California 2015-2016 Regular Session Status: Enacted Bipartisan · 1 D · 1 R cosponsors

AB 72 — Health care coverage: out-of-network coverage.

Last action — Chaptered by Secretary of State - Chapter 492, Statutes of 2016.

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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 December 18, 2014. Enacted.

Prognosis

Likely to advance 98% · high confidence

Where this bill stands today.

Odds of enactment

High

How often bills like it became law.

  • Enacted

    Current position in the legislative process.

  • 7 sponsors

    1 primary, 6 co-sponsors signed on.

  • Bipartisan support

    Sponsored across 2 parties (1 D · 1 R) — cross-party backing.

  • Cleared a recorded vote

    Passed 12 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. A willful violation of the act is a crime. Existing law requires a health care service plan to reimburse providers for emergency services and care provided to its enrollees, until the care results in stabilization of the enrollee. Existing law prohibits a health care service plan from requiring a provider to obtain authorization prior to the provision of emergency services and care necessary to stabilize the enrollee's emergency medical care, as specified. Existing law also provides for the regulation of health insurers by the Insurance Commissioner. Existing law requires a health insurance policy issued, amended, or renewed on or after January 1, 2014, that provides or covers benefits with respect to services in an emergency department of a hospital to cover emergency services without the need for prior authorization, regardless of whether the provider is a participating provider, and subject to the same cost sharing required if the services were provided by a participating provider, as specified. This bill would require a health care service plan contract or health insurance policy issued, amended, or renewed on or after July 1, 2017, to provide that if an enrollee or insured receives covered services from a contracting health facility, as defined, at which, or as a result of which, the enrollee or insured receives covered services provided by a noncontracting individual health professional, as defined, the enrollee or insured would be required to pay the noncontracting individual health professional only the same cost sharing required if the services were provided by a contracting individual health professional, which would be referred to as the "in-network cost-sharing amount." The bill would prohibit an enrollee or insured from owing the noncontracting individual health professional at the contracting health facility more than the in-network cost-sharing amount if the noncontracting individual health professional receives reimbursement for services provided to the enrollee or insured at a contracting health facility from the health care service plan or health insurer. However, the bill would make an exception from this prohibition if the enrollee or insured provides written consent that satisfies specified criteria. The bill would require a noncontracting individual health professional who collects more than the in-network cost-sharing amount from the enrollee or insured to refund any overpayment to the enrollee or insured, as specified, and would provide that interest on any amount not refunded to the enrollee or insured shall accrue at 15% per annum, as specified. Existing law requires a contract between a health care service plan and a provider, or a contract between an insurer and a provider, to contain provisions requiring a fast, fair, and cost-effective dispute resolution mechanism under which providers may submit disputes to the plan or insurer. Existing law requires that dispute resolution mechanism also be made accessible to a noncontracting provider for the purpose of resolving billing and claims disputes. This bill would require the department and the commissioner to each establish, by September 1, 2017, an independent dispute resolution process that would allow a noncontracting individual health professional who rendered services at a contracting health facility, or a plan or insurer, to appeal a claim payment dispute, as specified. The bill would authorize the department and the commissioner to contract with one or more independent dispute resolution organizations to conduct the independent dispute resolution process, as specified. Contracts entered into pursuant to these provisions would be exempt from specified statutory provisions and related state agency review and approval requirements. The bill would provide that the decision of the organization would be binding on the parties. The bill would require a plan or insurer to base reimbursement for covered services on the amount the individual health professional would have been reimbursed by Medicare for the same or similar services in the general geographic area in which the services were rendered pursuant to a specified methodology and would specify, among other responsibilities, the duties of health care service plans, their delegated entities, and health insurers in identifying and calculating the applicable reimbursement rates, as well as various related duties of the department and the commissioner. The bill would require the department and the commissioner to report on the data and information provided in the independent dispute resolution process to the Governor and other specified recipients by January 1, 2019. The bill would require a noncontracting individual health professional, health care service plan or delegated entity, or health insurer that disputes that claim reimbursement to utilize the independent dispute resolution process. The bill would provide that these provisions do not apply to emergency services and care, as defined. Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest. This bill would make legislative findings to that effect. Because a willful violation of the bill's provisions relative to a health care service plan would be a crime, the bill would impose a state-mandated local program. The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that no reimbursement is required by this act for a specified reason.

Bill Text

Action History

  1. Chaptered by Secretary of State - Chapter 492, Statutes of 2016.

  2. Approved by the Governor.

  3. Enrolled and presented to the Governor at 2:30 p.m.

  4. Senate amendments concurred in. To Engrossing and Enrolling. (Ayes 79. Noes 0. Page 6534.).

  5. From committee: That the Senate amendments be concurred in. (Ayes 15. Noes 0.) (August 30).

  6. Joint Rule 62(a), file notice suspended. (Page 6474.)

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

  8. In Assembly. Concurrence in Senate amendments pending.

  9. Read third time. Passed. Ordered to the Assembly. (Ayes 35. Noes 1. Page 5488.).

  10. Ordered to third reading.

  11. (Ayes 38. Noes 0. Page 5451.)

  12. Withdrawn from committee.

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

  14. Senate Rule 29.3(b) suspended. (Page 5433.)

  15. Re-referred to Com. on RLS.

  16. Read second time. Ordered to third reading.

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

  18. Read second time. Ordered to third reading.

  19. From committee: Do pass. (Ayes 5. Noes 0.) (August 11).

  20. Referred to APPR. suspense file.

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

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

  23. From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 7. Noes 1.) (June 29).

  24. Re-referred to Com. on HEALTH.

  25. Re-referred to Com. on RLS. pursuant to Senate Rule 29.10(c).

  26. Read second time. Ordered to third reading.

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

  28. Ordered to second reading.

  29. From inactive file.

  30. Ordered to inactive file at the request of Senator Hancock.

  31. Read second time. Ordered to third reading.

  32. From committee: Do pass. (Ayes 4. Noes 3.) (September 10).

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

  34. Re-referred to Com. on GOV. & F.

  35. Joint Rule 62(a) suspended. (Ayes 27. Noes 6. Page 2646.)

  36. Joint Rule 61(a) suspended. (Ayes 27. Noes 6. Page 2645.)

  37. Re-referred to Com. on RLS. pursuant to Senate Rule 29.10(c).

  38. Read second time. Ordered to third reading.

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

  40. Read second time. Ordered to third reading.

  41. Ordered to second reading.

  42. From inactive file.

  43. Ordered to inactive file at the request of Senator Hernandez.

  44. Read second time. Ordered to third reading.

  45. From committee: Do pass. (Ayes 6. Noes 0.) (August 17).

  46. From committee: Do pass and re-refer to Com. on APPR. with recommendation: To Consent Calendar. (Ayes 9. Noes 0.) (July 15). Re-referred to Com. on APPR.

  47. In committee: Hearing postponed by committee.

  48. Referred to Com. on HEALTH.

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

  50. Read third time. Urgency clause adopted. Passed. Ordered to the Senate. (Ayes 78. Noes 0. Page 1107.).

  51. Read second time. Ordered to Consent Calendar.

  52. From committee: Do pass. To Consent Calendar. (Ayes 16. Noes 0.) (April 15).

  53. From committee: Do pass and re-refer to Com. on APPR. (Ayes 18. Noes 0.) (April 7). Re-referred to Com. on APPR.

  54. Referred to Com. on HEALTH.

  55. Read first time.

  56. From printer. May be heard in committee January 18.

  57. Introduced. To print.

Sponsors

  • Bonilla · Cosponsor
  • Dahle · Cosponsor
  • Maienschein · Cosponsor
  • Santiago · Cosponsor
  • Wood · Cosponsor
  • Jeff Gonzalez · Cosponsor
  • Mia Bonta · Primary

Sponsorship breakdown

Export CSV (upgrade) →

1 sponsors · 6 co-sponsors · 115 not signed on · 1 voted No

Sponsors (1)

Co-sponsors (6)

Not signed on (115)

115 members have not signed on to this bill.

Show all 115 →

"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 72 BONTA Concurrence in Senate Amendments

Passed 79 Yea · 0 Nay · 1 Other
Party YeaNayPresentNot Voting
Unaffiliated 69001
Democratic 5000
Republican 5000
Total 79001
% of votes cast 99%0%0%1%
How each member voted (80)
Member Party Vote
Achadjian — Yea
Alejo — Yea
Baker — Yea
Bloom — Yea
Brough — Yea
Brown — Yea
Low — Yea
Maienschein — Yea
Mathis — Yea
O'Donnell — Yea
Quirk — Yea
Rodriguez — Yea
Thurmond — Yea
Waldron — Yea
Williams — Yea
Wood — Yea
Eggman — Yea
Chávez — Yea
Cooper — Yea
Daly — Yea
Frazier — Yea
Gatto — Yea
Salas — Yea
Gomez — Yea
Gordon — Yea
Harper — Yea
Jones-Sawyer — Yea
Kim — Yea
Levine — Yea
Burke — Yea
Linder — Yea
Mayes — Yea
Bigelow — Yea
Chang — Yea
Chau — Yea
Chiu — Yea
Chu — Yea
Cooley — Yea
McCarty — Yea
Melendez — Yea
Nazarian — Yea
Obernolte — Yea
Olsen — Yea
Rendon — Yea
Ridley-Thomas — Yea
Steinorth — Yea
Weber — Yea
Wilk — Yea
Hadley — Yea
Atkins — Yea
Campos — Yea
Bonilla — Yea
Lopez — Yea
Gray — Not Voting
Dababneh — Yea
Dodd — Yea
Holden — Yea
Medina — Yea
Mullin — Yea
Santiago — Yea
Ting — Yea
Wagner — Yea
Beth Gaines — Yea
Cristina Garcia — Yea
Eduardo Garcia — Yea
Jim Patterson — Yea
Lorena Gonzalez — Yea
Mark Stone — Yea
Roger Hernández — Yea
Travis Allen — Yea
Arambula, Joaquin Democratic Yea
Bonta, Mia Democratic Yea
Calderon, Lisa Democratic Yea
Gipson, Mike A. Democratic Yea
Irwin, Jacqui Democratic Yea
Dahle, Megan Republican Yea
Gallagher, James Republican Yea
Grove, Shannon Republican Yea
Jones, Brian W. Republican Yea
Lackey, Tom Republican Yea

Official roll call →

With recommendation: That Senate amendments be concurred in.

Passed 15 Yea · 0 Nay · 3 Other
Party YeaNayPresentNot Voting
Republican 1000
Unaffiliated 14003
Total 15003
% of votes cast 83%0%0%17%
How each member voted (18)
Member Party Vote
Waldron — Yea
Wood — Yea
Chiu — Yea
Burke — Not Voting
Campos — Yea
Bonilla — Yea
Gomez — Not Voting
Gordon — Yea
Maienschein — Yea
Nazarian — Yea
Olsen — Yea
Ridley-Thomas — Not Voting
Rodriguez — Yea
Santiago — Yea
Steinorth — Yea
Thurmond — Yea
Jim Patterson — Yea
Lackey, Tom Republican Yea

Official roll call →

3rd Reading AB72 Bonta By Hernandez

Passed 35 Yea · 1 Nay · 3 Other
Party YeaNayPresentNot Voting
Unaffiliated 32103
Democratic 3000
Total 35103
% of votes cast 90%3%0%8%
How each member voted (39)
Member Party Vote
Beall — Yea
Hancock — Yea
Hertzberg — Yea
Huff — Yea
Lara — Yea
Pavley — Yea
Wieckowski — Yea
Wolk — Yea
Hill — Yea
Allen — Yea
Mitchell — Yea
Cannella — Yea
De León — Yea
Galgiani — Not Voting
Hall — Yea
Hernandez — Yea
Hueso — Yea
Anderson — Nay
Bates — Yea
Block — Yea
Leno — Yea
Leyva — Yea
Liu — Yea
Mendoza — Yea
Monning — Yea
Moorlach — Not Voting
Morrell — Yea
Nielsen — Yea
Pan — Not Voting
Roth — Yea
Vidak — Yea
Fuller — Yea
Glazer — Yea
Beth Gaines — Yea
Bill Berryhill — Yea
Mark Stone — Yea
Jackson, Corey A. Democratic Yea
McGuire, Mike Democratic Yea
Nguyen, Stephanie Democratic Yea

Official roll call →

Do pass

Passed 5 Yea · 0 Nay · 2 Other
Party YeaNayPresentNot Voting
Unaffiliated 4002
Democratic 1000
Total 5002
% of votes cast 71%0%0%29%
How each member voted (7)
Member Party Vote
Bates — Not Voting
Beall — Yea
Hill — Yea
Lara — Yea
Mendoza — Yea
Nielsen — Not Voting
McGuire, Mike Democratic Yea

Official roll call →

Placed on suspense file

Passed 7 Yea · 0 Nay
Party YeaNayPresentNot Voting
Unaffiliated 6000
Democratic 1000
Total 7000
% of votes cast 100%0%0%0%
How each member voted (7)
Member Party Vote
Bates — Yea
Hill — Yea
Lara — Yea
Beall — Yea
Mendoza — Yea
Nielsen — Yea
McGuire, Mike Democratic Yea

Official roll call →

Do pass

Passed 4 Yea · 3 Nay
Party YeaNayPresentNot Voting
Unaffiliated 4200
Democratic 0100
Total 4300
% of votes cast 57%43%0%0%
How each member voted (7)
Member Party Vote
Beall — Yea
Hernandez — Yea
Pavley — Yea
Hertzberg — Nay
Lara — Yea
Moorlach — Nay
Nguyen, Stephanie Democratic Nay

Official roll call →

Do pass

Passed 6 Yea · 0 Nay · 1 Other
Party YeaNayPresentNot Voting
Unaffiliated 6001
Total 6001
% of votes cast 86%0%0%14%
How each member voted (7)
Member Party Vote
Bates — Yea
Hill — Yea
Leyva — Yea
Mendoza — Yea
Nielsen — Not Voting
Beall — Yea
Lara — Yea

Official roll call →

AB 72 BONTA Consent Calendar Second Day

Passed 78 Yea · 0 Nay · 2 Other
Party YeaNayPresentNot Voting
Unaffiliated 68002
Democratic 4000
Republican 6000
Total 78002
% of votes cast 98%0%0%3%
How each member voted (80)
Member Party Vote
Achadjian — Yea
Alejo — Yea
Bloom — Yea
Brough — Yea
Brown — Yea
Kim — Yea
Linder — Yea
Maienschein — Yea
Mathis — Yea
McCarty — Yea
Nazarian — Yea
Olsen — Yea
Rodriguez — Yea
Thurmond — Yea
Weber — Yea
Eggman — Yea
Cooley — Yea
Cooper — Yea
Frazier — Yea
Gatto — Yea
Gomez — Yea
Gordon — Yea
Burke — Yea
Harper — Yea
Jones-Sawyer — Yea
Levine — Yea
Low — Yea
Mayes — Yea
Medina — Yea
Gray — Yea
Melendez — Yea
Mullin — Yea
Atkins — Yea
Chang — Yea
Bonilla — Yea
Baker — Yea
Bigelow — Yea
Chau — Yea
Chiu — Yea
Chu — Yea
Chávez — Yea
Dababneh — Yea
Daly — Yea
Dodd — Yea
O'Donnell — Yea
Obernolte — Yea
Perea — Yea
Rendon — Yea
Ridley-Thomas — Yea
Steinorth — Yea
Wagner — Yea
Waldron — Yea
Wilk — Yea
Williams — Yea
Lopez — Yea
Salas — Not Voting
Campos — Not Voting
Hadley — Yea
Holden — Yea
Quirk — Yea
Santiago — Yea
Ting — Yea
Wood — Yea
Gonzalez — Yea
Beth Gaines — Yea
Cristina Garcia — Yea
Eduardo Garcia — Yea
Mark Stone — Yea
Roger Hernández — Yea
Travis Allen — Yea
Bonta, Mia Democratic Yea
Calderon, Lisa Democratic Yea
Gipson, Mike A. Democratic Yea
Irwin, Jacqui Democratic Yea
Dahle, Megan Republican Yea
Gallagher, James Republican Yea
Grove, Shannon Republican Yea
Jones, Brian W. Republican Yea
Lackey, Tom Republican Yea
Patterson, Joe Republican Yea

Official roll call →

Do pass. To Consent Calendar.

Passed 16 Yea · 0 Nay · 1 Other
Party YeaNayPresentNot Voting
Unaffiliated 12001
Democratic 2000
Republican 2000
Total 16001
% of votes cast 94%0%0%6%
How each member voted (17)
Member Party Vote
Bigelow — Yea
Wagner — Yea
Eggman — Yea
Chang — Yea
Bonilla — Not Voting
Gomez — Yea
Holden — Yea
Daly — Yea
Quirk — Yea
Rendon — Yea
Weber — Yea
Wood — Yea
Eduardo Garcia — Yea
Bonta, Mia Democratic Yea
Calderon, Lisa Democratic Yea
Gallagher, James Republican Yea
Jones, Brian W. Republican Yea

Official roll call →

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

Passed 18 Yea · 0 Nay · 1 Other
Party YeaNayPresentNot Voting
Democratic 1000
Unaffiliated 15001
Republican 2000
Total 18001
% of votes cast 95%0%0%5%
How each member voted (19)
Member Party Vote
Santiago — Yea
Wood — Yea
Bonilla — Yea
Gomez — Yea
Maienschein — Yea
Nazarian — Yea
Ridley-Thomas — Yea
Rodriguez — Yea
Burke — Yea
Chiu — Yea
Chávez — Yea
Steinorth — Yea
Thurmond — Yea
Waldron — Yea
Gonzalez — Yea
Roger Hernández — Not Voting
Bonta, Mia Democratic Yea
Lackey, Tom Republican Yea
Patterson, Joe Republican Yea

Official roll call →

Subjects

healthcare health-insurance
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Frequently asked questions

What does AB 72 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. A willful violation of the act is a crime. Existing law requires a health care service plan to reimburse providers for emergency services and care provided to its enrollees, until the care results in stabilization of the enrollee. Existing law prohibits a health care service plan from requiring a provider to obtain authorization prior to the provision of emergency services and care necessary to stabilize the enrollee's emergency medical care, as specified. Existing law also provides for the regulation of health insurers by the Insurance Commissioner. Existing law requires a health insurance policy issued, amended, or renewed on or after January 1, 2014, that provides or covers benefits with respect to services in an emergency department of a hospital to cover emergency services without the need for prior authorization, regardless of whether the provider is a participating provider, and subject to the same cost sharing required if the services were provided by a participating provider, as specified. This bill would require a health care service plan contract or health insurance policy issued, amended, or renewed on or after July 1, 2017, to provide that if an enrollee or insured receives covered services from a contracting health facility, as defined, at which, or as a result of which, the enrollee or insured receives covered services provided by a noncontracting individual health professional, as defined, the enrollee or insured would be required to pay the noncontracting individual health professional only the same cost sharing required if the services were provided by a contracting individual health professional, which would be referred to as the "in-network cost-sharing amount." The bill would prohibit an enrollee or insured from owing the noncontracting individual health professional at the contracting health facility more than the in-network cost-sharing amount if the noncontracting individual health professional receives reimbursement for services provided to the enrollee or insured at a contracting health facility from the health care service plan or health insurer. However, the bill would make an exception from this prohibition if the enrollee or insured provides written consent that satisfies specified criteria. The bill would require a noncontracting individual health professional who collects more than the in-network cost-sharing amount from the enrollee or insured to refund any overpayment to the enrollee or insured, as specified, and would provide that interest on any amount not refunded to the enrollee or insured shall accrue at 15% per annum, as specified. Existing law requires a contract between a health care service plan and a provider, or a contract between an insurer and a provider, to contain provisions requiring a fast, fair, and cost-effective dispute resolution mechanism under which providers may submit disputes to the plan or insurer. Existing law requires that dispute resolution mechanism also be made accessible to a noncontracting provider for the purpose of resolving billing and claims disputes. This bill would require the department and the commissioner to each establish, by September 1, 2017, an independent dispute resolution process that would allow a noncontracting individual health professional who rendered services at a contracting health facility, or a plan or insurer, to appeal a claim payment dispute, as specified. The bill would authorize the department and the commissioner to contract with one or more independent dispute resolution organizations to conduct the independent dispute resolution process, as specified. Contracts entered into pursuant to these provisions would be exempt from specified statutory provisions and related state agency review and approval requirements. The bill would provide that the decision of the organization would be binding on the parties. The bill would require a plan or insurer to base reimbursement for covered services on the amount the individual health professional would have been reimbursed by Medicare for the same or similar services in the general geographic area in which the services were rendered pursuant to a specified methodology and would specify, among other responsibilities, the duties of health care service plans, their delegated entities, and health insurers in identifying and calculating the applicable reimbursement rates, as well as various related duties of the department and the commissioner. The bill would require the department and the commissioner to report on the data and information provided in the independent dispute resolution process to the Governor and other specified recipients by January 1, 2019. The bill would require a noncontracting individual health professional, health care service plan or delegated entity, or health insurer that disputes that claim reimbursement to utilize the independent dispute resolution process. The bill would provide that these provisions do not apply to emergency services and care, as defined. Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest. This bill would make legislative findings to that effect. Because a willful violation of the bill's provisions relative to a health care service plan would be a crime, the bill would impose a state-mandated local program. The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that no reimbursement is required by this act for a specified reason.
Who sponsors AB 72?
AB 72 is sponsored by Bonilla, Dahle, Maienschein, Santiago, Wood, Gonzalez, Jeff (Republican), and Bonta, Mia (Democratic).
What is the current status of AB 72?
This bill has been enacted into law. Introduced December 18, 2014. Enacted.
Where can I track AB 72?
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