BILL NUMBER: AB 1296	AMENDED
	BILL TEXT

	AMENDED IN SENATE  JULY 3, 2007
	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   an entity  offering services
relating to the administration of health benefit plans  to
members and annuitants  , 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   ,
and contract  allowance amounts for  health care 
services  billed   rendered by participating
hospitals, with specified restrictions and disclosure limitations
imposed upon the board  . 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   members  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.  staff the cost, utilization, 
 actual claim payments, and contract allowance amounts for
health care services rendered by participating hospitals to each
member and annuitant. 
   (b) The  member and annuitant health care services cost,
utilization, and payment information   information
specified in subdivision (a)  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   information specified in subdivision (a)
 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 information specified in
subdivision (a) in either individual or aggregated form to any other
health care service plan or insurer or any entity offering services
relating to the administration of health benefit plans, and shall not
make this information available to the public, including, but not
limited to, any summaries, compilations, or rankings derived from
this information. This information shall be used only to make
decisions that materially affect the members and annuitants of the
health benefits program established by the board.  
   (d) The board shall not disclose the member and annuitant health
care services cost, utilization, and payment information or 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 contract allowance
amounts   information specified in subdivision (a), in
either individual or aggregated form,  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) Upon request from a hospital, the board shall, on an annual
basis, provide the hospital a reasonable opportunity to validate the
data that has been provided to the board by a health insurer, health
care service plan, or entity pursuant to subdivision (a). 

   (f) 
    (g)  For purposes of this section:
   (1) "Actual claim payment" means the actual amount paid by the
health care plan or administrator to the  participating 
hospital for a health care service  rendered to a member or
annuitant  , exclusive of member  or annuitant  cost
sharing and any other payment adjustments.
   (2) "Contract allowance amounts" means the negotiated rate that
the  participating  hospital agrees to accept as payment for
a health care service  rendered to a member or annuitant 
under the provider agreement between the health plan or administrator
and the  participating  hospital.
   (3) "Cost" means the full amount billed by the  participating
 hospital for a health care service  rendered to a member or
annuitant  .