BILL NUMBER: SB 1135	CHAPTERED
	BILL TEXT

	CHAPTER  500
	FILED WITH SECRETARY OF STATE  SEPTEMBER 23, 2016
	APPROVED BY GOVERNOR  SEPTEMBER 23, 2016
	PASSED THE SENATE  AUGUST 24, 2016
	PASSED THE ASSEMBLY  AUGUST 18, 2016
	AMENDED IN ASSEMBLY  AUGUST 15, 2016
	AMENDED IN ASSEMBLY  JUNE 30, 2016
	AMENDED IN SENATE  JUNE 1, 2016
	AMENDED IN SENATE  MARCH 30, 2016

INTRODUCED BY   Senator Monning

                        FEBRUARY 18, 2016

   An act to add Section 1367.031 to the Health and Safety Code, and
to add Section 10133.53 to the Insurance Code, relating to health
care coverage.



	LEGISLATIVE COUNSEL'S DIGEST


   SB 1135, Monning. Health care coverage: notice of timely access to
care.
   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 the act a crime. Existing law also provides for the
regulation of health insurers by the Department of Insurance.
Existing law requires each department to develop and adopt
regulations to ensure that enrollees have access to needed health
care services in a timely manner.
   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. Existing law requires each prepaid
health plan to establish a grievance procedure under which enrollees
may submit their grievances.
   This bill would require a health care service plan contract or a
health insurance policy that provides benefits through contracts with
providers for alternative rates that is issued, renewed, or amended
on or after July 1, 2017, to provide information to enrollees and
insureds regarding the standards for timely access to health care
services and other specified health care access information,
including information related to receipt of interpreter services in a
timely manner, no less than annually, and would make these
provisions applicable to Medi-Cal managed care plans. The bill would
also require a health care service plan or a health insurer that
contracts with providers for alternative rates of payment to provide
a contracting health care provider with specified information
relating to the provision of referrals or health care services in a
timely manner.
   Because a willful violation of the bill's provisions by a health
care service plan would be a crime, the 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.


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

  SECTION 1.  Section 1367.031 is added to the Health and Safety
Code, to read:
   1367.031.  (a) A health care service plan contract that is issued,
renewed, or amended on or after July 1, 2017, shall provide
information to an enrollee regarding the standards for timely access
to care adopted pursuant to Section 1367.03 and the information
required by this section, including information related to receipt of
interpreter services in a timely manner, no less than annually.
   (b) A health care service plan at a minimum shall provide
information regarding appointment wait times for urgent care,
nonurgent primary care, nonurgent specialty care, and telephone
screening established pursuant to Section 1367.03 to enrollees and
contracting providers. The information shall also include notice of
the availability of interpreter services at the time of the
appointment pursuant to Section 1367.04. A health care service plan
may indicate that exceptions to appointment wait times may apply if
the department has found exceptions to be permissible.
   (c) The information required to be provided pursuant to this
section shall be provided to an enrollee with individual coverage
upon initial enrollment and annually thereafter upon renewal, and to
enrollees and subscribers with group coverage upon initial enrollment
and annually thereafter upon renewal. A health care service plan may
include this information with other materials sent to the enrollee.
The information shall also be provided in the following manner:
   (1) In a separate section of the evidence of coverage titled
"Timely Access to Care."
   (2) At least annually, in or with newsletters, outreach, or other
materials that are routinely disseminated to the plan's enrollees.
   (3) Commencing January 1, 2018, in a separate section of the
provider directory published and maintained by the health care
service plan pursuant to Section 1367.27. The separate section shall
be titled "Timely Access to Care."
   (4) On the Internet Web site published and maintained by the
health care service plan, in a manner that allows enrollees and
prospective enrollees to easily locate the information.
   (d) (1) A health care service plan shall provide the information
required by this section to contracting providers on no less than an
annual basis.
   (2) A health care service plan shall also inform a contracting
provider of all of the following:
   (A) Information about a health care service plan's obligation
under California law to provide or arrange for timely access to care.

   (B) How a contracting provider or enrollee can contact the health
care service plan to obtain assistance if a patient is unable to
obtain a timely referral to an appropriate provider.
   (C) The toll-free telephone number for the Department of Managed
Health Care where providers and enrollees can file a complaint if
they are unable to obtain a timely referral to an appropriate
provider.
   (3) A health care service plan may comply with this subdivision by
including the information with an existing communication with a
contracting provider.
   (e) This section shall apply to Medi-Cal managed care plan
contracts entered into with the State Department of Health Care
Services pursuant to Chapter 7 (commencing with Section 14000) or
Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of
the Welfare and Institutions Code.
  SEC. 2.  Section 10133.53 is added to the Insurance Code, to read:
   10133.53.  (a) A health insurance policy that is issued, renewed,
or amended on or after July 1, 2017, that provides benefits through
contracts with providers for alternative rates pursuant to Section
10133 shall provide information to an insured regarding the standards
for timely access to care adopted pursuant to Section 10133.5 and
the information required by this section, including information
related to receipt of interpreter services in a timely manner, no
less than annually.
   (b) A health insurer that contracts with providers for alternative
rates of payment pursuant to Section 10133 shall, at a minimum,
provide information regarding appointment wait times for urgent care,
nonurgent primary care, nonurgent specialty care, and telephone
screening established pursuant to Section 10133.5 to insureds and
contracting providers. The information shall also include notice of
the availability of interpreter services at the time of the
appointment pursuant to Section 10133.8. A health insurer may
indicate that exceptions to appointment wait times may apply if the
department has found exceptions to be permissible.
   (c) The information required to be provided pursuant to this
section shall be provided to an insured with individual coverage upon
initial enrollment and annually thereafter upon renewal, and to
insureds and group policyholders with group coverage upon initial
enrollment and annually thereafter upon renewal. An insurer may
include this information with other materials sent to the insured.
The information shall also be provided in the following manner:
   (1) In a separate section of the evidence of coverage titled
"Timely Access to Care."
   (2) At least annually, in or with newsletters, outreach, or other
materials that are routinely disseminated to the policy's insureds.
   (3) Commencing January 1, 2018, in a separate section of the
provider directory published and maintained by the insurer pursuant
to Section 10133.15. The separate section shall be titled "Timely
Access to Care."
   (4) On the Internet Web site published and maintained by the
insurer, in a manner that allows insureds and prospective insureds to
easily locate the information.
   (d) (1) A health insurer shall provide the information required by
this section to contracting providers on no less than an annual
basis.
   (2) A health insurer shall also inform a contracting provider of
all of the following:
   (A) Information about a health insurer's obligation under
California law to provide or arrange for timely access to care.
   (B) How a contracting provider or insured can contact the health
insurer to obtain assistance if a patient is unable to obtain a
timely referral to an appropriate provider.
   (C) The toll-free telephone number for the Department of Insurance
where providers and insureds can file a complaint if they are unable
to obtain a timely referral to an appropriate provider.
   (3)  A health insurer may comply with this subdivision by
including the information with an existing communication with a
contracting provider.
  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.