California 2017-2018 Regular Session Status: Enacted

AB 1092 — Health care service plans: vision care services: provider claims: fraud.

Last action — Chaptered by Secretary of State - Chapter 525, Statutes of 2018.

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  1. ✓
    Introduced
  2. ✓
    In Committee
  3. ✓
    Passed Assembly
  4. ✓
    Passed Senate
  5. ✓
    To Executive
  6. 6
    Enacted

This bill has been enacted into law. Introduced February 17, 2017. Enacted.

Prognosis

Likely to advance 72% · moderate confidence

Where this bill stands today.

Odds of enactment

High

How often bills like it became law.

  • Enacted

    Current position in the legislative process.

  • 2 sponsors

    1 primary, 1 co-sponsors signed on.

  • Cleared a recorded vote

    Passed 7 recorded votes so far.

Prognosis reads this bill's own signals — stage, sponsorship breadth, committee status, recorded votes and cross-state momentum. Odds come from a model trained on which bills have become law.

Summary

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 requires a health care service plan doing business in this state to establish an antifraud plan to organize and implement an antifraud strategy to identify and reduce costs, and to protect consumers through the timely detection, investigation, and prosecution of suspected fraud. Existing law specifies required elements of an antifraud plan and requires a health care service plan to annually submit a written report to the department director describing the plan's efforts to deter, detect, and investigate fraud, and to report cases of fraud to a law enforcement agency. Existing law requires a health care service plan to reimburse a claim or portion of a claim no later than 30 working days after receipt of the claim, unless the plan contests or denies the claim, in which case the plan is required to notify the claimant within 30 working days that the claim is contested or denied. Existing law extends these timelines to 45 working days for a health maintenance organization. Existing law provides for the accrual of interest after these 30- and 45-day periods. Existing law requires a health care service plan or health maintenance organization to comply with additional timelines when a claim is reasonably contested. This bill would specify that a specialized health care service plan that undertakes solely to arrange for the provision of vision care services may use a statistically reliable method, as specified, to investigate suspected fraud and to recover overpayments made as a result of fraud, under designated circumstances. The bill would require the specialized health care service plan's statistically reliable method, and how the plan intends to utilize that method to determine recovery of overpayments made as a result of fraud, to be submitted to, and approved by, the department as elements of the specialized health care service plan's antifraud plan. The bill would specify procedures and timelines for a provider to contest a specialized health care service plan's notice of suspected fraud or to request a hearing, and the circumstances under which a specialized health care service plan may offset the amount the specialized health care service plan disclosed as overpaid to the provider in an uncontested notice of suspected fraud against a provider's current claim submissions. Because a violation of these provisions by a specialized health care service plan would be a crime, this 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.

Bill Text

Action History

  1. Chaptered by Secretary of State - Chapter 525, Statutes of 2018.

  2. Approved by the Governor.

  3. Enrolled and presented to the Governor at 3:30 p.m.

  4. Senate amendments concurred in. To Engrossing and Enrolling. (Ayes 79. Noes 0. Page 6982.).

  5. From committee: That the Senate amendments be concurred in. (Ayes 13. Noes 0.) (August 29).

  6. Joint Rule 62(a), file notice suspended. (Page 6729.)

  7. Re-referred to Com. on HEALTH. pursuant to Assembly Rule 77.2.

  8. In Assembly. Concurrence in Senate amendments pending. May be considered on or after August 29 pursuant to Assembly Rule 77.

  9. Read third time. Passed. Ordered to the Assembly. (Ayes 39. Noes 0. Page 5781.).

  10. Read second time. Ordered to third reading.

  11. Read third time and amended. Ordered to second reading.

  12. Read second time. Ordered to third reading.

  13. From committee: Be ordered to second reading pursuant to Senate Rule 28.8.

  14. Read second time and amended. Re-referred to Com. on APPR.

  15. From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 9. Noes 0.) (June 27).

  16. From committee chair, with author's amendments: Amend, and re-refer to committee. Read second time, amended, and re-referred to Com. on HEALTH.

  17. From committee chair, with author's amendments: Amend, and re-refer to committee. Read second time, amended, and re-referred to Com. on HEALTH.

  18. In committee: Hearing postponed by committee.

  19. Referred to Coms. on HEALTH and APPR.

  20. In Senate. Read first time. To Com. on RLS. for assignment.

  21. Read third time. Passed. Ordered to the Senate. (Ayes 77. Noes 0. Page 1938.)

  22. Read second time. Ordered to third reading.

  23. Read second time and amended. Ordered returned to second reading.

  24. From committee: Amend, and do pass as amended. (Ayes 16. Noes 0.) (May 26).

  25. In committee: Set, first hearing. Referred to APPR. suspense file.

  26. From committee: Do pass and re-refer to Com. on APPR. (Ayes 14. Noes 0.) (April 4). Re-referred to Com. on APPR.

  27. Coauthors revised.

  28. Referred to Com. on HEALTH.

  29. From printer. May be heard in committee March 21.

  30. Read first time. To print.

Sponsors

  • Cooley · Primary
  • Nielsen · Cosponsor

Sponsorship breakdown

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1 sponsors · 1 co-sponsors · 120 not signed on

Sponsors (1)

  • Cooley

Co-sponsors (1)

  • Nielsen

Not signed on (120)

120 members have not signed on to this bill.

Show all 120 →

"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

Whip count is in markup. Polling the chamber and every recorded vote this session. Only the first open is slow. It’s instant for you after this. Calling the roll · Tallying · Engrossing

Votes

AB 1092 COOLEY Concurrence in Senate Amendments

Passed 79 Yea · 0 Nay · 1 Other
Party YeaNayPresentNot Voting
Unaffiliated 58000
Democratic 16000
Republican 5001
Total 79001
% of votes cast 99%0%0%1%
How each member voted (80)
Member Party Vote
Acosta — Yea
Bigelow — Yea
Bloom — Yea
Brough — Yea
Jones-Sawyer — Yea
Maienschein — Yea
Mathis — Yea
Rendon — Yea
Santiago — Yea
Steinorth — Yea
Voepel — Yea
Waldron — Yea
Chávez — Yea
Eggman — Yea
Cunningham — Yea
Daly — Yea
Frazier — Yea
Harper — Yea
Gonzalez Fletcher — Yea
Mayes — Yea
Wood — Yea
Friedman — Yea
Rubio — Yea
Salas — Yea
Burke — Yea
Gloria — Yea
Rivas — Yea
Holden — Yea
Fong — Yea
Gray — Yea
Kamlager-Dove — Yea
Kiley — Yea
Levine — Yea
Low — Yea
McCarty — Yea
Baker — Yea
Chau — Yea
Chiu — Yea
Chu — Yea
Cooley — Yea
Cooper — Yea
Medina — Yea
Melendez — Yea
Mullin — Yea
Nazarian — Yea
O'Donnell — Yea
Obernolte — Yea
Quirk — Yea
Rodriguez — Yea
Thurmond — Yea
Ting — Yea
Weber — Yea
Cristina Garcia — Yea
Eduardo Garcia — Yea
Jim Patterson — Yea
Mark Stone — Yea
Travis Allen — Yea
Wendy Carrillo — Yea
Aguiar-Curry, Cecilia M. Democratic Yea
Arambula, Joaquin Democratic Yea
Berman, Marc Democratic Yea
Bonta, Mia Democratic Yea
Caballero, Anna M. Democratic Yea
Calderon, Lisa Democratic Yea
Cervantes, Sabrina Democratic Yea
Gabriel, Jesse Democratic Yea
Gipson, Mike A. Democratic Yea
Grayson, Timothy S. Democratic Yea
Irwin, Jacqui Democratic Yea
Kalra, Ash Democratic Yea
Limón, Monique Democratic Yea
Muratsuchi, Al Democratic Yea
Quirk-Silva, Sharon Democratic Yea
Reyes, Eloise Gómez Democratic Yea
Chen, Phillip Republican Yea
Choi, Steven S. Republican Yea
Dahle, Megan Republican Yea
Flora, Heath Republican Not Voting
Gallagher, James Republican Yea
Lackey, Tom Republican Yea

Official roll call →

With recommendation: That Senate amendments be concurred in.

Passed 13 Yea · 0 Nay · 2 Other
Party YeaNayPresentNot Voting
Unaffiliated 11000
Democratic 1002
Republican 1000
Total 13002
% of votes cast 87%0%0%13%
How each member voted (15)
Member Party Vote
Bigelow — Yea
Nazarian — Yea
Santiago — Yea
Thurmond — Yea
Waldron — Yea
Burke — Yea
Mayes — Yea
McCarty — Yea
Rodriguez — Yea
Wood — Yea
Wendy Carrillo — Yea
Aguiar-Curry, Cecilia M. Democratic Yea
Bonta, Mia Democratic Not Voting
Limón, Monique Democratic Not Voting
Flora, Heath Republican Yea

Official roll call →

3rd Reading AB1092 Cooley et al. By Nielsen

Passed 39 Yea · 0 Nay · 1 Other
Party YeaNayPresentNot Voting
Unaffiliated 34001
Democratic 5000
Total 39001
% of votes cast 98%0%0%3%
How each member voted (40)
Member Party Vote
Anderson — Yea
Bates — Yea
Bradford — Yea
Leyva — Yea
Nielsen — Yea
Skinner — Yea
Vidak — Yea
Wieckowski — Yea
Delgado — Yea
Galgiani — Yea
Fuller — Yea
Cannella — Yea
Glazer — Yea
Allen — Yea
De León — Yea
Hernandez — Yea
Chang — Yea
Portantino — Yea
Atkins — Yea
Mitchell — Yea
Hertzberg — Yea
Hill — Yea
Hueso — Yea
Lara — Yea
Monning — Yea
Beall — Yea
Dodd — Yea
Moorlach — Yea
Morrell — Yea
Pan — Yea
Roth — Yea
Wilk — Yea
Beth Gaines — Yea
Bill Berryhill — Not Voting
Mark Stone — Yea
Jackson, Corey A. Democratic Yea
McGuire, Mike Democratic Yea
Nguyen, Stephanie Democratic Yea
Stern, Henry I. Democratic Yea
Wiener, Scott D. Democratic Yea

Official roll call →

AB 1092 COOLEY Assembly Third Reading

Passed 77 Yea · 0 Nay · 3 Other
Party YeaNayPresentNot Voting
Unaffiliated 55002
Democratic 16000
Republican 6001
Total 77003
% of votes cast 96%0%0%4%
How each member voted (80)
Member Party Vote
Acosta — Yea
Baker — Yea
Bigelow — Yea
Bloom — Yea
Brough — Yea
Levine — Yea
Mathis — Yea
Mullin — Yea
O'Donnell — Yea
Quirk — Yea
Santiago — Yea
Ting — Yea
Voepel — Yea
Wood — Yea
Cooley — Yea
Eggman — Not Voting
Cunningham — Yea
Dababneh — Yea
Daly — Yea
Frazier — Yea
Burke — Yea
Gonzalez Fletcher — Yea
Friedman — Yea
Gloria — Yea
Rubio — Yea
Salas — Yea
Gomez — Yea
Harper — Yea
Holden — Yea
Jones-Sawyer — Yea
Bocanegra — Yea
Gray — Yea
Kiley — Yea
Low — Yea
Maienschein — Yea
Mayes — Yea
Chau — Yea
Chiu — Yea
Chu — Yea
Chávez — Yea
Cooper — Yea
McCarty — Yea
Medina — Yea
Melendez — Not Voting
Nazarian — Yea
Obernolte — Yea
Rendon — Yea
Ridley-Thomas — Yea
Rodriguez — Yea
Steinorth — Yea
Thurmond — Yea
Waldron — Yea
Weber — Yea
Cristina Garcia — Yea
Eduardo Garcia — Yea
Mark Stone — Yea
Travis Allen — Yea
Aguiar-Curry, Cecilia M. Democratic Yea
Arambula, Joaquin Democratic Yea
Berman, Marc Democratic Yea
Bonta, Mia Democratic Yea
Caballero, Anna M. Democratic Yea
Calderon, Lisa Democratic Yea
Cervantes, Sabrina Democratic Yea
Fong, Mike Democratic Yea
Gipson, Mike A. Democratic Yea
Grayson, Timothy S. Democratic Yea
Irwin, Jacqui Democratic Yea
Kalra, Ash Democratic Yea
Limón, Monique Democratic Yea
Muratsuchi, Al Democratic Yea
Quirk-Silva, Sharon Democratic Yea
Reyes, Eloise Gómez Democratic Yea
Chen, Phillip Republican Yea
Choi, Steven S. Republican Not Voting
Dahle, Megan Republican Yea
Flora, Heath Republican Yea
Gallagher, James Republican Yea
Lackey, Tom Republican Yea
Patterson, Joe Republican Yea

Official roll call →

Do pass as amended.

Passed 16 Yea · 0 Nay · 1 Other
Party YeaNayPresentNot Voting
Unaffiliated 10001
Democratic 5000
Republican 1000
Total 16001
% of votes cast 94%0%0%6%
How each member voted (17)
Member Party Vote
Bigelow — Yea
Bloom — Yea
Brough — Yea
Obernolte — Not Voting
Friedman — Yea
Gray — Yea
Gonzalez Fletcher — Yea
Bocanegra — Yea
McCarty — Yea
Quirk — Yea
Eduardo Garcia — Yea
Bonta, Mia Democratic Yea
Calderon, Lisa Democratic Yea
Fong, Mike Democratic Yea
Muratsuchi, Al Democratic Yea
Reyes, Eloise Gómez Democratic Yea
Gallagher, James Republican Yea

Official roll call →

Do pass and be re-referred to the Committee on [Appropriations]

Passed 14 Yea · 0 Nay · 1 Other
Party YeaNayPresentNot Voting
Democratic 3000
Unaffiliated 9001
Republican 2000
Total 14001
% of votes cast 93%0%0%7%
How each member voted (15)
Member Party Vote
Maienschein — Yea
Santiago — Yea
Wood — Yea
Burke — Yea
McCarty — Yea
Nazarian — Yea
Ridley-Thomas — Not Voting
Rodriguez — Yea
Thurmond — Yea
Waldron — Yea
Bonta, Mia Democratic Yea
Limón, Monique Democratic Yea
Quirk-Silva, Sharon Democratic Yea
Gallagher, James Republican Yea
Patterson, Joe Republican Yea

Official roll call →

Subjects

healthcare health-insurance
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Frequently asked questions

What does AB 1092 do?
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 requires a health care service plan doing business in this state to establish an antifraud plan to organize and implement an antifraud strategy to identify and reduce costs, and to protect consumers through the timely detection, investigation, and prosecution of suspected fraud. Existing law specifies required elements of an antifraud plan and requires a health care service plan to annually submit a written report to the department director describing the plan's efforts to deter, detect, and investigate fraud, and to report cases of fraud to a law enforcement agency. Existing law requires a health care service plan to reimburse a claim or portion of a claim no later than 30 working days after receipt of the claim, unless the plan contests or denies the claim, in which case the plan is required to notify the claimant within 30 working days that the claim is contested or denied. Existing law extends these timelines to 45 working days for a health maintenance organization. Existing law provides for the accrual of interest after these 30- and 45-day periods. Existing law requires a health care service plan or health maintenance organization to comply with additional timelines when a claim is reasonably contested. This bill would specify that a specialized health care service plan that undertakes solely to arrange for the provision of vision care services may use a statistically reliable method, as specified, to investigate suspected fraud and to recover overpayments made as a result of fraud, under designated circumstances. The bill would require the specialized health care service plan's statistically reliable method, and how the plan intends to utilize that method to determine recovery of overpayments made as a result of fraud, to be submitted to, and approved by, the department as elements of the specialized health care service plan's antifraud plan. The bill would specify procedures and timelines for a provider to contest a specialized health care service plan's notice of suspected fraud or to request a hearing, and the circumstances under which a specialized health care service plan may offset the amount the specialized health care service plan disclosed as overpaid to the provider in an uncontested notice of suspected fraud against a provider's current claim submissions. Because a violation of these provisions by a specialized health care service plan would be a crime, this 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.
Who sponsors AB 1092?
AB 1092 is sponsored by Cooley and Nielsen.
What is the current status of AB 1092?
This bill has been enacted into law. Introduced February 17, 2017. Enacted.
Where can I track AB 1092?
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