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 BillNo. 145

Introduced by Senator Pan

January 27, 2015

An act to addbegin insert and repealend insert Section 100235begin delete toend deletebegin insert ofend insert the Health and Safety Code, relating to health care.


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 wouldbegin delete requireend deletebegin 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:

P2    1


The Legislature finds and declares all of the

3(a) The Robert F. Kennedy Farm Workers Medical Plan is a
4joint labor-management health plan for farm workers organized
5under Section 302(c)(5) of the federal Labor Management Relations
6Act of 1947.

7(b) This plan has been in existence for more than 45 years and
8has provided vital health services to farm workers and their
9families, enabling them to lead healthier lives, make better use of
10their available income, and achieve self-sufficiency.

11(c) The plan has focused on primary and preventive care and
12has significantly alleviated the burden on publicly funded health
13resources in the plan’s coverage areas.

14(d) The plan has saved the state significant sums of money that
15would have otherwise been expended to provide health care.

16(e) The Legislature has determined that the plan isbegin delete the mostend deletebegin insert anend insert
17 efficient andbegin delete least expensiveend deletebegin insert cost-effectiveend insert means to deliver health
18care services to farm workers and their families within the plan’s
19coverage areas. Thus, it is in the state’s interest tobegin delete expandend deletebegin insert maintainend insert
20 the range of health care services provided by the plan without
21threatening the plan’s financial viability.


SEC. 2.  

Section 100235 is added to the Health and Safety Code,
23to read:



(a) The department shall annually reimburse the
25Robert F. Kennedy Farm Workers Medical Plan for claim payments
26that exceed seventy thousand dollars ($70,000) made by the plan
27on behalf of an eligible employee or dependent for a single episode
28of care on or after September 1, 2016. This reimbursement shall
29not exceed three million dollars ($3,000,000) per year.

30(b) To seek reimbursement, commencing after September 1,
312017, and annually thereafter, the plan shall submit to the
32department completed data, verified by an independent certified
33public accountant, for claims paid by the plan for services during
34the preceding year from September 1 to August 31, inclusive.

P3    1(c) (1) If the department receives claims data from the plan
2pursuant to subdivision (b), the department shall analyze that data
3to determine the aggregate amount of claims that exceed seventy
4thousand dollars ($70,000) paid by the plan on behalf of an eligible
5employee or dependent for anybegin delete separateend deletebegin insert singleend insert episode of care.

6(2) No later than 60 days after the department receives claims
7data submitted by the plan, the department shall reimburse the plan
8the amount determined pursuant to paragraph (1), up to the amount
9of three million dollars ($3,000,000) per year.

begin insert

10(d) This section shall remain in effect only until January 1, 2021,
11and as of that date is repealed, unless a later enacted statute that
12is enacted before January 1, 2021, deletes or extends that date.

end insert