BILL ANALYSIS �
AB 922
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CONCURRENCE IN SENATE AMENDMENTS
AB 922 (Monning)
As Amended September 2, 2011
Majority vote
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|ASSEMBLY: |51-27|(June 2, 2011) |SENATE: |21-12|(September 7, |
| | | | | |2011) |
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|COMMITTEE VOTE: |10-4 |(September 7, 2011) |RECOMMENDATION: |concur |
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Original Committee Reference: HEALTH
SUMMARY : Transfers the Department of Managed Health Care (DMHC)
from the Business, Transportation and Housing Agency (BT&H) to the
California Health and Human Services Agency (CHHSA). Transfers the
Office of the Patient Advocate (OPA) from DMHC to CHHSA effective
July 1, 2012, and requires existing OPA duties to apply to health
insurers regulated by the Department of Insurance (DOI) and their
insureds (in addition to DMHC-regulated health plans). Assigns new
duties to OPA related to assisting consumers obtain public and
private health care coverage and navigate public and private
coverage consistent with requirements under the Patient Protection
and Affordable Care Act (PPACA).
The Senate amendments :
1)Transfer DMHC from BT&H to CHHSA.
2)Transfer OPA from DMHC to CHHSA effective July 1, 2012.
3)Make the provisions affecting insureds covered by health insurers
regulated by DOI and individuals who receive or are eligible for
coverage under Medi-Cal Program, the California Health Benefit
Exchange (Exchange), the Healthy Families Program (HFP), or any
other county or state health care program effective January 1,
2013, and specify that for the period July 1, 2012, through
January 1, 2013, OPA will continue with any duties,
responsibilities or activities in place as of July 1, 2011.
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4)Require OPA to consult with DMHC, DOI, the Managed Risk Medical
Insurance Board (MRMIB), the Department of Health Care Services
(DHCS), and the Exchange in developing consumer educational and
information guides.
5)Commencing January 1, 2013:
a) Require OPA to adopt standards for the organizations with
which it contracts to ensure compliance with the privacy and
confidentiality laws, as specified;
b) Require OPA to conduct privacy trainings as necessary, and
regularly verify that the organizations have measures in place
to ensure compliance with this provision;
c) Require OPA to coordinate with other state and federal
agencies engaged in outreach and education regarding the
implementation of federal health reform;
d) Require OPA to refer consumers to the appropriate regulator
of health coverage program for filing complaints, and
grievances, claims or payment problems; and,
e) Permit OPA to provide grants to community-based consumer
assistance organizations for portions of its functions.
6)Delete detailed data reporting provisions and instead require,
commencing January 1, 2013:
a) OPA to track and analyze data on problems and complaints by
and questions from consumers about health care coverage for
the purpose of providing public information about problems
faced and information needed by consumers in obtaining
coverage and care;
b) Data collected to include demographic data, source of
coverage, regulator, and resolution of complaints, including
timeliness of resolution;
c) OPA to collect and report data to the United States
Secretary of Health and Human Services (HHS) on complaints and
consumer assistance as required to comply with requirements of
PPACA;
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d) DMHC, DHCS, DOI, MRMIB, the Exchange, and other public
coverage programs to provide to the office data in the
aggregate concerning consumer complaints and grievances;
e) OPA, for the purpose of publicly reporting information
about the problems faced by consumers in obtaining care and
coverage, to analyze data on consumer complaints and
grievances resolved by these agencies, including demographic
data, source of coverage, insurer or plan, resolution of
complaints and other information intended to improve health
care and coverage for consumers; and,
f) OPA to develop and provide comprehensive and timely data
and analysis based on the information provided by other
agencies.
7)Delete detailed provisions related to the development of
protocols and procedures and instead require OPA to develop:
a) A procedure for referral of complaints and grievances to
the appropriate regulator or health coverage program for
resolution by the relevant regulator or public program; and,
b) A protocol or procedures for reporting to the appropriate
regulatory and health coverage program regarding complaints
and grievances relevant to that agency that the OPA received
and was able to resolve without further action or referral.
8)Delete further provisions that:
a) Give OPA access to records of DOI and sunset the access to
DMHC records on January 1, 2013;
b) Require OPA to provide education about how to navigate the
health care arena, as specified;
c) Require OPA to educate consumers on their rights and
responsibilities with respect to health care coverage;
d) Require OPA to advise and assist consumers with resolving
problems with obtaining premium tax credits under Section 36B
of the Internal Revenue Code;
e) Require OPA to implement and oversee a training program
with continuing education components for organizations with
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which it contracts;
f) Give OPA the power to revoke the contract of any
organization that violates specified standards and require OPA
to include a clause reserving that power in every contract
entered into with such an organization;
g) Require educational materials on health care coverage
options and how to resolve problems to be made available to
all consumer assistance programs and on the Internet Web site
of the OPA; and,
h) Define "group health plan."
9)Define "health coverage program" to include the Medi-Cal Program,
HFP, tax subsidies and premium credits under the Exchange, the
Basic Health Program, if enacted, county health coverage
programs, and the Access to Infants and Mothers Program.
10)Permit, rather than require, OPA to apply to the Secretary of
HHS for a grant under PPACA.
11)Make other clarifying, conforming changes.
AS PASSED BY THE ASSEMBLY , this bill transferred OPA from DMHC to
operate as an independent entity within state government, required
existing OPA duties to apply to health insurers regulated by DOI
and their insureds (in addition to DMHC-regulated health plans) and
assigned new duties to OPA consistent with requirements under
PPACA.
FISCAL EFFECT : According to the Senate Appropriations Committee:
Fiscal Impact (in thousands)
Major Provisions 2011-12 2012-13 2013-14 Fund
OPA expansion unknown, potentially in the
hundreds Special*
and shift of thousands of dollars
OPA additional duties and likely in the
millions of dollars annually Special*
ongoing administrationcommencing January 1, 2013
DMHC data reporting $0 about $250$500Special**
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DOI data reporting $0 $1,100 $550Special***
DHCS, MRMIB, and unknown, potentially
significant General/****
Exchange data reporting commencing January 1,
2013Federal/
Special
*Office of the Patient Advocate Trust Fund
**Managed Care Fund
***Insurance Fund
****MRMIB costs shared 35% General Fund (GF), 65% federal funds;
Medi-Cal costs shared 50% GF, 50% federal funds Exchange costs paid
from the California Health Trust Fund; to the extent federal
financial participation is available.
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 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.
This bill also moves DMHC from BT&H to CHHSA. According to the
author, this move makes sense for three reasons:
1)The move is meant to create a clear internal chain of command for
the Administration. DMHC's actions should be vetted through the
Health and Human Services Agency, which is focused on consumers
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and implementation of the Affordable Care Act (along with other
aspects of healthcare delivery and regulation), rather than BT&H,
which has no expertise in federal health care reform and its
requirements.
2)The state has a lot of obligations and changes to make under the
PPACA. The Secretary of Health and Human Services should be
responsible for overseeing the state's progress on this, which
should include DMHC. There are significant federal-state
relationships in other areas under HHS programs (such as
Medi-Cal, CalWORKs, and the Supplemental Nutrition Assistance
Program), and, the ACA is going to extend this federal-state
relationship even further.
3)This bill moves the OPA to the Health and Human Services Agency.
Since its inception, the OPA and DMHC have been intertwined, with
much of OPA's focus being on the vast number of enrollees within
DMHC's purview. If we move one, we should move the other.
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.
Analysis Prepared by : Melanie Moreno / HEALTH / (916) 319-2097
FN: 0002812
AB 922
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