BILL NUMBER: AB 1809	INTRODUCED
	BILL TEXT


INTRODUCED BY   Assembly Member Monning

                        FEBRUARY 21, 2012

   An act to amend Section 12923.5 of, and to repeal Sections
12693.925 and 12693.95 of, the Insurance Code, relating to health
care coverage.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 1809, as introduced, Monning. Health care coverage: reports.
   Existing law requires the Managed Risk Medical Insurance Board to,
by January 20, 2004, specified information with regard to the State
Children's Health Insurance Program. Existing law also requires the
board to provide, by April 15, 1998, a proposal relating to drug and
alcohol treatment programs for children.
   This bill would delete those obsolete provisions.
   Existing law requires the Department of Managed Health Care and
the Department of Insurance to maintain a joint senior level working
group to ensure clarity for health care consumers about who enforces
their patient rights and consistency in the regulations of these
departments. Existing law requires the working group to report its
findings to the Insurance Commissioner and the Director of the
Department of Managed Health Care for review and approval and,
commencing January 1, 2004, requires the commissioner and the
director to submit the approved report to the Legislature every year
for 5 years.
   This bill would delete that reporting requirement.
   Vote: majority. Appropriation: no. Fiscal committee: no.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 12693.925 of the Insurance Code is repealed.

   12693.925.  (a) The Managed Risk Medical Insurance Board shall
report to the Legislature on or before January 30, 2004, the
following information with respect to the State Children's Health
Insurance Program:
   (1) A list of the categories of vulnerable children who should be
the targets of public health initiatives, including, but not limited
to, immigrant children, homeless children, and other children that
face health disparities.
   (2) Recommendations on innovative methods available under the
federal program for addressing health needs and barriers to care for
the identified groups of vulnerable children. The board shall report
as many recommendations as possible that are available under the
federal program and the expected impact of each recommendation.
   (3) Recommendations on innovative methods available under the
federal program for developing in urban areas initiatives similar to
the rural demonstration projects. The board shall report as many
recommendations as possible that are available under the federal
program and the expected impact of each recommendation.
   (b) The board shall seek input, at regularly scheduled meetings of
the board, from the Healthy Families Advisory Panel and stakeholder
organizations, including, but not limited to, organizations that
represent immigrant and homeless populations, other communities that
experience health disparities, and traditional providers of care to
low-income populations.
   (c) This section shall be implemented only to the extent that
federal financial participation is obtained. 
  SEC. 2.  Section 12693.95 of the Insurance Code is repealed.

   12693.95.  (a) The board in consultation with the Department of
Alcohol and Drug Programs shall provide the Legislature by April 15,
1998, a proposal assessing the viability of providing additional drug
and alcohol treatment services for children enrolled in the program.

   If the board determines that it is feasible to provide additional
federal funds received pursuant to Title XXI (commencing with Section
2101) of the Social Security Act to counties to finance drug and
alcohol services and required federal approval is obtained, the board
shall negotiate with participating health plans to establish
memoranda of understanding between plans and counties to facilitate
referral of children in need of these services.
   (b) Based on the April 15, 1998, report by the board to the
Legislature, the Legislature finds and declares that there is a
statewide gap in publicly funded alcohol and other drug treatment for
adolescents which is significant and systemic.
   (1) Therefore, the Department of Alcohol and Drug Programs, in
cooperation with the board, shall do the following:
   (A) Review capacity needs for the Healthy Families Program target
group after year one data has been collected and an assessment of the
adequacy of the benefit can be made.
   (B) Request that counties provide data on the number of
adolescents requesting alcohol and other drug treatment and whether
they are participating in the Healthy Families Program.
   (2) The board shall do the following:
   (A) Request the participating health plans to voluntarily collect
data, as prescribed by the board, on the number of children needing
services that exceed the substance abuse benefit in their plan.
   (B) Upon contract renewal, require participating health plans to
collect and report the data.
   (C) By September 1, 1999, provide the policy and fiscal committees
of the Legislature with an analysis of the data obtained by the
Department of Alcohol and Drug Programs and from the participating
health plans. 
  SEC. 3.  Section 12923.5 of the Insurance Code is amended to read:
   12923.5.  (a) The Department of Managed Health Care and the
Department of Insurance shall maintain a joint senior level working
group to ensure clarity for health care consumers about who enforces
their patient rights and consistency in the regulations of these
departments.
   (b) The joint working group shall undertake a review and
examination of the Health and Safety Code, the Insurance Code, and
the Welfare and Institutions Code as they apply to the Department of
Managed Health Care and the Department of Insurance to ensure
consistency in consumer protection.
   (c) The joint working group shall review and examine all of the
following processes in each department:
   (1) Grievance and consumer complaint processes, including, but not
limited to, outreach, standard complaints, including coverage and
medical necessity complaints, independent medical review, and
information developed for consumer use.
   (2) The processes used to ensure enforcement of the law,
including, but not limited to, the medical survey and audit process
in the Health and Safety Code and market conduct exams in the
Insurance Code.
   (3) The processes for regulating the timely payment of claims.

   (d) The joint working group shall report its findings to the
Insurance Commissioner and the Director of the Department of Managed
Health Care for review and approval. The commissioner and the
director shall submit the approved final report under signature to
the Legislature by January 1 of every year for five years.