BILL NUMBER: AB 2350 AMENDED
BILL TEXT
AMENDED IN SENATE JUNE 25, 2012
AMENDED IN ASSEMBLY APRIL 11, 2012
INTRODUCED BY Assembly Member Monning
FEBRUARY 24, 2012
An act to add Section 1348.95 to the Health and Safety Code, and
to add Section 10127.19 to the Insurance Code, relating to health
care coverage.
LEGISLATIVE COUNSEL'S DIGEST
AB 2350, as amended, Monning. Health care coverage.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975,
provides for the licensure and 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 for the
regulation of health insurers by the Department of Insurance.
This bill would require health care service plans and health
insurers to annually, commencing March 31, 2013
on the date specified health plans are required to report
certain information under the federal Patient Protection and
Affordable Care Act , provide specified information regarding
their plan contracts or policies to the Department of Managed Health
Care or the Department of Insurance, as applicable, including claims
payment policies and practices, periodic financial disclosures, and
data on enrollment and disenrollment, as specified. The bill
would authorize the Director of the Department of Managed Health Care
and the Insurance Commissioner to adopt rules and regulations
necessary to implement these provisions, as specified. The bill would
also require the Department of Managed Health Care and the
Department of Insurance to work with stakeholders to determine the
form and manner of reporting the data according to these provisions
and to avoid redundant reporting, and would authorize these
departments to waive specified reporting requirements or modify the
timeframe of existing reporting requirements, as specified.
Because a willful violation of this reporting requirement by a
health care service plan 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: yes.
State-mandated local program: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. It is the intent of the Legislature by enacting this
act that the reporting requirements for health care service
plans and health insurers be consistent with the reporting
requirements, including form and manner, imposed on qualified health
plans pursuant to Section 156.220 of Title 45 of the Code of Federal
Regulations to comply with Section 2715A of the
federal Public Health Services Act (42 U.S.C. Sec. 300gg-15a) and
paragraph (3) of subdivision (e) of the federal Patient Protection
and Affordable Care Act (42 U.S.C. Sec. 18031(e)(3)), and any
subsequent rules, regulations, and guidance promulgated or
issued pursuant to the provisions of these sections .
SEC. 2. Section 1348.95 is added to the Health and Safety Code, to
read:
1348.95. (a) Commencing March 1, 2013 on
the date that a health plan is required to report information
pursuant to Section 1311(e)(3) of the PPACA (42 U.S.C. Sec. 18031(e)
(3)) , and at least annually thereafter, every health care
service plan, not including a health care service plan offering
specialized health care service plan contracts, shall provide to the
department, in a form and manner determined by the department
in consultation with the Department of Insurance
pursuant to subdivision (d) , the following information:
(1) Claims payment policies and practices.
(2) Periodic financial disclosures.
(3) Data on enrollment.
(4) Data on disenrollment.
(5) Data on the number of claims that are denied.
(6) Data on rating practices.
(7) Information on cost-sharing and payments with respect to any
out-of-network coverage.
(8) Information on enrollee rights.
(9) Enrollee cost-sharing transparency.
(b) For the purposes of this section:
(1) "PPACA" means the federal Patient Protection and Affordable
Care Act (PPACA; Public Law 111-148) as amended by the Health Care
and Education Reconciliation Act of 2010 (Public Law 111-152), and
any rules, regulations, and guidance promulgated or issued under that
law.
(2) The terms used in subdivision (a) shall have the same meaning
as established under the PPACA.
(b)
(c) (1) The data on
enrollment specified in paragraph (3) of subdivision (a) shall
include the number of enrollees as of December 31 of the prior year,
that receive health care coverage under a health care service plan
contract that covers individuals, a small group health care service
plan contract as defined in Section 1385.01, or a large group health
care service plan contract as defined in Section 1385.01, or under
administrative services only business lines. Health
(2) Health care service plans
shall include the unduplicated enrollment data in specific product
lines as determined by the department, including, but not limited to,
HMO, point-of-service, PPO, Medicare excluding Medicare
supplement, and Medi-Cal managed care ,
and traditional indemnity non-PPO health insurance . The
department shall determine how to ensure when a health care
service plan subcontracts with another health plan that duplicated
enrollment data is not reported for the same enrollees.
(3) The department shall publicly
report the data provided by each health care service plan pursuant
to this section, including, but not limited to, posting the data on
the department's Internet Web site. The department shall consult with
the Department of Insurance to ensure that the data reported is
comparable and consistent.
(4) The director may adopt rules and regulations necessary to
implement the provisions of this section pursuant to the rulemaking
provisions of the Administrative Procedure Act (Chapter 3.5
(commencing with Section 11340) of Part 1 of Division 3 of Title 2 of
the Government Code).
(d) The department shall work with the Department of Insurance and
with stakeholders to determine the appropriate format and manner for
reporting the data under this section consistent with the
requirements under federal law and to avoid redundant reporting.
Until two years after the date specified in subdivision (a) or
January 1, 2016, whichever comes first, the department may waive any
reporting requirements it deems duplicative of the requirements
specified in subdivision (a) and modify the timeframe for submission
of these duplicative reports to be consistent with the timeframe
specified in subdivision (a).
SEC. 3. Section 10127.19 is added to the Insurance Code, to read:
10127.19. (a) Commencing March 1, 2013 on
the date that a health plan is required to report information
pursuant to Section 1311(e)(3) of the PPACA (42 U.S.C. Sec. 18031(e)
(3)) , and at least annually thereafter, every insurer, that
issues policies of health insurance, not including specialized health
insurance policies, shall provide to the department, in a form and
manner determined by the department in consultation with the
Department of Managed Health Care pursuant to
subdivision (d) , the following information:
(1) Claims payment policies and practices.
(2) Periodic financial disclosures.
(3) Data on enrollment.
(4) Data on disenrollment.
(5) Data on the number of claims that are denied.
(6) Data on rating practices.
(7) Information on cost-sharing and payments with respect to any
out-of-network coverage.
(8) Information on rights of insureds.
(9) Insured cost-sharing transparency.
(b) For the purposes of this section:
(1) "PPACA" means the federal Patient Protection and Affordable
Care Act (PPACA; Public Law 111-148) as amended by the Health Care
and Education Reconciliation Act of 2010 (Public Law 111-152), and
any rules, regulations, and guidance promulgated or issued under that
law.
(2) The terms used in subdivision (a) shall have the same meaning
as established under the PPACA.
(b)
(c) (1) The data on enrollment
specified in paragraph (3) of subdivision (a) shall include the
number of covered lives, as of December 31 of the prior year, that
receive health care coverage under a health insurance policy that
covers individuals, a small group health insurance policy as defined
in Section 10181, or a large group health insurance policy as defined
in Section 10181, or under administrative services only business
lines. Insurers
(2) Insurers shall include the
unduplicated enrollment data in specific product lines as determined
by the commissioner, including, but not limited to HMO,
point-of-service, PPO, Medicare excluding Medicare
supplement, Medi-Cal managed care, and traditional
indemnity non-PPO health insurance. The
(3) The department shall publicly
report the data provided by each insurer pursuant to this section,
including, but not limited to, posting the data on the department's
Internet Web site. The department shall consult with the Department
of Managed Health Care to ensure that the data reported is comparable
and consistent.
(4) The commissioner may adopt rules and regulations necessary to
implement the provisions of this section pursuant to the rulemaking
provisions of the Administrative Procedure Act (Chapter 3.5
(commencing with Section 11340) of Part 1 of Division 3 of Title 2 of
the Government Code).
(d) The department shall work with the Department of Managed
Health Care and with stakeholders to determine the appropriate format
and manner for reporting the data under this section consistent with
the requirements under federal law and to avoid redundant reporting.
Until two years after the date specified in subdivision (a), or
January 1, 2016, whichever comes first, the department may waive any
reporting requirements it deems duplicative of the requirements
specified in subdivision (a) and modify the timeframe for submission
of these duplicative reports to be consistent with the timeframe
specified in subdivision (a).
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.