AB 2301, as amended, Mansoor. California Health Benefit Exchange:begin insert individual marketend insert reports.
Existing 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. Existing law requires the board of the Exchange to annually prepare a written report on the implementation and performance of the Exchange functions during the preceding fiscal year, as specified, and requires that this report be submitted to the Legislature and the Governor and be made available to the public on the Internet Web site of the Exchange. Existing law requires the board to require carriers participating in the Exchange to immediately notify the Exchange when an individual is or will be disenrolled from a qualified health plan offered by the carrier.
This bill would also require the board to prepare a written report on a quarterly basis that identifies the number ofbegin delete covered lives underend deletebegin insert individuals enrolled inend insert qualified health plans purchased through the individual market of the Exchange bybegin delete specified categoriesend deletebegin insert demographics, level of coverage, and geographic region, and the number of applications filed through the individual market of the Exchange for each quarter, as specifiedend insert. The bill would also require this report to identify the number of individuals who have been disenrolled from those plansbegin delete due to nonpayment of the premiums, as specifiedend deletebegin insert
by total number, demographics, level of coverage, geographic region, and reason for disenrollmentend insert. The bill would require this report to be submitted to the Legislature and the Governor and to be made available to the public on the Internet Web site of the Exchange.
Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.
The people of the State of California do enact as follows:
Section 100503 of the Government Code, as
2amended by Section 4 of Chapter 5 of the 1st Extraordinary Session
3of the Statutes of 2013, is amended to read:
In addition to meeting the minimum requirements of
5Section 1311 of the federal act, the board shall do all of the
6following:
7(a) Determine the criteria and process for eligibility, enrollment,
8and disenrollment of enrollees and potential enrollees in the
9Exchange and coordinate that process with the state and local
10government entities administering other health care coverage
11programs, including the State Department of Health Care Services,
12the Managed Risk Medical Insurance Board, and California
13counties, in order to ensure consistent eligibility and enrollment
14processes and seamless transitions between coverage.
15(b) Develop processes to
coordinate with the county entities
16that administer eligibility for the Medi-Cal program and the entity
17that determines eligibility for the Healthy Families Program,
18including, but not limited to, processes for case transfer, referral,
19and enrollment in the Exchange of individuals applying for
20assistance to those entities, if allowed or required by federal law.
21(c) Determine the minimum requirements a carrier must meet
22to be considered for participation in the Exchange, and the
23standards and criteria for selecting qualified health plans to be
24offered through the Exchange that are in the best interests of
25qualified individuals and qualified small employers. The board
P3 1shall consistently and uniformly apply these requirements,
2standards, and criteria to all carriers. In the course of selectively
3contracting for health care coverage offered to
qualified individuals
4and qualified small employers through the Exchange, the board
5shall seek to contract with carriers so as to provide health care
6coverage choices that offer the optimal combination of choice,
7value, quality, and service.
8(d) Provide, in each region of the state, a choice of qualified
9health plans at each of the five levels of coverage contained in
10subsections (d) and (e) of Section 1302 of the federal act.
11(e) Require, as a condition of participation in the Exchange,
12carriers to fairly and affirmatively offer, market, and sell in the
13Exchange at least one product within each of the five levels of
14coverage contained in subsections (d) and (e) of Section 1302 of
15the federal act. The board may require carriers to offer additional
16products within each of those
five levels of coverage. This
17subdivision shall not apply to a carrier that solely offers
18supplemental coverage in the Exchange under paragraph (10) of
19subdivision (a) of Section 100504.
20(f) (1) Except as otherwise provided in this section and Section
21100504.5, require, as a condition of participation in the Exchange,
22carriers that sell any products outside the Exchange to do both of
23the following:
24(A) Fairly and affirmatively offer, market, and sell all products
25made available to individuals in the Exchange to individuals
26purchasing coverage outside the Exchange.
27(B) Fairly and affirmatively offer, market, and sell all products
28made available to small employers in the Exchange to small
29employers
purchasing coverage outside the Exchange.
30(2) For purposes of this subdivision, “product” does not include
31contracts entered into pursuant to Part 6.2 (commencing with
32Section 12693) of Division 2 of the Insurance Code between the
33Managed Risk Medical Insurance Board and carriers for enrolled
34
Healthy Families beneficiaries or contracts entered into pursuant
35to Chapter 7 (commencing with Section 14000) of, or Chapter 8
36(commencing with Section 14200) of, Part 3 of Division 9 of the
37Welfare and Institutions Code between the State Department of
38Health Care Services and carriers for enrolled Medi-Cal
39beneficiaries. “Product” also does not include a bridge plan product
40offered pursuant to Section 100504.5.
P4 1(3) Except as required by Section 1301(a)(1)(C)(ii) of the federal
2act, a carrier offering a bridge plan product in the Exchange may
3limit the products it offers in the Exchange solely to a bridge plan
4product contract.
5(g) Determine when an enrollee’s coverage commences and the
6extent and scope of coverage.
7(h) Provide for the processing of applications and the enrollment
8and disenrollment of enrollees.
9(i) Determine and approve cost-sharing provisions for qualified
10health plans.
11(j) Establish uniform billing and payment policies for qualified
12health plans offered in the Exchange to ensure consistent
13enrollment and disenrollment activities for individuals enrolled in
14the Exchange.
15(k) Undertake activities necessary to market and publicize the
16availability of health care coverage and federal subsidies through
17the Exchange. The board shall also undertake outreach and
18enrollment activities that seek to assist enrollees and potential
19enrollees with enrolling and reenrolling in the Exchange in the
20least
burdensome manner, including populations that may
21experience barriers to enrollment, such as the disabled and those
22with limited English language proficiency.
23(l) Select and set performance standards and compensation for
24navigators selected under subdivision (l) of Section 100502.
25(m) Employ necessary staff.
26(1) The board shall hire a chief fiscal officer, a chief operations
27officer, a director for the SHOP Exchange, a director of Health
28Plan Contracting, a chief technology and information officer, a
29general counsel, and other key executive positions, as determined
30by the board, who shall be exempt from civil service.
31(2) (A) The board shall set
the salaries for the exempt positions
32described in paragraph (1) and subdivision (i) of Section 100500
33in amounts that are reasonably necessary to attract and retain
34individuals of superior qualifications. The salaries shall be
35published by the board in the board’s annual budget. The board’s
36
annual budget shall be posted on the Internet Web site of the
37Exchange. To determine the compensation for these positions, the
38board shall cause to be conducted, through the use of independent
39outside advisors, salary surveys of both of the following:
P5 1(i) Other state and federal health insurance exchanges that are
2most comparable to the Exchange.
3(ii) Other relevant labor pools.
4(B) The salaries established by the board under subparagraph
5(A) shall not exceed the highest comparable salary for a position
6of that type, as determined by the surveys conducted pursuant to
7subparagraph (A).
8(C) The Department of Human Resources shall review the
9methodology
used in the surveys conducted pursuant to
10subparagraph (A).
11(3) The positions described in paragraph (1) and subdivision (i)
12of Section 100500 shall not be subject to otherwise applicable
13provisions of the Government Code or the Public Contract Code
14and, for those purposes, the Exchange shall not be considered a
15state agency or public entity.
16(n) Assess a charge on the qualified health plans offered by
17carriers that is reasonable and necessary to support the
18development, operations, and prudent cash management of the
19Exchange. This charge shall not affect the requirement under
20Section 1301 of the federal act that carriers charge the same
21premium rate for each qualified health plan whether offered inside
22or outside the Exchange.
23(o) Authorize expenditures, as necessary, from the California
24Health Trust Fund to pay program expenses to administer the
25Exchange.
26(p) Keep an accurate accounting of all activities, receipts, and
27expenditures, and annually submit to the United States Secretary
28of Health and Human Services a report concerning that accounting.
29Commencing January 1, 2016, the board shall conduct an annual
30audit.
31(q) (1) Notwithstanding Section 10231.5, annually prepare a
32written report on the implementation and performance of the
33Exchange functions during the preceding fiscal year, including, at
34a minimum, the manner in which funds were expended and the
35progress toward, and the achievement of, the requirements of this
36title. The report shall also include data
provided by health care
37service plans and health insurers offering bridge plan products
38regarding the extent of health care provider and health facility
39overlap in their Medi-Cal networks as compared to the health care
P6 1provider and health facility networks contracting with the plan or
2insurer in their bridge plan contracts.
3(2) The Exchange shall prepare, or contract for the preparation
4of, an evaluation of the bridge plan program using the first three
5years of experience with the program. The evaluation shall be
6provided to the health policy and fiscal committees of the
7Legislature in the fourth year following federal approval of the
8bridge plan option. The evaluation shall include, but not be limited
9to, all of the following:
10(A) The number of individuals eligible to
participate in the
11bridge plan program each year by category of eligibility.
12(B) The number of eligible individuals who elect a bridge plan
13option each year by category of eligibility.
14(C) The average length of time, by region and statewide, that
15individuals remain in the bridge plan option each year by category
16of eligibility.
17(D) The regions of the state with a bridge plan option, and the
18carriers in each region that offer a bridge plan, by year.
19(E) The premium difference each year, by region, between the
20bridge plan and the first and second lowest costbegin delete planend deletebegin insert
plansend insert for
21individuals in the Exchange who are not eligible for the bridge
22plan.
23(F) The effect of the bridge plan on the premium subsidy amount
24for bridge plan eligible individuals each year by each region.
25(G) Based on a survey of individuals enrolled in the bridge plan:
26(i) Whether individuals enrolling in the bridge plan product are
27able to keep their existing health care providers.
28(ii) Whether individuals would want to retain their bridge plan
29product, buy a different Exchange product, or decline to purchase
30health insurance if there was no bridge plan product available. The
31Exchange may include questions designed to elicit the
information
32in this subparagraph as part of an existing survey of individuals
33receiving coverage in the Exchange.
34(3) In addition to the evaluation required by paragraph (2), the
35Exchange shall post the items in subparagraphs (A) to (F),
36inclusive, on its Internet Web site each year.
37(4) (A) In addition to the report described in paragraph (1), and
38notwithstanding Section 10231.5, the board shallbegin delete quarterlyend delete prepare
39a written reportbegin delete that identifies the number of covered lives under begin insert
on a quarterly basis
40qualified health plans purchased through the individual market of
P7 1the Exchange by the following categories:end delete
2regarding the status of the individual market of the Exchange. The
3report shall be made available, as described in paragraph (5),
4within 30 days following the end of each quarter and shall, at a
5minimum, include all of the following information:end insert
6(i) Total number overall.
end delete7(ii) Age.
end delete8(iii) Ethnicity.
end delete9(iv) Gender.
end delete10(v) Income level.
end delete
11(i) Demographic information regarding the number of
12individuals enrolled in qualified health plans purchased through
13the individual market of the Exchange, including, but not limited
14to, gender, age, race, ethnicity, primary language, and income
15level.
16(ii) The number of individuals enrolled in qualified health plans
17purchased through the individual market of the Exchange in each
18of the levels of coverage identified in Section 1367.008 of the
19Health and Safety Code and Section 10112.295 of the Insurance
20Code.
21(vi)
end delete
22begin insert(iii)end insert Thebegin insert number of individuals enrolled in qualified health plans
23purchased through the individual market of the Exchange in each
24of theend insert geographic regions listed in Sectionbegin delete 1357.512end deletebegin insert 1399.855end insert of
25the Health and Safety Code and Section 10965.9 of the Insurance
26Code.
27(iv) The number of applications that were filed through the
28individual market of the Exchange since the end of the previous
29quarter.
30(v) The number of applications that were filed through the
31individual market of the
Exchange since the end of the previous
32quarter with the help of an agent, a certified enrollment counselor,
33as defined in Section 6650 of Title 10 of the California Code of
34Regulations, or any other person or entity.
35(vi) The number of applications that were filed through the
36individual market of the Exchange using the Internet Web site of
37the Exchange maintained under subdivision (c) of Section 100502.
38(B) The report required by this paragraph shall also identify the
39number of individualsbegin delete, by the categories listed in subparagraph
who, since the end of the
40(A),end deletebegin delete lastend deletebegin insert previousend insert quarter, or since January
P8 11, 2014, in the case of the first report, have been disenrolled from
2a qualified health plan purchased through the individual market
3of the Exchangebegin delete due to nonpayment of the premiums.end deletebegin insert by the
4following categories:end insert
5(C) The report required by this paragraph shall be completed
6within 30 days of the end of a quarter.
7(i) Total number.
end insertbegin insert
8(ii) Demographics, including, but not limited to, gender, age,
9race, ethnicity, primary language, and income level.
10(iii) The levels of coverage described in Section 1367.008 of
11the Health and Safety Code and Section 10112.295 of the Insurance
12Code.
13(iv) The geographic regions listed in Section 1399.855 of the
14Health and Safety Code and Section 10965.9 of the Insurance
15Code.
16(v) Reasons for disenrollment.
end insert
17(5) The reports required by this subdivision shall be transmitted
18to the Legislature and the Governor and shall be made available
19to the public on the Internet Web site of the Exchange. The reports
20made to the Legislature pursuant to this subdivision shall be
21submitted pursuant to Section 9795.
22(6) In addition to the reports described inbegin delete paragraphs (1) and begin insert
this subdivisionend insert, the board shall be responsive to requests for
23(2)end delete
24additional information from the Legislature, including providing
25testimony and commenting on proposed state legislation or policy
26issues. The Legislature finds and declares that activities, including,
27but not limited to, responding to legislative or executive inquiries,
28tracking and commenting on legislation and regulatory activities,
29and preparing reports on the implementation of this title and the
30performance of the Exchange, are necessary state requirements
31and are distinct from the promotion of legislative or regulatory
32modifications referred to in subdivision (d) of Section 100520.
33(r) Maintain enrollment and expenditures to ensure that
34expenditures do not exceed the amount of revenue in the fund, and
35if sufficient revenue is not
available to pay estimated expenditures,
36institute appropriate measures to ensure fiscal solvency.
37(s) Exercise all powers reasonably necessary to carry out and
38comply with the duties, responsibilities, and requirements of this
39act and the federal act.
P9 1(t) Consult with stakeholders relevant to carrying out the
2activities under this title, including, but not limited to, all of the
3following:
4(1) Health care consumers who are enrolled in health plans.
5(2) Individuals and entities with experience in facilitating
6enrollment in health plans.
7(3) Representatives of small businesses and self-employed
8individuals.
9(4) The State Medi-Cal Director.
10(5) Advocates for enrolling hard-to-reach populations.
11(u) Facilitate the purchase of qualified health plans in the
12Exchange by qualified individuals and qualified small employers
13no later than January 1, 2014.
14(v) Report, or contract with an independent entity to report, to
15the Legislature by December 1, 2018, on whether to adopt the
16option in Section 1312(c)(3) of the federal act to merge the
17individual and small employer markets. In its report, the board
18shall provide information, based on at least two years of data from
19the Exchange, on the potential impact on rates paid by individuals
20and by small employers in a merged
individual and small employer
21market, as compared to the rates paid by individuals and small
22employers if a separate individual and small employer market is
23maintained. A report made pursuant to this subdivision shall be
24submitted pursuant to Section 9795.
25(w) With respect to the SHOP Program, collect premiums and
26administer all other necessary and related tasks, including, but not
27limited to, enrollment and plan payment, in order to make the
28offering of employee plan choice as simple as possible for qualified
29small employers.
30(x) Require carriers participating in the Exchange to immediately
31notify the Exchange, under the terms and conditions established
32by the board when an individual is or will be enrolled in or
33disenrolled from any qualified health plan offered by the
carrier.
34(y) Ensure that the Exchange provides oral interpretation
35services in any language for individuals seeking coverage through
36the Exchange and makes available a toll-free telephone number
37for the hearing and speech impaired. The board shall ensure that
38written information made available by the Exchange is presented
39in a plainly worded, easily understandable format and made
40available in prevalent languages.
P10 1(z) This section shall become inoperative on the October 1 that
2is five years after the date that federal approval of the bridge plan
3option occurs, and, as of the second January 1 thereafter, is
4repealed, unless a later enacted statute that is enacted before that
5date deletes or extends the dates on which it becomes inoperative
6and is
repealed.
Section 100503 of the Government Code, as added by
8Section 5 of Chapter 5 of the 1st Extraordinary Session of the
9Statutes of 2013, is amended to read:
In addition to meeting the minimum requirements of
11Section 1311 of the federal act, the board shall do all of the
12following:
13(a) Determine the criteria and process for eligibility, enrollment,
14and disenrollment of enrollees and potential enrollees in the
15Exchange and coordinate that process with the state and local
16government entities administering other health care coverage
17programs, including the State Department of Health Care Services,
18the Managed Risk Medical Insurance Board, and California
19counties, in order to ensure consistent eligibility and enrollment
20processes and seamless transitions between coverage.
21(b) Develop processes to
coordinate with the county entities
22that administer eligibility for the Medi-Cal program and the entity
23that determines eligibility for the Healthy Families Program,
24including, but not limited to, processes for case transfer, referral,
25and enrollment in the Exchange of individuals applying for
26assistance to those entities, if allowed or required by federal law.
27(c) Determine the minimum requirements a carrier must meet
28to be considered for participation in the Exchange, and the
29standards and criteria for selecting qualified health plans to be
30offered through the Exchange that are in the best interests of
31qualified individuals and qualified small employers. The board
32shall consistently and uniformly apply these requirements,
33standards, and criteria to all carriers. In the course of selectively
34contracting for health care coverage offered
to qualified individuals
35and qualified small employers through the Exchange, the board
36shall seek to contract with carriers so as to provide health care
37coverage choices that offer the optimal combination of choice,
38value, quality, and service.
P11 1(d) Provide, in each region of the state, a choice of qualified
2health plans at each of the five levels of coverage contained in
3subsections (d) and (e) of Section 1302 of the federal act.
4(e) Require, as a condition of participation in the Exchange,
5carriers to fairly and affirmatively offer, market, and sell in the
6Exchange at least one product within each of the five levels of
7coverage contained in subsections (d) and (e) of Section 1302 of
8the federal act. The board may require carriers to offer additional
9products within each of those five
levels of coverage. This
10subdivision shall not apply to a carrier that solely offers
11 supplemental coverage in the Exchange under paragraph (10) of
12subdivision (a) of Section 100504.
13(f) (1) Require, as a condition of participation in the Exchange,
14carriers that sell any products outside the Exchange to do both of
15the following:
16(A) Fairly and affirmatively offer, market, and sell all products
17made available to individuals in the Exchange to individuals
18purchasing coverage outside the Exchange.
19(B) Fairly and affirmatively offer, market, and sell all products
20made available to small employers in the Exchange to small
21employers purchasing coverage outside the Exchange.
22(2) For purposes of this subdivision, “product” does not include
23contracts entered into pursuant to Part 6.2 (commencing with
24Section 12693) of Division 2 of the Insurance Code between the
25Managed Risk Medical Insurance Board and carriers for enrolled
26Healthy Families beneficiaries or contracts entered into pursuant
27to Chapter 7 (commencing with Section 14000) of, or Chapter 8
28(commencing with Section 14200) of, Part 3 of Division 9 of the
29Welfare and Institutions Code between the State Department of
30Health Care Services and carriers for enrolled Medi-Cal
31beneficiaries.
32(g) Determine when an enrollee’s coverage commences and the
33extent and scope of coverage.
34(h) Provide for the processing of applications and
the enrollment
35and disenrollment of enrollees.
36(i) Determine and approve cost-sharing provisions for qualified
37health plans.
38(j) Establish uniform billing and payment policies for qualified
39health plans offered in the Exchange to ensure consistent
P12 1enrollment and disenrollment activities for individuals enrolled in
2the Exchange.
3(k) Undertake activities necessary to market and publicize the
4availability of health care coverage and federal subsidies through
5the Exchange. The board shall also undertake outreach and
6enrollment activities that seek to assist enrollees and potential
7enrollees with enrolling and reenrolling in the Exchange in the
8least burdensome manner, including populations that may
9experience barriers
to enrollment, such as the disabled and those
10with limited English language proficiency.
11(l) Select and set performance standards and compensation for
12navigators selected under subdivision (l) of Section 100502.
13(m) Employ necessary staff.
14(1) The board shall hire a chief fiscal officer, a chief operations
15officer, a director for the SHOP Exchange, a director of Health
16
Plan Contracting, a chief technology and information officer, a
17general counsel, and other key executive positions, as determined
18by the board, who shall be exempt from civil service.
19(2) (A) The board shall set the salaries for the exempt positions
20described in paragraph (1) and subdivision (i) of Section 100500
21in amounts that are reasonably necessary to attract and retain
22individuals of superior qualifications. The salaries shall be
23published by the board in the board’s annual budget. The board’s
24annual budget shall be posted on the Internet Web site of the
25Exchange. To determine the compensation for these positions, the
26board shall cause to be conducted, through the use of independent
27outside advisors, salary surveys of both of the following:
28(i) Other state and federal health insurance exchanges that are
29most comparable to the Exchange.
30(ii) Other relevant labor pools.
31(B) The salaries established by the board under subparagraph
32(A) shall not exceed the highest comparable salary for a position
33of that type, as determined by the surveys conducted pursuant to
34subparagraph (A).
35(C) The Department of Human Resources shall review the
36methodology used in the surveys conducted pursuant to
37subparagraph (A).
38(3) The positions described in paragraph (1) and subdivision (i)
39of Section 100500 shall not be subject to otherwise applicable
40provisions of the Government Code or the Public Contract
Code
P13 1and, for those purposes, the Exchange shall not be considered a
2state agency or public entity.
3(n) Assess a charge on the qualified health plans offered by
4carriers that is reasonable and necessary to support the
5development, operations, and prudent cash management of the
6Exchange. This charge shall not affect the requirement under
7Section 1301 of the federal act that carriers charge the same
8premium rate for each qualified health plan whether offered inside
9or outside the Exchange.
10(o) Authorize expenditures, as necessary, from the California
11Health Trust Fund to pay program expenses to administer the
12Exchange.
13(p) Keep an accurate accounting of all activities, receipts, and
14expenditures, and annually
submit to the United States Secretary
15of Health and Human Services a report concerning that accounting.
16Commencing January 1, 2016, the board shall conduct an annual
17audit.
18(q) (1) Notwithstanding Section 10231.5, annually prepare a
19written report on the implementation and performance of the
20Exchange functions during the preceding fiscal year, including, at
21a minimum, the manner in which funds were expended and the
22progress toward, and the achievement of, the requirements of this
23title.
24(2) (A) In addition to the report described in paragraph (1), and
25notwithstanding Section 10231.5, the board shallbegin delete quarterlyend delete prepare
26a written reportbegin delete that identifies the number of covered lives under
27qualified health plans purchased through the
individual market of
28the Exchange by the following categories:end delete
29regarding the status of the individual market of the Exchange. The
30report shall be made available, as described in paragraph (3),
31within 30 days following the end of each quarter and shall, at a
32minimum, include all of the following information:end insert
33(i) Total number overall.
end delete34(ii) Age.
end delete35(iii) Ethnicity.
end delete36(iv) Gender.
end delete37(v) Income level.
end delete
38(i) Demographic information regarding the number of
39individuals enrolled in qualified health plans purchased through
40the individual market of the Exchange, including, but not limited
P14 1to, gender, age, race, ethnicity, primary language, and income
2level.
3(ii) The number of individuals enrolled in qualified health plans
4purchased through the individual market of the Exchange in each
5of the levels of coverage identified in Section 1367.008 of the
6Health and Safety Code and Section 10112.295 of the Insurance
7Code.
8(vi)
end delete
9begin insert(iii)end insert Thebegin insert number of individuals enrolled in qualified health plans
10purchased through the individual market of the Exchange in each
11of theend insert geographic regions listed in Sectionbegin delete 1357.512end deletebegin insert 1399.855end insert of
12the Health and Safety Code and Section 10965.9 of the Insurance
13Code.
14(iv) The number of applications that were filed through the
15individual market of the Exchange since the end of the previous
16
quarter.
17(v) The number of applications that were filed through the
18individual market of the Exchange since the end of the previous
19quarter with the help of an agent, a certified enrollment counselor,
20as defined in Section 6650 of Title 10 of the California Code of
21Regulations, or any other person or entity.
22(vi) The number of applications that were filed through the
23individual market of the Exchange using the Internet Web site of
24the Exchange maintained under subdivision (c) of Section 100502.
25(B) The report required by this paragraph shall also identify the
26number of individualsbegin delete, by the categories listed in subparagraph who, since the end of the
27(A),end deletebegin delete lastend deletebegin insert
previousend insert quarter, or since January
281, 2014, in the case of the first report, have been disenrolled from
29a qualified health plan purchased through the individual market
30of the Exchangebegin delete was canceled due to nonpayment of the premiums.end delete
31begin insert
by the following categories:end insert
32(C) The report required by this paragraph shall be completed
33within 30 days of the end of each quarter.
34(i) Total number.
end insertbegin insert
35(ii) Demographics, including, but not limited to, gender, age,
36race, ethnicity, primary language, and income level.
37(iii) The levels of coverage described in Section 1367.008 of
38the Health and Safety Code and Section 10112.295 of the Insurance
39Code.
P15 1(iv) The geographic regions listed in Section 1399.855 of the
2Health and Safety Code and Section 10965.9 of the Insurance
3Code.
4(v) Reasons for disenrollment.
end insert
5(3) The reports required by this subdivision shall be transmitted
6
to the Legislature and the Governor and shall be made available
7to the public on the Internet Web site of the Exchange. The reports
8made to the Legislature pursuant to this subdivision shall be
9submitted pursuant to Section 9795.
10(4) In addition to the reports described in
paragraphs (1) and
11(2), the board shall be responsive to requests for additional
12information from the Legislature, including providing testimony
13and commenting on proposed state legislation or policy issues.
14The Legislature finds and declares that activities, including, but
15not limited to, responding to legislative or executive inquiries,
16tracking and commenting on legislation and regulatory activities,
17and preparing reports on the implementation of this title and the
18performance of the Exchange, are necessary state requirements
19and are distinct from the promotion of legislative or regulatory
20modifications referred to in subdivision (d) of Section 100520.
21(r) Maintain enrollment and expenditures to ensure that
22expenditures do not exceed the amount of revenue in the fund, and
23if sufficient revenue is not available to pay estimated
expenditures,
24institute appropriate measures to ensure fiscal solvency.
25(s) Exercise all powers reasonably necessary to carry out and
26comply with the duties, responsibilities, and requirements of this
27act and the federal act.
28(t) Consult with stakeholders relevant to carrying out the
29activities under this title, including, but not limited to, all of the
30following:
31(1) Health care consumers who are enrolled in health plans.
32(2) Individuals and entities with experience in facilitating
33enrollment in health plans.
34(3) Representatives of small businesses and self-employed
35individuals.
36(4) The State Medi-Cal Director.
37(5) Advocates for enrolling hard-to-reach populations.
38(u) Facilitate the purchase of qualified health plans in the
39Exchange by qualified individuals and qualified small employers
40no later than January 1, 2014.
P16 1(v) Report, or contract with an independent entity to report, to
2the Legislature by December 1, 2018, on whether to adopt the
3option in Section 1312(c)(3) of the federal act to merge the
4individual and small employer markets. In its report, the board
5shall provide information, based on at least two years of data from
6the Exchange, on the potential impact on rates paid by individuals
7and by small employers in a merged
individual and small employer
8market, as compared to the rates paid by individuals and small
9employers if a separate individual and small employer market is
10maintained. A report made pursuant to this subdivision shall be
11submitted pursuant to Section 9795.
12(w) With respect to the SHOP Program, collect premiums and
13administer all other necessary and related tasks, including, but not
14limited to, enrollment and plan payment, in order to make the
15offering of employee plan choice as simple as possible for qualified
16small employers.
17(x) Require carriers participating in the Exchange to immediately
18notify the Exchange, under the terms and conditions established
19by the board, when an individual is or will be enrolled in or
20disenrolled from any qualified health plan offered by the
carrier.
21(y) Ensure that the Exchange provides oral interpretation
22services in any language for individuals seeking coverage through
23the Exchange and makes available a toll-free telephone number
24for the hearing and speech impaired. The board shall ensure that
25written information made available by the Exchange is presented
26in a plainly worded, easily understandable format and made
27available in prevalent languages.
28(z) This section shall become operative only if Section 4 of the
29act that added this section becomes inoperative pursuant to
30subdivision (z) of that Section 4.
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