AB 2400, as introduced, Ridley-Thomas. Health care coverage: physician contracts.
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 also provides for the regulation of health insurers by the Department of Insurance. Existing law prescribes restrictions on the types of contractual provisions that may be included in agreements between health care service plans or health insurers and health care providers.
This bill would prohibit a contract between a physician or physician group with a health care service plan or health insurer, that is issued, amended, delivered, or renewed in this state on or after January 1, 2015, from including any provision that requires a physician, as a condition of entering into the contract, to participate in any product that provides different rates, methods of payment, or lines of business unless that participation is negotiated and agreed to between the health care service plan or health insurer and the physician. The bill would require any contract that contains a provision attempting to obligate the physician to participate in any product that provides different rates, methods of payment, or lines of business to contain a provision for each product permitting the physician to affirmatively agree to participate in each product. The bill would state findings and declarations of the Legislature with respect to these provisions.
By expanding the scope of a crime, this bill would create 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 1375.65 is added to the Health and Safety
2Code, to read:
(a) The Legislature finds and declares that prohibiting
4health care service plans from executing agreements with
5physicians that contain provisions requiring physicians to
6participate in all networks or products that are currently offered
7or that may be offered by the health plan without allowing
8physicians to affirmatively agree and opt-in to participate in each
9network or product will assist in maintaining patient access to
10adequate physician networks. The Legislature further finds and
11declares that the ability of physicians to exercise this choice will
12further protect patients as physicians will be able to decide on the
13merits of the product being offered and whether participation, in
14their reasonable professional judgment, would further patients’
15access to continuous quality of medical care.
16(b) A contract between a physician or physician group and a
17health care service plan that is issued, amended, delivered, or
18renewed in this state on or after January 1, 2015, shall not include
19any provision that requires a physician, as a condition of entering
20into the contract, to participate in any product that provides
21different rates, methods of payment, or lines of business unless
22that participation is negotiated and agreed to between the health
23care service plan and the physician. Any contract that contains a
24provision attempting to obligate the physician to participate in any
P3 1product that provides different rates, methods of payment, or lines
2of business shall contain a provision for each product permitting
3the physician to affirmatively agree to participate in each product.
4The status of a physician as a member of, or as being eligible for,
5other existing or new provider panels shall not be adversely
6affected by the physician’s exercise of
his or her right to not
7participate pursuant to this section.
Section 10133.651 is added to the Insurance Code, to
9read:
(a) The Legislature finds and declares that
11prohibiting health insurers from executing agreements with
12physicians or physician groups that contain provisions requiring
13physicians to participate in all networks or products that are
14currently offered or that may be offered by the health insurer
15without allowing physicians to affirmatively agree and opt-in to
16participate in each network or product will assist in maintaining
17patient access to adequate physician networks. The Legislature
18further finds and declares that the ability of physicians to exercise
19this choice will further protect patients as physicians will be able
20to decide on the merits of the product being offered and whether
21participation, in their reasonable professional judgment, would
22further patients’ access to continuous quality of medical
care.
23(b) A contract between a physician or physician group and a
24health insurer that is issued, amended, delivered, or renewed in
25this state on or after January 1, 2015, shall not include any
26provision that requires a physician, as a condition of entering into
27the contract, to participate in any product that provides different
28rates, methods of payment, or lines of business unless that
29participation is negotiated and agreed to between the health insurer
30and the physician. Any contract that contains a provision attempting
31to obligate the physician to participate in any product that provides
32different rates, methods of payment, or lines of business shall
33contain a provision for each product permitting the physician to
34affirmatively agree to participate in each product. The status of a
35physician as a member of, or as being eligible for, other existing
36or new provider panels shall not be adversely affected by the
37physician’s exercise of his or her
right to not participate pursuant
38to this section.
No reimbursement is required by this act pursuant to
40Section 6 of Article XIII B of the California Constitution because
P4 1the only costs that may be incurred by a local agency or school
2district will be incurred because this act creates a new crime or
3infraction, eliminates a crime or infraction, or changes the penalty
4for a crime or infraction, within the meaning of Section 17556 of
5the Government Code, or changes the definition of a crime within
6the meaning of Section 6 of Article XIII B of the California
7Constitution.
O
99