end insert  

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begin insertSection 100522 is added to the end insertbegin insertGovernment Codeend insertbegin insert, to
23read:end insert

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24

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(a) The Secretary of California Health and Human
25Services shall apply to the United States Department of Health
26and Human Services for a waiver authorized under Section 1332
27of the federal act as defined in subdivision (e) of Section 100501
28in order to allow persons otherwise not able to obtain coverage
29by reason of immigration status through the Exchange to obtain
30coverage from the Exchange by waiving the requirement that the
31Exchange offer only qualified health plans.

P5    1(b) The Exchange shall offer qualified health benefit plans which
2shall be subject to the requirements of this title, including all of
3those requirements applicable to qualified health plans. In addition,
4California qualified health plans shall be subject to the
5requirements of Section 1366.6 of the Health and Safety Code and
6Section 10112.3 of the Insurance Code in the same manner as
7qualified health plans.

8(c) Persons eligible to purchase California qualified health
9plans shall pay the cost of coverage without federal advanced
10premium tax credit, federal cost-sharing reduction, or any other
11federal assistance.

12(d) Subdivisions (b) and (c) of this section shall become
13operative upon federal approval of the waiver pursuant to
14subdivision (a). If subdivisions (b) and (c) of this section do not
15become operative on or before January 1, 2017, Title 22.5
16(commencing with Section 100530) shall become operative, and
17as of that date, this section is repealed, unless a later enacted
18statute, that is enacted before January 1, 2017, deletes or extends
19that date.

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20begin insert

begin insertSEC. 3.end insert  

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begin insertTitle 22.5 (commencing with Section 100530) is added
21to the end insert
begin insertGovernment Codeend insertbegin insert, to read:end insert

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22 

23Title begin insert22.5.end insert  California Health Exchange Program
24for All Californians

25

 

26

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(a) There is in state government the California Health
27Exchange Program For All Californians, an independent public
28entity not affiliated with an agency or department.

29(b) The program shall be governed by the executive board
30established pursuant to Section 100500. The board shall be subject
31to Section 100500.

32(c) It is the intent of the Legislature in enacting the program to
33provide coverage for Californians who would be eligible for
34coverage and premium subsidies under the California Health
35Benefit Exchange established under Title 22 (commencing with
36Section 100500) but for their immigration status.

37(d) This title shall become operative only if federal approval of
38the waiver described in subdivision (a) of Section 100522 is not
39granted on or before January 1, 2017. If this title does not become
40operative by January 1, 2017, as of that date, this title is repealed,
P6    1unless a later enacted statute, that is enacted before January 1,
22017, deletes or extends that date.

3

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For purposes of this title, the following definitions
4shall apply:

5(a) “Board” means the executive board described in subdivision
6(b) of Section 100530.

7(b) “Carrier” means either a private health insurer holding a
8valid outstanding certificate of authority from the Insurance
9Commissioner or a health care service plan, as defined under
10subdivision (f) of Section 1345 of the Health and Safety Code,
11licensed by the Department of Managed Health Care.

12(c) “Eligible individual” means an individual who would have
13been eligible to purchase coverage through the Exchange but for
14his or her immigration status and who is not eligible for full-scope
15 Medi-Cal coverage under state law.

16(d) “Exchange” means the California Health Benefit Exchange
17established by Section 100500.

18(e) “Federal act” means the federal Patient Protection and
19Affordable Care Act (Public Law 111-148), as amended by the
20federal Health Care and Education Reconciliation Act of 2010
21(Public Law 111-152), and any amendments to, or regulations or
22guidance issued under, those acts.

23(f) “Fund” means the California Health Trust Fund For All
24Californians established by Section 100540.

25(g) “Health plan” and “qualified health plan” have the same
26meanings as those terms are defined in Section 1301 of the federal
27act.

28(h) “Medi-Cal coverage” means coverage under the Medi-Cal
29 program pursuant to Chapter 7 (commencing with Section 14000)
30of Part 3 of Division 9 of the Welfare and Institutions Code.

31(i) “Product” means one of the following:

32(1) A health care service plan contract subject to Article 11.8
33(commencing with Section 1399.845) of Chapter 2.2 of Division
342 of the Health and Safety Code.

35(2) An individual policy of health insurance as defined in Section
36106 of the Insurance Code, subject to Chapter 9.9 (commencing
37with Section 10965) of Part 2 of Division 2 of the Insurance Code.

38(j) “Program” means the California Health Exchange Program
39For All Californians.

P7    1(k) “Supplemental coverage” means coverage through a
2specialized health care service plan contract, as defined in
3subdivision (o) of Section 1345 of the Health and Safety Code, or
4a specialized health insurance policy, as defined in Section 106
5of the Insurance Code.

6

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The board shall, at a minimum, do all of the following:

7(a) Enroll individuals into coverage who would be eligible to
8enroll in the Exchange but for immigration status.

9(b) Implement procedures for the certification, recertification,
10and decertification, of health plans as qualified health plans. The
11board shall require health plans seeking certification as qualified
12health plans to do all of the following:

13(1) Submit a justification for any premium increase before
14implementation of the increase consistent with Article 6.2
15(commencing with Section 1385.01) of Chapter 2.2 of Division 2
16of the Health and Safety Code and Article 4.5 (commencing with
17Section 10181) of Chapter 1 of Part 2 of Division 2 of the
18Insurance Code.

19(2) (A) Make available to the public and submit to the board
20accurate and timely disclosure of the following information:

21(i) Claims payment policies and practices.

22(ii) Periodic financial disclosures.

23(iii) Data on enrollment.

24(iv) Data on disenrollment.

25(v) Data on the number of claims that are denied.

26(vi) Data on rating practices.

27(vii) Information on cost sharing and payments with respect to
28any out-of-network coverage.

29(viii) Information on enrollee and participant rights under state
30law.

31(B) The information required under subparagraph (A) shall be
32provided in plain language.

33(3) Permit individuals to learn, in a timely manner upon the
34request of the individual, the amount of cost sharing, including,
35but not limited to, deductibles, copayments, and coinsurance, under
36the individual’s plan or coverage that the individual would be
37responsible for paying with respect to the furnishing of a specific
38item or service by a participating provider. At a minimum, this
39information shall be made available to the individual through an
P8    1Internet Web site and through other means for individuals without
2access to the Internet.

3(c) Provide for the operation of a toll-free telephone hotline to
4respond to requests for assistance.

5(d) Maintain an Internet Web site through which enrollees and
6prospective enrollees of qualified health plans may obtain
7standardized comparative information on those plans.

8(e) Assign a rating to each qualified health plan offered through
9the program in accordance with the criteria developed by the
10board.

11(f) Utilize a standardized format for presenting health benefits
12plan options in the program.

13(g) Inform individuals of eligibility requirements for the
14Medi-Cal program, the Exchange, or any applicable state or local
15public program and, if through screening of the application by the
16program, the program determines that an individual is eligible for
17the state or local program, enroll that individual in that program.

18(h) Establish and make available by electronic means a
19calculator to determine the actual cost of coverage.

20(i) Establish a navigator program. Any entity chosen by the
21board as a navigator under this subdivision shall do all of the
22following:

23(1) Conduct public education activities to raise awareness of
24the availability of qualified health plans through the program.

25(2) Distribute fair and impartial information concerning
26enrollment in qualified health plans, and the availability of
27premium subsidies and cost-sharing reductions through the
28program.

29(3) Facilitate enrollment in qualified health plans.

30(4) Provide referrals to any applicable office of health insurance
31consumer assistance or health insurance ombudsman established
32under Section 2793 of the federal Public Health Service Act (42
33U.S.C. Sec. 300gg-93), or any other appropriate state agency or
34agencies, for any enrollee with a grievance, complaint, or question
35regarding his or her health plan, coverage, or a determination
36under that plan or coverage.

37(5) Provide information in a manner that is culturally and
38linguistically appropriate to the needs of the population being
39served by the program.

P9    1

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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
35100534.

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
13health plans.

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
17program.

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
25language proficiency.

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
29consistent 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
34program.

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 issues. The
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
33title.

34(t) Consult with stakeholders relevant to carrying out the
35activities under this title, including, but not limited to, all of the
36following:

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.

16

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(a) The board may do the following:

17(1) Collect premiums.

18(2) Enter into contracts.

19(3) Sue and be sued.

20(4) Receive and accept gifts, grants, or donations of moneys
21from any agency of the United States, any agency of the state, or
22any municipality, county, or other political subdivision of the state.

23(5) Receive and accept gifts, grants, or donations from
24individuals, associations, private foundations, or corporations, in
25compliance with the conflict-of-interest provisions to be adopted
26 by the board at a public meeting.

27(6) Adopt rules and regulations, as necessary. Until January 1,
282018, any necessary rules and regulations may be adopted as
29emergency regulations in accordance with the Administrative
30Procedure Act (Chapter 3.5 (commencing with Section 11340) of
31Part 1 of Division 3 of Title 2). The adoption of these regulations
32shall be deemed to be an emergency and necessary for the
33immediate preservation of the public peace, health and safety, or
34general welfare.

35(7) Collaborate with the Exchange and the State Department
36of Health Care Services, to the extent possible, to allow an
37individual the option to remain enrolled with his or her carrier
38and provider network in the event the individual experiences a
39loss of eligibility for enrollment in a qualified health plan under
40this title and becomes eligible for the Exchange or the Medi-Cal
P13   1program, or loses eligibility for the Medi-Cal program and
2becomes eligible for a qualified health plan through the program.

3(8) Share information with relevant state departments, consistent
4with the applicable laws governing confidentiality, necessary for
5the administration of the program.

6(9) Require carriers participating in the program to make
7available to the program and regularly update an electronic
8directory of contracting health care providers so that individuals
9seeking coverage through the program can search by health care
10provider name to determine which health plans in the program
11include that health care provider in their network. The board may
12also require a carrier to provide regularly updated information
13to the program as to whether a health care provider is accepting
14new patients for a particular health plan. The program may provide
15an integrated and uniform consumer directory of health care
16providers indicating which carriers the providers contract with
17and whether the providers are currently accepting new patients.
18The program may also establish methods by which health care
19providers may transmit relevant information directly to the
20program, rather than through a carrier.

21(10) Make available supplemental coverage for enrollees of the
22program to the extent permitted by available funding. Any
23supplemental coverage offered in the program shall be subject to
24the charge imposed under subdivision (n) of Section 100533.

25(11) Make available premium subsidies and cost-sharing
26reductions to the extent funding is available.

27(b) (1) An applicant for health care coverage shall be required
28to provide only the information strictly necessary to authenticate
29identity, determine eligibility, and determine the amount of the
30credit or reduction.

31(2) Any person who receives information provided by an
32applicant pursuant to paragraph (1), whether directly or by another
33person at the request of the applicant, or otherwise obtains
34information about the applicant through the program process shall
35do both of the following:

36(A) Use the information only for the purposes of, and to the
37extent necessary in, ensuring the efficient operation of the program,
38including verifying the eligibility of an individual to enroll through
39the program.

P14   1(B) Not disclose the information to any other person except as
2provided in this section.

3(c) The board shall have the authority to standardize products
4to be offered through the program.

5

begin insert100535.end insert  

The board shall establish and use a competitive
6process to select participating carriers and any other contractors
7under this title. Any contract entered into pursuant to this title
8shall be exempt from Chapter 1 (commencing with Section 10100)
9of Part 2 of Division 2 of the Public Contract Code, and shall be
10exempt from the review or approval of any division of the
11Department of General Services.

12

begin insert100536.end insert  

(a) The board shall establish an appeals process for
13prospective and current enrollees of the program.

14(b) The board shall not be required to provide an appeal if the
15subject of the appeal is within the jurisdiction of the Department
16of Managed Health Care pursuant to the Knox-Keene Health Care
17Service Plan Act of 1975 (Chapter 2.2 (commencing with Section
181340) of Division 2 of the Health and Safety Code) and its
19implementing regulations, or within the jurisdiction of the
20Department of Insurance pursuant to the Insurance Code and its
21implementing regulations.

22

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(a) Notwithstanding any other law, the program shall
23not be subject to licensure or regulation by the Department of
24Insurance or the Department of Managed Health Care.

25(b) Carriers that contract with the program shall have a license
26or certificate of authority from, and shall be in good standing with,
27their respective regulatory agencies.

28

begin insert100538.end insert  

(a) Records of the program that reveal the deliberative
29processes, discussions, communications, or any other portion of
30the negotiations with entities contracting or seeking to contract
31with the program, entities with which the program is considering
32a contract, or entities with which the program is considering or
33enters into any other arrangement under which the program
34provides, receives, or arranges services or reimbursement shall
35be exempt from disclosure under the California Public Records
36Act (Chapter 3.5 (commencing with Section 6250) of Division 7
37of Title 1).

38(b) The following records of the program shall be exempt from
39disclosure under the California Public Records Act (Chapter 3.5
P15   1(commencing with Section 6250) of Division 7 of Title 1) as
2follows:

3(1) (A) Except for the portion of a contract that contains the
4rates of payments, contracts with participating carriers entered
5into pursuant to this title on or after the date the act that added
6this subparagraph becomes effective, shall be open to inspection
7one year after the effective dates of the contracts.

8(B) If contracts with participating carriers entered into pursuant
9to this title are amended, the amendments shall be open to
10inspection one year after the effective date of the amendments.

11(c) Three years after a contract or amendment is open to
12inspection pursuant to subdivision (b), the portion of the contract
13or amendment containing the rates of payment shall be open to
14inspection.

15(d) Notwithstanding any other law, entire contracts with
16participating carriers or amendments to contracts with
17participating carriers shall be open to inspection by the Joint
18Legislative Audit Committee. The committee shall maintain the
19confidentiality of the contracts and amendments until the contracts
20or amendments to a contract are open to inspection pursuant to
21subdivisions (b) and (c).

22

begin insert100539.end insert  

(a) No individual or entity shall hold himself, herself,
23or itself out as representing, constituting, or otherwise providing
24services on behalf of the program unless that individual or entity
25has a valid agreement with the program to engage in those
26activities.

27(b) Any individual or entity who aids or abets another individual
28or entity in violation of this section shall also be in violation of
29this section.

30

begin insert100540.end insert  

(a) The California Health Trust Fund For All
31Californians is hereby created in the State Treasury for the purpose
32of this title. Notwithstanding Section 13340, all moneys in the fund
33shall be continuously appropriated without regard to fiscal year
34for the purposes of this title. Any moneys in the fund that are
35unexpended or unencumbered at the end of a fiscal year may be
36carried forward to the next succeeding fiscal year.

37(b) The board of the program shall establish and maintain a
38prudent reserve in the fund.

39(c) The board or staff of the program shall not utilize any funds
40intended for the administrative and operational expenses of the
P16   1program for staff retreats, promotional giveaways, excessive
2executive compensation, or promotion of federal or state legislative
3or regulatory modifications.

4(d) Notwithstanding Section 16305.7, all interest earned on the
5moneys that have been deposited into the fund shall be retained
6in the fund and used for purposes consistent with the fund.

7(e) Effective January 1, 2018, if at the end of any fiscal year,
8the fund has unencumbered funds in an amount that equals or is
9more than the board approved operating budget of the program
10for the next fiscal year, the board shall reduce the charges imposed
11under subdivision (n) of Section 100533 during the following fiscal
12year in an amount that will reduce any surplus funds of the
13program to an amount that is equal to the agency’s operating
14budget for the next fiscal year.

15

begin insert100541.end insert  

(a) The board shall ensure that the establishment,
16operation, and administrative functions of the program do not
17exceed the combination of state funds, private donations, and other
18non-General Fund moneys available for this purpose.

19(b) The implementation of the provisions of this title, other than
20this section, Section 100530, and paragraphs (4) and (5) of
21subdivision (a) of Section 100534, shall be contingent on a
22determination by the board that sufficient financial resources exist
23or will exist in the fund. The determination shall be based on at
24least the following:

25(1) Financial projections identifying that sufficient resources
26exist or will exist in the fund to implement the program.

27(2) A comparison of the projected resources available to support
28the program and the projected costs of activities required by this
29title.

30(3) The financial projections demonstrate the sufficiency of
31resources for at least the first two years of operation under this
32title.

33(c) The board shall provide notice to the Joint Legislative Budget
34Committee and the Director of Finance that sufficient financial
35resources exist in the fund to implement this title.

36(d) If the board determines that the level of resources in the
37fund cannot support the actions and responsibilities described in
38subdivision (a), it shall provide the Department of Finance and
39the Joint Legislative Budget Committee a detailed report on the
40changes to the functions, contracts, or staffing necessary to address
P17   1the fiscal deficiency along with any contingency plan should it be
2impossible to operate the program without the use of General Fund
3moneys.

4(e) The board shall assess the impact of the program’s
5operations and policies on other publicly funded health programs
6administered by the state and the impact of publicly funded health
7programs administered by the state on the program’s operations
8and policies. This assessment shall include, at a minimum, an
9analysis of potential cost shifts or cost increases in other programs
10that may be due to program policies or operations. The assessment
11shall be completed on at least an annual basis and submitted to
12the Secretary of California Health and Human Services and the
13Director of Finance.

end insert
14begin insert

begin insertSEC. 4.end insert  

end insert

begin insertSection 1366.7 is added to the end insertbegin insertHealth and Safety Codeend insertbegin insert,
15to read:end insert

begin insert
16

begin insert1366.7.end insert  

(a) For purposes of this section, the following
17definitions shall apply:

18(1) “Federal act” means the federal Patient Protection and
19Affordable Care Act (Public Law 111-148), as amended by the
20federal Health Care and Education Reconciliation Act of 2010
21(Public Law 111-152), and any amendments to, or regulations or
22guidance issued under, those acts.

23(2) “Health plan” has the same meaning as that term is defined
24in subdivision (g) of Section 100530 of the Government Code.

25(3) “Program” means the California Health Exchange Program
26For All Californians established in Title 22.5 (commencing with
27Section 100530) of the Government Code.

28(b) Health care service plans participating in the program shall
29fairly and affirmatively offer, market, and sell in the program at
30least one product within each of the five levels of coverage
31contained in Section 1302(d) and (e) of the federal act. The
32executive board established under Section 100530 of the
33Government Code may require plans to sell additional products
34within each of those levels of coverage. This subdivision shall not
35apply to a plan that solely offers supplemental coverage in the
36program under paragraph (10) of subdivision (a) of Section 100534
37of the Government Code.

38(c) (1) Health care service plans participating in the program
39that sell any products outside the program shall fairly and
40affirmatively offer, market, and sell all products made available
P18   1to individuals in the program to individuals purchasing coverage
2 outside the program.

3(2) For purposes of this subdivision, “product” does not include
4contracts entered into pursuant to Chapter 8 (commencing with
5Section 14200) of Part 3 of Division 9 of the Welfare and
6Institutions Code between the State Department of Health Care
7Services and health care service plans for enrolled Medi-Cal
8beneficiaries.

9(d) Commencing January 1, 2015, a health care service plan
10shall, with respect to plan contracts that cover hospital, medical,
11or surgical benefits, only sell the five levels of coverage contained
12in Section 1302(d) and (e) of the federal act, except that a health
13care service plan that does not participate in the program shall,
14with respect to plan contracts that cover hospital, medical, or
15surgical benefits, only sell the four levels of coverage contained
16in Section 1302(d) of the federal act.

17(e) Commencing January 1, 2015, a health care service plan
18that does not participate in the program shall, with respect to plan
19contracts that cover hospital, medical, or surgical benefits, offer
20at least one standardized product that has been designated by the
21program in each of the four levels of coverage contained in Section
221302(d) of the federal act. This subdivision shall only apply if the
23executive board of the program exercises its authority under
24subdivision (c) of Section 100534 of the Government Code. Nothing
25in this subdivision shall require a plan that does not participate
26in the program to offer standardized products in the small employer
27market if the plan only sells products in the individual market.
28Nothing in this subdivision shall require a plan that does not
29participate in the program to offer standardized products in the
30individual market if the plan only sells products in the small
31employer market. This subdivision shall not be construed to
32prohibit the plan from offering other products provided that it
33complies with subdivision (d).

34(f) A health care service plan participating in the program shall
35charge the same rate for the same product whether that product
36is offered through the program or in the outside market
37notwithstanding any charge imposed by the program pursuant to
38subdivision (n) of Section 100533 of the Government Code.

39(g) This section shall become operative only if Title 22.5
40(commencing with Section 100530) of the Government Code
P19   1becomes operative on or before January 1, 2017. If this section
2does not become operative by January 1, 2017, as of that date,
3this section is repealed, unless a later enacted statute, that is
4enacted before January 1, 2017, deletes or extends that date.

end insert
5begin insert

begin insertSEC. 5.end insert  

end insert

begin insertSection 10112.31 is added to the end insertbegin insertInsurance Codeend insertbegin insert, to
6read:end insert

begin insert
7

begin insert10112.31.end insert  

(a) For purposes of this section, the following
8definitions shall apply:

9(1) “Federal act” means the federal Patient Protection and
10Affordable Care Act (Public Law 111-148), as amended by the
11federal Health Care and Education Reconciliation Act of 2010
12(Public Law 111-152), and any amendments to, or regulations or
13guidance issued under, those acts.

14(2) “Health plan” has the same meaning as that term is defined
15in subdivision (g) of Section 100530 of the Government Code.

16(3) “Program” means the California Health Exchange Program
17For All Californians established in Title 22.5 (commencing with
18Section 100530) of the Government Code.

19(b) Health insurers participating in the program shall fairly
20and affirmatively offer, market, and sell in the program at least
21one product within each of the five levels of coverage contained
22in Section 1302(d) and (e) of the federal act. The executive board
23established under Section 100530 of the Government Code may
24require insurers to sell additional products within each of those
25levels of coverage. This subdivision shall not apply to an insurer
26that solely offers supplemental coverage in the program under
27paragraph (10) of subdivision (a) of Section 100534 of the
28Government Code.

29(c) (1) Health insurers participating in the program that sell
30any products outside the program shall fairly and affirmatively
31offer, market, and sell all products made available to individuals
32in the program to individuals purchasing coverage outside the
33 program.

34(2) For purposes of this subdivision, “product” does not include
35contracts entered into pursuant to Chapter 8 (commencing with
36Section 14200) of Part 3 of Division 9 of the Welfare and
37Institutions Code between the State Department of Health Care
38Services and health insurers for enrolled Medi-Cal beneficiaries.

39(d) Commencing January 1, 2015, an insurer shall, with respect
40to policies that cover hospital, medical, or surgical benefits, only
P20   1sell the five levels of coverage contained in Section 1302(d) and
2(e) of the federal act, except that an insurer that does not
3participate in the program shall, with respect to policies that cover
4hospital, medical, or surgical benefits, only sell the four levels of
5coverage contained in Section 1302(d) of the federal act.

6(e) Commencing January 1, 2015, an insurer that does not
7participate in the program shall, with respect to policies that cover
8hospital, medical, or surgical benefits, offer at least one
9standardized product that has been designated by the program in
10each of the four levels of coverage contained in Section 1302(d)
11of the federal act. This subdivision shall only apply if the board
12of the program exercises its authority under subdivision (c) of
13Section 100534 of the Government Code. Nothing in this
14subdivision shall require an insurer that does not participate in
15the program to offer standardized products in the small employer
16market if the insurer only sells products in the individual market.
17Nothing in this subdivision shall require an insurer that does not
18participate in the program to offer standardized products in the
19individual market if the insurer only sells products in the small
20employer market. This subdivision shall not be construed to
21prohibit the insurer from offering other products provided that it
22complies with subdivision (d).

23(f) An insurer participating in the program shall charge the
24same rate for the same product whether that product is offered
25through the program or in the outside market notwithstanding any
26charge imposed by the program pursuant to subdivision (n) of
27Section 100533 of the Government Code.

28(g) This section shall become operative only if Title 22.5
29(commencing with Section 100530) of the Government Code
30becomes operative on or before January 1, 2017. If this section
31does not become operative by January 1, 2017, as of that date,
32this section is repealed, unless a later enacted statute, that is
33enacted before January 1, 2017, deletes or extends that date.

end insert
34begin insert

begin insertSEC. 6.end insert  

end insert

begin insertSection 14102.1 is added to the end insertbegin insertWelfare and Institutions
35Code
end insert
begin insert, to read:end insert

begin insert
36

begin insert14102.1.end insert  

(a) Notwithstanding any other law, individuals who
37meet all of the eligibility requirements for full-scope Medi-Cal
38benefits under this chapter, but for their immigration status, shall
39be eligible for full-scope Medi-Cal benefits.

P21   1(b) This section shall not apply to individuals eligible for
2coverage pursuant to Section 14102.

3(c) Individuals who are eligible under subdivision (a) shall be
4required to enroll into Medi-Cal managed care health plans to the
5extent required of otherwise eligible Medi-Cal recipients who are
6similarly situated.

7(d) Individuals who are eligible under subdivision (a) shall pay
8copayments and premium contributions to the extent required of
9otherwise eligible Medi-Cal recipients who are similarly situated.

10(e) Benefits for services under this section shall be provided
11with state-only funds only if federal financial participation is not
12available for those services. The department shall maximize federal
13financial participation in implementing this section to the extent
14allowable.

15(f) Notwithstanding Chapter 3.5 (commencing with Section
1611340) of Part 1 of Division 3 of Title 2 of the Government Code,
17the department, without taking any further regulatory action, shall
18implement, interpret, or make specific this section by means of
19all-county letters, plan letters, plan or provider bulletins, or similar
20instructions until the time regulations are adopted. The department
21shall adopt regulations by July 1, 2018, in accordance with the
22requirements of Chapter 3.5 (commencing with Section 11340) of
23Part 1 of Division 3 of Title 2 of the Government Code.
24Commencing July 1, 2016, and notwithstanding Section 10231.5
25of the Government Code, the department shall provide a status
26report to the Legislature on a semiannual basis, in compliance
27with Section 9795 of the Government Code, until regulations have
28been adopted.

end insert
29begin insert

begin insertSEC. 7.end insert  

end insert

begin insertSection 14102.2 is added to the end insertbegin insertWelfare and Institutions
30Code
end insert
begin insert, to read:end insert

begin insert
31

begin insert14102.2.end insert  

(a) (1) Except as provided in subdivision (c),
32individuals who are enrolled in restricted scope Medi-Cal as of
33December 31, 2015, who are eligible under Section 14102.1 shall
34be transitioned directly to full-scope coverage under the Medi-Cal
35program in accordance with the requirements of this section. The
36department shall develop a transition plan for those currently
37enrolled in restricted scope Medi-Cal.

38(2) For purposes of this section, an “emergency care provider”
39is defined as a hospital in the county of his or her residence where
40the individual received emergency care, if any.

P22   1(b) Except as provided in subdivision (c), with respect to
2managed care health plan enrollment, a restricted-scope enrollee
3who applies and is determined eligible before October 1, 2015,
4shall be notified by the department at least 60 days before January
51, 2016, in accordance with the department’s transition plan of
6all of the following:

7(1) Which Medi-Cal managed care health plan or plans contain
8his or her existing emergency care provider, if the department has
9this information and the emergency care provider is contracted
10with a Medi-Cal managed care health plan.

11(2) That the restricted scope enrollee, subject to his or her ability
12to change as described in paragraph (3), will be assigned to a
13health plan that includes his or her emergency care provider and
14enrolled effective January 1, 2014. If the enrollee wants to keep
15his or her emergency care provider, no additional action shall be
16required if the emergency care provider is contracted with a
17 Medi-Cal managed care health plan.

18(3) That the restricted scope enrollee may choose any available
19Medi-Cal managed care health plan and primary care provider
20in his or her county of residence before January 1, 2016, if more
21than one such plan is available in the county where he or she
22resides, and he or she will receive all provider and health plan
23information required to be sent to new enrollees and instructions
24on how to choose or change his or her health plan and primary
25care provider.

26(4) That in counties with more than one Medi-Cal managed
27care health plan, if the restricted scope enrollee does not
28affirmatively choose a plan within 30 days of receipt of the notice,
29he or she shall be enrolled into the Medi-Cal managed care health
30plan that contains his or her emergency care provider as part of
31the Medi-Cal managed care contracted network, if the department
32has this information about the emergency care provider, and the
33emergency care provider is contracted with a Medi-Cal managed
34care health plan. If the emergency care provider is contracted with
35more than one Medi-Cal managed care health plan, then the
36restricted scope enrollee shall be assigned to one of the health
37plans containing his or her emergency care provider in accordance
38with an assignment process established to ensure the linkage.

39(5) That the enrollee subject to this section shall receive all
40provider and health plan information required to be sent to new
P23   1enrollees. If the restricted scope enrollee is not assigned to two
2pursuant to paragraph (2), and does not affirmatively select one
3of the available Medi-Cal managed care health plans within 30
4days of receipt of the notice, he or she shall automatically be
5assigned a plan through the department-prescribed
6auto-assignment process.

7(6) That the restricted scope enrollee does not need to take any
8action to be transitioned to full-scope Medi-Cal or to retain his
9or her emergency care provider, if the emergency care provider
10is available pursuant to paragraph (2).

11(7) That the restricted scope enrollee may choose not to
12transition to the full-scope Medi-Cal program, and what this choice
13will mean for his or her health care coverage and access to health
14care services.

15(c) Individuals who qualify under subdivision (a) and who apply
16and are determined eligible for restricted scope after the date
17identified by the department, that is not later than October 1, 2015,
18shall be considered late enrollees. Late enrollees shall be notified
19in accordance with subdivision (b), except according to a different
20timeframe, but will transition to full-scope Medi-Cal coverage on
21January 1, 2016. Late enrollees after the date identified in this
22subdivision shall be transitioned pursuant to the department’s
23restricted scope transition plan process.

24(d) Emergency care providers that receive reimbursement for
25restricted scope coverage shall work with the department and its
26designees during the 2015 and 2016 calendar years to facilitate
27enrollment and data sharing for the purposes of delivering
28Medi-Cal services in the 2016 calendar year.

end insert
29begin insert

begin insertSEC. 8.end insert  

end insert
begin insert

The Legislature finds and declares that Section 3 of
30this act, which adds Section 100538 to the Government Code,
31imposes a limitation on the public’s right of access to the meetings
32of public bodies or the writings of public officials and agencies
33within the meaning of Section 3 of Article I of the California
34Constitution. Pursuant to that constitutional provision, the
35Legislature makes the following findings to demonstrate the interest
36protected by this limitation and the need for protecting that
37interest:

end insert
begin insert

38In order to ensure that the California Health Exchange Program
39For All Californians is not constrained in exercising its fiduciary
40powers and obligations to negotiate on behalf of the public, the
P24   1limitations on the public’s right of access imposed by Section 3 of
2this act are necessary.

end insert
3begin insert

begin insertSEC. 9.end insert  

end insert
begin insert

No reimbursement is required by this act pursuant to
4Section 6 of Article XIII B of the California Constitution for certain
5costs that may be incurred by a local agency or school district
6because, in that regard, this act creates a new crime or infraction,
7eliminates a crime or infraction, or changes the penalty for a crime
8or infraction, within the meaning of Section 17556 of the
9Government Code, or changes the definition of a crime within the
10meaning of Section 6 of Article XIII B of the California
11Constitution.

end insert
begin insert

12However, if the Commission on State Mandates determines that
13this act contains other costs mandated by the state, reimbursement
14to local agencies and school districts for those costs shall be made
15pursuant to Part 7 (commencing with Section 17500) of Division
164 of Title 2 of the Government Code.

end insert
begin delete
17

SECTION 1.  

(a) It is the intent of the Legislature that all
18Californians, regardless of immigration status, have access to
19affordable health coverage and care.

20(b) It is the intent of the Legislature that all Californians who
21are eligible for Medi-Cal, a qualified health plan offered through
22the California Health Benefits Exchange, or affordable
23employer-based health coverage, enroll in that coverage and obtain
24the care that they need.

25(c) It is further the intent of the Legislature to ensure that all
26Californians be included in eligibility for coverage without regard
27to immigration status.

end delete

CORRECTIONS:

Text--Pages 5, 6, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, and 23.




O

Corrected 4-9-15—See last page.     98