BILL ANALYSIS �
AB 922
Page 1
ASSEMBLY THIRD READING
AB 922 (Monning)
As Amended May 27, 2011
Majority vote
HEALTH 12-6 APPROPRIATIONS 12-5
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|Ayes:|Monning, Ammiano, Atkins, |Ayes:|Fuentes, Blumenfield, |
| |Bonilla, Eng, Gordon, | |Bradford, Charles |
| |Hayashi, | |Calderon, Campos, Davis, |
| |Roger Hern�ndez, Bonnie | |Gatto, Hall, Hill, Lara, |
| |Lowenthal, Mitchell, Pan, | |Mitchell, Solorio |
| |Williams | | |
| | | | |
|-----+--------------------------+-----+--------------------------|
|Nays:|Logue, Garrick, Mansoor, |Nays:|Harkey, Donnelly, |
| |Nestande, Silva, Knight | |Nielsen, Norby, Wagner |
| | | | |
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SUMMARY : Transfers the Office of the Patient Advocate (OPA)
from the Department of Managed Health Care (DMHC) to operate as
an independent entity within state government, requires existing
OPA duties to apply to health insurers regulated by the
California Department of Insurance (CDI) and their insureds (in
addition to DMHC-regulated health plans) and assigns new duties
to OPA consistent with requirements under the Patient Protection
and Affordable Care Act (PPACA). Specifically, this bill :
1)Transfers the OPA from DMHC to operate as an independent
entity within state government. Requires existing OPA duties
to apply to health insurers regulated by CDI and their
insureds (in addition to DMHC-regulated health plans).
Requires the OPA to be headed by a patient advocate that is
appointed by the Governor and serves at the pleasure of the
Governor. Adds the following duties to the OPA:
a) Receive and respond to all telephone and in-person
inquiries, complaints, and requests for assistance from
individuals concerning all health care coverage available
in California, including Medi-Cal, the California Health
Benefits Exchange (Exchange), the Healthy Families Program
(HFP), or any other health care coverage program, or
individual or group coverage available through health care
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service plans or health insurers;
b) Make existing educational and informational guides
regarding enrollee rights and responsibilities to be
available in "threshold" languages, using an appropriate
literacy level, and in a culturally competent manner.
Defines "threshold languages" to be languages spoken by at
least 20,000 or more limited English proficient (LEP)
health consumers residing in California;
c) Provide outreach and education about health care
coverage options including, but not limited to, information
regarding the cost of coverage and education about how to
navigate the health care arena, including what health
services a plan or insurer offers or provides, how to
select a plan or insurer, and how to find a doctor or other
health care provider;
d) Educate consumers on their rights and responsibilities
with respect to health care coverage;
e) Advise and assist consumers regarding eligibility for
health care coverage, including enrollment in, retention
in, and transitions between, health care coverage programs
by providing information, referral, and direct application
assistance for all types of payors, including public
programs such as Medi-Cal, HFP, Medicare, private
individual coverage, employer-sponsored coverage, Employee
Retirement Income Security Act (ERISA) plans, charity care,
unsubsidized Exchange coverage, and Exchange coverage with
tax subsidies and/or tax credits;
f) Advise consumers on problems related to mental health
parity and coverage for substance abuse treatment,
consistent with existing state and federal law;
g) Advise and assist consumers to resolve problems with
obtaining federal premium tax credits; and,
h) Operate a HealthHelp toll-free telephone hotline that
can route callers to the consumer assistance program in
their area and provide interpreters for LEP callers and
operate a HealthHelp Internet Website, other social media,
and up-to-date communication systems to give information
regarding the consumer assistance programs.
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2)Requires OPA to provide the assistance and education above to
consumers with LEP in their primary oral language, written
materials in threshold languages using an appropriate literacy
level, and in a culturally competent manner.
3)Permits OPA to contract with community-based consumer
assistance organizations to assist in some or all of the
above, as specified.
4)Requires OPA to develop protocols and procedures for the
resolution of consumer complaints and the establishment of
responsibility or referral, as appropriate, to the federal
Department of Labor (DOL) regarding employee welfare benefit
plans regulated under the Employee Retirement Income Security
Act, the Centers for Medicare and Medicaid Services regarding
the Medicare Program, DMHC regarding health plan coverage, CDI
regarding health insurance policies, the State Department of
Health Care Services (DHCS) regarding the Medi-Cal program,
the Managed Risk Medical Insurance Board (MRMIB) regarding
HFP, the Access for Infants and Mothers Program, the
California Major Risk Medical Insurance Program Federal
Temporary High Risk Pool, and the Exchange.
5)Requires OPA to collect, track, quantify, and analyze problems
and inquiries encountered by consumers with respect to health
care coverage, including, but not limited to, the complaints
reported to the network of health consumer assistance
organizations and the agencies. Requires OPA to publicly
report its analysis of these problems and inquiries at least
quarterly on its Web site.
6)Requires OPA to track, analyze, and publicly report on
problems, inquiries, and complaints according to the nature
and resolution of the complaints and, including, but not
limited to, the health status, age, race, ethnicity, language,
geographic region, gender, gender identity/expression, or
sexual orientation of the complainants in order to identify
the most common types of problems and the problems faced by
particular populations, including any health disparity
population, as specified.
7)Requires OPA to collect and report data to the United States
Secretary of Health and Human Services (HHS) on the categories
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of populations in 6) above, including subgroup categories of
race/ethnicity, and types of problems and inquiries
encountered by consumers.
8)Requires DMHC, CDI, DHCS, MRMIB, the Department of Public
Health (DPH), and the Exchange to report data and other
information to the OPA regarding consumer complaints submitted
to those agencies, including the nature of the complaints, the
resolution of the complaints, and the timeliness of the
resolution, and further including, but not limited to, the
health status, age, race, ethnicity, language, geographic
region, gender, or sexual orientation of the complainants.
Requires this information to be reported according to the
particular health insurer or health care service plan
involved.
9)Requires OPA and any local community-based nonprofit consumer
assistance programs that they contract with to have as their
primary mission the assistance of health care consumers.
Requires contracting consumer assistance programs to have
specified experience.
10)Requires consumer assistance programs that contract with OPA
to provide direct consumer assistance to qualify as
"navigators" under the Exchange, as specified.
11)Requires OPA to develop protocols, procedures, and training
modules for organizations with whom it contracts and to
implement and oversee a training program for contracted
organizations with continuing education components. Requires
OPA to adopt standards for contracted organizations regarding
confidentiality and conduct. Gives OPA the power to revoke
the contract of organizations that violate these standards, as
specified.
12)Permits OPA to contract with consumer assistance programs to
develop a series of appropriate literacy level and culturally
and linguistically appropriate educational materials in all
threshold languages for consumers regarding health care
coverage options and how to resolve problems. Requires these
materials to be made available to all consumer assistance
programs and on the OPA Web site.
13)Requires funding for the actual and necessary expenses of the
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OPA to be provided, subject to appropriation by the
Legislature, from the Managed Care Fund and the Insurance
Fund, as specified.
14)Requires OPA to apply to HHS for a grant, as specified.
Permits OPA to apply for other federal grants, and to the
extent permitted by federal law, to seek federal funding for
assisting beneficiaries of the Medi-Cal Program.
15)Creates the OPA Trust Fund in the State Treasury, and upon
appropriation by the Legislature, requires moneys in the fund
to be made available for implementing the provisions of this
bill.
FISCAL EFFECT : According to the Assembly Appropriations
Committee:
1)One-time state costs to expand the OPA, not likely to exceed
$1 million.
2)Ongoing increased special fund/federal fund costs to fund the
increased workload, likely in the range of several million
dollars annually. This estimate is subject to uncertainty and
could exceed this amount. The bill specifies that funding is
to be provided through federal grant funding as well as fee
revenue from existing regulatory fees paid by health plans and
health insurers to DMHC and CDI.
3)Unknown potential increased costs to existing local and state
entities that provide complaint resolution and consumer
assistance services, to the extent interaction with the OPA
increases the number of referrals to these entities.
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 the OPA.
COMMENTS : According to the author, this bill establishes the
OPA in state government to position California to receive
federal monies made available by 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
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states that there are currently eight governmental entities and
several private, non-profit entities that provide a number of
services to assist persons with public and private health care
coverage. These services include advice on coverage options,
education about how to navigate the system, assistance with
complaints and grievances, and assistance in choosing a health
plan and finding a provider. These entities also respond to
complaints about, among other things, eligibility, coverage of
services, and timely access to health care providers. The
author argues it is imperative that Californians be provided
with a single source of correct and current information on
PPACA, and that the OPA will also provide for much needed, clear
and understandable consumer information and assistance by
expanding and strengthening current programs operating at the
local level that will be consistent with the federal
requirements for independence and consumer orientation.
California currently has a fragmented system for consumer
assistance with health care coverage complaints. There are
eight governmental entities and several private, non-profit
entities that provide a number of services for assistance with
public and private health care coverage. These services include
advice on coverage options, education about how to navigate the
system, assistance with complaints and grievances, assistance in
choosing a health plan, and finding a provider. These entities
also respond to complaints about, among other things,
eligibility, coverage of services, and timely access to
providers. While these entities exist to help consumers and
purchasers of their specific services, implementation of the
PPACA will lead to millions of more Californians enrolled in
coverage, including expansions of public programs. Consumers
will also have expanded choices of coverage and different
options to use, should they lose a source of job-based coverage,
have a child, divorce, or have an increase in income.
This bill is supported by consumer and children's health groups.
Western Center on Law & Poverty (WCLP), a cosponsor of this
bill, writes that California's uninsured population has
different needs than those who are consistently covered. This
includes people who primarily speak a language other than
English, those who have never navigated a health insurance plan,
and those who have perhaps never consistently seen a health care
provider. For all those reasons, WCLP states that Californians
need a centralized hub to connect to when dealing with questions
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or problems with their coverage. WCLP asserts that the OPA
created under this bill will fill this void by providing
information on coverage options, education about how to navigate
the system, assistance with complaints and grievances, and
assistance in choosing a health plan and finding a provider.
WCLP further states that OPA will also respond to complaints
regarding eligibility, coverage of services, and timely access
to providers and that this model, which incorporates all kinds
of health coverage, does not currently exist at the state level.
Health Access California writes that the enactment of federal
health reform means that virtually every Californian will have
access to quality, affordable health care. Existing programs,
including the HMOHelp line has done much of what is contemplated
in this bill, but not all. Health Access contends that these
programs have filled the void created by the failures of CDI,
the Medi-Cal Program, and MRMIB to have effective consumer
assistance systems, but that this bill will create a OPA that
will serve as the first line of triage for consumer complaints
while leaving with the respective regulators and sources of
coverage the responsibility for resolving the complaints and
grievances within their jurisdiction. Health Access California
states that this bill connects state government with the federal
government agencies responsible for resolving complaints, such
as the DOL for ERISA plans and Medicare for Medicare coverage.
Finally, Health Access California asserts that this bill
envisions robust response to grievances and complaints about the
health care system.
The California Right to Life Committee (CRLC), Inc. writes that
this is advancing the federal PPACA when presently there are
serious challenges to its constitutionality; and, that it would
be better public policy not to depend on federal tax dollars
under these circumstances. CRLC contends that this bill "is
another attempt to promote family planning and abortion services
to low-income persons and non-English speaking populations"
Analysis Prepared by : Melanie Moreno / HEALTH / (916)
319-2097
FN: 0001017
AB 922
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