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| 1 | + | CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION Assembly Bill No. 1656Introduced by Assembly Member GallagherFebruary 22, 2019 An act to amend Sections 1367 and 1374.20 of the Health and Safety Code, relating to health care. LEGISLATIVE COUNSEL'S DIGESTAB 1656, as introduced, Gallagher. Health care service plans.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. Existing law prohibits, except as specified, a health care service plan from changing its premium rates or applicable copayments, coinsurances, or deductibles for group health care service plan contracts during specified time periods, including after the start of the employers annual open enrollment period, unless an exception is met. Existing law requires a health care service plan to meet certain requirements, including that personnel employed by or under contract to the plan be licensed or certified as required by law and that all services be readily available at reasonable times to an enrollee.This bill would make technical, nonsubstantive changes to those provisions.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: NO Local Program: NO Bill TextThe people of the State of California do enact as follows:SECTION 1. Section 1367 of the Health and Safety Code is amended to read:1367. (a) A health care service plan and, if applicable, a specialized health care service plan plan, shall meet the following requirements:(a)(1) Facilities located in this state including, but not limited to, clinics, hospitals, and skilled nursing facilities to be utilized by the plan plan, shall be licensed by the State Department of Public Health, where if licensure is required by law. Facilities not located in this state shall conform to all licensing and other requirements of the jurisdiction in which they are located.(b)(2) Personnel employed by or under contract to the plan shall be licensed or certified by their respective board or agency,where if licensure or certification is required by law.(c)(3) Equipment required to be licensed or registered by law shall be so licensed or registered, and the operating personnel for that equipment shall be licensed or certified as required by law.(d)(4) The plan shall furnish services in a manner providing continuity of care and ready referral of patients to other providers at times as may be appropriate as appropriate, consistent with good professional practice.(e)(1)(5) (A) All services shall be readily available at reasonable times to each enrollee an enrollee, consistent with good professional practice. To the extent feasible, the plan shall make all services readily accessible to all enrollees consistent with Section 1367.03.(2)(B) To the extent that telehealth services are appropriately provided through telehealth, as defined in subdivision (a) of Section 2290.5 of the Business and Professions Code, these services shall be considered in determining compliance with Section 1300.67.2 of Title 28 of the California Code of Regulations.(3)(C) The plan shall make all services accessible and appropriate consistent with Section 1367.04.(f)(6) The plan shall employ and utilize allied health manpower for the furnishing of services to the extent permitted by law and consistent with good medical practice.(g)(7) The plan shall have the organizational and administrative capacity to provide services to subscribers and enrollees. The plan shall be able to demonstrate to the department that medical decisions are rendered by qualified medical providers, unhindered by fiscal and administrative management.(h)(1)(8) (A) Contracts with subscribers and enrollees, including group contracts, and contracts with providers, providers and other persons furnishing services, equipment, or facilities to or in connection with the plan, shall be fair, reasonable, and consistent with the objectives of this chapter. All contracts with providers shall contain provisions requiring a fast, fair, and cost-effective dispute resolution mechanism under which providers may submit disputes to the plan, and requiring the plan to inform its providers upon contracting with the plan, or upon change to these provisions, of the procedures for processing and resolving disputes, including the location and telephone number where information regarding disputes may be submitted.(2)(B) A health care service plan shall ensure that a dispute resolution mechanism is accessible to noncontracting providers for the purpose of resolving billing and claims disputes.(3)(C) On and after January 1, 2002, a health care service plan shall annually submit a report to the department regarding its dispute resolution mechanism. The report shall include information on the number of providers who utilized the dispute resolution mechanism and a summary of the disposition of those disputes.(i)(9) A health care service plan contract shall provide to subscribers and enrollees all of the basic health care services included in subdivision (b) of Section 1345, except that the director may, for good cause, by rule or order exempt a plan contract or any a class of plan contracts from that requirement. The director shall by rule define the scope of each basic health care service that health care service plans are required to provide as a minimum for licensure under this chapter. Nothing in this(10) A health care service plan shall not require registration under the federal Controlled Substances Act (21 U.S.C. Sec. 801 et seq.) as a condition for participation by an optometrist certified to use therapeutic pharmaceutical agents pursuant to Section 3041.3 of the Business and Professions Code.(b) (1) This chapter shall does not prohibit a health care service plan from charging subscribers or enrollees a copayment or a deductible for a basic health care service consistent with Section 1367.006 or 1367.007, provided that the copayments, deductibles, or other cost sharing are reported to the director and set forth to the subscriber or enrollee pursuant to the disclosure provisions of Section 1363. Nothing in this(2) This chapter shall does not prohibit a health care service plan from setting forth, by contract, limitations on maximum coverage of basic health care services, provided that the limitations are reported to, and held unobjectionable by, the director and set forth to the subscriber or enrollee pursuant to the disclosure provisions of Section 1363.(j)A health care service plan shall not require registration under the federal Controlled Substances Act (21 U.S.C. Sec. 801 et seq.) as a condition for participation by an optometrist certified to use therapeutic pharmaceutical agents pursuant to Section 3041.3 of the Business and Professions Code.Nothing in this(c) (1) This section shall not be construed to permit the director to establish the rates charged subscribers and enrollees for contractual health care services.The(2) The directors enforcement of Article 3.1 (commencing with Section 1357) shall not be deemed to does not establish the rates charged subscribers and enrollees for contractual health care services. The(d) The obligation of the plan to comply with this chapter shall not be is not waived when the plan delegates any services that it is required to perform to its medical groups, independent practice associations, or other contracting entities.SEC. 2. Section 1374.20 of the Health and Safety Code is amended to read:1374.20. (a) No A group health care service plan shall not change the premium rates or applicable copayments or coinsurances copayments, coinsurances, or deductibles for the length of the contract, except as specified in subdivision (b), during any of the following time periods:(1) After the group contractholder has delivered written notice of acceptance of the contract.(2) After the start of the employers annual open enrollment period.(3) After the receipt of payment of the premium for the first month of coverage in accordance with the contract effective date.(b) Changes to the premium rates or applicable copayments or coinsurances or deductibles of a contract shall, subject to the plan meeting the requirements of this article, be allowed in any of the following circumstances:(1) When If authorized or required in the group contract.(2) When If the contract was agreed to under a preliminary agreement that states that it is subject to execution of a definitive agreement.(3) When If the plan and contractholder mutually agree in writing. | |
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| 3 | + | CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION Assembly Bill No. 1656Introduced by Assembly Member GallagherFebruary 22, 2019 An act to amend Sections 1367 and 1374.20 of the Health and Safety Code, relating to health care. LEGISLATIVE COUNSEL'S DIGESTAB 1656, as introduced, Gallagher. Health care service plans.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. Existing law prohibits, except as specified, a health care service plan from changing its premium rates or applicable copayments, coinsurances, or deductibles for group health care service plan contracts during specified time periods, including after the start of the employers annual open enrollment period, unless an exception is met. Existing law requires a health care service plan to meet certain requirements, including that personnel employed by or under contract to the plan be licensed or certified as required by law and that all services be readily available at reasonable times to an enrollee.This bill would make technical, nonsubstantive changes to those provisions.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: NO Local Program: NO | |
| 4 | 4 | ||
| 5 | - | Amended IN Assembly March 21, 2019 | |
| 6 | 5 | ||
| 7 | - | Amended IN Assembly March 21, 2019 | |
| 6 | + | ||
| 7 | + | ||
| 8 | 8 | ||
| 9 | 9 | CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION | |
| 10 | 10 | ||
| 11 | 11 | Assembly Bill No. 1656 | |
| 12 | 12 | ||
| 13 | 13 | Introduced by Assembly Member GallagherFebruary 22, 2019 | |
| 14 | 14 | ||
| 15 | 15 | Introduced by Assembly Member Gallagher | |
| 16 | 16 | February 22, 2019 | |
| 17 | 17 | ||
| 18 | - | An act to amend Sections 1367 and 1374.20 | |
| 18 | + | An act to amend Sections 1367 and 1374.20 of the Health and Safety Code, relating to health care. | |
| 19 | 19 | ||
| 20 | 20 | LEGISLATIVE COUNSEL'S DIGEST | |
| 21 | 21 | ||
| 22 | 22 | ## LEGISLATIVE COUNSEL'S DIGEST | |
| 23 | 23 | ||
| 24 | - | AB 1656, as | |
| 24 | + | AB 1656, as introduced, Gallagher. Health care service plans. | |
| 25 | 25 | ||
| 26 | - | Existing law prohibits the treatment of a person for addiction to a narcotic drug except in a specified facility, including a licensed health facility, a state or county hospital, or a jail or prison. Existing law authorizes the use of a controlled substance in that treatment only in narcotic treatment programs licensed by the State Department of Health Care Services.This bill would clarify that a physician or authorized hospital staff may administer or dispense narcotic drugs in a hospital to maintain or detoxify a person incidental to medical or surgical treatment of conditions other than addiction, or to treat persons with intractable pain for which relief or cure is not possible or has not been found after reasonable efforts.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. Existing law prohibits, except as specified, a health care service plan from changing its premium rates or applicable copayments, coinsurances, or deductibles for group health care service plan contracts during specified time periods, including after the start of the employers annual open enrollment period, unless an exception is met. Existing law requires a health care service plan to meet certain requirements, including that personnel employed by or under contract to the plan be licensed or certified as required by law and that all services be readily available at reasonable times to an enrollee.This bill would make technical, nonsubstantive changes to those provisions. | |
| 27 | - | ||
| 28 | - | Existing law prohibits the treatment of a person for addiction to a narcotic drug except in a specified facility, including a licensed health facility, a state or county hospital, or a jail or prison. Existing law authorizes the use of a controlled substance in that treatment only in narcotic treatment programs licensed by the State Department of Health Care Services. | |
| 29 | - | ||
| 30 | - | This bill would clarify that a physician or authorized hospital staff may administer or dispense narcotic drugs in a hospital to maintain or detoxify a person incidental to medical or surgical treatment of conditions other than addiction, or to treat persons with intractable pain for which relief or cure is not possible or has not been found after reasonable efforts. | |
| 26 | + | 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. Existing law prohibits, except as specified, a health care service plan from changing its premium rates or applicable copayments, coinsurances, or deductibles for group health care service plan contracts during specified time periods, including after the start of the employers annual open enrollment period, unless an exception is met. Existing law requires a health care service plan to meet certain requirements, including that personnel employed by or under contract to the plan be licensed or certified as required by law and that all services be readily available at reasonable times to an enrollee.This bill would make technical, nonsubstantive changes to those provisions. | |
| 31 | 27 | ||
| 32 | 28 | 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. Existing law prohibits, except as specified, a health care service plan from changing its premium rates or applicable copayments, coinsurances, or deductibles for group health care service plan contracts during specified time periods, including after the start of the employers annual open enrollment period, unless an exception is met. Existing law requires a health care service plan to meet certain requirements, including that personnel employed by or under contract to the plan be licensed or certified as required by law and that all services be readily available at reasonable times to an enrollee. | |
| 33 | 29 | ||
| 34 | - | ||
| 35 | - | ||
| 36 | 30 | This bill would make technical, nonsubstantive changes to those provisions. | |
| 37 | - | ||
| 38 | - | ||
| 39 | 31 | ||
| 40 | 32 | ## Digest Key | |
| 41 | 33 | ||
| 42 | 34 | ## Bill Text | |
| 43 | 35 | ||
| 44 | - | The people of the State of California do enact as follows:SECTION 1. Section | |
| 36 | + | The people of the State of California do enact as follows:SECTION 1. Section 1367 of the Health and Safety Code is amended to read:1367. (a) A health care service plan and, if applicable, a specialized health care service plan plan, shall meet the following requirements:(a)(1) Facilities located in this state including, but not limited to, clinics, hospitals, and skilled nursing facilities to be utilized by the plan plan, shall be licensed by the State Department of Public Health, where if licensure is required by law. Facilities not located in this state shall conform to all licensing and other requirements of the jurisdiction in which they are located.(b)(2) Personnel employed by or under contract to the plan shall be licensed or certified by their respective board or agency,where if licensure or certification is required by law.(c)(3) Equipment required to be licensed or registered by law shall be so licensed or registered, and the operating personnel for that equipment shall be licensed or certified as required by law.(d)(4) The plan shall furnish services in a manner providing continuity of care and ready referral of patients to other providers at times as may be appropriate as appropriate, consistent with good professional practice.(e)(1)(5) (A) All services shall be readily available at reasonable times to each enrollee an enrollee, consistent with good professional practice. To the extent feasible, the plan shall make all services readily accessible to all enrollees consistent with Section 1367.03.(2)(B) To the extent that telehealth services are appropriately provided through telehealth, as defined in subdivision (a) of Section 2290.5 of the Business and Professions Code, these services shall be considered in determining compliance with Section 1300.67.2 of Title 28 of the California Code of Regulations.(3)(C) The plan shall make all services accessible and appropriate consistent with Section 1367.04.(f)(6) The plan shall employ and utilize allied health manpower for the furnishing of services to the extent permitted by law and consistent with good medical practice.(g)(7) The plan shall have the organizational and administrative capacity to provide services to subscribers and enrollees. The plan shall be able to demonstrate to the department that medical decisions are rendered by qualified medical providers, unhindered by fiscal and administrative management.(h)(1)(8) (A) Contracts with subscribers and enrollees, including group contracts, and contracts with providers, providers and other persons furnishing services, equipment, or facilities to or in connection with the plan, shall be fair, reasonable, and consistent with the objectives of this chapter. All contracts with providers shall contain provisions requiring a fast, fair, and cost-effective dispute resolution mechanism under which providers may submit disputes to the plan, and requiring the plan to inform its providers upon contracting with the plan, or upon change to these provisions, of the procedures for processing and resolving disputes, including the location and telephone number where information regarding disputes may be submitted.(2)(B) A health care service plan shall ensure that a dispute resolution mechanism is accessible to noncontracting providers for the purpose of resolving billing and claims disputes.(3)(C) On and after January 1, 2002, a health care service plan shall annually submit a report to the department regarding its dispute resolution mechanism. The report shall include information on the number of providers who utilized the dispute resolution mechanism and a summary of the disposition of those disputes.(i)(9) A health care service plan contract shall provide to subscribers and enrollees all of the basic health care services included in subdivision (b) of Section 1345, except that the director may, for good cause, by rule or order exempt a plan contract or any a class of plan contracts from that requirement. The director shall by rule define the scope of each basic health care service that health care service plans are required to provide as a minimum for licensure under this chapter. Nothing in this(10) A health care service plan shall not require registration under the federal Controlled Substances Act (21 U.S.C. Sec. 801 et seq.) as a condition for participation by an optometrist certified to use therapeutic pharmaceutical agents pursuant to Section 3041.3 of the Business and Professions Code.(b) (1) This chapter shall does not prohibit a health care service plan from charging subscribers or enrollees a copayment or a deductible for a basic health care service consistent with Section 1367.006 or 1367.007, provided that the copayments, deductibles, or other cost sharing are reported to the director and set forth to the subscriber or enrollee pursuant to the disclosure provisions of Section 1363. Nothing in this(2) This chapter shall does not prohibit a health care service plan from setting forth, by contract, limitations on maximum coverage of basic health care services, provided that the limitations are reported to, and held unobjectionable by, the director and set forth to the subscriber or enrollee pursuant to the disclosure provisions of Section 1363.(j)A health care service plan shall not require registration under the federal Controlled Substances Act (21 U.S.C. Sec. 801 et seq.) as a condition for participation by an optometrist certified to use therapeutic pharmaceutical agents pursuant to Section 3041.3 of the Business and Professions Code.Nothing in this(c) (1) This section shall not be construed to permit the director to establish the rates charged subscribers and enrollees for contractual health care services.The(2) The directors enforcement of Article 3.1 (commencing with Section 1357) shall not be deemed to does not establish the rates charged subscribers and enrollees for contractual health care services. The(d) The obligation of the plan to comply with this chapter shall not be is not waived when the plan delegates any services that it is required to perform to its medical groups, independent practice associations, or other contracting entities.SEC. 2. Section 1374.20 of the Health and Safety Code is amended to read:1374.20. (a) No A group health care service plan shall not change the premium rates or applicable copayments or coinsurances copayments, coinsurances, or deductibles for the length of the contract, except as specified in subdivision (b), during any of the following time periods:(1) After the group contractholder has delivered written notice of acceptance of the contract.(2) After the start of the employers annual open enrollment period.(3) After the receipt of payment of the premium for the first month of coverage in accordance with the contract effective date.(b) Changes to the premium rates or applicable copayments or coinsurances or deductibles of a contract shall, subject to the plan meeting the requirements of this article, be allowed in any of the following circumstances:(1) When If authorized or required in the group contract.(2) When If the contract was agreed to under a preliminary agreement that states that it is subject to execution of a definitive agreement.(3) When If the plan and contractholder mutually agree in writing. | |
| 45 | 37 | ||
| 46 | 38 | The people of the State of California do enact as follows: | |
| 47 | 39 | ||
| 48 | 40 | ## The people of the State of California do enact as follows: | |
| 49 | 41 | ||
| 50 | - | SECTION 1. Section | |
| 42 | + | SECTION 1. Section 1367 of the Health and Safety Code is amended to read:1367. (a) A health care service plan and, if applicable, a specialized health care service plan plan, shall meet the following requirements:(a)(1) Facilities located in this state including, but not limited to, clinics, hospitals, and skilled nursing facilities to be utilized by the plan plan, shall be licensed by the State Department of Public Health, where if licensure is required by law. Facilities not located in this state shall conform to all licensing and other requirements of the jurisdiction in which they are located.(b)(2) Personnel employed by or under contract to the plan shall be licensed or certified by their respective board or agency,where if licensure or certification is required by law.(c)(3) Equipment required to be licensed or registered by law shall be so licensed or registered, and the operating personnel for that equipment shall be licensed or certified as required by law.(d)(4) The plan shall furnish services in a manner providing continuity of care and ready referral of patients to other providers at times as may be appropriate as appropriate, consistent with good professional practice.(e)(1)(5) (A) All services shall be readily available at reasonable times to each enrollee an enrollee, consistent with good professional practice. To the extent feasible, the plan shall make all services readily accessible to all enrollees consistent with Section 1367.03.(2)(B) To the extent that telehealth services are appropriately provided through telehealth, as defined in subdivision (a) of Section 2290.5 of the Business and Professions Code, these services shall be considered in determining compliance with Section 1300.67.2 of Title 28 of the California Code of Regulations.(3)(C) The plan shall make all services accessible and appropriate consistent with Section 1367.04.(f)(6) The plan shall employ and utilize allied health manpower for the furnishing of services to the extent permitted by law and consistent with good medical practice.(g)(7) The plan shall have the organizational and administrative capacity to provide services to subscribers and enrollees. The plan shall be able to demonstrate to the department that medical decisions are rendered by qualified medical providers, unhindered by fiscal and administrative management.(h)(1)(8) (A) Contracts with subscribers and enrollees, including group contracts, and contracts with providers, providers and other persons furnishing services, equipment, or facilities to or in connection with the plan, shall be fair, reasonable, and consistent with the objectives of this chapter. All contracts with providers shall contain provisions requiring a fast, fair, and cost-effective dispute resolution mechanism under which providers may submit disputes to the plan, and requiring the plan to inform its providers upon contracting with the plan, or upon change to these provisions, of the procedures for processing and resolving disputes, including the location and telephone number where information regarding disputes may be submitted.(2)(B) A health care service plan shall ensure that a dispute resolution mechanism is accessible to noncontracting providers for the purpose of resolving billing and claims disputes.(3)(C) On and after January 1, 2002, a health care service plan shall annually submit a report to the department regarding its dispute resolution mechanism. The report shall include information on the number of providers who utilized the dispute resolution mechanism and a summary of the disposition of those disputes.(i)(9) A health care service plan contract shall provide to subscribers and enrollees all of the basic health care services included in subdivision (b) of Section 1345, except that the director may, for good cause, by rule or order exempt a plan contract or any a class of plan contracts from that requirement. The director shall by rule define the scope of each basic health care service that health care service plans are required to provide as a minimum for licensure under this chapter. Nothing in this(10) A health care service plan shall not require registration under the federal Controlled Substances Act (21 U.S.C. Sec. 801 et seq.) as a condition for participation by an optometrist certified to use therapeutic pharmaceutical agents pursuant to Section 3041.3 of the Business and Professions Code.(b) (1) This chapter shall does not prohibit a health care service plan from charging subscribers or enrollees a copayment or a deductible for a basic health care service consistent with Section 1367.006 or 1367.007, provided that the copayments, deductibles, or other cost sharing are reported to the director and set forth to the subscriber or enrollee pursuant to the disclosure provisions of Section 1363. Nothing in this(2) This chapter shall does not prohibit a health care service plan from setting forth, by contract, limitations on maximum coverage of basic health care services, provided that the limitations are reported to, and held unobjectionable by, the director and set forth to the subscriber or enrollee pursuant to the disclosure provisions of Section 1363.(j)A health care service plan shall not require registration under the federal Controlled Substances Act (21 U.S.C. Sec. 801 et seq.) as a condition for participation by an optometrist certified to use therapeutic pharmaceutical agents pursuant to Section 3041.3 of the Business and Professions Code.Nothing in this(c) (1) This section shall not be construed to permit the director to establish the rates charged subscribers and enrollees for contractual health care services.The(2) The directors enforcement of Article 3.1 (commencing with Section 1357) shall not be deemed to does not establish the rates charged subscribers and enrollees for contractual health care services. The(d) The obligation of the plan to comply with this chapter shall not be is not waived when the plan delegates any services that it is required to perform to its medical groups, independent practice associations, or other contracting entities. | |
| 51 | 43 | ||
| 52 | - | SECTION 1. Section | |
| 44 | + | SECTION 1. Section 1367 of the Health and Safety Code is amended to read: | |
| 53 | 45 | ||
| 54 | 46 | ### SECTION 1. | |
| 55 | 47 | ||
| 56 | - | ||
| 48 | + | 1367. (a) A health care service plan and, if applicable, a specialized health care service plan plan, shall meet the following requirements:(a)(1) Facilities located in this state including, but not limited to, clinics, hospitals, and skilled nursing facilities to be utilized by the plan plan, shall be licensed by the State Department of Public Health, where if licensure is required by law. Facilities not located in this state shall conform to all licensing and other requirements of the jurisdiction in which they are located.(b)(2) Personnel employed by or under contract to the plan shall be licensed or certified by their respective board or agency,where if licensure or certification is required by law.(c)(3) Equipment required to be licensed or registered by law shall be so licensed or registered, and the operating personnel for that equipment shall be licensed or certified as required by law.(d)(4) The plan shall furnish services in a manner providing continuity of care and ready referral of patients to other providers at times as may be appropriate as appropriate, consistent with good professional practice.(e)(1)(5) (A) All services shall be readily available at reasonable times to each enrollee an enrollee, consistent with good professional practice. To the extent feasible, the plan shall make all services readily accessible to all enrollees consistent with Section 1367.03.(2)(B) To the extent that telehealth services are appropriately provided through telehealth, as defined in subdivision (a) of Section 2290.5 of the Business and Professions Code, these services shall be considered in determining compliance with Section 1300.67.2 of Title 28 of the California Code of Regulations.(3)(C) The plan shall make all services accessible and appropriate consistent with Section 1367.04.(f)(6) The plan shall employ and utilize allied health manpower for the furnishing of services to the extent permitted by law and consistent with good medical practice.(g)(7) The plan shall have the organizational and administrative capacity to provide services to subscribers and enrollees. The plan shall be able to demonstrate to the department that medical decisions are rendered by qualified medical providers, unhindered by fiscal and administrative management.(h)(1)(8) (A) Contracts with subscribers and enrollees, including group contracts, and contracts with providers, providers and other persons furnishing services, equipment, or facilities to or in connection with the plan, shall be fair, reasonable, and consistent with the objectives of this chapter. All contracts with providers shall contain provisions requiring a fast, fair, and cost-effective dispute resolution mechanism under which providers may submit disputes to the plan, and requiring the plan to inform its providers upon contracting with the plan, or upon change to these provisions, of the procedures for processing and resolving disputes, including the location and telephone number where information regarding disputes may be submitted.(2)(B) A health care service plan shall ensure that a dispute resolution mechanism is accessible to noncontracting providers for the purpose of resolving billing and claims disputes.(3)(C) On and after January 1, 2002, a health care service plan shall annually submit a report to the department regarding its dispute resolution mechanism. The report shall include information on the number of providers who utilized the dispute resolution mechanism and a summary of the disposition of those disputes.(i)(9) A health care service plan contract shall provide to subscribers and enrollees all of the basic health care services included in subdivision (b) of Section 1345, except that the director may, for good cause, by rule or order exempt a plan contract or any a class of plan contracts from that requirement. The director shall by rule define the scope of each basic health care service that health care service plans are required to provide as a minimum for licensure under this chapter. Nothing in this(10) A health care service plan shall not require registration under the federal Controlled Substances Act (21 U.S.C. Sec. 801 et seq.) as a condition for participation by an optometrist certified to use therapeutic pharmaceutical agents pursuant to Section 3041.3 of the Business and Professions Code.(b) (1) This chapter shall does not prohibit a health care service plan from charging subscribers or enrollees a copayment or a deductible for a basic health care service consistent with Section 1367.006 or 1367.007, provided that the copayments, deductibles, or other cost sharing are reported to the director and set forth to the subscriber or enrollee pursuant to the disclosure provisions of Section 1363. Nothing in this(2) This chapter shall does not prohibit a health care service plan from setting forth, by contract, limitations on maximum coverage of basic health care services, provided that the limitations are reported to, and held unobjectionable by, the director and set forth to the subscriber or enrollee pursuant to the disclosure provisions of Section 1363.(j)A health care service plan shall not require registration under the federal Controlled Substances Act (21 U.S.C. Sec. 801 et seq.) as a condition for participation by an optometrist certified to use therapeutic pharmaceutical agents pursuant to Section 3041.3 of the Business and Professions Code.Nothing in this(c) (1) This section shall not be construed to permit the director to establish the rates charged subscribers and enrollees for contractual health care services.The(2) The directors enforcement of Article 3.1 (commencing with Section 1357) shall not be deemed to does not establish the rates charged subscribers and enrollees for contractual health care services. The(d) The obligation of the plan to comply with this chapter shall not be is not waived when the plan delegates any services that it is required to perform to its medical groups, independent practice associations, or other contracting entities. | |
| 57 | 49 | ||
| 58 | - | ||
| 50 | + | 1367. (a) A health care service plan and, if applicable, a specialized health care service plan plan, shall meet the following requirements:(a)(1) Facilities located in this state including, but not limited to, clinics, hospitals, and skilled nursing facilities to be utilized by the plan plan, shall be licensed by the State Department of Public Health, where if licensure is required by law. Facilities not located in this state shall conform to all licensing and other requirements of the jurisdiction in which they are located.(b)(2) Personnel employed by or under contract to the plan shall be licensed or certified by their respective board or agency,where if licensure or certification is required by law.(c)(3) Equipment required to be licensed or registered by law shall be so licensed or registered, and the operating personnel for that equipment shall be licensed or certified as required by law.(d)(4) The plan shall furnish services in a manner providing continuity of care and ready referral of patients to other providers at times as may be appropriate as appropriate, consistent with good professional practice.(e)(1)(5) (A) All services shall be readily available at reasonable times to each enrollee an enrollee, consistent with good professional practice. To the extent feasible, the plan shall make all services readily accessible to all enrollees consistent with Section 1367.03.(2)(B) To the extent that telehealth services are appropriately provided through telehealth, as defined in subdivision (a) of Section 2290.5 of the Business and Professions Code, these services shall be considered in determining compliance with Section 1300.67.2 of Title 28 of the California Code of Regulations.(3)(C) The plan shall make all services accessible and appropriate consistent with Section 1367.04.(f)(6) The plan shall employ and utilize allied health manpower for the furnishing of services to the extent permitted by law and consistent with good medical practice.(g)(7) The plan shall have the organizational and administrative capacity to provide services to subscribers and enrollees. The plan shall be able to demonstrate to the department that medical decisions are rendered by qualified medical providers, unhindered by fiscal and administrative management.(h)(1)(8) (A) Contracts with subscribers and enrollees, including group contracts, and contracts with providers, providers and other persons furnishing services, equipment, or facilities to or in connection with the plan, shall be fair, reasonable, and consistent with the objectives of this chapter. All contracts with providers shall contain provisions requiring a fast, fair, and cost-effective dispute resolution mechanism under which providers may submit disputes to the plan, and requiring the plan to inform its providers upon contracting with the plan, or upon change to these provisions, of the procedures for processing and resolving disputes, including the location and telephone number where information regarding disputes may be submitted.(2)(B) A health care service plan shall ensure that a dispute resolution mechanism is accessible to noncontracting providers for the purpose of resolving billing and claims disputes.(3)(C) On and after January 1, 2002, a health care service plan shall annually submit a report to the department regarding its dispute resolution mechanism. The report shall include information on the number of providers who utilized the dispute resolution mechanism and a summary of the disposition of those disputes.(i)(9) A health care service plan contract shall provide to subscribers and enrollees all of the basic health care services included in subdivision (b) of Section 1345, except that the director may, for good cause, by rule or order exempt a plan contract or any a class of plan contracts from that requirement. The director shall by rule define the scope of each basic health care service that health care service plans are required to provide as a minimum for licensure under this chapter. Nothing in this(10) A health care service plan shall not require registration under the federal Controlled Substances Act (21 U.S.C. Sec. 801 et seq.) as a condition for participation by an optometrist certified to use therapeutic pharmaceutical agents pursuant to Section 3041.3 of the Business and Professions Code.(b) (1) This chapter shall does not prohibit a health care service plan from charging subscribers or enrollees a copayment or a deductible for a basic health care service consistent with Section 1367.006 or 1367.007, provided that the copayments, deductibles, or other cost sharing are reported to the director and set forth to the subscriber or enrollee pursuant to the disclosure provisions of Section 1363. Nothing in this(2) This chapter shall does not prohibit a health care service plan from setting forth, by contract, limitations on maximum coverage of basic health care services, provided that the limitations are reported to, and held unobjectionable by, the director and set forth to the subscriber or enrollee pursuant to the disclosure provisions of Section 1363.(j)A health care service plan shall not require registration under the federal Controlled Substances Act (21 U.S.C. Sec. 801 et seq.) as a condition for participation by an optometrist certified to use therapeutic pharmaceutical agents pursuant to Section 3041.3 of the Business and Professions Code.Nothing in this(c) (1) This section shall not be construed to permit the director to establish the rates charged subscribers and enrollees for contractual health care services.The(2) The directors enforcement of Article 3.1 (commencing with Section 1357) shall not be deemed to does not establish the rates charged subscribers and enrollees for contractual health care services. The(d) The obligation of the plan to comply with this chapter shall not be is not waived when the plan delegates any services that it is required to perform to its medical groups, independent practice associations, or other contracting entities. | |
| 59 | 51 | ||
| 60 | - | ||
| 52 | + | 1367. (a) A health care service plan and, if applicable, a specialized health care service plan plan, shall meet the following requirements:(a)(1) Facilities located in this state including, but not limited to, clinics, hospitals, and skilled nursing facilities to be utilized by the plan plan, shall be licensed by the State Department of Public Health, where if licensure is required by law. Facilities not located in this state shall conform to all licensing and other requirements of the jurisdiction in which they are located.(b)(2) Personnel employed by or under contract to the plan shall be licensed or certified by their respective board or agency,where if licensure or certification is required by law.(c)(3) Equipment required to be licensed or registered by law shall be so licensed or registered, and the operating personnel for that equipment shall be licensed or certified as required by law.(d)(4) The plan shall furnish services in a manner providing continuity of care and ready referral of patients to other providers at times as may be appropriate as appropriate, consistent with good professional practice.(e)(1)(5) (A) All services shall be readily available at reasonable times to each enrollee an enrollee, consistent with good professional practice. To the extent feasible, the plan shall make all services readily accessible to all enrollees consistent with Section 1367.03.(2)(B) To the extent that telehealth services are appropriately provided through telehealth, as defined in subdivision (a) of Section 2290.5 of the Business and Professions Code, these services shall be considered in determining compliance with Section 1300.67.2 of Title 28 of the California Code of Regulations.(3)(C) The plan shall make all services accessible and appropriate consistent with Section 1367.04.(f)(6) The plan shall employ and utilize allied health manpower for the furnishing of services to the extent permitted by law and consistent with good medical practice.(g)(7) The plan shall have the organizational and administrative capacity to provide services to subscribers and enrollees. The plan shall be able to demonstrate to the department that medical decisions are rendered by qualified medical providers, unhindered by fiscal and administrative management.(h)(1)(8) (A) Contracts with subscribers and enrollees, including group contracts, and contracts with providers, providers and other persons furnishing services, equipment, or facilities to or in connection with the plan, shall be fair, reasonable, and consistent with the objectives of this chapter. All contracts with providers shall contain provisions requiring a fast, fair, and cost-effective dispute resolution mechanism under which providers may submit disputes to the plan, and requiring the plan to inform its providers upon contracting with the plan, or upon change to these provisions, of the procedures for processing and resolving disputes, including the location and telephone number where information regarding disputes may be submitted.(2)(B) A health care service plan shall ensure that a dispute resolution mechanism is accessible to noncontracting providers for the purpose of resolving billing and claims disputes.(3)(C) On and after January 1, 2002, a health care service plan shall annually submit a report to the department regarding its dispute resolution mechanism. The report shall include information on the number of providers who utilized the dispute resolution mechanism and a summary of the disposition of those disputes.(i)(9) A health care service plan contract shall provide to subscribers and enrollees all of the basic health care services included in subdivision (b) of Section 1345, except that the director may, for good cause, by rule or order exempt a plan contract or any a class of plan contracts from that requirement. The director shall by rule define the scope of each basic health care service that health care service plans are required to provide as a minimum for licensure under this chapter. Nothing in this(10) A health care service plan shall not require registration under the federal Controlled Substances Act (21 U.S.C. Sec. 801 et seq.) as a condition for participation by an optometrist certified to use therapeutic pharmaceutical agents pursuant to Section 3041.3 of the Business and Professions Code.(b) (1) This chapter shall does not prohibit a health care service plan from charging subscribers or enrollees a copayment or a deductible for a basic health care service consistent with Section 1367.006 or 1367.007, provided that the copayments, deductibles, or other cost sharing are reported to the director and set forth to the subscriber or enrollee pursuant to the disclosure provisions of Section 1363. Nothing in this(2) This chapter shall does not prohibit a health care service plan from setting forth, by contract, limitations on maximum coverage of basic health care services, provided that the limitations are reported to, and held unobjectionable by, the director and set forth to the subscriber or enrollee pursuant to the disclosure provisions of Section 1363.(j)A health care service plan shall not require registration under the federal Controlled Substances Act (21 U.S.C. Sec. 801 et seq.) as a condition for participation by an optometrist certified to use therapeutic pharmaceutical agents pursuant to Section 3041.3 of the Business and Professions Code.Nothing in this(c) (1) This section shall not be construed to permit the director to establish the rates charged subscribers and enrollees for contractual health care services.The(2) The directors enforcement of Article 3.1 (commencing with Section 1357) shall not be deemed to does not establish the rates charged subscribers and enrollees for contractual health care services. The(d) The obligation of the plan to comply with this chapter shall not be is not waived when the plan delegates any services that it is required to perform to its medical groups, independent practice associations, or other contracting entities. | |
| 61 | 53 | ||
| 62 | 54 | ||
| 63 | 55 | ||
| 64 | - | ||
| 56 | + | 1367. (a) A health care service plan and, if applicable, a specialized health care service plan plan, shall meet the following requirements: | |
| 65 | 57 | ||
| 66 | 58 | (a) | |
| 67 | 59 | ||
| 68 | 60 | ||
| 69 | 61 | ||
| 70 | - | (1) | |
| 62 | + | (1) Facilities located in this state including, but not limited to, clinics, hospitals, and skilled nursing facilities to be utilized by the plan plan, shall be licensed by the State Department of Public Health, where if licensure is required by law. Facilities not located in this state shall conform to all licensing and other requirements of the jurisdiction in which they are located. | |
| 71 | 63 | ||
| 72 | 64 | (b) | |
| 73 | 65 | ||
| 74 | 66 | ||
| 75 | 67 | ||
| 76 | - | (2) | |
| 68 | + | (2) Personnel employed by or under contract to the plan shall be licensed or certified by their respective board or agency,where if licensure or certification is required by law. | |
| 77 | 69 | ||
| 78 | 70 | (c) | |
| 79 | 71 | ||
| 80 | 72 | ||
| 81 | 73 | ||
| 82 | - | (3) | |
| 74 | + | (3) Equipment required to be licensed or registered by law shall be so licensed or registered, and the operating personnel for that equipment shall be licensed or certified as required by law. | |
| 83 | 75 | ||
| 84 | 76 | (d) | |
| 85 | 77 | ||
| 86 | 78 | ||
| 87 | 79 | ||
| 88 | - | (4) | |
| 80 | + | (4) The plan shall furnish services in a manner providing continuity of care and ready referral of patients to other providers at times as may be appropriate as appropriate, consistent with good professional practice. | |
| 89 | 81 | ||
| 90 | - | (e) | |
| 82 | + | (e)(1) | |
| 91 | 83 | ||
| 92 | 84 | ||
| 93 | 85 | ||
| 94 | - | (5) A state hospital. | |
| 86 | + | (5) (A) All services shall be readily available at reasonable times to each enrollee an enrollee, consistent with good professional practice. To the extent feasible, the plan shall make all services readily accessible to all enrollees consistent with Section 1367.03. | |
| 87 | + | ||
| 88 | + | (2) | |
| 89 | + | ||
| 90 | + | ||
| 91 | + | ||
| 92 | + | (B) To the extent that telehealth services are appropriately provided through telehealth, as defined in subdivision (a) of Section 2290.5 of the Business and Professions Code, these services shall be considered in determining compliance with Section 1300.67.2 of Title 28 of the California Code of Regulations. | |
| 93 | + | ||
| 94 | + | (3) | |
| 95 | + | ||
| 96 | + | ||
| 97 | + | ||
| 98 | + | (C) The plan shall make all services accessible and appropriate consistent with Section 1367.04. | |
| 95 | 99 | ||
| 96 | 100 | (f) | |
| 97 | 101 | ||
| 98 | 102 | ||
| 99 | 103 | ||
| 100 | - | (6) | |
| 104 | + | (6) The plan shall employ and utilize allied health manpower for the furnishing of services to the extent permitted by law and consistent with good medical practice. | |
| 101 | 105 | ||
| 102 | 106 | (g) | |
| 103 | 107 | ||
| 104 | 108 | ||
| 105 | 109 | ||
| 106 | - | (7) | |
| 110 | + | (7) The plan shall have the organizational and administrative capacity to provide services to subscribers and enrollees. The plan shall be able to demonstrate to the department that medical decisions are rendered by qualified medical providers, unhindered by fiscal and administrative management. | |
| 107 | 111 | ||
| 108 | - | (h) | |
| 112 | + | (h)(1) | |
| 109 | 113 | ||
| 110 | 114 | ||
| 111 | 115 | ||
| 112 | - | (8) | |
| 116 | + | (8) (A) Contracts with subscribers and enrollees, including group contracts, and contracts with providers, providers and other persons furnishing services, equipment, or facilities to or in connection with the plan, shall be fair, reasonable, and consistent with the objectives of this chapter. All contracts with providers shall contain provisions requiring a fast, fair, and cost-effective dispute resolution mechanism under which providers may submit disputes to the plan, and requiring the plan to inform its providers upon contracting with the plan, or upon change to these provisions, of the procedures for processing and resolving disputes, including the location and telephone number where information regarding disputes may be submitted. | |
| 113 | 117 | ||
| 114 | - | A | |
| 115 | - | ||
| 116 | - | ||
| 117 | - | ||
| 118 | - | (b) A narcotic controlled substance in the continuing treatment of addiction to a controlled substance shall be used only in those programs licensed by the State Department of Health Care Services pursuant to Article 1 (commencing with Section 11839) of Chapter 10 of Part 2 of Division 10.5 on either an inpatient or outpatient basis, or both. | |
| 119 | - | ||
| 120 | - | This | |
| 121 | - | ||
| 122 | - | ||
| 123 | - | ||
| 124 | - | (c) This section does not apply during emergency treatment, or where the patients addiction is complicated by the presence of incurable disease, serious accident, or injury, or the infirmities of old age. | |
| 125 | - | ||
| 126 | - | Neither this section nor any other provision of this division shall be construed to | |
| 127 | - | ||
| 128 | - | ||
| 129 | - | ||
| 130 | - | (d) This section is not intended to impose any limitations on a physician or authorized hospital staff to administer or dispense narcotic drugs in a hospital to maintain or detoxify a person as an incidental adjunct to medical or surgical treatment of conditions other than addiction, or to administer or dispense narcotic drugs to persons with intractable pain in which no relief or cure is possible or none has been found after reasonable efforts. | |
| 131 | - | ||
| 132 | - | (e) (1) This division does not prohibit the maintenance of a place in which persons seeking to recover from addiction to a controlled substance reside and endeavor to aid one another and receive aid from others in recovering from that addiction, nor does this section or this division prohibit that aid, provided that no person is treated for addiction in a place by means of administering, furnishing, or prescribing of controlled substances. The preceding sentence is declaratory of preexisting law. | |
| 133 | - | ||
| 134 | - | Neither this section or any other provision of this division shall be construed to | |
| 135 | - | ||
| 136 | - | ||
| 137 | - | ||
| 138 | - | (2) This division does not prohibit short-term narcotic detoxification treatment in a controlled setting approved by the director and pursuant to rules and regulations of the director. Facilities and treatment approved by the director under this paragraph shall not be subject to approval or inspection by the Medical Board of California, nor shall persons in those facilities be required to register with, or report the termination of residence with, the police department or sheriffs office. | |
| 139 | - | ||
| 140 | - | ||
| 141 | - | ||
| 142 | - | ||
| 143 | - | ||
| 144 | - | (a)A health care service plan and, if applicable, a specialized health care service plan, shall meet the following requirements: | |
| 145 | - | ||
| 146 | - | ||
| 147 | - | ||
| 148 | - | (1)Facilities located in this state including, but not limited to, clinics, hospitals, and skilled nursing facilities to be utilized by the plan, shall be licensed by the State Department of Public Health, if licensure is required by law. Facilities not located in this state shall conform to all licensing and other requirements of the jurisdiction in which they are located. | |
| 149 | - | ||
| 150 | - | ||
| 151 | - | ||
| 152 | - | (2)Personnel employed by or under contract to the plan shall be licensed or certified by their respective board or agency, if licensure or certification is required by law. | |
| 153 | - | ||
| 154 | - | ||
| 155 | - | ||
| 156 | - | (3)Equipment required to be licensed or registered by law shall be licensed or registered, and the operating personnel for that equipment shall be licensed or certified as required by law. | |
| 157 | - | ||
| 158 | - | ||
| 159 | - | ||
| 160 | - | (4)The plan shall furnish services in a manner providing continuity of care and ready referral of patients to other providers as appropriate, consistent with good professional practice. | |
| 161 | - | ||
| 162 | - | ||
| 163 | - | ||
| 164 | - | (5)(A)All services shall be readily available at reasonable times to an enrollee, consistent with good professional practice. To the extent feasible, the plan shall make all services readily accessible to all enrollees consistent with Section 1367.03. | |
| 165 | - | ||
| 166 | - | ||
| 167 | - | ||
| 168 | - | (B)To the extent that telehealth services are appropriately provided through telehealth, as defined in subdivision (a) of Section 2290.5 of the Business and Professions Code, these services shall be considered in determining compliance with Section 1300.67.2 of Title 28 of the California Code of Regulations. | |
| 169 | - | ||
| 170 | - | ||
| 171 | - | ||
| 172 | - | (C)The plan shall make all services accessible and appropriate consistent with Section 1367.04. | |
| 173 | - | ||
| 174 | - | ||
| 175 | - | ||
| 176 | - | (6)The plan shall employ and utilize allied health manpower for the furnishing of services to the extent permitted by law and consistent with good medical practice. | |
| 177 | - | ||
| 178 | - | ||
| 179 | - | ||
| 180 | - | (7)The plan shall have the organizational and administrative capacity to provide services to subscribers and enrollees. The plan shall be able to demonstrate to the department that medical decisions are rendered by qualified medical providers, unhindered by fiscal and administrative management. | |
| 181 | - | ||
| 182 | - | ||
| 183 | - | ||
| 184 | - | (8)(A)Contracts with subscribers and enrollees, including group contracts, and contracts with providers and other persons furnishing services, equipment, or facilities to or in connection with the plan, shall be fair, reasonable, and consistent with the objectives of this chapter. All contracts with providers shall contain provisions requiring a fast, fair, and cost-effective dispute resolution mechanism under which providers may submit disputes to the plan, and requiring the plan to inform its providers upon contracting with the plan, or upon change to these provisions, of the procedures for processing and resolving disputes, including the location and telephone number where information regarding disputes may be submitted. | |
| 118 | + | (2) | |
| 185 | 119 | ||
| 186 | 120 | ||
| 187 | 121 | ||
| 188 | 122 | (B) A health care service plan shall ensure that a dispute resolution mechanism is accessible to noncontracting providers for the purpose of resolving billing and claims disputes. | |
| 189 | 123 | ||
| 124 | + | (3) | |
| 125 | + | ||
| 190 | 126 | ||
| 191 | 127 | ||
| 192 | 128 | (C) On and after January 1, 2002, a health care service plan shall annually submit a report to the department regarding its dispute resolution mechanism. The report shall include information on the number of providers who utilized the dispute resolution mechanism and a summary of the disposition of those disputes. | |
| 193 | 129 | ||
| 194 | - | ||
| 195 | - | ||
| 196 | - | (9)A health care service plan contract shall provide to subscribers and enrollees all of the basic health care services included in subdivision (b) of Section 1345, except that the director may, for good cause, by rule or order exempt a plan contract or a class of plan contracts from that requirement. The director shall by rule define the scope of each basic health care service that health care service plans are required to provide as a minimum for licensure under this chapter. | |
| 130 | + | (i) | |
| 197 | 131 | ||
| 198 | 132 | ||
| 199 | 133 | ||
| 134 | + | (9) A health care service plan contract shall provide to subscribers and enrollees all of the basic health care services included in subdivision (b) of Section 1345, except that the director may, for good cause, by rule or order exempt a plan contract or any a class of plan contracts from that requirement. The director shall by rule define the scope of each basic health care service that health care service plans are required to provide as a minimum for licensure under this chapter. Nothing in this | |
| 135 | + | ||
| 200 | 136 | (10) A health care service plan shall not require registration under the federal Controlled Substances Act (21 U.S.C. Sec. 801 et seq.) as a condition for participation by an optometrist certified to use therapeutic pharmaceutical agents pursuant to Section 3041.3 of the Business and Professions Code. | |
| 137 | + | ||
| 138 | + | (b) (1) This chapter shall does not prohibit a health care service plan from charging subscribers or enrollees a copayment or a deductible for a basic health care service consistent with Section 1367.006 or 1367.007, provided that the copayments, deductibles, or other cost sharing are reported to the director and set forth to the subscriber or enrollee pursuant to the disclosure provisions of Section 1363. Nothing in this | |
| 139 | + | ||
| 140 | + | (2) This chapter shall does not prohibit a health care service plan from setting forth, by contract, limitations on maximum coverage of basic health care services, provided that the limitations are reported to, and held unobjectionable by, the director and set forth to the subscriber or enrollee pursuant to the disclosure provisions of Section 1363. | |
| 141 | + | ||
| 142 | + | (j)A health care service plan shall not require registration under the federal Controlled Substances Act (21 U.S.C. Sec. 801 et seq.) as a condition for participation by an optometrist certified to use therapeutic pharmaceutical agents pursuant to Section 3041.3 of the Business and Professions Code. | |
| 201 | 143 | ||
| 202 | 144 | ||
| 203 | 145 | ||
| 204 | - | (b)(1)This chapter does not prohibit a health care service plan from charging subscribers or enrollees a copayment or a deductible for a basic health care service consistent with Section 1367.006 or 1367.007, provided that the copayments, deductibles, or other cost sharing are reported to the director and set forth to the subscriber or enrollee pursuant to the disclosure provisions of Section 1363. | |
| 205 | - | ||
| 206 | - | ||
| 207 | - | ||
| 208 | - | (2)This chapter does not prohibit a health care service plan from setting forth, by contract, limitations on maximum coverage of basic health care services, provided that the limitations are reported to, and held unobjectionable by, the director and set forth to the subscriber or enrollee pursuant to the disclosure provisions of Section 1363. | |
| 146 | + | Nothing in this | |
| 209 | 147 | ||
| 210 | 148 | ||
| 211 | 149 | ||
| 212 | 150 | (c) (1) This section shall not be construed to permit the director to establish the rates charged subscribers and enrollees for contractual health care services. | |
| 213 | 151 | ||
| 214 | - | ||
| 215 | - | ||
| 216 | - | (2)The directors enforcement of Article 3.1 (commencing with Section 1357) does not establish the rates charged subscribers and enrollees for contractual health care services. | |
| 152 | + | The | |
| 217 | 153 | ||
| 218 | 154 | ||
| 219 | 155 | ||
| 220 | - | (d)The obligation of the plan to comply with this chapter is not waived when the plan delegates any services that it is required to perform to its medical groups, independent practice associations, or other contracting entities. | |
| 156 | + | (2) The directors enforcement of Article 3.1 (commencing with Section 1357) shall not be deemed to does not establish the rates charged subscribers and enrollees for contractual health care services. | |
| 157 | + | ||
| 158 | + | The | |
| 221 | 159 | ||
| 222 | 160 | ||
| 223 | 161 | ||
| 162 | + | (d) The obligation of the plan to comply with this chapter shall not be is not waived when the plan delegates any services that it is required to perform to its medical groups, independent practice associations, or other contracting entities. | |
| 163 | + | ||
| 164 | + | SEC. 2. Section 1374.20 of the Health and Safety Code is amended to read:1374.20. (a) No A group health care service plan shall not change the premium rates or applicable copayments or coinsurances copayments, coinsurances, or deductibles for the length of the contract, except as specified in subdivision (b), during any of the following time periods:(1) After the group contractholder has delivered written notice of acceptance of the contract.(2) After the start of the employers annual open enrollment period.(3) After the receipt of payment of the premium for the first month of coverage in accordance with the contract effective date.(b) Changes to the premium rates or applicable copayments or coinsurances or deductibles of a contract shall, subject to the plan meeting the requirements of this article, be allowed in any of the following circumstances:(1) When If authorized or required in the group contract.(2) When If the contract was agreed to under a preliminary agreement that states that it is subject to execution of a definitive agreement.(3) When If the plan and contractholder mutually agree in writing. | |
| 165 | + | ||
| 166 | + | SEC. 2. Section 1374.20 of the Health and Safety Code is amended to read: | |
| 167 | + | ||
| 168 | + | ### SEC. 2. | |
| 169 | + | ||
| 170 | + | 1374.20. (a) No A group health care service plan shall not change the premium rates or applicable copayments or coinsurances copayments, coinsurances, or deductibles for the length of the contract, except as specified in subdivision (b), during any of the following time periods:(1) After the group contractholder has delivered written notice of acceptance of the contract.(2) After the start of the employers annual open enrollment period.(3) After the receipt of payment of the premium for the first month of coverage in accordance with the contract effective date.(b) Changes to the premium rates or applicable copayments or coinsurances or deductibles of a contract shall, subject to the plan meeting the requirements of this article, be allowed in any of the following circumstances:(1) When If authorized or required in the group contract.(2) When If the contract was agreed to under a preliminary agreement that states that it is subject to execution of a definitive agreement.(3) When If the plan and contractholder mutually agree in writing. | |
| 171 | + | ||
| 172 | + | 1374.20. (a) No A group health care service plan shall not change the premium rates or applicable copayments or coinsurances copayments, coinsurances, or deductibles for the length of the contract, except as specified in subdivision (b), during any of the following time periods:(1) After the group contractholder has delivered written notice of acceptance of the contract.(2) After the start of the employers annual open enrollment period.(3) After the receipt of payment of the premium for the first month of coverage in accordance with the contract effective date.(b) Changes to the premium rates or applicable copayments or coinsurances or deductibles of a contract shall, subject to the plan meeting the requirements of this article, be allowed in any of the following circumstances:(1) When If authorized or required in the group contract.(2) When If the contract was agreed to under a preliminary agreement that states that it is subject to execution of a definitive agreement.(3) When If the plan and contractholder mutually agree in writing. | |
| 173 | + | ||
| 174 | + | 1374.20. (a) No A group health care service plan shall not change the premium rates or applicable copayments or coinsurances copayments, coinsurances, or deductibles for the length of the contract, except as specified in subdivision (b), during any of the following time periods:(1) After the group contractholder has delivered written notice of acceptance of the contract.(2) After the start of the employers annual open enrollment period.(3) After the receipt of payment of the premium for the first month of coverage in accordance with the contract effective date.(b) Changes to the premium rates or applicable copayments or coinsurances or deductibles of a contract shall, subject to the plan meeting the requirements of this article, be allowed in any of the following circumstances:(1) When If authorized or required in the group contract.(2) When If the contract was agreed to under a preliminary agreement that states that it is subject to execution of a definitive agreement.(3) When If the plan and contractholder mutually agree in writing. | |
| 224 | 175 | ||
| 225 | 176 | ||
| 226 | 177 | ||
| 227 | - | ||
| 228 | - | (a)A group health care service plan shall not change the premium rates or applicable copayments, coinsurances, or deductibles for the length of the contract, except as specified in subdivision (b), during any of the following time periods: | |
| 229 | - | ||
| 230 | - | ||
| 178 | + | 1374.20. (a) No A group health care service plan shall not change the premium rates or applicable copayments or coinsurances copayments, coinsurances, or deductibles for the length of the contract, except as specified in subdivision (b), during any of the following time periods: | |
| 231 | 179 | ||
| 232 | 180 | (1) After the group contractholder has delivered written notice of acceptance of the contract. | |
| 233 | 181 | ||
| 234 | - | ||
| 235 | - | ||
| 236 | 182 | (2) After the start of the employers annual open enrollment period. | |
| 237 | - | ||
| 238 | - | ||
| 239 | 183 | ||
| 240 | 184 | (3) After the receipt of payment of the premium for the first month of coverage in accordance with the contract effective date. | |
| 241 | 185 | ||
| 242 | - | ||
| 243 | - | ||
| 244 | 186 | (b) Changes to the premium rates or applicable copayments or coinsurances or deductibles of a contract shall, subject to the plan meeting the requirements of this article, be allowed in any of the following circumstances: | |
| 245 | 187 | ||
| 188 | + | (1) When If authorized or required in the group contract. | |
| 246 | 189 | ||
| 190 | + | (2) When If the contract was agreed to under a preliminary agreement that states that it is subject to execution of a definitive agreement. | |
| 247 | 191 | ||
| 248 | - | (1)If authorized or required in the group contract. | |
| 249 | - | ||
| 250 | - | ||
| 251 | - | ||
| 252 | - | (2)If the contract was agreed to under a preliminary agreement that states that it is subject to execution of a definitive agreement. | |
| 253 | - | ||
| 254 | - | ||
| 255 | - | ||
| 256 | - | (3)If the plan and contractholder mutually agree in writing. | |
| 192 | + | (3) When If the plan and contractholder mutually agree in writing. |