BILL NUMBER: SB 1092	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  MAY 30, 2002
	AMENDED IN SENATE  APRIL 17, 2001

INTRODUCED BY   Senator Sher

                        FEBRUARY 23, 2001

   An act to  amend Section 1368 of   add
Section 1348.9 to  the Health and Safety Code, relating to
health care service plans.



	LEGISLATIVE COUNSEL'S DIGEST


   SB 1092, as amended, Sher.  Health care service plans.
   Existing law, the Knox-Keene Health Care Service Plan Act of 1975,
provides for the regulation of health care service plans by the
Department of Managed Health Care.   The act requires, as
part of this regulation, that each plan establish and maintain a
system approved by the department whereby subscribers and enrollees
may submit their grievances to the plan.
   This bill would define the term grievance for these purposes.  The
bill would also define the term "complaint" and would make
distinctions between grievances and complaints.  This bill would also
require each plan to develop a mechanism for logging, tracking, and
reviewing complaints submitted by subscribers and enrollees.
   Because this bill would place additional requirements on health
care service plans which are governed by the Knox-Keene Health Care
Service Plan Act of 1975, a violation of which is a crime, it would
create 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.    Existing law requires
each plan licensed by the department to pay various fees associated
with the department's regulatory activities, including a share of
costs and expenses associated with financial examinations,
grievances, and complaints.
   This bill would require the Director of Managed Health Care to
adopt regulations on or before July 1, 2003, to establish the
Consumer Participation Program, which would allow for the director to
award reasonable advocacy and witness fees to any person who
demonstrates that the person represents the interests of consumers
and who has made a substantial contribution on behalf of consumers to
the adoption of any order, regulation, or decision made by the
director, other than the resolution of individual grievances,
complaints, or cases.  The bill would provide that fees awarded under
these provisions would be considered costs and expenses of the
department that may be recovered from health care service plans.

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


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

  
  SECTION 1.  Section 1368 of the Health and Safety Code is 

  SECTION 1.  (a) The Legislature finds and declares that consumer
participation programs at the Public Utilities Commission and the
Department of Insurance have been a cost-effective and successful
means of encouraging consumer protection, expertise, and
participation in rate setting and adjudicatory and quasi-legislative
proceedings.
   (b) The Legislature further finds and declares that by ensuring
that these proceedings have the benefit of consumer expertise and
evidence, consumer participation programs have saved California
taxpayers billions of dollars and have significantly improved the
decisions made by the affected agencies.
   (c) It is the intent of the Legislature to establish a consumer
participation program administered by the Department of Managed
Health Care that will promote the interests and effective
representation of consumers and assist the department in ensuring
affordable and effective delivery of health care to the people of
this state who are eligible to enroll in or subscribe to a health
care service plan or a specialized health care service plan.
   (d) It is further the intent of the Legislature that this act
shall be administered in a manner that encourages the effective and
efficient participation of all organizations representing the
interests of consumers that have a stake in the regulation of health
care service plans or specialized health care service plans.
  SEC. 2.  Section 1348.9 is added to the Health and Safety Code, to
read:
   1348.9.  (a) On or before July 1, 2003, the director shall adopt
regulations to establish the Consumer Participation Program, which
shall allow for the director to award reasonable advocacy and witness
fees to any person who demonstrates that the person represents the
interests of consumers and who has made a substantial contribution on
behalf of consumers to the adoption of any order, regulation, or
decision made by the director.
   (b) The regulations adopted by the director shall include
specifications for eligibility of participation, rates of
compensation, and procedures for seeking compensation.
   (c) This section shall apply to all proceedings of the department,
but shall not apply to resolution of individual grievances,
complaints, or cases.
   (d) Fees awarded pursuant to this section shall be considered
costs and expenses pursuant to Section 1356. 
_____________________________________    All matter omitted in this
version    of the bill appears in the bill as    amended in the
Senate    April 17, 2001 (JR 11)
____________________________________