BILL ANALYSIS
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|SENATE RULES COMMITTEE | SB 1283|
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VETO
Bill No: SB 1283
Author: Steinberg (D)
Amended: 8/19/10
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
SENATE FLOOR : 23-10, 6/1/10
AYES: Alquist, Calderon, Cedillo, Corbett, Correa,
DeSaulnier, Ducheny, Florez, Hancock, Hollingsworth,
Kehoe, Leno, Liu, Lowenthal, Negrete McLeod, Pavley,
Price, Romero, Simitian, Steinberg, Wolk, Wright, Yee
NOES: Aanestad, Cogdill, Cox, Denham, Dutton, Harman,
Huff, Runner, Strickland, Wyland
NO VOTE RECORDED: Ashburn, Oropeza, Padilla, Walters,
Wiggins, Vacancy, Vacancy
ASSEMBLY FLOOR : 54-21, 8/23/10 - See last page for vote
SENATE FLOOR : 24-11, 8/26/10
AYES: Alquist, Calderon, Cedillo, Corbett, Correa,
DeSaulnier, Ducheny, Florez, Hancock, Hollingsworth,
Kehoe, Leno, Liu, Lowenthal, Negrete McLeod, Padilla,
Pavley, Price, Romero, Simitian, Steinberg, Wolk, Wright,
Yee
CONTINUED
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NOES: Aanestad, Blakeslee, Cogdill, Denham, Dutton,
Harman, Huff, Runner, Strickland, Walters, Wyland
NO VOTE RECORDED: Ashburn, Emmerson, Oropeza, Wiggins,
Vacancy
SUBJECT : Health care coverage: grievance system
SOURCE : Author
DIGEST : This bill modifies consumer health coverage
grievance procedures administered by the Department of
Managed Health Care.
Assembly Amendments (1) clarify that the Department of
Health Care Services (DHCS) may send a written notice of
the final disposition of the grievance against a health
plan, as specified, after 30 calendar days of receipt of
the request for review only if the Director determines
that, due to extraordinary circumstances, additional time
is reasonable necessary to fully and fairly evaluate the
relevant grievance and if the delay is in the interest of
the enrollee, (2) require DHCS to make a determination
within 15 calendar days of receipt of the request for
review, rather than 30 calendar days, as to what additional
information is necessary for DHCS to complete its review of
the grievance and make a determination, and (3) strike out
a provision that authorizes DHCS to pursue specified
options if the grievance to DHCS involves clinical services
that are being denied on the basis of a "coverage
decision."
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 the Department of
Managed Health Care (DMHC) oversees compliance by health
plans with state law. Existing law 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
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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:
1. Requires DMHC, if the Director determines that, due to
extraordinary circumstances, additional time is
necessary to evaluate a grievance and make a
determination and that such a delay is in the interest
of the enrollee to:
A. Make a determination, within 15 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 15 calendar days of receipt of the request for
review, of the additional information necessary to
complete the grievance review and to make a
determination and the circumstances that necessitate
the additional time.
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 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.
E. Notify the subscriber or enrollee of the decision
in writing within five business days of the final
disposition of the grievance.
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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.
4. 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. 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.
7. 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.
8. Requires health plans to also include in its specified
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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 : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Assembly Appropriations Committee, this
bill will have $50,000 to $100,000 in special 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.
SUPPORT : (Verified 8/24/10)
ABC Schools
Alliance of California Autism Organizations
Association of Regional Center Agencies
Behavior Intervention Associates
California Legislative Advocates
Center for Autism and Related Disorders
Central Valley Regional Center
Consumer Watchdog
Health Access
Rick Rollens Consulting
Special Education Local Plan Area Administrators
State Council on Developmental Disabilities
GOVERNOR'S VETO MESSAGE :
"I am returning Senate Bill 1283 without my
signature.
I appreciate the author's dedication to working in a
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collaborative and constructive manner to try and
address this highly-emotional issue with advocates,
families and patients. My Administration has also
worked with these stakeholders to improve the
delivery system for the diagnosis and treatment of
autism. Over the past two years, the Department of
Managed Health Care (Department) has placed a
significant focus on autism treatment benefits
resulting in more timely evaluations, comprehensive
treatment plans, coordinated services, and, when
necessary, enforcement actions against licensed
health plans.
Notwithstanding all this progress, I cannot support
this particular bill because it is overbroad in its
application and would affect all of the Department's
grievance procedures. Since the Department currently
resolves 95% of its annual grievance caseload within
30 days, I do not believe this bill is necessary and
may actually lead to longer delays due to some of the
bill's provisions.
For these reasons, I cannot sign this bill."
ASSEMBLY FLOOR :
AYES: Adams, Ammiano, Arambula, Bass, Beall, Block,
Blumenfield, Bradford, Brownley, Buchanan, Caballero,
Charles Calderon, Carter, Chesbro, Coto, Davis, De La
Torre, De Leon, Eng, Evans, Feuer, Fletcher, Fong,
Fuentes, Galgiani, Gatto, Hall, Hayashi, Hernandez, Hill,
Huber, Huffman, Jones, Lieu, Bonnie Lowenthal, Ma,
Mendoza, Monning, Nava, V. Manuel Perez, Portantino,
Ruskin, Salas, Saldana, Skinner, Solorio, Swanson,
Torlakson, Torres, Torrico, Tran, Villines, Yamada, John
A. Perez
NOES: Anderson, Bill Berryhill, Tom Berryhill, Conway,
Cook, DeVore, Fuller, Gaines, Garrick, Gilmore, Hagman,
Harkey, Jeffries, Knight, Logue, Miller, Niello, Nielsen,
Silva, Smyth, Audra Strickland
NO VOTE RECORDED: Furutani, Nestande, Norby, Vacancy,
Vacancy
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CTW:mw 10/5/10 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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