BILL NUMBER: SB 1092 ENROLLED
BILL TEXT
PASSED THE SENATE AUGUST 31, 2002
PASSED THE ASSEMBLY AUGUST 26, 2002
AMENDED IN ASSEMBLY AUGUST 23, 2002
AMENDED IN ASSEMBLY JUNE 19, 2002
AMENDED IN ASSEMBLY MAY 30, 2002
AMENDED IN SENATE APRIL 17, 2001
INTRODUCED BY Senator Sher
FEBRUARY 23, 2001
An act to add and repeal Section 1348.9 of the Health and Safety
Code, relating to health care service plans.
LEGISLATIVE COUNSEL'S DIGEST
SB 1092, 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. 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 until January 1, 2007, that the Director
of the Department of Managed Health Care 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 or organization demonstrating that the
person or organization represents the interests of consumers and has
made a substantial contribution on behalf of consumers to the
adoption of any regulation or to an order or decision, as specified,
made by the director. 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 but
would prohibit an increase in the amount of the fees. The bill would
also require the department to report to the Legislature before
March 1, 2004, and annually thereafter, specified information
concerning the Consumer Participation Program.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
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 or organization that demonstrates that the person
or organization represents the interests of consumers and has made a
substantial contribution on behalf of consumers to the adoption of
any regulation or to an order or decision made by the director if the
order or decision has the potential to impact a significant number
of enrollees.
(b) The regulations adopted by the director shall include
specifications for eligibility of participation, rates of
compensation, and procedures for seeking compensation. The
regulations shall require that the person or organization demonstrate
a record of advocacy on behalf of health care consumers in
administrative or legislative proceedings in order to determine
whether the person or organization represents the interests of
consumers.
(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 may not exceed three
hundred fifty thousand dollars ($350,000) each fiscal year.
(e) The fees awarded pursuant to this section shall be considered
costs and expenses pursuant to Section 1356 and shall be paid from
the assessment made under that section. Notwithstanding the
provisions of this subdivision, the amount of the assessment shall
not be increased to pay the fees awarded under this section.
(f) The department shall report to the appropriate policy and
fiscal committees of the Legislature before March 1, 2004, and
annually thereafter, the following information:
(1) The amount of reasonable advocacy and witness fees awarded
each fiscal year.
(2) The individuals or organization to whom advocacy and witness
fees were awarded pursuant to this section.
(3) The orders, decisions, and regulations pursuant to which the
advocacy and witness fees were awarded.
(g) This section shall remain in effect only until January 1,
2007, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2007, deletes or extends
that date.