Amended in Assembly September 10, 2015

Amended in Assembly August 31, 2015

Amended in Senate May 5, 2015

Amended in Senate April 23, 2015

Senate Bill No. 145

Introduced by Senator Pan

January 27, 2015

An act to add begin insert and repeal end insert Section 100235 begin delete to end delete begin insert of end insert the Health and Safety Code, relating to health care.

LEGISLATIVE COUNSEL’S DIGEST

SB 145, as amended, Pan. Robert F. Kennedy Farm Workers Medical Plan.

Existing state law requires, for the 2015-16 fiscal year, the State Department of Health Care Services to provide a grant to a health benefit plan that is funded by contributions from agricultural employers, as specified, upon an appropriation of funds for this purpose. Under existing federal law, the Robert F. Kennedy Farm Workers Medical Plan is a nonprofit voluntary employees beneficiary association that provides payments for health care and other benefits to its members.

This bill would begin delete require end delete begin insert require, until January 1, 2021, end insert the department to annually reimburse the Robert F. Kennedy Farm Workers Medical Plan up to $3,000,000 per year for claim payments that exceed $70,000 made by the plan on behalf of an eligible employee or dependent for a single episode of care on or after September 1, 2016. The bill would require the department to make the reimbursement payment within 60 days after it receives specified claims data from the plan.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

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

SECTION 1.  

The Legislature finds and declares all of the
following:

(a) The Robert F. Kennedy Farm Workers Medical Plan is a
joint labor-management health plan for farm workers organized
under Section 302(c)(5) of the federal Labor Management Relations
Act of 1947.

(b) This plan has been in existence for more than 45 years and
has provided vital health services to farm workers and their
families, enabling them to lead healthier lives, make better use of
their available income, and achieve self-sufficiency.

(c) The plan has focused on primary and preventive care and
has significantly alleviated the burden on publicly funded health
resources in the plan’s coverage areas.

(d) The plan has saved the state significant sums of money that
would have otherwise been expended to provide health care.

(e) The Legislature has determined that the plan is begin delete the most end delete begin insert an end insert
efficient and begin delete least expensive end delete begin insert cost-effective end insert means to deliver health
care services to farm workers and their families within the plan’s
coverage areas. Thus, it is in the state’s interest to begin delete expand end delete begin insert maintain end insert
the range of health care services provided by the plan without
threatening the plan’s financial viability.

SEC. 2.  

Section 100235 is added to the Health and Safety Code,
to read:

100235.  

(a) The department shall annually reimburse the
Robert F. Kennedy Farm Workers Medical Plan for claim payments
that exceed seventy thousand dollars ($70,000) made by the plan
on behalf of an eligible employee or dependent for a single episode
of care on or after September 1, 2016. This reimbursement shall
not exceed three million dollars ($3,000,000) per year.

(b) To seek reimbursement, commencing after September 1,
2017, and annually thereafter, the plan shall submit to the
department completed data, verified by an independent certified
public accountant, for claims paid by the plan for services during
the preceding year from September 1 to August 31, inclusive.

(c) (1) If the department receives claims data from the plan
pursuant to subdivision (b), the department shall analyze that data
to determine the aggregate amount of claims that exceed seventy
thousand dollars ($70,000) paid by the plan on behalf of an eligible
employee or dependent for any begin delete separate end delete begin insert single end insert episode of care.

(2) No later than 60 days after the department receives claims
data submitted by the plan, the department shall reimburse the plan
the amount determined pursuant to paragraph (1), up to the amount
of three million dollars ($3,000,000) per year.

begin insert

(d) This section shall remain in effect only until January 1, 2021,
and as of that date is repealed, unless a later enacted statute that
is enacted before January 1, 2021, deletes or extends that date.

end insert