BILL ANALYSIS �
Senate Appropriations Committee Fiscal Summary
Senator Kevin de Le�n, Chair
AB 369 (Pan) - Continuity of Care.
Amended: February 18, 2014 Policy Vote: Health 7-0
Urgency: Yes Mandate: Yes
Hearing Date: February 24, 2014
Consultant: Brendan McCarthy
This bill does not meet the criteria for referral to the
Suspense File.
Bill Summary: AB 369, an urgency measure, would allow new
enrollees in a health plan or health insurance policy to
continue to receive treatment from their existing provider, if
the enrollee's prior health care coverage was cancelled between
December 1, 2013 and March 31, 2014.
Fiscal Impact:
One-time costs of about $120,000 in 2013-14 and $110,000 in
2014-15 to the Department of Insurance for enforcement and
consumer assistance (Insurance Fund).
One-time costs of about $15,000 in 2013-14 and $80,000 in
2014-15 to the Department of Managed Health Care for
enforcement and consumer assistance (Managed Care Fund).
No anticipated impact on the Medi-Cal program. Under
current law and practice, Medi-Cal managed care plans are
already required to provide continuity of care for new
enrollees as would be required under this bill.
Background: Under current law, health insurers are regulated by
the Department of Insurance and health plans are regulated by
the Department of Managed Health Care. Current law generally
requires health insurers and managed care plans to provide
"continuity of care" for enrollees who have certain medical
conditions. Under this requirement, if an insurance policy or
health plan terminates a contract with a medical provider, the
insurer or health plan must continue to provide coverage for
services provided by the terminated provider for specified time
periods. Current law does not extend continuity of care
requirements to newly covered enrollees who have an individual
AB 369 (Pan)
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subscriber agreement (i.e. a consumer who has bought a health
plan in the individual market) or to enrollees in a health
insurance plan.
Proposed Law: AB 369 would allow new enrollees in a health plan
or health insurance policy to continue to receive treatment from
their existing provider, if the enrollee's prior health care
coverage was cancelled between December 1, 2013 and March 31,
2014.
Under the bill, insurers and health plans would be authorized to
pay non-participating providers at the same rates and terms as a
imposed on participating providers. If the provider does not
wish to provide services under those terms and cannot agree to
other terms with the insurer or health plan, the provider would
not be obligated to continue to provide services under the bill.
In cases where a new enrollee has a health insurance policy and
the existing provider agrees to continue to provide care under
the bill, the provider would have to accept payment from the
insurer as payment in full for services. The provider would be
prohibited from billing the patient for any amount in excess of
the insurer's reimbursement rate, except for copayments and/or
deductibles allowed under the insurance policy.
This bill is an urgency measure.
Related Legislation: AB 1507 (Logue) would allow an individual
or small group health plan in effect on October 1, 2013 to be
renewed until October 1, 2014 and remain in effect until
December 31, 2014. That bill is in the Assembly.
Staff Comments: The only costs that may be incurred by a local
agency relate to crimes and infractions. Under the California
Constitution, such costs are not reimbursable by the state.