AB 2601, as amended, Conway. California Health Benefit Exchange: charge on qualified health plans.
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 to assess a charge on qualified health plans and supplemental coverage offered by carriers that is reasonable and necessary to support the development, operations, and prudent cash management of the Exchange.
This bill would prohibit the board from assessing a charge on qualified health plans or supplemental coverage, on or after January 1, 2016, or increasing that charge thereafter, unless the charge is enacted as a statute.
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 First Extraordinary
3Session of 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
26shall consistently and uniformly apply these requirements,
27standards, and criteria to all carriers. In the course of selectively
28contracting for health care coverage offered to qualified individuals
29and qualified small employers through the Exchange, the board
30shall seek to contract with carriers so as to provide health care
31coverage choices that offer the
optimal combination of choice,
32value, quality, and service.
33(d) Provide, in each region of the state, a choice of qualified
34health plans at each of the five levels of coverage contained in
35subsections (d) and (e) of Section 1302 of the federal act.
36(e) Require, as a condition of participation in the Exchange,
37carriers to fairly and affirmatively offer, market, and sell in the
38Exchange at least one product within each of the five levels of
P3 1coverage contained in subsections (d) and (e) of Section 1302 of
2the federal act. The board may require carriers to offer additional
3products within each of those five levels of coverage. This
4subdivision shall not apply to a carrier that solely offers
5supplemental coverage in the Exchange under paragraph (10) of
6subdivision (a) of Section 100504.
7(f) (1) Except as otherwise provided in this section and Section
8100504.5, require, as a condition of participation in the Exchange,
9carriers that sell any products outside the Exchange to do both of
10the following:
11(A) Fairly and affirmatively offer, market, and sell all products
12made available to individuals in the Exchange to individuals
13purchasing coverage outside the Exchange.
14(B) Fairly and affirmatively offer, market, and sell all products
15made available to small employers in the Exchange to small
16employers purchasing coverage outside the Exchange.
17(2) For purposes of this subdivision, “product” does not include
18contracts entered into pursuant to Part 6.2 (commencing with
19Section 12693) of Division 2 of the Insurance Code between the
20Managed Risk Medical Insurance Board and carriers for enrolled
21
Healthy Families beneficiaries or contracts entered into pursuant
22to Chapter 7 (commencing with Section 14000) of, or Chapter 8
23(commencing with Section 14200) of, Part 3 of Division 9 of the
24Welfare and Institutions Code between the State Department of
25Health Care Services and carriers for enrolled Medi-Cal
26beneficiaries. “Product” also does not include a bridge plan product
27offered pursuant to Section 100504.5.
28(3) Except as required by Section 1301(a)(1)(C)(ii) of the federal
29act, a carrier offering a bridge plan product in the Exchange may
30limit the products it offers in the Exchange solely to a bridge plan
31product contract.
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
P4 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 re-enrolling 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
16Plan 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
24
annual 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
P5 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. The board shall not assess a charge on
10qualified health plans pursuant to this subdivision, or on
11supplemental coverage pursuant to paragraph (10) of subdivision
12(a) of Section 100504, on or after January 1, 2016, or
increase that
13charge thereafter, unless the charge or increase is enacted as a
14statute.
15(o) Authorize expenditures, as necessary, from thebegin delete California begin insert fundend insert to pay program expenses to administer the
16Health Trust Fundend delete
17Exchange.
18(p) Keep an accurate accounting of all activities, receipts, and
19expenditures, and annually submit to the United States Secretary
20of Health and Human Services a report concerning that accounting.
21Commencing January 1, 2016, the board shall conduct an annual
22audit.
23(q) (1) Annually prepare a written report on the implementation
24and performance of the Exchange functions during the
preceding
25fiscal year, including, at a minimum, the manner in which funds
26were expended and the progress toward, and the achievement of,
27the requirements of this title. The report shall also include data
28provided by health care service plans and health insurers offering
29bridge plan products regarding the extent of health care provider
30and health facility overlap in their Medi-Cal networks as compared
31to the health care provider and health facility networks contracting
32with the plan or insurer in their bridge plan contracts. This report
33shall be transmitted to the Legislature and the Governor and shall
34be made available to the public on the Internet Web site of the
35Exchange. A report made to the Legislature pursuant to this
36subdivision shall be submitted pursuant to Section 9795.
37(2) The Exchange shall prepare, or contract for the preparation
38of, an evaluation of the bridge plan program using the first three
39years of experience with the program.
The evaluation shall be
40provided to the health policy and fiscal committees of the
P6 1Legislature in the fourth year following federal approval of the
2bridge plan option. The evaluation shall include, but not be limited
3to, all of the following:
4(A) The number of individuals eligible to participate in the
5bridge plan program each year by category of eligibility.
6(B) The number of eligible individuals who elect a bridge plan
7option each year by category of eligibility.
8(C) The average length of time, by region and statewide, that
9individuals remain in the bridge plan option each year by category
10of eligibility.
11(D) The regions of the state with a bridge plan option, and the
12carriers in each region that offer a bridge plan, by year.
13(E) The premium difference each year, by region, between the
14bridge plan and the first and second lowest cost plan for individuals
15in the Exchange who are not eligible for the bridge plan.
16(F) The effect of the bridge plan on the premium subsidy amount
17for bridge plan eligible individuals each year by each region.
18(G) Based on a survey of individuals enrolled in the bridge plan:
19(i) Whether individuals enrolling in the bridge plan product are
20able to keep their existing health care providers.
21(ii) Whether individuals would want to retain their bridge plan
22product, buy a different Exchange product, or decline to purchase
23health insurance if there was no bridge plan product available. The
24
Exchange may include questions designed to elicit the information
25in this subparagraph as part of an existing survey of individuals
26receiving coverage in the Exchange.
27(3) In addition to the evaluation required by paragraph (2), the
28Exchange shall post the items in subparagraphs (A) to (F)begin insert of
29paragraph (2)end insert, inclusive, on its Internet Web site each year.
30(4) In addition to the report described in paragraph (1), the board
31shall be responsive to requests for additional information from the
32Legislature, including providing testimony and commenting on
33proposed state legislation or policy issues. The Legislature finds
34and declares that activities including, but not limited to, responding
35to legislative or executive inquiries, tracking and commenting on
36legislation and regulatory
activities, and preparing reports on the
37implementation of this title and the performance of the Exchange,
38are necessary state requirements and are distinct from the
39promotion of legislative or regulatory modifications referred to in
40subdivision (d) of Section 100520.
P7 1(r) Maintain enrollment and expenditures to ensure that
2expenditures do not exceed the amount of revenue in the fund, and
3if sufficient revenue is not available to pay estimated expenditures,
4institute appropriate measures to ensure fiscal solvency.
5(s) Exercise all powers reasonably necessary to carry out and
6comply with the duties, responsibilities, and requirements of this
7act and the federal act.
8(t) Consult with stakeholders relevant to carrying out the
9activities under this title, including, but not limited to, all of the
10following:
11(1) Health care consumers who are enrolled in health plans.
12(2) Individuals and entities with experience in facilitating
13enrollment in health plans.
14(3) Representatives of small businesses and self-employed
15individuals.
16(4) The State Medi-Cal Director.
17(5) Advocates for enrolling hard-to-reach populations.
18(u) Facilitate the purchase of qualified health plans in the
19Exchange by qualified individuals and qualified small employers
20no later than January 1, 2014.
21(v) Report, or contract with an independent entity to report, to
22the Legislature by December 1, 2018, on
whether to adopt the
23option in Section 1312(c)(3) of the federal act to merge the
24individual and small employer markets. In its report, the board
25shall provide information, based on at least two years of data from
26the Exchange, on the potential impact on rates paid by individuals
27and by small employers in a merged individual and small employer
28market, as compared to the rates paid by individuals and small
29employers if a separate individual and small employer market is
30maintained. A report made pursuant to this subdivision shall be
31submitted pursuant to Section 9795.
32(w) With respect to the SHOP Program, collect premiums and
33administer all other necessary and related tasks, including, but not
34limited to, enrollment and plan payment, in order to make the
35offering of employee plan choice as simple as possible for qualified
36small employers.
37(x) Require carriers participating in the
Exchange to immediately
38notify the Exchange, under the terms and conditions established
39by the board when an individual is or will be enrolled in or
40disenrolled from any qualified health plan offered by the carrier.
P8 1(y) Ensure that the Exchange provides oral interpretation
2services in any language for individuals seeking coverage through
3the Exchange and makes available a toll-free telephone number
4for the hearing and speech impaired. The board shall ensure that
5written information made available by the Exchange is presented
6in a plainly worded, easily understandable format and made
7available in prevalent languages.
8(z) This section shall become inoperative on the October 1 that
9is five years after the date that federal approval of the bridge plan
10option occurs, and, as of the second January 1 thereafter, is
11repealed, unless a later enacted statute that is enacted before that
12date
deletes or extends the dates on which it becomes inoperative
13and is repealed.
Section 100503 of the Government Code, as added by
15Section 5 of Chapter 5 of the First Extraordinary Session of the
16Statutes of 2013, is amended to read:
In addition to meeting the minimum requirements of
18Section 1311 of the federal act, the board shall do all of the
19following:
20(a) Determine the criteria and process for eligibility, enrollment,
21and disenrollment of enrollees and potential enrollees in the
22Exchange and coordinate that process with the state and local
23government entities administering other health care coverage
24programs, including the State Department of Health Care Services,
25the Managed Risk Medical Insurance Board, and California
26counties, in order to ensure consistent eligibility and enrollment
27processes and seamless transitions between coverage.
28(b) Develop processes to coordinate with the county entities
29that administer eligibility for the Medi-Cal
program and the entity
30that determines eligibility for the Healthy Families Program,
31including, but not limited to, processes for case transfer, referral,
32and enrollment in the Exchange of individuals applying for
33assistance to those entities, if allowed or required by federal law.
34(c) Determine the minimum requirements a carrier must meet
35to be considered for participation in the Exchange, and the
36standards and criteria for selecting qualified health plans to be
37offered through the Exchange that are in the best interests of
38qualified individuals and qualified small employers. The board
39shall consistently and uniformly apply these requirements,
40standards, and criteria to all carriers. In the course of selectively
P9 1contracting for health care coverage offered to qualified individuals
2and qualified small employers through the Exchange, the board
3shall seek to contract with carriers so as to provide health care
4coverage choices that offer the
optimal combination of choice,
5value, quality, and service.
6(d) Provide, in each region of the state, a choice of qualified
7health plans at each of the five levels of coverage contained in
8subsections (d) and (e) of Section 1302 of the federal act.
9(e) Require, as a condition of participation in the Exchange,
10carriers to fairly and affirmatively offer, market, and sell in the
11Exchange at least one product within each of the five levels of
12coverage contained in subsections (d) and (e) of Section 1302 of
13the federal act. The board may require carriers to offer additional
14products within each of those five levels of coverage. This
15subdivision shall not apply to a carrier that solely offers
16supplemental coverage in the Exchange under paragraph (10) of
17subdivision (a) of Section 100504.
18(f) (1) Require, as a condition of participation in the Exchange,
19carriers that sell any products outside the Exchange to do both of
20the following:
21(A) Fairly and affirmatively offer, market, and sell all products
22made available to individuals in the Exchange to individuals
23purchasing coverage outside the Exchange.
24(B) Fairly and affirmatively offer, market, and sell all products
25made available to small employers in the Exchange to small
26employers purchasing coverage outside the Exchange.
27(2) For purposes of this subdivision, “product” does not include
28contracts entered into pursuant to Part 6.2 (commencing with
29Section 12693) of Division 2 of the Insurance Code between the
30Managed Risk Medical Insurance Board and carriers for enrolled
31Healthy Families beneficiaries or contracts entered into pursuant
32to
Chapter 7 (commencing with Section 14000) of, or Chapter 8
33(commencing with Section 14200) of, Part 3 of Division 9 of the
34Welfare and Institutions Code between the State Department of
35Health Care Services and carriers for enrolled Medi-Cal
36beneficiaries.
37(g) Determine when an enrollee’s coverage commences and the
38extent and scope of coverage.
39(h) Provide for the processing of applications and the enrollment
40and disenrollment of enrollees.
P10 1(i) Determine and approve cost-sharing provisions for qualified
2health plans.
3(j) Establish uniform billing and payment policies for qualified
4health plans offered in the Exchange to ensure consistent
5enrollment and disenrollment activities for individuals enrolled in
6the Exchange.
7(k) Undertake activities necessary to market and publicize the
8availability of health care coverage and federal subsidies through
9the Exchange. The board shall also undertake outreach and
10enrollment activities that seek to assist enrollees and potential
11enrollees with enrolling and re-enrolling in the Exchange in the
12least burdensome manner, including populations that may
13experience barriers to enrollment, such as the disabled and those
14with limited English language proficiency.
15(l) Select and set performance standards and compensation for
16navigators selected under subdivision (l) of Section 100502.
17(m) Employ necessary staff.
18(1) The board shall hire a chief fiscal officer, a chief operations
19officer, a director for the SHOP Exchange, a director of Health
20
Plan Contracting, a chief technology and information officer, a
21general counsel, and other key executive positions, as determined
22by the board, who shall be exempt from civil service.
23(2) (A) The board shall set the salaries for the exempt positions
24described in paragraph (1) and subdivision (i) of Section 100500
25in amounts that are reasonably necessary to attract and retain
26individuals of superior qualifications. The salaries shall be
27published by the board in the board’s annual budget. The board’s
28annual budget shall be posted on the Internet Web site of the
29Exchange. To determine the compensation for these positions, the
30board shall cause to be conducted, through the use of independent
31outside advisors, salary surveys of both of the following:
32(i) Other state and federal health insurance exchanges that are
33most comparable to the Exchange.
34(ii) Other relevant labor pools.
35(B) The salaries established by the board under subparagraph
36(A) shall not exceed the highest comparable salary for a position
37of that type, as determined by the surveys conducted pursuant to
38subparagraph (A).
P11 1(C) The Department of Human Resources shall review the
2methodology used in the surveys conducted pursuant to
3subparagraph (A).
4(3) The positions described in paragraph (1) and subdivision (i)
5of Section 100500 shall not be subject to otherwise applicable
6provisions of the Government Code or the Public Contract Code
7and, for those purposes, the Exchange shall not be considered a
8state agency or public entity.
9(n) Assess a charge on the qualified health
plans offered by
10carriers that is reasonable and necessary to support the
11development, operations, and prudent cash management of the
12Exchange. This charge shall not affect the requirement under
13Section 1301 of the federal act that carriers charge the same
14premium rate for each qualified health plan whether offered inside
15or outside the Exchange. The board shall not assess a charge on
16qualified health plans pursuant to this subdivision, or on
17supplemental coverage pursuant to paragraph (10) of subdivision
18(a) of Section 100504, on or after January 1, 2016, or increase that
19charge thereafter, unless the charge or increase is enacted as a
20statute.
21(o) Authorize expenditures, as necessary, from thebegin delete California begin insert fundend insert to pay program expenses to
administer the
22Health Trust Fundend delete
23Exchange.
24(p) Keep an accurate accounting of all activities, receipts, and
25expenditures, and annually submit to the United States Secretary
26of Health and Human Services a report concerning that accounting.
27Commencing January 1, 2016, the board shall conduct an annual
28audit.
29(q) (1) Annually prepare a written report on the implementation
30and performance of the Exchange functions during the preceding
31fiscal year, including, at a minimum, the manner in which funds
32were expended and the progress toward, and the achievement of,
33the requirements of this title. This report shall be transmitted to
34the Legislature and the Governor and shall be made available to
35the public on the Internet Web site of the Exchange. A report made
36to the Legislature pursuant to this subdivision shall be submitted
37pursuant to Section 9795.
38(2) In addition to the report described in paragraph (1), the board
39shall be responsive to requests for additional information from the
40Legislature, including providing testimony and commenting on
P12 1proposed state legislation or policy issues. The Legislature finds
2and declares that activities including, but not limited to, responding
3to legislative or executive inquiries, tracking and commenting on
4legislation and regulatory activities, and preparing reports on the
5implementation of this title and the performance of the Exchange,
6are necessary state requirements and are distinct from the
7promotion of legislative or regulatory modifications referred to in
8subdivision (d) of Section 100520.
9(r) Maintain enrollment and expenditures to ensure that
10expenditures do not exceed the amount of revenue in the fund, and
11if sufficient revenue is not available to pay estimated expenditures,
12
institute appropriate measures to ensure fiscal solvency.
13(s) Exercise all powers reasonably necessary to carry out and
14comply with the duties, responsibilities, and requirements of this
15act and the federal act.
16(t) Consult with stakeholders relevant to carrying out the
17activities under this title, including, but not limited to, all of the
18following:
19(1) Health care consumers who are enrolled in health plans.
20(2) Individuals and entities with experience in facilitating
21enrollment in health plans.
22(3) Representatives of small businesses and self-employed
23individuals.
24(4) The State Medi-Cal Director.
25(5) Advocates for enrolling hard-to-reach populations.
26(u) Facilitate the purchase of qualified health plans in the
27Exchange by qualified individuals and qualified small employers
28no later than January 1, 2014.
29(v) Report, or contract with an independent entity to report, to
30the Legislature by December 1, 2018, on whether to adopt the
31option in Section 1312(c)(3) of the federal act to merge the
32individual and small employer markets. In its report, the board
33shall provide information, based on at least two years of data from
34the Exchange, on the potential impact on rates paid by individuals
35and by small employers in a merged individual and small employer
36market, as compared to the rates paid by individuals and small
37employers if a separate individual and small employer market is
38maintained. A report made pursuant to this
subdivision shall be
39submitted pursuant to Section 9795.
P13 1(w) With respect to the SHOP Program, collect premiums and
2administer all other necessary and related tasks, including, but not
3limited to, enrollment and plan payment, in order to make the
4offering of employee plan choice as simple as possible for qualified
5small employers.
6(x) Require carriers participating in the Exchange to immediately
7notify the Exchange, under the terms and conditions established
8by the board when an individual is or will be enrolled in or
9disenrolled from any qualified health plan offered by the carrier.
10(y) Ensure that the Exchange provides oral interpretation
11services in any language for individuals seeking coverage through
12the Exchange and makes available a toll-free telephone number
13for the hearing and speech impaired. The board
shall ensure that
14written information made available by the Exchange is presented
15in a plainly worded, easily understandable format and made
16available in prevalent languages.
17(z) This section shall become operative only if Section 4 of the
18act that added this section becomes inoperative pursuant to
19subdivision (z) of that Section 4.
O
97