BILL ANALYSIS
------------------------------------------------------------
|SENATE RULES COMMITTEE | SB 1283|
|Office of Senate Floor Analyses | |
|1020 N Street, Suite 524 | |
|(916) 651-1520 Fax: (916) | |
|327-4478 | |
------------------------------------------------------------
THIRD READING
Bill No: SB 1283
Author: Steinberg (D)
Amended: 5/28/10
Vote: 21
SENATE HEALTH COMMITTEE : 5-0, 4/21/10
AYES: Alquist, Leno, Negrete McLeod, Pavley, Romero
NO VOTE RECORDED: Strickland, Aanestad, Cedillo, Cox
SENATE APPROPRIATIONS COMMITTEE : 7-3, 5/27/10
AYES: Kehoe, Alquist, Corbett, Leno, Price, Wolk, Yee
NOES: Denham, Walters, Wyland
NO VOTE RECORDED: Cox
SUBJECT : Health care coverage: grievance system
SOURCE : Author
DIGEST : This bill deletes the authority of the Director
of the Department of Managed Health Care (DMHC) to
determine that additional time is necessary to review a
grievance. This bill requires 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.
ANALYSIS : The Knox-Keene Health Care Service Plan Act of
1975 (Knox-Keene Act) regulates the licensure of health
care service plans (health plan), and DMHC oversees
compliance by health plans with state law. Existing law
CONTINUED
SB 1283
Page
2
also requires all health plans to establish and maintain a
grievance process, approved by DMHC, under which enrollees
and subscribers may submit their grievances to the plan.
An enrollee or subscriber, who has either (1) completed
his/her plan's grievance process, or (2) participated in
the plan's grievance process for a minimum of 30 days, is
authorized under existing law to submit his/her grievance
to DMHC for review. Existing law also allows providers to
assist their patients in the filing of grievances with
DMHC. Upon receiving a request to review a grievance,
existing law requires DMHC to send a written notice of the
final disposition of the grievance to the enrollee or
subscriber within 30 days, unless the Director of DMHC,
using his/her discretion, determines that additional time
is reasonably needed to complete the review.
This bill deletes the authority of the Director of DMHC to
determine that additional time is necessary to review a
grievance. This bill requires DMHC to send written notice
to the enrollee or subscriber of the final disposition of
the grievance within 30 days of receipt of the request for
review unless the Director, in his/her discretion,
determines that additional time is reasonably necessary to
fully and fairly evaluate the relevant grievance. If the
Director determines that additional time is necessary to
evaluate a grievance and make a determination, DMHC shall
do all of the following:
1. Make a determination, within 30 calendar days of receipt
of the request for review, as to what additional
information is necessary for DMHC to complete its review
of the grievance and make a determination.
2. Notify the subscriber or the enrollee in writing, within
30 calendar days of receipt of the request for review,
of the additional information that DMHC has identified
for it to complete the grievance review and to make a
determination.
3. Upon receipt of all information that constitutes a
completed application, notify the subscriber or the
enrollee, in writing within five business days, of the
date the application was completed.
SB 1283
Page
3
4. Make a determination of the final disposition of the
grievance, and the reasons therefor, within 30 calendar
days of having established a completed application.
5. Notify the subscriber or enrollee of the decision in
writing within five business days of the final
disposition of the grievance.
This bill requires DMHC to specify the necessary
information on its Internet Web site and on each
application used for filing a grievance with DMHC.
Existing law requires the Director to make and file
annually with DMHC as a public record an aggregate summary
of grievances against plans filed with DMHC, as specified.
This bill outlines 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
DMHC.
This bill states that the Director shall also include in
the report a review of the grievances not resolved within
30 days and shall report on the number, proportion by type
and medical condition, and causes of the grievances, as
well as the reasons for the failure to resolve any
grievance pending for more than 30 days.
This bill states that the grievance resolution plan shall
include in a quarterly report data regarding the timeframes
for grievance resolution. This data shall include, but is
not limited to, the average number of days before a
grievance is closed, a breakdown of the number of cases
resolved in less than 30 days and in more than 30 days, and
for grievances not resolved within 30 days, the number,
proportion by type and medical condition, and causes of the
grievances, as well as the reasons for the failure to
resolve any grievance pending for more than 30 days.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
SB 1283
Page
4
According to the Senate Appropriations Committee:
Fiscal Impact (in thousands)
Major Provisions 2010-11 2011-12
2012-13 Fund
DMHC regulations $38-$76 $75-$152
ongoing minor Special*
* Managed Care Fund
SUPPORT : (Verified 5/27/10)
Alliance of California Autism Organization
Association of Regional Center Agencies
PTA
Special Education Local Plan Area Administrators
CTW:mw 5/28/10 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
**** END ****