BILL ANALYSIS
Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair
1283 (Steinberg)
Hearing Date: 5/27/2010 Amended: 4/27/2010
Consultant: Katie Johnson Policy Vote: Health 5-0
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BILL SUMMARY: SB 1283 would delete the authority of the
Director of the Department of Managed Health Care (DMHC) to
determine that additional time is necessary to review a
grievance. Instead, the bill would require DMHC to send written
notice to the enrollee or subscriber of the final disposition of
the grievance within 30 days of receipt of all relevant
information.
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Fiscal Impact (in thousands)
Major Provisions 2010-11 2011-12 2012-13 Fund
DMHC regulations $38 - $76 $75 - $152ongoing
minor Special*
*Managed Care Fund
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STAFF COMMENTS: SUSPENSE FILE. AS PROPOSED TO BE AMENDED.
Currently, the department must process complaints within 30 days
of receipt of them. The Director of DMHC has the authority to
extend the 30 day timeline when necessary. This bill would
remove that authority and would, instead, provide that the
department would have 30 days to complete a grievance review
after making a determination that all relevant information was
provided to the department. This bill would also require DMHC to
define "all relevant information" on its Internet Web site and
on each application used for filing a grievance. For the past
several years, Calendar Years 2006-2008, DMHC completed over 95
percent of the approximately 7,000 annual complaints within 30
days. In CY 2009, the department completed 92 percent of its
claims within 30 days. The length of time after 30 days to the
resolution of the remaining claims or the reasons for which they
were extended beyond 30 days are unknown. This bill would also
require DMHC and health plans to report grievance resolution
data in their respective annual and quarterly reports.
DMHC would likely need to promulgate regulations to determine
the information that would constitute "all relevant
information," which could vary greatly for the different types
of grievances filed, and to identify the grievance resolution
data that DMHC and plans would need to include in their
respective annual and quarterly reports at a cost of
approximately $38,000-$76,000 in FY 2010-11 and $75,000 -
$152,000 in FY 2011-12 for staff counsel. Costs could be higher
if more than one attorney or additional support staff were
needed. Conversely, the department could decide that the bill is
prescriptive enough to provide guidance to enrollees and plans
and that there would not be a need for regulations.
Additionally, there would be unknown costs to the department to
post the required information on its Web site and to include it
in its annual plan, which could be minor and absorbable,
probably commencing in FY 2011-12 upon the completion of the
regulation process.
Page 2
SB 1283 (Steinberg)
The proposed amendments would outline a timeline for DMHC to
complete the grievance process for complaints that exceed 30
days instead of the bill's current provisions that would provide
that DMHC would need to complete the complaint process in 30
days once all relevant information was submitted to the
department.