BILL NUMBER: AB 1296	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  MAY 31, 2007
	AMENDED IN ASSEMBLY  APRIL 19, 2007
	AMENDED IN ASSEMBLY  APRIL 9, 2007

INTRODUCED BY   Assembly Member Torrico

                        FEBRUARY 23, 2007

   An act to 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
claim payments on behalf of each member and annuitant for health
care services rendered by hospitals, 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.
   Vote: majority. Appropriation: no. Fiscal committee: 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 claim payments on behalf of
each member and annuitant for health care services rendered by
hospitals, including the contract allowance amounts for services
billed for each individual hospital.
   (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 hospital  cost,  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. 
   (f) For purposes of this section:  
   (1) "Actual claim payment" means the actual amount paid by the
health care plan or administrator to the hospital for a health care
service, exclusive of member cost sharing and any other payment
adjustments.  
   (2) "Contract allowance amounts" means the negotiated rate that
the hospital agrees to accept as payment for a health care service
under the provider agreement between the health plan or administrator
and the hospital.  
   (3) "Cost" means the full amount billed by the hospital for a
health care service.