BILL NUMBER: AB 1887 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY APRIL 28, 2010
INTRODUCED BY Assembly Member Villines
( Coauthor: Assembly Member
Monning )
FEBRUARY 16, 2010
An act to amend Section 12711 add Part
6.45 (commencing with Section 12699.70) to Division 2 of the
Insurance Code, relating to health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
AB 1887, as amended, Villines. California Major Risk
Medical Insurance Program. Temporary high risk pool.
Existing law, the federal Patient Protection and Affordable Care
Act, requires the United States Secretary of Health and Human
Services to establish a temporary high-risk health insurance pool
program to provide health insurance coverage for eligible individuals
until January 1, 2014. Existing law authorizes the secretary to
carry out this program directly or through contracts to eligible
entities, including states, and requires that money made available
pursuant to these provisions be used to establish a qualified high
risk pool that meets certain requirements.
Existing law establishes the California Major Risk Medical
Insurance Program, which is administered by the Managed Risk Medical
Insurance Board (MRMIB), to provide major risk medical coverage to
persons who, among other matters, have been rejected for coverage by
at least one private health plan. Existing law authorizes
MRMIB to, among other things, determine the eligibility of
applicants, determine the major risk medical coverage to be provided
to program subscribers, and authorize expenditures from the Major
Risk Medical Insurance Fund to pay program expenses that exceed
subscriber contributions.
This bill would also authorize MRMIB to apply for any federal
funding it determines to be cost effective for purposes of extending
major risk medical coverage to more applicants.
This bill would require MRMIB to establish a temporary high risk
pool to provide health care coverage to specified individuals who
have preexisting conditions and have not been covered under
creditable coverage, as defined, for the 6 months prior to applying
for coverage in the pool. The bill would require coverage in the pool
to meet specified requirements and would require premiums to be
established at a standard rate for a standard population and not have
age rating greater than 4 to 1. The bill would require MRMIB to
apply for federal funding in order to operate the pool and would
enact other related provisions.
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. Part 6.45 (commencing with Section
12699.70) is added to Division 2 of the Insurance Code
, to read:
PART 6.45. TEMPORARY HIGH RISK POOL
12699.70. For purposes of this part, the following definitions
shall apply:
(a) "Board" means the Managed Risk Medical Insurance Board created
pursuant to Section 12710.
(b) "Creditable coverage" has the same meaning as defined in
Section 10198.6.
(c) "Pool" means the temporary high risk pool established by the
board pursuant to this part.
12699.72. (a) The board shall establish a temporary high risk
pool to provide health care coverage to eligible individuals.
(b) Each individual who meets all of the following requirements is
eligible to apply for coverage through the pool:
(1) Is a citizen or national of the United States, or is lawfully
present in the United States, as determined in accordance with
Section 1411 of the Patient Protection and Affordable Care Act
(Public Law 111-148).
(2) Has not been covered under creditable coverage for the six
months prior to applying for coverage through the pool.
(3) Has a preexisting condition.
(c) The benefits and coverage provided through the pool shall, at
a minimum, have an actuarial value of at least 65 percent of total
allowed costs, an out-of-pocket limit no greater than the applicable
amount for high deductible health plans linked to health savings
accounts, and no preexisting condition exclusions.
(d) Premiums for coverage provided through the pool shall be
established at a standard rate for a standard population and not have
an age rating greater than four to one.
(e) The board shall apply for federal funding pursuant to Section
1101 of the Patient Protection and Affordable Care Act (Public Law
111-148) to operate the pool created by this part.
12699.74. Nothing in this part shall be construed to preclude the
board from creating more expansive standards and benefits, lower
cost-sharing requirements, or eligibility criteria that would result
in the inclusion of more enrollees if permitted under federal law and
funded exclusively with federal funds.
SECTION 1. Section 12711 of the Insurance Code
is amended to read:
12711. The board shall have the authority to do all of the
following:
(a) To determine the eligibility of applicants.
(b) To determine the major risk medical coverage to be provided to
program subscribers.
(c) To research and assess the needs of persons not adequately
covered by existing private and public health care delivery systems
and promote means of assuring the availability of adequate health
care services.
(d) To approve subscriber contributions and plan rates and
establish program contribution amounts.
(e) To provide major risk medical coverage for subscribers or to
contract with a participating health plan or plans to provide or
administer major risk medical coverage for subscribers.
(f) To authorize expenditures from the fund to pay program
expenses that exceed subscriber contributions.
(g) To contract for administration of the program or any portion
thereof with any public agency, including any agency of state
government, or with any private entity.
(h) To issue rules and regulations to carry out the purposes of
this part.
(i) To authorize expenditures from the fund or from other moneys
appropriated in the annual Budget Act for purposes relating to
Section 10127.15 of this code or Section 1373.62 of the Health and
Safety Code.
(j) To apply for any federal funding the board determines to be
cost effective for purposes of extending major risk medical coverage
to more applicants.
(k) To exercise all powers reasonably necessary to carry out the
powers and responsibilities expressly granted or imposed upon it
under this part.