BILL NUMBER: AB 1296	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  APRIL 9, 2007

INTRODUCED BY   Assembly Member Torrico

                        FEBRUARY 23, 2007

   An act to  amend Section 22853 of   add
Section 22854.5 to  the Government Code, relating to public
employee health benefits.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 1296, as amended, Torrico. Public employee health benefits 
: disclosures . 
   The Public Employees' Medical and Hospital Care Act requires the
Board of Administration of the Public Employees' Retirement System to
approve health benefit plans for certain public employees and
annuitants, and authorizes the board to contract with carriers
offering health benefit plans. The act sets forth certain criteria
the board may take into account when considering a contract with an
entity seeking to provide health care benefits or services, and
allows the board to require specified documents from that entity.
 
   This bill would require a health benefit plan or contract, or
entities offering services relating to the administration of health
benefit plans, to disclose to the Board of Administration of the
Public Employees' Retirement System the cost, utilization, and actual
provider claim payments on behalf of each member and annuitant for
all health care services rendered, including the allowance amounts
for services billed. The bill would deem this information
confidential, subject to evidentiary trade secret protections, and
exempt from the California Public Records Act, as specified. 

   The Public Employees' Medical and Hospital Care Act requires the
Board of Administration of the Public Employees' Retirement System to
approve health benefit plans for certain public employees and
annuitants, and authorizes the board to contract with carriers
offering health benefit plans.  
   This bill would make technical, nonsubstantive changes to a
provision of that act. 
   Vote: majority. Appropriation: no. Fiscal committee:  no
  yes  . State-mandated local program: no.


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

   SECTION 1.    Section 22854.5 is added to the 
 Government Code  , to read:  
   22854.5.  (a) A health benefit plan or contract, or an entity
offering services relating to the administration of health benefit
plans to employees and annuitants, shall disclose to the board and
staff the cost, utilization, and actual provider claim payments on
behalf of each member and annuitant for all health care services
rendered, including the provider contract allowance amounts for
services billed for each individual health care provider.
   (b) The member and annuitant health care services cost,
utilization, and payment information shall be deemed confidential
information and protected in accordance with the federal Health
Insurance Portability and Accountability Act of 1996 (42 U.S.C. Sec.
300gg) and the final regulations issued pursuant to the act by the
United States Department of Health and Human Services (45 C.F.R.
Parts 160 and 164). As such, information provided to the board and
staff shall not include individual member or annuitant identifying
information.
   (c) The provider contract allowance amounts and payments shall be
deemed to be confidential trade secret information in accordance with
subdivision (d) of Section 3426.1 of the Civil Code and Section 1060
of the Evidence Code.
   (d) The board shall not disclose the member and annuitant health
care services cost, utilization, and payment information or provider
contract allowance amounts to any other carrier or entity, and shall
not make that information available to the public.
   (e) The member and annuitant health care services cost,
utilization, and payment information and the provider contract
allowance amounts shall be exempt from disclosure under the
California Public Records Act (Chapter 3.5 (commencing with Section
6250) of Division 7 of Title 1) pursuant to subdivision (k) of
Section 6254.  
  SECTION 1.    Section 22853 of the Government Code
is amended to read:
   22853.  (a) Each contract shall contain a detailed statement of
benefits offered and shall include maximums, limitations, exclusions,
and other definitions of benefits as the board deems necessary or
desirable.
   (b) Except as otherwise provided by this part, a health benefit
plan or contract may not exclude any person on account of physical
condition, age, race, or any other status. Except as otherwise
provided by this part, transfer of enrollment to a health benefit
plan shall be open to all employees and annuitants in accordance with
Section 22841.
   (c) A health benefit plan or contract shall offer to each employee
or annuitant whose enrollment in the plan is terminated other than
by cancellation of enrollment, voluntary separation from employment,
or dismissal from employment for cause, the option to convert to an
individual health benefit policy, without regard to health status,
but within the time limit approved by the board. An employee or
annuitant that exercises this option shall pay the full periodic
charges of the individual policy according to the terms and
conditions prescribed by the carrier and approved by the board.
   (d) A health benefit plan or contract shall provide grievance
procedures to protect the rights of employees and annuitants.
   (e) The board shall provide a sufficient number of health benefit
plans that provide chiropractic services so that every employee and
annuitant has a reasonable opportunity to enroll in a health benefit
plan that provides chiropractic services without prior referral by a
physician.