BILL NUMBER: SB 2136	CHAPTERED  09/29/00

	CHAPTER   856
	FILED WITH SECRETARY OF STATE   SEPTEMBER 29, 2000
	APPROVED BY GOVERNOR   SEPTEMBER 28, 2000
	PASSED THE SENATE   AUGUST 31, 2000
	PASSED THE ASSEMBLY   AUGUST 30, 2000
	AMENDED IN ASSEMBLY   AUGUST 29, 2000
	AMENDED IN ASSEMBLY   AUGUST 25, 2000
	AMENDED IN ASSEMBLY   JULY 6, 2000
	AMENDED IN ASSEMBLY   JUNE 22, 2000
	AMENDED IN SENATE   MAY 9, 2000
	AMENDED IN SENATE   APRIL 24, 2000

INTRODUCED BY   Senator Dunn

                        FEBRUARY 25, 2000

   An act to repeal and add Section 1380.1 of the Health and Safety
Code, relating to health care.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 2136, Dunn.  Health care providers:  multiple audits.
   Existing law requires the Department of Managed Care to conduct
periodically an onsite medical survey of the health delivery system
of each health care plan.  Existing law requires the director, to
avoid duplication, and to the extent feasible, to employ reviews of
providers conducted by professional standards review organizations.
Existing law required a working group, as specified, to recommend
ways to reduce duplicative audits of providers by health plans and to
report, as specified, its findings and recommendations, on or before
January 1, 2000.
   This bill would repeal the provisions relating to the working
group.  The bill would require the Advisory Committee on Managed
Care, in the Department of Managed Care, after having sought comment
from a broad and balanced range of interested parties, to recommend
to the Director of the Department of Managed Care standards for a
uniform medical quality audit system, which would be required to
include a single periodic medical quality audit.  The bill would
require the recommendations to include a list of those private sector
accreditation organizations, if any, that have standards comparable
to the recommended system, and the capability and expertise to
accredit, audit, or credential providers.  The bill would authorize
the director to approve private sector accreditation organizations as
qualified organizations to perform single periodic medical quality
audits.
   The bill would require the Director of the Department of Managed
Care to adopt regulations on a uniform medical quality audit system
on or before January 1, 2002.


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


  SECTION 1.  Section 1380.1 of the Health and Safety Code is
repealed.
  SEC. 2.  Section 1380.1 is added to the Health and Safety Code, to
read:
   1380.1.  (a) The Legislature finds and declares as follows:
   (1) Multiple medical quality audits of health care providers, as
many as 25 for some physician offices, increase costs for health care
providers and health plans, and thus ultimately increase costs for
the purchaser and the consumer, and result in the direction of
limited health care resources to administrative costs instead of to
patient care.
   (2) Streamlining the multiple medical quality audits required by
health care service plans and insurers is vital to increasing the
resources directed to patient care.
   (3) Few legislative proposals affecting health care services have
the potential of benefiting all of the affected parties, including
health plans, health care providers, purchasers, and consumers,
through a reduction in administrative costs but without negatively
affecting patient care.
   (b) The Advisory Committee on Managed Care shall recommend to the
director standards for a uniform medical quality audit system, which
shall include a single periodic medical quality audit.  The director
shall publish proposed regulations in that regard on or before
January 1, 2002.
   (c) In developing those standards, the Advisory Committee on
Managed Care shall seek comment from a broad and balanced range of
interested parties.
   (d) The recommendations shall include all of the following:
   (1) Standards that will serve as the basis of the single periodic
medical quality audit necessary to meet the criteria of this section.

   (2) Standards that will not be covered by the single periodic
medical quality audit and that may be audited directly by health care
service plans.
   (3) A list of those private sector accreditation organizations, if
any, that have or can develop systems comparable to the recommended
system, and the capability and expertise to accredit, audit, or
credential providers.
   (e) (1) The director may approve private sector accreditation
organizations as qualified organizations to perform the single
periodic medical quality audits.
   (2) Audits shall be conducted at least annually.
   (f) The single medical quality audit shall not prevent licensed
health care service plans from developing performance criteria or
conducting separate audits for governmental or regulatory purposes,
purchasers, or to address consumer complaints and grievances,
management changes, or plan initiatives to improve or monitor
quality.