AB 290 — Health care service plans and health insurance: third-party payments.

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 also provides for the regulation of health insurers by the Department of Insurance. These provisions govern, among other things, procedures by health care service plans and insurers with respect to premium payments. This bill would require a health care service plan or an insurer that provides a policy of health insurance to accept payments from specified third-party entities, including an Indian tribe or a local, state, or federal government program. The bill would also require a financially interested entity, as defined, other than those entities, that is making a third-party premium payment to provide that assistance in a specified manner and to perform other related duties, including disclosing to the plan or the insurer the name of the enrollee or insured, as applicable, for each plan or policy on whose behalf a third-party premium payment will be made. The bill would require each plan or insurer to provide to the appropriate department information regarding premium payments by financially interested entities and reimbursement for services to providers, and would set forth standards governing the reimbursement of financially interested providers, including, but not limited to, chronic dialysis clinics, that meet certain criteria. Commencing January 1, 2022, the bill would require reimbursement to contracted providers to be the higher of the Medicare reimbursement rate or the rate determined pursuant to an independent dispute resolution process, as established by the bill, if either party seeks a rate determination pursuant to that process, and would require reimbursement for noncontracted providers to be governed by the terms and conditions of the health care service plan contract or health insurance policy, or the rate determined pursuant to the dispute resolution process, as prescribed. The reimbursement rates and dispute resolution process established by the bill would not apply to reimbursement for an enrollee or insured on behalf of whom a financially interested provider was already making premium payments to a health care service plan or insurer on or before October 1, 2019, except under specified circumstances. The bill would not alter existing obligations and requirements applicable to a health care service plan or health insurer relating to offering, marketing, selling, and issuing a health benefit plan, and cancellation or nonrenewal, as specified. The bill would specify that its requirements do not supersede or modify any privacy and information security requirements and protections in federal and state law regarding protected health information or personally identifiable information. The bill would declare that an enrollee's or insured's loss of coverage due to a financially interested entity's failure to pay premiums on a timely basis would be deemed a triggering event to allow for special enrollment, requiring a health care service plan or health insurer to allow an individual to enroll in or change individual health benefit plans, as specified. Existing law establishes requirements for the licensure and regulation of clinics by the State Department of Public Health, which include certain types of specialty clinics, such as chronic dialysis clinics, as defined. A violation of these provisions is a crime. This bill would prohibit a chronic dialysis clinic from steering, directing, or advising a patient regarding any specific coverage program option or health care service plan contract. The bill would require a chronic dialysis clinic to post a notice requiring questions about Medicare coverage for patients with end stage renal disease to be directed to the Health Insurance Counseling and Advocacy Program, as specified. This bill would make certain of its provisions operative, for specified financially interested entities, on July 1, 2020, or upon a finding by the United States Department of Health and Human Services Office of Inspector General that compliance by the financially interested entities with those provisions does not violate federal law, as specified. By expanding the requirements applicable to chronic dialysis clinics, and because a willful violation of certain of the bill's requirements by a 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

• Chaptered 10/13/19 - Chaptered Current pdf October 13, 2019
• Enrolled 09/13/19 - Enrolled pdf September 13, 2019
• Amended 09/05/19 - Amended Senate pdf September 05, 2019
• Amended 07/10/19 - Amended Senate pdf July 10, 2019
• Amended 06/25/19 - Amended Senate pdf June 25, 2019
• Amended 05/17/19 - Amended Assembly pdf May 17, 2019
• Amended 03/05/19 - Amended Assembly pdf March 05, 2019
• Introduced 01/28/19 - Introduced pdf January 28, 2019
• AB290 View text html

Action History

1. October 13, 2019

   Chaptered by Secretary of State - Chapter 862, Statutes of 2019.

2. October 13, 2019

   Approved by the Governor.

3. September 18, 2019

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

4. September 10, 2019

   Senate amendments concurred in. To Engrossing and Enrolling. (Ayes 47. Noes 20. Page 3268.).

5. September 10, 2019

   Assembly Rule 77 suspended. (Page 3252.)

6. September 09, 2019

   In Assembly. Concurrence in Senate amendments pending. May be considered on or after September 11 pursuant to Assembly Rule 77.

7. September 09, 2019

   Read third time. Passed. Ordered to the Assembly. (Ayes 21. Noes 13. Page 2679.).

8. September 05, 2019

   Read second time and amended. Ordered to third reading.

9. September 04, 2019

   From committee: Amend, and do pass as amended. (Ayes 5. Noes 2.) (August 30).

10. August 12, 2019

    In committee: Referred to APPR. suspense file.

11. July 10, 2019

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

12. July 09, 2019

    From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 5. Noes 3.) (July 3).

13. June 25, 2019

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

14. May 29, 2019

    Referred to Com. on HEALTH.

15. May 23, 2019

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

16. May 22, 2019

    Read third time. Passed. Ordered to the Senate. (Ayes 46. Noes 15. Page 1801.)

17. May 20, 2019

    Read second time. Ordered to third reading.

18. May 17, 2019

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

19. May 17, 2019

    From committee: Amend, and do pass as amended. (Ayes 12. Noes 3.) (May 16).

20. April 24, 2019

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

21. March 20, 2019

    From committee: Do pass and re-refer to Com. on APPR. (Ayes 11. Noes 2.) (March 19). Re-referred to Com. on APPR.

22. March 06, 2019

    Re-referred to Com. on HEALTH.

23. March 05, 2019

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

24. February 07, 2019

    Referred to Com. on HEALTH.

25. January 29, 2019

    From printer. May be heard in committee February 28.

26. January 28, 2019

    Read first time. To print.

Sponsors

• Wood · Primary
• Leyva · Cosponsor

Votes

Subjects