California Assembly Bill AB2350 Amended / Bill

 BILL NUMBER: AB 2350AMENDED BILL TEXT AMENDED IN ASSEMBLY APRIL 11, 2012 INTRODUCED BY Assembly Member Monning FEBRUARY 24, 2012 An act to add Section 1348.95 to the Health and Safety Code, and to add Section 10127.19 to the Insurance Code, relating to health care coverage. LEGISLATIVE COUNSEL'S DIGEST AB 2350, as amended, Monning. Health care coverage. 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 provides for the regulation of health  carriers   insurers  by the Department of Insurance.  This bill would require every health care service plan except those providing coverage for specialized health care services, to provide the number of enrollees that receive health care coverage from the service plan as of December 31st of each year, as well as other specified information, to the Department of Managed Health Care, in a form and manner specified by the department in consultation with the Department of Insurance to ensure that the data reported is comparable and consistent.   This bill would likewise require a health insurer, except those providing coverage for specialized health care services, to provide the number of covered lives as of December 31st of each year, as well as other specified information, to the Department of Insurance in a form and manner specified by the department in consultation with the Department of Managed Health Care.   This bill would require health care service plans and health insurers to annually, commencing March 31, 2013, provide specified information regarding their plan contracts or policies to the Department of Managed Health Care or the Department of Insurance, as applicable, including claims payment policies and practices, periodic financial disclosures, and data on enrollment and disenrollment, as specified.  Because a willful violation of  the bill's provisions relative to   this reporting requirement by a  health care service  plans   plan  would be a crime, the bill would impose 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 1.   It is the intent of the Legislature by enacting this act that the reporting requirements for health care service plans and health insurers be consistent with the reporting requirements, including form and manner, imposed on qualified health plans pursuant to Section 156.220 of Title 45 of the Code of Federal Regulations.  SECTION 1.   SEC. 2.  Section 1348.95 is added to the Health and Safety Code, to read: 1348.95.  (a)    Commencing March 1, 2013, and at least annually thereafter, every health care service plan, not including a health care service plan offering specialized health care service plan contracts, shall provide to the department, in a form and manner determined by the department in consultation with the Department of Insurance, the  following information:   (1) Claims payment policies and practices.   (2) Periodic financial disclosures.   (3) Data on enrollment.   (4) Data on disenrollment.   (5) Data on the number of claims that are denied.   (6) Data on rating practices.   (7) Information on cost-sharing and payments with respect to any out-of-network coverage.   (8) Information on enrollee rights.   (9) Enrollee cost-sharing transparency.   (b)    The data on enrollment specified in paragraph (3) of subdivision (a) shall include the  number of enrollees as of December 31 of the prior year, that receive health care coverage under a health care service plan contract that covers individuals,  small groups, groups of 51-100, groups of 101 or more, or   a small group health care service plan contract as defined in Section 1385.01, or a large group health care service plan contract as defined in Section 1385.01, or under  administrative services only business lines. Health care service plans shall include the unduplicated enrollment data in specific product lines as determined by the department, including, but not limited to, HMO, point-of-service, PPO, Medicare excluding Medicare supplement, Medi-Cal managed care, and traditional indemnity non-PPO health insurance. The department shall publicly report the data provided by each health care service plan pursuant to this section, including, but not limited to, posting the data on the department's Internet Web site. The department shall consult with the Department of Insurance to ensure that the data reported is comparable and consistent.  SEC. 2.   SEC. 3.  Section 10127.19 is added to the Insurance Code, to read: 10127.19.  (a)    Commencing March 1, 2013, and at least annually thereafter, every  health  insurer,  that issues policies of health insurance,  not including  a health insurer offering  specialized health insurance policies, shall provide to the department, in a form and manner determined by the department in consultation with the Department of Managed Health Care, the  following information:   (1) Claims payment policies and practices.   (2) Periodic financial disclosures.   (3) Data on enrollment.   (4) Data on disenrollment.   (5) Data on the number of claims that are denied.   (6) Data on rating practices.   (7) Information on cost-sharing and payments with respect to any out-of-network coverage.   (8) Information on rights of insureds.   (9) Insured cost-sharing transparency.   (b)     The data on enrollment specified in paragraph (3) of subdivision (a) shall include the  number of covered lives, as of December 31 of the prior year, that receive health care coverage under a health insurance policy that covers individuals,  a  small  groups, groups of 51-100, groups of 101   or more,   group health insurance policy as defined in Section 10181, or a large group health insurance policy as   defined in Section 10181,  or  under  administrative services only business lines.  Health   insurers   Insurers  shall include the unduplicated enrollment data in specific product lines as determined by the  department,   commissioner,  including, but not limited to HMO, point-of-service, PPO, Medicare excluding Medicare supplement, Medi-Cal managed care, and traditional indemnity non-PPO health insurance. The department shall publicly report the data provided by each  health  insurer pursuant to this section, including, but not limited to, posting the data on the department's Internet Web site. The department shall consult with the Department of Managed Health Care to ensure that the data reported is comparable and consistent.  SEC. 3.   SEC. 4.  No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.