California Senate Bill SB917 Latest Draft

 BILL NUMBER: SB 917AMENDED BILL TEXT AMENDED IN SENATE MARCH 6, 2014 INTRODUCED BY Senator Gaines JANUARY 27, 2014 An act to amend  Section 2122 of the Unemployment Insurance Code, relating to fraud   Sections 10133.1 and 10604.1 of the Insurance Code, and to amend Sections 1363.02 and 1367.26 of the Health and Safety Code, relating to health care coverage  . LEGISLATIVE COUNSEL'S DIGEST SB 917, as amended, Gaines.  Unemployment insurance: fraud: penalties.  Health care coverage: provider information.   (1) 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, with some exceptions, requires a health care service plan or disability insurer, as defined, to, on or before July 1, 2001, include a specified statement at the beginning of each provider directory.   This bill would additionally require health care service plans and disability insurers to include a statement that states, among other things, that the information in the directory is subject to change. The bill would also make other conforming and technical changes.   (2) Existing law requires insurers to provide group policyholders with a current roster of institutional and professional providers under contract to provide services at alternative rates under their group policy and to make the lists available for public inspection during regular business hours at the insurer's or plan's principal office within the state.   This bill would require the insurers to also provide this information to prospective group policyholders and would authorize insurers to satisfy the requirement by directing the group policyholders and prospective group policyholders to the insurer's Internet Web site. The bill would require insurers to ensure that the information provided is updated daily and would authorize the insurer to satisfy the update requirement by providing the information on its Internet Web site.   (3) Existing law requires a health care service plan to provide, upon request, a list of specified contracting providers within the enrollee's or prospective enrollee's general geographic area. Existing law requires the health care service plan to provide the information in written form, upon request, and authorizes the health care service plan, with the permission of the enrollee, to satisfy this requirement by directing the enrollee or prospective enrollee to the plan's provider listings on its Internet Web site. Existing law also requires that the health care service plan ensure that the information provided is updated at least quarterly, as specified.   This bill would instead authorize the health care service plan to satisfy the requirement by directing the enrollee to the plan's provider listings on its Internet Web site without requiring the permission of the enrollee and would require the plan to update the information provided daily. The bill would authorize the health care service plan to satisfy the update requirement by providing the information on its Internet Web site.   Because a willful violation of the bill's requirements relative to health care service plans 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.   Existing law provides that, among other things, it is unlawful to commit fraud to obtain unemployment compensation or disability benefits, including, but not limited to, falsely certifying the medical condition of any person in order to obtain disability benefits, knowingly presenting a false statement in support of a claim for benefits, knowingly soliciting, receiving, offering, paying, or accepting any payment for soliciting a claimant to apply for disability insurance benefits, or knowingly assisting any person who engages in fraudulent or prohibited actions, as specified. The violation of these provisions, except as provided, is punishable by imprisonment in the county jail not to exceed one year, or in the state prison, or by a fine of not more than $20,000, or by both the fine and imprisonment, at the discretion of the court.   This bill would raise the limit of the fine to not more than $50,000.  Vote: majority. Appropriation: no. Fiscal committee:  no   yes  . State-mandated local program:  no   yes  . THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:  SECTION 1.   Section 10133.1 of the   Insurance Code   is amended to read:  10133.1.  (a)    Insurers shall provide group policyholders  or prospective group policyholders  with a current roster of institutional and professional providers under contract to provide services at alternative rates under their group policy and shall also make  such   the  lists available for public inspection during regular business hours at the insurer's or plan's principal office within the state.  (b) Insurers may satisfy the requirement in subdivision (a) by directing the group policyholders or prospective group policyholders to the insurer's provider listings on its Internet Web site.   (c) Insurers shall ensure that the information provided under this section is updated daily. An insurer may satisfy this update requirement by providing the information on its Internet Web site.   SEC. 2.   Section 10604.1 of the   Insurance Code   is amended to read:  10604.1. (a) The Legislature finds and declares that the right of every patient to receive basic information necessary to give full and informed consent is a fundamental tenet of good public health policy and has long been the established law of this state. Some hospitals and other providers do not provide a full range of reproductive health services and may prohibit or otherwise not provide sterilization, infertility treatments, abortion, or contraceptive services, including emergency contraception. It is the intent of the Legislature that every patient be given full and complete information about the health care services available to allow patients to make well informed health care decisions. (b)  On or before July 1, 2001, every   A    disability insurer that provides coverage for hospital, medical, or surgical benefits, and which provides a list of network providers to prospective insureds and insureds, shall do both of the following: (1) Include the following  statement,   statements,  in at least 12-point boldface type, at the beginning of each provider directory:  "Some   (A)     "Some  hospitals and other providers do not provide one or more of the following services that may be covered under your policy and that you or your family member might need: family planning; contraceptive services, including emergency contraception; sterilization, including tubal ligation at the time of labor and delivery; infertility treatments; or abortion. You should obtain more information before you become a policyholder or select a network provider. Call your prospective doctor or clinic, or call the insurer at (insert the insurer's membership services number or other appropriate number that individuals can call for assistance) to ensure that you can obtain the health care services that you need."  (2) Place the statement described in paragraph (1) in a prominent location on any provider directory posted on the insurer's website, if any, and include this statement in a conspicuous place in the insurer's evidence of coverage and disclosure forms.   (c)   (   i)  A disability insurer shall not be required to provide the statement described in  paragraph (1) of subdivision (b)   this subparagraph  in a service area in which none of the hospitals, health facilities, clinics, medical groups, or independent practice associations with which it contracts limit or restrict any of the reproductive services described in the statement.  (d)   (ii)  This  section   subparagraph  shall not apply to vision-only, dental-only, accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, or disability income insurance.  (B) "All information in this directory is subject to change. Prior to signing up for any disability insurance policy, consumers should call or otherwise verify the participation of any doctor or other health care provider listed in this directory to ensure they are currently participating in this policy and are taking new patients."   (2) Place the statements described in paragraph (1) in a prominent location on any provider directory posted on the disability insurer' s Internet Web site, if any, and include the statements in a conspicuous place in the insurer's evidence of coverage and disclosure forms.   SEC. 3  .   Section 1363.02 of the   Health and Safety Code   is amended to read:  1363.02. (a) The Legislature finds and declares that the right of every patient to receive basic information necessary to give full and informed consent is a fundamental tenet of good public health policy and has long been the established law of this state. Some hospitals and other providers do not provide a full range of reproductive health services and may prohibit or otherwise not provide sterilization, infertility treatments, abortion, or contraceptive services, including emergency contraception. It is the intent of the Legislature that every patient be given full and complete information about the health care services available to allow patients to make well informed health care decisions. (b)  On or before July 1, 2001, a   A    health care service plan that covers hospital, medical, and surgical benefits shall do both of the following: (1) Include the following  statement,   statements,  in at least 12-point boldface type, at the beginning of each provider directory:  "Some   (A)    "Some  hospitals and other providers do not provide one or more of the following services that may be covered under your plan contract and that you or your family member might need: family planning; contraceptive services, including emergency contraception; sterilization, including tubal ligation at the time of labor and delivery; infertility treatments; or abortion. You should obtain more information before you enroll. Call your prospective doctor, medical group, independent practice association, or clinic, or call the health plan at (insert the health plan's membership services number or other appropriate number that individuals can call for assistance) to ensure that you can obtain the health care services that you need."  (2) Place the statement described in paragraph (1) in a prominent location on any provider directory posted on the health plan's website, if any, and include this statement in a conspicuous place in the plan's evidence of coverage and disclosure forms.   (c)   (i)  A health care service plan shall not be required to provide the statement described in  paragraph (1) of subdivision (b)   this subparagraph  in a service area in which none of the hospitals, health facilities, clinics, medical groups, or independent practice associations with which it contracts limit or restrict any of the reproductive services described in the statement.  (d)   (ii)  This  section   subparagraph  shall not apply to specialized health care service plans or Medicare supplement plans.  (B) "All information in this directory is subject to change. Prior to signing up for any health insurance policy, consumers should call or otherwise verify the participation of any doctor or other health care provider listed in this directory to ensure they are currently participating in this policy and are taking new patients."   (2) Place the statements described in paragraph (1) in a prominent location on any provider directory posted on the health plan's Internet Web site, if any, and include the statements in a conspicuous place in the plan's evidence of coverage and disclosure forms.   SEC. 4.   Section 1367.26 of the   Health and Safety Code   is amended to read:  1367.26. (a) A health care service plan shall provide, upon request, a list of the following contracting providers, within the enrollee's or prospective enrollee's general geographic area: (1) Primary care providers. (2) Medical groups. (3) Independent practice associations. (4) Hospitals. (5) All other available contracting physicians and surgeons, psychologists, acupuncturists, optometrists, podiatrists, chiropractors, licensed clinical social workers, marriage and family therapists, professional clinical counselors, and nurse midwives to the extent their services may be accessed and are covered through the contract with the plan. (b) This list shall indicate which providers have notified the plan that they have closed practices or are otherwise not accepting new patients at that time. (c) The list shall indicate that it is subject to change without notice and shall provide a telephone number that enrollees can contact to obtain information regarding a particular provider. This information shall include whether or not that provider has indicated that he or she is accepting new patients. (d) A health care service plan shall provide this information in written form to its enrollees or prospective enrollees upon request. A plan may  , with the permission of the enrollee,  satisfy the requirements of this section by directing the enrollee or prospective enrollee to the plan's provider listings on its Internet Web site. Plans shall ensure that the information provided is updated  at least quarterly   daily  . A plan may satisfy this update requirement by providing  an insert or addendum to any existing provider listing   the information on its Internet Web site  . This requirement shall not mandate a complete republishing of a plan's provider directory. (e) Each plan shall make information available, upon request, concerning a contracting provider's professional degree, board certifications, and any recognized subspeciality qualifications a specialist may have. (f) Nothing in this section shall prohibit a plan from requiring its contracting providers, contracting provider groups, or contracting specialized health care plans to satisfy these requirements. If a plan delegates the responsibility of complying with this section to its contracting providers, contracting provider groups, or contracting specialized health care plans, the plan shall ensure that the requirements of this section are met. (g) Every health care service plan shall allow enrollees to request the information required by this section through their toll-free telephone number or in writing.  SEC. 5.   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.   SECTION 1.   Section 2122 of the Unemployment Insurance Code is amended to read: 2122. Except as provided in Sections 2117, 2117.5, 2118, and 2118.5, a violation of this chapter is punishable by imprisonment in the county jail not to exceed one year, or in the state prison, or by a fine of not more than fifty thousand dollars ($50,000), or by both the fine and imprisonment, at the discretion of the court.