BILL NUMBER: AB 1877 AMENDED
BILL TEXT
AMENDED IN SENATE JUNE 17, 2014
AMENDED IN ASSEMBLY MAY 23, 2014
AMENDED IN ASSEMBLY APRIL 2, 2014
INTRODUCED BY Assembly Member Cooley
(Coauthors: Assembly Members Dickinson, Beth Gaines, and Pan)
(Coauthor: Senator Gaines)
FEBRUARY 19, 2014
An act to add Title 22.1 (commencing with Section 100600) to the
Government Code, relating to health care coverage, making an
appropriation therefor, and declaring the urgency thereof, to take
effect immediately.
LEGISLATIVE COUNSEL'S DIGEST
AB 1877, as amended, Cooley. California Vision Care Access
Council.
Existing law, the federal Patient Protection and Affordable Care
Act, requires each state to establish an American Health Benefits
Exchange to facilitate the purchase of qualified health plans by
qualified individuals and small employers. PPACA prohibits an
Exchange from making available any health plan other than a qualified
health plan, except for certain stand-alone dental plans. Existing
state law establishes the California Health Benefit Exchange within
state government, specifies the powers and duties of the board
governing the Exchange, and requires the board to facilitate the
purchase of qualified health plans through the Exchange by qualified
individuals and small employers by January 1, 2014.
This bill would establish the California Vision Care Access
Council within state government and would require that the Council be
governed by a board composed of 5 members appointed by the
Governor and the Legislature, as specified. The bill would prohibit a
member of the board or staff to the Council from being an employee
of, or in specified relationships with, a health care provider or
health care facility, or from benefiting financially from a decision
that he or she participated in making or attempted to use his or her
official position to influence, as specified. the
executive board that governs the California Health Benefit Exchange.
The bill would require the Council to establish an interagency
agreement with the California Health Benefit Exchange allowing the
Council to utilize the executive, administrative, and other related
resources of the Exchange and would prohibit the use of specified
Exchange funds for purposes of the Council. The bill
would require the Council to construct, manage, and maintain a
marketplace for the purchase of vision plans through participating
carriers by qualified individuals and qualified employers and
would require the Council to facilitate enrollment of those
individuals and employers in plans offered by the Council through
licensed insurance agents. The bill would require the Council
to work with the Exchange to establish a direct link between the
Internet Web site of the Exchange and the Internet Web site of the
Council in order to connect consumers of the Exchange to the
marketplace established by the Council and to licensed insurance
agents . The bill would require the Council to refer consumer
questions regarding health care eligibility and enrollment options to
the Exchange and to licensed insurance agents
, as specified.
This bill would impose specified requirements on
participating carriers and would also require the Council to
establish the other requirements for
carrier participation in the marketplace and the standards
and criteria for selecting vision plans that are in the best
interests of qualified individuals and employers, and
imposing specified requirements on participating carriers
employers . The bill would require a participating carrier
to submit a justification for a premium increase to the Council
prior to implementing the increase, increase
and require participating carrier's to make
available to consumers an electronic directory of contracting vision
care providers. The bill would also enact other related provisions.
This bill would create the California Vision Care Access Trust
Fund as a continuously appropriated fund, thereby making an
appropriation, would authorize the Council to assess a charge on the
vision plans offered by participating carriers through the Council
that is reasonable and necessary to support the development,
operations, and prudent cash management of the Council, and would
make the implementation of the bill's provisions contingent on a
determination by the board that at least $250,000 exists in the fund.
The bill would prohibit General Fund moneys from being used for any
of these purposes and would require that any costs associated with
the implementation of these provisions be paid from the California
Vision Care Access Trust Fund.
This bill would declare that it is to take effect immediately as
an urgency statute.
Vote: 2/3. Appropriation: yes. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. This act shall be known and may be cited as the
California Vision Care Access Act.
SEC. 2. It is the intent of the Legislature to make the statutory
changes to California law necessary to establish a Vision Care Access
Council in California and its administrative board
in a manner that is consistent with the rules, regulations,
and guidance implementing the federal Patient Protection and
Affordable Care Act (Public Law 111-148), as amended by the federal
Health Care and Education Reconciliation Act of 2010 (Public Law
111-152), hereafter the federal act. In doing so, it is the intent of
the Legislature to do all of the following:
(a) Provide Californians an organized, transparent marketplace for
the purchase of affordable, quality vision care coverage, augmenting
and supplementing the essential health benefits available through
the California Health Benefit Exchange.
(b) Guarantee the availability of vision coverage through the
private health insurance market to qualified individuals and
employees of qualified employers.
(c) Offer specialized vision health care service plan and health
insurance coverage in the individual and group markets on the basis
of price, quality, and service.
(d) Meet the requirements of the federal act and all applicable
federal guidance, rules, and regulations.
SEC. 3. Title 22.1 (commencing with Section 100600) is added to
the Government Code, to read:
TITLE 22.1. CALIFORNIA VISION CARE ACCESS MARKETPLACE
100600. For purposes of this title, the following definitions
shall apply:
(a) "Board" means the board described in subdivision (a) of
Section 100601.
(b) "Carrier" means either a private health insurer holding a
valid outstanding certificate of authority from the Insurance
Commissioner or a health care service plan, as defined under
subdivision (f) of Section 1345 of the Health and Safety Code,
licensed by the Department of Managed Health Care.
(c) "Council" means the Vision Care Access Council created by
Section 100601.
(d) "Exchange" means the California Health Benefit Exchange
established by Section 100500.
(e) "Federal act" means the federal Patient Protection and
Affordable Care Act (Public Law 111-148), as amended by the federal
Health Care and Education Reconciliation Act of 2010 (Public Law
111-152), and any amendments to, or regulations or guidance issued
under, those acts.
(f) "Fund" means the California Vision Care Access Trust Fund
established by Section 100620.
(g) "Licensed agent" means an individual licensed by the
Department of Insurance pursuant to Section 1626 of the Insurance
Code.
(g)
(h) "Marketplace" means the marketplace established
under Section 100603.
(h)
(i) "Qualified individual" means an individual who is
eligible to purchase coverage through the Exchange.
(i)
(j) "Qualified employer" means an employer that is
eligible to purchase coverage through the Exchange.
(j)
(k) "Vision plan" means a specialized health care
service plan contract, as defined in Section 1345 of the Health and
Safety Code, covering vision care services or a specialized health
insurance policy, as defined in Section 106 of the Insurance Code,
covering vision care services.
100601. (a) There is in the state government the California
Vision Care Access Council, an independent public entity not
affiliated with an agency or department, which shall be known as the
Council. The Council shall be governed by an executive board
consisting of five members who are residents of California. Of the
members of the board, three shall be appointed by the Governor, one
shall be appointed by the Senate Committee on Rules, and one shall be
appointed by the Speaker of the Assembly. the
executive board established pursuant to Section 100500. The board
shall be subject to Section 100500.
(b) Members of the board shall be appointed for a term of four
years, except that the initial appointment by the Senate Committee on
Rules shall be for a term of three years, and the initial
appointment by the Speaker of the Assembly shall be for a term of two
years. Appointments by the Governor made on or after January 1,
2016, shall be subject to confirmation by the Senate. A member of the
board may continue to serve until the appointment and qualification
of his or her successor. Vacancies shall be filled by appointment for
the unexpired term. The board shall elect a chairperson on an annual
basis.
(c) (1) Each person appointed to the board shall have demonstrated
and acknowledged expertise in at least two of the following areas:
(A) Individual health care coverage.
(B) Small employer health care coverage.
(C) Health benefits plan administration.
(D) Health care finance.
(E) Administering a public or private health care delivery system.
(F) Purchasing health plan coverage.
(2) Appointing authorities shall consider the expertise of the
other members of the board and attempt to make appointments so that
the board's composition reflects a diversity of expertise.
(b) (1) To the extent permitted by the federal act, the Council
shall establish an interagency agreement with the Exchange allowing
the Council to utilize the executive, administrative, and other
related resources of the Exchange, including, but not limited to, the
staff employed by the Exchange and the programming and information
technology infrastructure supporting the Exchange.
(d) The
(2) In addition to establishing an
interagency agreement under paragraph (1), the
Council may establish interagency agreements with other agencies
for the purposes of contracting for executive, administrative,
and other related services, if necessary.
(e) (1) A member of the board or of the staff of the Council shall
not be employed by, a consultant to, a member of the board of
directors of, affiliated with, or otherwise a representative of, a
carrier or other insurer, an agent or broker, a health care provider,
or a health care facility or health clinic while serving on the
board or on the staff of the Council. A member of the board or of the
staff of the Council shall not be a member, a board member, or an
employee of a trade association of carriers, health facilities,
health clinics, or health care providers while serving on the board
or on the staff of the Council. A member of the board or of the staff
of the Council shall not be a health care provider unless he or she
is not compensated for rendering services as a health care provider
and does not have an ownership interest in a professional health care
practice.
(2) For purposes of this subdivision, "health care provider" means
a person licensed or certified pursuant to Division 2 (commencing
with Section 500) of the Business and Professions Code, or licensed
pursuant to the Osteopathic Act or the Chiropractic Act.
(3) No member of the board shall make, participate in making, or
in any way attempt to use his or her official position to influence
the making of, any decision that he or she knows or has reason to
know will have a reasonably foreseeable material financial effect,
distinguishable from its effect on the public generally, on him or
her or a member of his or her immediate family, or on either of the
following:
(A) Any source of income, other than gifts and other than loans by
a commercial lending institution in the regular course of business
on terms available to the public without regard to official status
aggregating two hundred fifty dollars ($250) or more in value
provided to, received by, or promised to, the member within 12 months
prior to the time when the decision is made.
(B) Any business entity in which the member is a director,
officer, partner, trustee, employee, or holds any position of
management.
(f)
(c) Each member of the board shall have the
responsibility and duty to meet the requirements of this title, the
federal act, and all applicable state and federal laws and
regulations, to serve the public interest of the individuals and
small businesses seeking health care coverage through the Council,
and to ensure the operational well-being and fiscal solvency of the
Council.
(g) A board member shall not receive compensation for his or her
service on the board but may receive a per diem and reimbursement for
travel and other necessary expenses, as provided in Section 103 of
the Business and Professions Code, while engaged in the performance
of official duties of the board.
(h)
(d) There shall not be any liability in a private
capacity on the part of the board or any member of the board, or any
officer or employee of the board, for or on account of any act
performed or obligation entered into in an official capacity, when
done in good faith, without the intent to defraud, and in connection
with the administration, management, or conduct of this title or
affairs related to this title.
(i) (1) The board shall hire an executive director to organize,
administer, and manage the operations of the Council. The executive
director shall be exempt from civil service and shall serve at the
pleasure of the board.
(2) The board shall identify and fill other key executive
positions, as determined necessary by the board, who shall be exempt
from civil service to the extent permitted by law.
(3) The board shall set the salaries for the exempt positions
described in paragraphs (1) and (2) in amounts that are reasonably
necessary to attract and retain individuals of superior
qualifications. The salaries shall be published by the board and
shall be posted on the Internet Web site of the Council.
(j) The board shall be subject to the Bagley-Keene Open Meeting
Act (Article 9 (commencing with Section 11120) of Chapter 1 of Part 1
of Division 3 of Title 2), except that the board may hold closed
sessions when considering matters related to litigation, personnel,
contracting, and rates.
(e) A member of the board or staff of the Council shall not be
employed by, a consultant to, a member of the board of directors of,
affiliated with, or otherwise a representative of, an optical company
that manufactures, sells, or distributes lenses, frames, or other
vision care appliances.
100603. The Council shall, at a minimum, do all of the following:
(a) Construct, manage, and maintain a marketplace for the purchase
of vision plans through participating carriers by qualified
individuals and qualified employers. The marketplace shall offer full
and complete carrier information to consumers, shall ensure a secure
purchase functionality, and shall allow enrollees and prospective
enrollees to obtain standardized comparative information on the plans
offered through the marketplace.
(b) Maintain an Internet Web site , separate from the
Internet Web site established by the Exchange,
through which enrollees and prospective enrollees of vision plans may
obtain standardized comparative information on the plans offered in
the marketplace.
(c) Work cooperatively with the Exchange to establish a direct
link from the Internet Web site maintained by the Exchange to an
Internet Web site maintained by the Council to connect Exchange
consumers to the marketplace and to licensed agents .
(d) Make the marketplace available to individuals without access
to the Internet.
(e) Determine the minimum requirements a carrier shall meet to be
considered for participation in the marketplace, and the standards
and criteria for selecting vision plans to be offered through the
marketplace that are in the best interests of consumers. The board
shall consistently and uniformly apply these requirements, standards,
and criteria to all carriers. In the course of selectively
contracting for vision coverage offered to qualified individuals and
qualified employers through the Council, the board shall seek to
contract with carriers so as to provide vision coverage choices that
offer the optimal combination of choice, value, quality, and service.
The requirements adopted pursuant to this subdivision shall, at a
minimum, include the following:
(1) A requirement that a carrier meet a minimum net asset
threshold as determined by the Council to ensure that it is both well
established and can demonstrate that it offers a proven model for
providing vision care coverage in California. The Council may also
consider the usefulness of setting a minimum annual premium revenue
as evidence of the soundness of the carrier.
(2) A requirement that a carrier have, and continuously maintain,
an established Internet Web site.
(3) A requirement that a carrier demonstrate to the Council
adequate vision care coverage networks sufficient to ensure
convenient geographic access to vision care in California.
(4) A requirement that a carrier demonstrate to the Council
adequate, multilingual consumer service and benefit delivery
capabilities.
(5) Any other requirements determined necessary by the board based
on input from health care consumer advocacy organizations,
representatives of the optometry and ophthalmology industries, health
insurers, and health care service plans ,
and licensed agents .
(f) Require vision plans offered in the marketplace to do both of
the following:
(1) (A) Make available to the public, and the Insurance
Commissioner or the Department of Managed Health Care, as applicable,
accurate and timely disclosure of the following information:
(i) Claims payment policies and practices.
(ii) Periodic financial disclosures.
(iii) Data on enrollment.
(iv) Data on disenrollment.
(v) Data on the number of claims that are denied.
(vi) Information on cost sharing and payments with respect to any
out-of-network coverage.
(B) The information required under subparagraph (A) shall be
provided in plain language.
(2) Permit individuals to learn, in a timely manner upon the
request of the individual, the amount of cost sharing, including, but
not limited to, deductibles, copayments, and coinsurance, under the
individual's plan or coverage that the individual would be
responsible for paying with respect to the furnishing of a specific
item or service by a participating provider. At a minimum, this
information shall be made available to the individual through an
Internet Web site , through licensed agents,
and through other means for individuals without access to the
Internet.
(g) Provide for the operation of a toll-free telephone hotline to
respond to requests for assistance.
(h) Establish and make available by electronic means a calculator
to determine the actual cost of a vision plan for a consumer.
(i) Conduct public education activities to raise awareness of the
availability of vision plans through the Council.
(j) Distribute fair and impartial information concerning
enrollment in coverage offered through the Council.
(k) Facilitate enrollment of qualified individuals and qualified
employers in vision plans offered through the Council by
licensed agents .
( l ) Provide referrals to any applicable office of
health insurance consumer assistance or health insurance ombudsman,
or any other appropriate state agency or agencies, for any enrollee
with a grievance, complaint, or question regarding a participating
carrier, coverage purchased pursuant to this title, or a
determination by the carrier or under that coverage.
(m) Provide information in a manner that is culturally and
linguistically appropriate to the needs of the population being
served by the Council using the services of licensed
agents .
(n) Undertake activities necessary to market and publicize the
availability of vision plans through the Council, ensuring clear
communication to consumers that federal subsidies are not available
for this coverage. The board shall also undertake outreach and
enrollment activities that seek using
licensed agents to assist enrollees and potential enrollees
with enrolling and reenrolling in the coverage offered by the Council
in the least burdensome manner, including populations that may
experience barriers to enrollment, such as the disabled and those
with limited English language proficiency.
(o) Employ necessary staff to the extent not provided
pursuant to the interagency agreements established under Section
100601 .
(p) Assess a charge on the vision plans offered by participating
carriers through the marketplace that is reasonable and necessary to
support the development, operations, and prudent cash management of
the Council.
(q) Authorize expenditures, as necessary, from the fund to pay
program expenses to administer the Council.
(r) Keep an accurate accounting of all activities, receipts, and
expenditures, and annually publish a report concerning that
accounting.
(s) (1) Annually publish a report on the implementation and
performance of the Council functions during the preceding fiscal
year, that shall be made available to the public on the Internet Web
site of the Council.
(2) In addition to the report described in paragraph (1), the
Council shall be responsive to requests for additional information
from the Legislature, including providing testimony and commenting on
proposed state legislation or policy issues.
(t) Exercise all powers reasonably necessary to carry out and
comply with the duties, responsibilities, and requirements of this
act.
(u) Consult with stakeholders relevant to carrying out the
activities under this title, including, but not limited to, all of
the following:
(1) Health care consumers who are enrolled in vision plans.
(2) Individuals and entities with experience in facilitating
enrollment in vision plans.
(3) Representatives of small businesses and self-employed
individuals.
(4) Licensed agents.
(v) Require participating carriers to regularly, as determined by
the Council, provide the Council with enrollment or disenrollment
data.
(w) Ensure that the Council provides oral interpretation services
in any language for individuals seeking coverage through the Council
and makes available a toll-free telephone number for the hearing and
speech impaired. The Council shall ensure that written information
made available by the Council is presented in a plainly worded,
easily understandable format and made available in California's
prevalent languages.
(x) Provide a choice of carrier in each region of the state.
(y) (1) Require, as a condition of participation in the Council,
carriers that sell vision products outside the Council to do both of
the following:
(A) Fairly and affirmatively offer, market, and sell all products
made available to individuals in the marketplace to individuals
purchasing coverage outside the Council. The products available
to individuals in the marketplace shall be the same individual
product products as offered outside the
Council through licensed agents .
(B) Fairly and affirmatively offer, market, and sell all products
made available to employers in the marketplace to employers
purchasing coverage outside the Council. The products available
to employers in the marketplace shall be the same
employer coverage products as offered outside the Council
through licensed agents .
(2) For purposes of this subdivision, "product" does not include
contracts entered into pursuant to Part 6.2 (commencing with Section
12693) of Division 2 of the Insurance Code between the Managed Risk
Medical Insurance Board and carriers for enrolled Healthy Families
beneficiaries or contracts entered into pursuant to Chapter 7
(commencing with Section 14000) of, or Chapter 8 (commencing with
Section 14200) of, Part 3 of Division 9 of the Welfare and
Institutions Code between the State Department of Health Care
Services and carriers for enrolled Medi-Cal beneficiaries.
(z) Determine and approve cost-sharing provisions for carriers.
(aa) Standardize products to be offered through the Council.
(ab) Share information with relevant state departments, consistent
with the confidentiality provisions in Section 1411 of the federal
act, necessary for the administration of the Council.
(ac) Collect only that information from individuals or designees
of individuals as is necessary to administer the Council and
consistent with the federal act.
100605. The Council may do any of the following:
(a) Enter into contracts.
(b) Adopt an official seal.
(c) Sue and be sued.
(d) Receive and accept gifts, grants, or donations of moneys from
any agency of the United States, any agency of the state, any
municipality, county, or other political subdivision of the state.
(e) Receive and accept gifts, grants, or donations from
individuals, associations, private foundations, or corporations, in
compliance with the conflict-of-interest provisions to be adopted by
the board at a public meeting.
(f) Adopt rules and regulations as necessary.
100606. (a) A participating carrier shall submit to the Council a
written justification for a premium increase prior to implementing
the increase.
(b) A participating carrier shall utilize a standardized format
for presenting vision plan options to the Council.
(c) The Council shall refer questions from consumers regarding
eligibility and enrollment options for Medi-Cal or through the
Exchange to the Exchange and to licensed agents .
(d) (1) The Council shall require a participating carrier to make
available to consumers and regularly update an electronic directory
of contracting vision care providers in the carrier's network.
(2) The Council may also require a participating carrier to
provide regularly updated information to the Council as to whether a
health care provider is accepting new patients for a particular
vision plan.
(3) The Council may provide an integrated and uniform consumer
directory of health care providers indicating which participating
carriers the providers contract with and whether the providers are
currently accepting new patients.
(4) The Council may establish methods by which health care
providers may transmit relevant information directly to the Council,
rather than through a participating carrier.
100607. (a) Notwithstanding any other provision of law, the
Council shall not be subject to licensure or regulation by the
Department of Insurance or the Department of Managed Health Care.
(b) Carriers that contract with the Council shall have and
maintain a license or certificate of authority from, and shall be in
good standing with, their respective regulatory agencies.
100609. Records of the Council that reveal any of the following
shall be exempt from disclosure under the California Public Records
Act (Chapter 3.5 (commencing with Section 6250) of Division 7 of
Title 1):
(a) The deliberative processes, discussions, communications, or
any other portion of the negotiations with entities contracting or
seeking to contract with the Council, entities with which the Council
is considering a contract, or entities with which the Council is
considering or enters into any other arrangement under which the
Council provides, receives, or arranges services or reimbursement.
(b) The impressions, opinions, recommendations, meeting minutes,
research, work product, theories, or strategy of the board or its
staff, or records that provide instructions, advice, or training to
employees.
100620. (a) The California Vision Care Access Trust Fund is
hereby created in the State Treasury for the purpose of this title.
Moneys collected pursuant to this title shall be deposited in the
fund. Notwithstanding Section 13340, all moneys in the fund shall be
continuously appropriated without regard to fiscal year for the
purposes of this title. Any moneys in the fund that are unexpended or
unencumbered at the end of a fiscal year may be carried forward to
the next succeeding fiscal year.
(b) Notwithstanding any other provision of law,
moneys deposited in the fund shall not be loaned to, or borrowed by,
any other special fund or the General Fund, or a county general fund
or any other county fund.
(c) The Council shall establish and maintain a prudent reserve in
the fund.
(d) The board or staff of the Council shall not utilize any funds
intended for the administrative and operational expenses of the
Council for staff retreats, promotional giveaways, excessive
executive compensation, or promotion of federal or state legislative
or regulatory modifications.
(e) Notwithstanding Section 16305.7, all interest earned on the
moneys that have been deposited into the fund shall be retained in
the fund and used for purposes consistent with the fund.
(f) (1) State General Fund moneys shall not be used for any
purpose under this title.
(2) Federal money paid to the state for the purpose of
establishing an American Health Benefit Exchange, as described in
Section 1311 of the federal act, and charges assessed by the Exchange
pursuant to subdivision (n) of Section 100503 of the Government
Code, shall not be used for purposes of this title.
(2)
(3) Any costs associated with the implementation of
this title , including, but not limited to, the proportionate
cost of Exchange resources used for purposes of this title,
shall be paid from the fund.
100621. (a) The implementation of the provisions of this title,
other than this section and Sections 100601 and
100601, 100605, and 100620, shall be contingent
on a determination by the board that at least two hundred fifty
thousand dollars ($250,000) exists in the fund.
(b) The board shall provide notice
to the Joint Legislative Budget Committee and the Director of Finance
when the financial threshold set forth in subdivision (a) has been
reached.
SEC. 4. The Legislature finds and declares that Section 3 of this
act, which adds Section 100609 to the Government Code, imposes a
limitation on the public's right of access to the meetings of public
bodies or the writings of public officials and agencies within the
meaning of Section 3 of Article I of the California Constitution.
Pursuant to that constitutional provision, the Legislature makes the
following findings to demonstrate the interest protected by this
limitation and the need for protecting that interest:
In order to ensure that the California Vision Care Access Council
is not constrained in exercising its fiduciary powers and obligations
to provide consumers with the most accessible and affordable vision
care benefits augmenting the benefits available through the
California Health Benefit Exchange, the limitations on the public's
right of access imposed by Section 3 of this act are necessary.
SEC. 5. This act is an urgency statute necessary for the immediate
preservation of the public peace, health, or safety within the
meaning of Article IV of the Constitution and shall go into immediate
effect. The facts constituting the necessity are:
In order to provide Californians an organized, transparent
marketplace for the purchase of affordable, quality vision care
coverage, augmenting and supplementing the essential health benefits
available through the California Health Benefit Exchange in a manner
consistent with evolving federal rules, regulations, and official
guidance implementing the federal Patient Protection and Affordable
Care Act (Public Law 111-148), as amended by the federal Health Care
and Education Reconciliation Act of 2010 (Public Law 111-152), it is
necessary that this act take effect immediately.