BILL ANALYSIS �
AB 922
Page 1
Date of Hearing: May 18, 2011
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Felipe Fuentes, Chair
AB 922 (Monning) - As Amended: March 29, 2011
Policy Committee: HealthVote:12-6
Urgency: No State Mandated Local Program:
No Reimbursable: No
SUMMARY
This bill creates an independent office of health coverage
consumer assistance, called the Office of Health Consumer
Assistance (OHCA), in state government. Specifically, this
bill:
1)Requires the new office to:
a) Maintain a HealthHelp website and call center.
b) Perform outreach and education on navigating the health
care system, including advice regarding eligibility and
enrollment in private and public health care programs.
c) Advise consumers on how to resolve care, service, and
claims payment problems, and provide direct assistance if
needed.
d) Assist consumers in accessing federal premium tax
credits for health care coverage.
e) Assume activities currently performed by the Office of
the Patient Advocate (OPA), including producing consumer
education and information guides, issuing health plan
quality of care report cards, and advising and assisting
enrollees related to the health care grievance system.
f) Track and analyze consumer complaints.
g) Develop protocols and procedures for resolution of
complaints, and establish responsibility or referral as
appropriate with regard to a variety of state and federal
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health care programs.
1)Requires a number of state entities to submit data to OHCA
regarding consumer complaints. These agencies include the
Department of Managed Health Care (DMHC), the Department of
Insurance (CDI), the Department of Health Care Services
(DHCS), the Managed Risk Medical Insurance Program (MRMIB),
the Department of Public Health (DPH), and the newly
established California Health Benefit Exchange.
2)Permits OHCA to contract with community-based consumer
assistance organizations to assist in some or all of the
above, subject to certain requirements.
3)Requires OHCA to apply to HHS for grant funding and authorizes
OHCA to seek outreach funding through Medicaid and Children's
Health Insurance Program (Healthy Families).
4)Creates the California Health Consumer Assistance Trust Fund
in the State Treasury, and requires moneys in the fund to be
made available for the purpose of this bill upon appropriation
by the Legislature.
5)Repeals existing law which establishes the Office of Patient
Advocate (OPA), and requires funds allocated to support the
OPA to be transferred to the California Health Consumer
Assistance Trust Fund.
FISCAL EFFECT
1)One-time state costs to establish the OHCA, not likely to
exceed $1 million.
2)Ongoing cost pressure to fund the office, likely in the range
of several million dollars annually. This estimate is subject
to uncertainty and could exceed this amount. Costs would
depend on several factors, including:
a) The extent to which the office is marketed to consumers.
b) The extent to which the OHCA depends on referrals to
existing entities, or directly intervenes on behalf of
consumers, to resolve consumer complaints and issues.
c) The extent of the assistance offered to consumers with
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respect to enrolling in health plans.
d) The extent to which individuals have problems accessing
federal premium tax credits.
e) Other unforeseen factors related to the implementation
of health care reform in the state.
3)Unknown potential increased costs to existing and local state
entities that provide complaint resolution and consumer
assistance services, to the extent interaction with the OHCA
increases the number of referrals to these entities. These
entities include:
a) The Help Center administered by the Department of
Managed Health Care.
b) The Consumer Hotline administered by the Department of
Insurance.
c) The Medi-Cal Managed Care Office of the Ombudsman.
4)Unknown, potentially significant costs to state entities
including DMHC, CDI, DHCS, MRMIB, DPH, and the Exchange to
collect and submit specific data regarding consumer complaints
to OHCA. Costs would depend on the required degree of
standardization of complaint data, how the new requirements
compare with the existing data collected, and whether a new
information technology system was required to collect and
transmit data.
5)This bill provides that approximately $2.3 million in special
funds currently allocated annually to support the Office of
the Patient Advocate (OPA) shall be transferred to a newly
created California Health Consumer Assistance Trust Fund to
offset the costs of this bill.
As this bill requires the OHCA to perform duties exceeding the
current duties of the OPA, this amount would be inadequate to
fully fund the new office. As noted above, the bill also
authorizes the OHCA to apply for grant funding.
To the extent additional funding is not secured through
grants, there would be GF cost pressure to fund the duties to
OHCA imposed by this bill that exceed the current duties of
the OPA.
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COMMENTS
1)Rationale . According to the author, this bill establishes the
OHCA in state government to position California to receive
federal monies made available by the federal Patient
Protection and Affordable Care Act (PPACA) for the purpose of
establishing and operating such an office. The author states
California currently has a fragmented system for consumer
assistance with health care coverage complaints. The author
argues it is imperative that Californians be provided with a
single source of correct and current information on PPACA, and
that the OHCA will also provide for much needed, clear and
understandable consumer information and assistance.
2)Multiple Sources of Consumer Assistance . Currently, a variety
of community-based organizations and governmental organization
assist consumers with health care eligibility, enrollment,
coverage, and access to services. Many consumers may not know
what their coverage options are, while others who have
coverage may not know who to contact with a complaint.
Consumer advocates argue that individuals should not have to
struggle to determine regulatory jurisdiction if they have a
complaint. This bill seeks to provide a single entity to
coordinate information and consumer services related to health
care.
3)Funding Available for Consumer Assistance . This bill
authorizes the new office to apply for several federal grants.
The Patient Protection and Affordable Care Act (PPACA) calls
for HHS to provide grants to states to establish and operate
independent offices of health insurance consumer assistance or
health insurance ombudsman programs. The PPACA makes $30
million available in the first fiscal year for health
insurance consumer assistance or health insurance ombudsman
programs, with additional funding planned for later years. As
a condition of receiving a grant, a state must collect and
report to HHS data on the types of problems and inquiries
encountered by consumers. To date, the state Department of
Managed Health Care and the California Department of Insurance
have received $3 million total funding for these activities.
In addition, federal law makes available outreach funding for
Medicaid and the Children's Health Insurance Program (Healthy
Families in California).
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4)Related Legislation . AB 2787 (Monning) of 2010 established the
Office of the California Health Ombudsman, governed by a chief
executive officer known as the California Health Ombudsman,
and required the Ombudsman to educate consumers on their
health care coverage rights and responsibilities, assist
consumers with enrollment in health care coverage, and resolve
problems with obtaining federal premium tax credits. AB 2787
was held on suspense in the Senate Appropriations Committee.
Analysis Prepared by : Lisa Murawski / APPR. / (916) 319-2081