BILL NUMBER: AB 778 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY MARCH 31, 2011
INTRODUCED BY Assembly Member Atkins
FEBRUARY 17, 2011
An act to add Sections 2553.7 and 2553.8 to the Business and
Professions Code, relating to health care service plans.
LEGISLATIVE COUNSEL'S DIGEST
AB 778, as amended, Atkins. Health care service plans.
plans: vision care.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975
(Knox-Keene Act), provides for the regulation of health care service
plans by the Department of Managed Health Care and makes a willful
violation of the act a crime. Existing law provides that health care
service plans shall not be deemed to be engaged in the practice of a
profession, and may employ, or contract with, any licensed health
care professional to deliver professional services, and may directly
own, and may directly operate through its professional employees or
contracted licensed professionals, offices and subsidiary
corporations. Existing law provides that those professionals may
not own or control offices or branch offices unless otherwise
expressly authorized.
Existing law provides for the licensure and regulation of
dispensing opticians by the Medical Board of California. Existing law
provides that a violation of those provisions is a misdemeanor.
This bill would declare the intent of the Legislature to
enact legislation related to health care service plans under the
Knox-Keene Act and the entities with which a health care service plan
may transact business authorize a dispensing
optician, an optical company, a manufacturer or distributor of
optical goods, or a nonoptometric corporation to own a health care
service plan that provides vision care services, share profits with
the health care service plan, contract for specified business
services with the health care service plan, and jointly
advertise vision care services with the health care
service plan. The bill would prohibit those persons or entities from
engaging in conduct designed to influence or interfere with the
medical decisions of an optometrist, as specified. Because a
violation of that provision would be a crime, the bill would impose a
state-mandated local program .
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
This bill would provide that no reimbursement is required by this
act for a specified reason.
Vote: majority. Appropriation: no. Fiscal committee: no
yes . State-mandated local program: no
yes .
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. The Legislature hereby finds and
declares the following:
(a) Health care service plans, including specialized health care
service plans, are regulated by the Department of Managed Health
Care.
(b) To ensure that quality care and coverage are provided to
enrollees, a health care service plan, including a specialized health
care service plan, is required to do all of the following:
(1) Establish a department-approved quality assurance program to
ensure that enrollees are continuously provided the appropriate level
of services covered by the plan.
(2) Ensure that a separation of fiscal and administrative
management from medical services exists within the plan.
(3) Periodically submit information to the department to
demonstrate delivery of quality care, accessibility of services to
enrollees, and prompt resolution of complaints.
(4) Establish procedures meeting specified requirements for
reviewing the utilization of services and facilities.
(5) Participate in comprehensive medical and financial audits
conducted by the department.
(c) Existing law prohibits an optometrist from engaging in certain
business relationships with a registered optical dispenser.
(d) Existing law allows a health care service plan to hire and
contract with licensed professionals and to engage in a business
relationship with any entity. However, existing law is unclear about
the relationships between health care service plans that provide
vision services and optical companies.
(e) Providing statutory clarity regarding permissible business
relationships between a health care service plan providing vision
services and optical companies will provide certainty and allow
regulating entities to ensure that plans are engaged in appropriate
business relationships.
SEC. 2. Section 2553.7 is added to the
Business and Professions Code , to read:
2553.7. Notwithstanding any other provision of law, a dispensing
optician, an optical company, a manufacturer or distributor of
optical goods, or a nonoptometric corporation may do all of the
following:
(a) Own a health care service plan that provides vision care
services and share its profits.
(b) Contract for business services with, lease office space or
equipment to or from, or share office space with, a health care
service plan that provides vision care services.
(c) Jointly advertise vision care services with a health care
service plan that provides vision care services.
SEC. 3. Section 2553.8 is added to the
Business and Professions Code , to read:
2553.8. (a) A registered dispensing optician, an optical company,
a manufacturer or distributor of optical goods, or a nonoptometric
corporation shall not engage in conduct designed to influence or
interfere with the medical decisions of an optometrist employed by,
or who has contracted with, a specialized vision care service plan
for fiscal or administrative reasons.
(b) Pursuant to subdivision (g) of Section 1367 of the Health and
Safety Code, the medical decisions of an optometrist who is employed
by, or who has contracted with, a specialized vision care service
plan shall be unhindered by fiscal and administrative management.
SEC. 4. No reimbursement is required by this act
pursuant to Section 6 of Article XIII B of the California
Constitution because the only costs that may be incurred by a local
agency or school district will be incurred because this act creates a
new crime or infraction, eliminates a crime or infraction, or
changes the penalty for a crime or infraction, within the meaning of
Section 17556 of the Government Code, or changes the definition of a
crime within the meaning of Section 6 of Article XIII B of the
California Constitution.
SECTION 1. It is the intent of the Legislature
to enact legislation to clarify existing law with regard to health
care service plans that are regulated under the Knox-Keene Health
Care Service Plan Act of 1975 (Chapter 2.2 (commencing with Section
1340) of Division 2 of the Health and Safety Code) and the entities
with which a health care service plan may transact business.