BILL ANALYSIS                                                                                                                                                                                                    



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          SENATE THIRD READING
          SB 1283 (Steinberg)
          As Amended August 2, 2010
          Majority vote 

           SENATE VOTE  :23-10  
           
           HEALTH              14-5        APPROPRIATIONS      12-5        
           
           ----------------------------------------------------------------- 
          |Ayes:|Monning, Fletcher,        |Ayes:|Fuentes, Bradford,        |
          |     |Ammiano, Carter, De La    |     |Charles Calderon, Coto,   |
          |     |Torre, De Leon, Eng,      |     |Davis, De Leon, Gatto,    |
          |     |Hayashi, Hernandez,       |     |Hall, Skinner, Solorio,   |
          |     |Jones, Bonnie Lowenthal,  |     |Torlakson, Torrico        |
          |     |Nava, V. Manuel Perez,    |     |                          |
          |     |Salas                     |     |                          |
          |     |                          |     |                          |
          |-----+--------------------------+-----+--------------------------|
          |Nays:|Conway, Gaines, Smyth,    |Nays:|Conway, Harkey, Miller,   |
          |     |Audra Strickland, Silva   |     |Nielsen, Norby            |
          |     |                          |     |                          |
           ----------------------------------------------------------------- 
           SUMMARY  :  Modifies consumer health coverage grievance procedures  
          administered by the California Department of Managed Health Care  
          (DMHC).  Specifically,  this bill  :   

          1)Requires DMHC, if the Director determines that additional time  
            is necessary to evaluate a grievance and make a determination  
            to:

             a)   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;

             b)   Notify the subscriber or the enrollee in writing, within  
               30 calendar days of receipt of the request for review, of  
               the additional information necessary to complete the  
               grievance review and to make a determination;

             c)   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  








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               the application was completed;

             d)   Make a determination of the final disposition of the  
               grievance, and the reasons for doing so, within 30 calendar  
               days of having established a completed application; and,

             e)   Notify the subscriber or enrollee of the decision in  
               writing within five business days of the final disposition  
               of the grievance.

          2)Prohibits DMHC from requesting from the subscriber or the  
            enrollee any information, data, or further evaluation that  
            imposes additional costs, expenses, or other fiscal  
            responsibilities upon the subscriber or enrollee, unless paid  
            for by DMHC.

          3)Requires a health plan to provide specified information  
            requested by DMHC within five calendar days of the request and  
            requires the plan to describe the actions being taken to  
            obtain the information or records and when receipt is  
            expected, if the requested information cannot be provided to  
            the DMHC.
          4)Requires DMHC to provide appropriate oversight to determine  
            that the plan complies with specified information requests and  
            requires DMHC to impose specified administrative fines upon  
            the plan and all other appropriate remedies and corrective  
            actions that DMHC deems necessary if DMHC determines that  
            noncompliance with an information request is the result of  
            factors that were within the purview and responsibility of the  
            plan.  

          5)Requires DMHC to notify the subscriber or enrollee in writing  
            of all specified remedies and corrective actions imposed upon  
            the plan.

          6)Authorizes DMHC to pursue the following if the grievances to  
            the department involve clinical services that are being denied  
            on the basis of a coverage decision:

             a)   Provide the completed application to a specified medical  
               provider or panel who are knowledgeable and qualified to  
               address the issues in question.

             b)   Request that the specified medical provider or panel  








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               review the completed application, as well as relevant data  
               and information, and provide findings and recommendations  
               to the department that include but are not limited to the  
               following whether the requested services are considered to  
               be health care services or non-health-care services or  
               whether the requested services are a covered benefit.

          7)Requires any individual or individuals consulted for purposes  
            of this bill to be identified by a specified independent  
            medical review organization.  

          8)Requires the Director of DMHC to include in its annually  
            published report that details the number and types of  
            complaints and grievances received during the calendar year,  
            as specified, data regarding timeframes for grievance  
            resolution, and requires the data to include, but not be  
            limited to the average number of days before a grievance is  
            closed; the average number days before a grievance is sent to  
            independent medical review; the average number days before the  
            independent medical review process is resolved and a decision  
            is rendered by the Director of DMHC; and, a breakdown of the  
            number of cases resolved in less than 30 days and in more than  
            30 days.

          9)Requires the Director of DMHC to include in the report a  
            review of the grievances not resolved within 30 days and to  
            report on the number, proportion by type and medical  
            condition, and causes of the grievances, as well as reasons  
            for the failure to resolve any grievance pending for more than  
            30 days.

          10)   Requires health plans to also include in its specified  
            quarterly report, data regarding the timeframes for grievance  
            resolution and requires the data to include but not be 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  :  According to the Assembly Appropriations  
          Committee, this bill will have $50,000 to $100,000 in special  








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          fund costs for DMHC to increase specificity of information  
          provided in annual reports and fulfill other requirements of  
          this bill.  Additionally, this bill will generate unknown  
          penalty revenues to the extent health plans are found in  
          violation of requirements established by this bill. 

           COMMENTS  :  According to the author, consumer grievances that are  
          filed with DMHC against private health plans, especially related  
          to autism spectrum disorders, are not resolved in a timely and  
          appropriate manner.  The author states that between September 1,  
          2009 and March 1, 2010 the DMHC Help Center processed 76 cases  
          that were filed against private health plans for denial of  
          services specifically related to autism treatment.  Data show  
          that consumers were notified within 30 days in only 42% of  
          autism complaints.  The author states that while this data are  
          only for autism-related complaints, these results raise the  
          possibility that other consumers with health challenges face  
          comparable delays.  The author states that this bill will  
          clarify existing law and assure that complaints of consumers are  
          evaluated in an appropriate and timely manner.


           Analysis Prepared by  :    Martin Radosevich / HEALTH / (916)  
          319-2097 


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