SB 514: California Health Benefit Exchange.
- Session Year: 2015-2016
- House: Senate
- Latest Version Date: 2016-08-19
Existing federal law, the federal Patient Protection and Affordable Care Act (PPACA), enacts various health care coverage market reforms that took effect January 1, 2014. Among other things, PPACA requires each health insurance issuer that offers health insurance coverage in the individual or group market in a state to accept every employer and individual in the state that applies for that coverage and to renew that coverage at the option of the plan sponsor or the individual. PPACA also requires each state to establish an American Health Benefit Exchange that facilitates the purchase of qualified health plans by qualified individuals and qualified small employers, as specified.
Existing law establishes the California Health Benefit Exchange (Exchange) within state government, specifies the powers and duties of the board governing the Exchange, and requires the board to facilitate the purchase of qualified health plans through the Exchange by qualified individuals and small employers. Existing law requires the board, among other things, to determine the criteria and process for eligibility, enrollment, and disenrollment of enrollees and potential enrollees in the Exchange and coordinate that process with state and local government entities administering other specified health care coverage programs, as specified.
This bill would prohibit the Exchange from disclosing personal information that was obtained from the application for health care coverage to a certified insurance agent or certified enrollment counselor without the consent of the applicant. The bill would provide that these provisions do not preclude the Exchange from sharing the information of current enrollees or applicants with the same certified enrollment counselor or certified insurance agent of record that provided the applicant assistance with an existing application, or their successor or authorized staff, as specified. The bill would define the term personal information for these purposes.
This bill would declare that it is to take effect immediately as an urgency statute.
Existing federal law, the federal Patient Protection and Affordable Care Act (PPACA), enacts various health care coverage market reforms that took effect January 1, 2014. Among other things, PPACA requires each health insurance issuer that offers health insurance coverage in the individual or group market in a state to accept every employer and individual in the state that applies for that coverage and to renew that coverage at the option of the plan sponsor or the individual. PPACA also requires each state to establish an American Health Benefit Exchange that facilitates the purchase of qualified health plans by qualified individuals and qualified small employers, as specified.
Existing law establishes the California Health Benefit Exchange (Exchange) within state government, specifies the powers and duties of the board governing the Exchange, and requires the board to facilitate the purchase of qualified health plans through the Exchange by qualified individuals and small employers. Existing law requires the board, among other things, to determine the criteria and process for eligibility, enrollment, and disenrollment of enrollees and potential enrollees in the Exchange and coordinate that process with state and local government entities administering other specified health care coverage programs, as specified.
This bill would prohibit the Exchange from disclosing personal information that was obtained from the application for health care coverage to a certified insurance agent or certified enrollment counselor without the consent of the applicant. The bill would provide that these provisions do not preclude the Exchange from sharing the information of current enrollees or applicants with the same certified enrollment counselor or certified insurance agent of record that provided the applicant assistance with an existing application, or their successor or authorized staff, as specified. The bill would define the term personal information for these purposes.
This bill would declare that it is to take effect immediately as an urgency statute.
Existing federal law, the federal Patient Protection and Affordable Care Act (PPACA), enacts various health care coverage market reforms that took effect January 1, 2014. Among other things, PPACA requires each health insurance issuer that offers health insurance coverage in the individual or group market in a state to accept every employer and individual in the state that applies for that coverage and to renew that coverage at the option of the plan sponsor or the individual. PPACA also requires each state to establish an American Health Benefit Exchange that facilitates the purchase of qualified health plans by qualified individuals and qualified small employers, as specified.
Existing law establishes the California Health Benefit Exchange (Exchange) within state government, specifies the powers and duties of the board governing the Exchange, and requires the board to facilitate the purchase of qualified health plans through the Exchange by qualified individuals and small employers. Existing law requires the board, among other things, to determine the criteria and process for eligibility, enrollment, and disenrollment of enrollees and potential enrollees in the Exchange and coordinate that process with state and local government entities administering other specified health care coverage programs, as specified.
This bill would additionally require the board, no later than September 30, 2016, to allow an applicant to indicate whether or not the applicant would like assistance with completing the application from an Exchange certified insurance agent or certified enrollment counselor. The bill would prohibit the Exchange from disclosing any personal information, as defined, that was obtained from the application for health care coverage to a certified insurance agent or certified enrollment counselor until the Exchange has complied with the provision described above. The bill would also prohibit the Exchange from disclosing personal information that was obtained from the application for health care coverage to a certified insurance agent or certified enrollment counselor if the applicant indicates that the applicant does not want assistance from an Exchange certified insurance agent or certified enrollment counselor. without the consent of the applicant. The bill would provide that these provisions do not preclude the Exchange from sharing the information of current enrollees or applicants with the same certified enrollment counselor or certified insurance agent of record that provided the applicant assistance with an existing application, or their successor or authorized staff, as specified. The bill would define the term personal information for these purposes.
This bill would declare that it is to take effect immediately as an urgency statute.
Existing federal law, the federal Patient Protection and Affordable Care Act (PPACA), enacts various health care coverage market reforms that took effect January 1, 2014. Among other things, PPACA requires each health insurance issuer that offers health insurance coverage in the individual or group market in a state to accept every employer and individual in the state that applies for that coverage and to renew that coverage at the option of the plan sponsor or the individual. PPACA also requires each state to establish an American Health Benefit Exchange that facilitates the purchase of qualified health plans by qualified individuals and qualified small employers, as specified.
Existing law establishes the California Health Benefit Exchange (Exchange) within state government, specifies the powers and duties of the board governing the Exchange, and requires the board to facilitate the purchase of qualified health plans through the Exchange by qualified individuals and small employers. Existing law requires the board, among other things, to determine the criteria and process for eligibility, enrollment, and disenrollment of enrollees and potential enrollees in the Exchange and coordinate that process with state and local government entities administering other specified health care coverage programs, as specified.
This bill would additionally require the board, without unreasonable delay, no later than September 30, 2016, to allow an applicant to indicate in an application for health care coverage whether or not the applicant would like assistance with completing the application from an Exchange certified insurance agent or certified enrollment counselor. The bill would prohibit the Exchange from disclosing any personal information, as defined, that was obtained from the application for health care coverage to a certified insurance agent or certified enrollment counselor until the Exchange has complied with the provision described above. The bill would also prohibit the Exchange from disclosing personal information that was obtained from the application for health care coverage to a certified insurance agent or certified enrollment counselor if the applicant indicates that the applicant does not want assistance from an Exchange certified insurance agent or certified enrollment counselor. The bill would provide that these provisions do not preclude the Exchange from sharing the information of current enrollees or applicants with the same certified enrollment counselor or certified insurance agent of record that provided the applicant assistance with an existing application, or their successor or authorized staff, as specified.
This bill would declare that it is to take effect immediately as an urgency statute.
Existing federal law, the federal Patient Protection and Affordable Care Act (PPACA), enacts various health care coverage market reforms that took effect January 1, 2014. Among other things, PPACA requires each health insurance issuer that offers health insurance coverage in the individual or group market in a state to accept every employer and individual in the state that applies for that coverage and to renew that coverage at the option of the plan sponsor or the individual. PPACA also requires each state to establish an American Health Benefit Exchange that facilitates the purchase of qualified health plans by qualified individuals and qualified small employers, as specified.
Existing law establishes the California Health Benefit Exchange (Exchange) within state government, specifies the powers and duties of the board governing the Exchange, and requires the board to facilitate the purchase of qualified health plans through the Exchange by qualified individuals and small employers. Existing law requires the board, among other things, to determine the criteria and process for eligibility, enrollment, and disenrollment of enrollees and potential enrollees in the Exchange and coordinate that process with state and local government entities administering other specified health care coverage programs, as specified.
This bill would additionally require the board, without unreasonable delay, to allow an applicant to indicate in an application for health care coverage whether or not the applicant would like assistance with completing the application from an Exchange certified insurance agent or certified enrollment counselor. The bill would prohibit the Exchange from disclosing any personal information, as defined, that was obtained from the application for health care coverage to a certified insurance agent or certified enrollment counselor until the Exchange has complied with the provision described above. The bill would also prohibit the Exchange from disclosing personal information that was obtained from the application for health care coverage to a certified insurance agent or certified enrollment counselor if the applicant indicates that the applicant does not want assistance from an Exchange certified insurance agent or certified enrollment counselor. The bill would provide that these provisions do not preclude the Exchange from sharing the information of current enrollees or applicants with the same certified enrollment counselor or certified insurance agent of record that provided the applicant assistance with an existing application, or their successor or authorized staff, as specified.
This bill would declare that it is to take effect immediately as an urgency statute.
Existing law governs the procedure for the adoption, amendment, or repeal of regulations by state agencies and for the review of those regulatory actions by the Office of Administrative Law. Existing law requires the office to provide for the publication of the California Regulatory Notice Register and to include specified information in the register, including notices of proposed action prepared by regulatory agencies, a summary of regulations filed with the Secretary of State, and a summary of regulation decisions issued, as specified.
This bill would make technical, nonsubstantive changes to that law.
Existing law governs the procedure for the adoption, amendment, or repeal of regulations by state agencies and for the review of those regulatory actions by the Office of Administrative Law. Existing law requires the office to provide for the publication of the California Regulatory Notice Register and to include specified information in the register, including notices of proposed action prepared by regulatory agencies, a summary of regulations filed with the Secretary of State, and a summary of regulation decisions issued, as specified.
This bill would make technical, nonsubstantive changes to that law.
In addition to meeting the minimum requirements of Section 1311 of the federal act, the board shall do all of the following:
(a)(1)Determine the criteria and process for eligibility, enrollment, and disenrollment of enrollees and potential enrollees in the Exchange and coordinate that process with the state and local government entities administering other health care coverage programs, including the State Department of Health Care Services, the Managed Risk Medical Insurance Board, and California counties, in order to ensure consistent eligibility and enrollment processes and seamless transitions between coverage.
(2)(A)The Exchange shall not disclose personal information obtained from an application for health care coverage to a certified insurance agent or certified enrollment counselor without the consent of the applicant.
(B)Nothing in this section shall preclude the Exchange from sharing the information of current enrollees or applicants with the same certified enrollment counselor or certified insurance agent of record that provided the applicant assistance with an existing application, or their successor or authorized staff, as otherwise permitted by federal and state laws and regulations.
(C)For purposes of this section, the term personal information has the same meaning as set forth in Section 1798.3 of the Civil Code.
(b)Develop processes to coordinate with the county entities that administer eligibility for the Medi-Cal program and the entity that determines eligibility for the Healthy Families Program, including, but not limited to, processes for case transfer, referral, and enrollment in the Exchange of individuals applying for assistance to those entities, if allowed or required by federal law.
(c)Determine the minimum requirements a carrier must meet to be considered for participation in the Exchange, and the standards and criteria for selecting qualified health plans to be offered through the Exchange that are in the best interests of qualified individuals and qualified small employers. The board shall consistently and uniformly apply these requirements, standards, and criteria to all carriers. In the course of selectively contracting for health care coverage offered to qualified individuals and qualified small employers through the Exchange, the board shall seek to contract with carriers so as to provide health care coverage choices that offer the optimal combination of choice, value, quality, and service.
(d)Provide, in each region of the state, a choice of qualified health plans at each of the five levels of coverage contained in subsections (d) and (e) of Section 1302 of the federal act, subject to subdivision (e) of this section, paragraph (2) of subdivision (d) of Section 1366.6 of the Health and Safety Code, and paragraph (2) of subdivision (d) of Section 10112.3 of the Insurance Code.
(e)Require, as a condition of participation in the individual market of the Exchange, carriers to fairly and affirmatively offer, market, and sell in the individual market of the Exchange at least one product within each of the five levels of coverage contained in subsections (d) and (e) of Section 1302 of the federal act and require, as a condition of participation in the SHOP Program, carriers to fairly and affirmatively offer, market, and sell in the SHOP Program at least one product within each of the four levels of coverage contained in subsection (d) of Section 1302 of the federal act. The board may require carriers to offer additional products within each of those levels of coverage. This subdivision shall not apply to a carrier that solely offers supplemental coverage in the Exchange under paragraph (10) of subdivision (a) of Section 100504.
(f)(1)Except as otherwise provided in this section and Section 100504.5, require, as a condition of participation in the Exchange, carriers that sell any products outside the Exchange to do both of the following:
(A)Fairly and affirmatively offer, market, and sell all products made available to individuals in the Exchange to individuals purchasing coverage outside the Exchange.
(B)Fairly and affirmatively offer, market, and sell all products made available to small employers in the Exchange to small employers purchasing coverage outside the Exchange.
(2)For purposes of this subdivision, product does not include contracts entered into pursuant to Part 6.2 (commencing with Section 12693) of Division 2 of the Insurance Code between the Managed Risk Medical Insurance Board and carriers for enrolled Healthy Families beneficiaries or contracts entered into pursuant to Chapter 7 (commencing with Section 14000) of, or Chapter 8 (commencing with Section 14200) of, Part 3 of Division 9 of the Welfare and Institutions Code between the State Department of Health Care Services and carriers for enrolled Medi-Cal beneficiaries. Product also does not include a bridge plan product offered pursuant to Section 100504.5.
(3)Except as required by Section 1301(a)(1)(C)(ii) of the federal act, a carrier offering a bridge plan product in the Exchange may limit the products it offers in the Exchange solely to a bridge plan product contract.
(g)Determine when an enrollees coverage commences and the extent and scope of coverage.
(h)Provide for the processing of applications and the enrollment and disenrollment of enrollees.
(i)Determine and approve cost-sharing provisions for qualified health plans.
(j)Establish uniform billing and payment policies for qualified health plans offered in the Exchange to ensure consistent enrollment and disenrollment activities for individuals enrolled in the Exchange.
(k)Undertake activities necessary to market and publicize the availability of health care coverage and federal subsidies through the Exchange. The board shall also undertake outreach and enrollment activities that seek to assist enrollees and potential enrollees with enrolling and reenrolling in the Exchange in the least burdensome manner, including populations that may experience barriers to enrollment, such as the disabled and those with limited English language proficiency.
(l)Select and set performance standards and compensation for navigators selected under subdivision (l) of Section 100502.
(m)Employ necessary staff.
(1)The board shall hire a chief fiscal officer, a chief operations officer, a director for the SHOP Exchange, a director of health plan contracting, a chief technology and information officer, a general counsel, and other key executive positions, as determined by the board, who shall be exempt from civil service.
(2)(A)The board shall set the salaries for the exempt positions described in paragraph (1) and subdivision (i) of Section 100500 in amounts that are reasonably necessary to attract and retain individuals of superior qualifications. The salaries shall be published by the board in the boards annual budget. The boards annual budget shall be posted on the Internet Web site of the Exchange. To determine the compensation for these positions, the board shall cause to be conducted, through the use of independent outside advisors, salary surveys of both of the following:
(i)Other state and federal health insurance exchanges that are most comparable to the Exchange.
(ii)Other relevant labor pools.
(B)The salaries established by the board under subparagraph (A) shall not exceed the highest comparable salary for a position of that type, as determined by the surveys conducted pursuant to subparagraph (A).
(C)The Department of Human Resources shall review the methodology used in the surveys conducted pursuant to subparagraph (A).
(3)The positions described in paragraph (1) and subdivision (i) of Section 100500 shall not be subject to otherwise applicable provisions of the Government Code or the Public Contract Code and, for those purposes, the Exchange shall not be considered a state agency or public entity.
(n)Assess a charge on the qualified health plans offered by carriers that is reasonable and necessary to support the development, operations, and prudent cash management of the Exchange. This charge shall not affect the requirement under Section 1301 of the federal act that carriers charge the same premium rate for each qualified health plan whether offered inside or outside the Exchange.
(o)Authorize expenditures, as necessary, from the California Health Trust Fund to pay program expenses to administer the Exchange.
(p)Keep an accurate accounting of all activities, receipts, and expenditures, and annually submit to the United States Secretary of Health and Human Services a report concerning that accounting. Commencing January 1, 2016, the board shall conduct an annual audit.
(q)(1)Annually prepare a written report on the implementation and performance of the Exchange functions during the preceding fiscal year, including, at a minimum, the manner in which funds were expended and the progress toward, and the achievement of, the requirements of this title. The report shall also include data provided by health care service plans and health insurers offering bridge plan products regarding the extent of health care provider and health facility overlap in their Medi-Cal networks as compared to the health care provider and health facility networks contracting with the plan or insurer in their bridge plan contracts. This report shall be transmitted to the Legislature and the Governor and shall be made available to the public on the Internet Web site of the Exchange. A report made to the Legislature pursuant to this subdivision shall be submitted pursuant to Section 9795.
(2)The Exchange shall prepare, or contract for the preparation of, an evaluation of the bridge plan program using the first three years of experience with the program. The evaluation shall be provided to the health policy and fiscal committees of the Legislature in the fourth year following federal approval of the bridge plan option. The evaluation shall include, but not be limited to, all of the following:
(A)The number of individuals eligible to participate in the bridge plan program each year by category of eligibility.
(B)The number of eligible individuals who elect a bridge plan option each year by category of eligibility.
(C)The average length of time, by region and statewide, that individuals remain in the bridge plan option each year by category of eligibility.
(D)The regions of the state with a bridge plan option, and the carriers in each region that offer a bridge plan, by year.
(E)The premium difference each year, by region, between the bridge plan and the first and second lowest cost plan for individuals in the Exchange who are not eligible for the bridge plan.
(F)The effect of the bridge plan on the premium subsidy amount for bridge plan eligible individuals each year by each region.
(G)Based on a survey of individuals enrolled in the bridge plan:
(i)Whether individuals enrolling in the bridge plan product are able to keep their existing health care providers.
(ii)Whether individuals would want to retain their bridge plan product, buy a different Exchange product, or decline to purchase health insurance if there was no bridge plan product available. The Exchange may include questions designed to elicit the information in this subparagraph as part of an existing survey of individuals receiving coverage in the Exchange.
(3)In addition to the evaluation required by paragraph (2), the Exchange shall post the items in subparagraphs (A) to (F), inclusive, on its Internet Web site each year.
(4)In addition to the report described in paragraph (1), the board shall be responsive to requests for additional information from the Legislature, including providing testimony and commenting on proposed state legislation or policy issues. The Legislature finds and declares that activities including, but not limited to, responding to legislative or executive inquiries, tracking and commenting on legislation and regulatory activities, and preparing reports on the implementation of this title and the performance of the Exchange, are necessary state requirements and are distinct from the promotion of legislative or regulatory modifications referred to in subdivision (d) of Section 100520.
(r)Maintain enrollment and expenditures to ensure that expenditures do not exceed the amount of revenue in the fund, and if sufficient revenue is not available to pay estimated expenditures, institute appropriate measures to ensure fiscal solvency.
(s)Exercise all powers reasonably necessary to carry out and comply with the duties, responsibilities, and requirements of this act and the federal act.
(t)Consult with stakeholders relevant to carrying out the activities under this title, including, but not limited to, all of the following:
(1)Health care consumers who are enrolled in health plans.
(2)Individuals and entities with experience in facilitating enrollment in health plans.
(3)Representatives of small businesses and self-employed individuals.
(4)The Chief Deputy Director of Health Care Programs.
(5)Advocates for enrolling hard-to-reach populations.
(u)Facilitate the purchase of qualified health plans in the Exchange by qualified individuals and qualified small employers no later than January 1, 2014.
(v)Report, or contract with an independent entity to report, to the Legislature by December 1, 2018, on whether to adopt the option in Section 1312(c)(3) of the federal act to merge the individual and small employer markets. In its report, the board shall provide information, based on at least two years of data from the Exchange, on the potential impact on rates paid by individuals and by small employers in a merged individual and small employer market, as compared to the rates paid by individuals and small employers if a separate individual and small employer market is maintained. A report made pursuant to this subdivision shall be submitted pursuant to Section 9795.
(w)With respect to the SHOP Program, collect premiums and administer all other necessary and related tasks, including, but not limited to, enrollment and plan payment, in order to make the offering of employee plan choice as simple as possible for qualified small employers.
(x)Require carriers participating in the Exchange to immediately notify the Exchange, under the terms and conditions established by the board when an individual is or will be enrolled in or disenrolled from any qualified health plan offered by the carrier.
(y)Ensure that the Exchange provides oral interpretation services in any language for individuals seeking coverage through the Exchange and makes available a toll-free telephone number for the hearing and speech impaired. The board shall ensure that written information made available by the Exchange is presented in a plainly worded, easily understandable format and made available in prevalent languages.
(z)This section shall become inoperative on the October 1 that is five years after the date that federal approval of the bridge plan option occurs, and, as of the second January 1 thereafter, is repealed, unless a later enacted statute that is enacted before that date deletes or extends the dates on which it becomes inoperative and is repealed.
SEC. 2.Section 100503 of the Government Code, as amended by Section 2 of Chapter 572 of the Statutes of 2014, is amended to read:100503.In addition to meeting the minimum requirements of Section 1311 of the federal act, the board shall do all of the following:
(a)(1)Determine the criteria and process for eligibility, enrollment, and disenrollment of enrollees and potential enrollees in the Exchange and coordinate that process with the state and local government entities administering other health care coverage programs, including the State Department of Health Care Services, the Managed Risk Medical Insurance Board, and California counties, in order to ensure consistent eligibility and enrollment processes and seamless transitions between coverage.
(2)(A)The Exchange shall not disclose personal information obtained from an application for health care coverage to a certified insurance agent or certified enrollment counselor without the consent of the applicant.
(B)Nothing in this section shall preclude the Exchange from sharing the information of current enrollees or applicants with the same certified enrollment counselor or certified insurance agent of record that provided the applicant assistance with an existing application, or their successor or authorized staff, as otherwise permitted by federal and state laws and regulations.
(C)For purposes of this section, the term personal information has the same meaning as set forth in Section 1798.3 of the Civil Code.
(b)Develop processes to coordinate with the county entities that administer eligibility for the Medi-Cal program and the entity that determines eligibility for the Healthy Families Program, including, but not limited to, processes for case transfer, referral, and enrollment in the Exchange of individuals applying for assistance to those entities, if allowed or required by federal law.
(c)Determine the minimum requirements a carrier must meet to be considered for participation in the Exchange, and the standards and criteria for selecting qualified health plans to be offered through the Exchange that are in the best interests of qualified individuals and qualified small employers. The board shall consistently and uniformly apply these requirements, standards, and criteria to all carriers. In the course of selectively contracting for health care coverage offered to qualified individuals and qualified small employers through the Exchange, the board shall seek to contract with carriers so as to provide health care coverage choices that offer the optimal combination of choice, value, quality, and service.
(d)Provide, in each region of the state, a choice of qualified health plans at each of the five levels of coverage contained in subsections (d) and (e) of Section 1302 of the federal act, subject to subdivision (e) of this section, paragraph (2) of subdivision (d) of Section 1366.6 of the Health and Safety Code, and paragraph (2) of subdivision (d) of Section 10112.3 of the Insurance Code.
(e)Require, as a condition of participation in the Exchange, carriers to fairly and affirmatively offer, market, and sell in the Exchange at least one product within each of the five levels of coverage contained in subsections (d) and (e) of Section 1302 of the federal act and require, as a condition of participation in the SHOP Program, carriers to fairly and affirmatively offer, market, and sell in the SHOP Program at least one product within each of the four levels of coverage contained in subsection (d) of Section 1302 of the federal act. The board may require carriers to offer additional products within each of those levels of coverage. This subdivision shall not apply to a carrier that solely offers supplemental coverage in the Exchange under paragraph (10) of subdivision (a) of Section 100504.
(f)(1)Require, as a condition of participation in the Exchange, carriers that sell any products outside the Exchange to do both of the following:
(A)Fairly and affirmatively offer, market, and sell all products made available to individuals in the Exchange to individuals purchasing coverage outside the Exchange.
(B)Fairly and affirmatively offer, market, and sell all products made available to small employers in the Exchange to small employers purchasing coverage outside the Exchange.
(2)For purposes of this subdivision, product does not include contracts entered into pursuant to Part 6.2 (commencing with Section 12693) of Division 2 of the Insurance Code between the Managed Risk Medical Insurance Board and carriers for enrolled Healthy Families beneficiaries or contracts entered into pursuant to Chapter 7 (commencing with Section 14000) of, or Chapter 8 (commencing with Section 14200) of, Part 3 of Division 9 of the Welfare and Institutions Code between the State Department of Health Care Services and carriers for enrolled Medi-Cal beneficiaries.
(g)Determine when an enrollees coverage commences and the extent and scope of coverage.
(h)Provide for the processing of applications and the enrollment and disenrollment of enrollees.
(i)Determine and approve cost-sharing provisions for qualified health plans.
(j)Establish uniform billing and payment policies for qualified health plans offered in the Exchange to ensure consistent enrollment and disenrollment activities for individuals enrolled in the Exchange.
(k)Undertake activities necessary to market and publicize the availability of health care coverage and federal subsidies through the Exchange. The board shall also undertake outreach and enrollment activities that seek to assist enrollees and potential enrollees with enrolling and reenrolling in the Exchange in the least burdensome manner, including populations that may experience barriers to enrollment, such as the disabled and those with limited English language proficiency.
(l)Select and set performance standards and compensation for navigators selected under subdivision (l) of Section 100502.
(m)Employ necessary staff.
(1)The board shall hire a chief fiscal officer, a chief operations officer, a director for the SHOP Exchange, a director of health plan contracting, a chief technology and information officer, a general counsel, and other key executive positions, as determined by the board, who shall be exempt from civil service.
(2)(A)The board shall set the salaries for the exempt positions described in paragraph (1) and subdivision (i) of Section 100500 in amounts that are reasonably necessary to attract and retain individuals of superior qualifications. The salaries shall be published by the board in the boards annual budget. The boards annual budget shall be posted on the Internet Web site of the Exchange. To determine the compensation for these positions, the board shall cause to be conducted, through the use of independent outside advisors, salary surveys of both of the following:
(i)Other state and federal health insurance exchanges that are most comparable to the Exchange.
(ii)Other relevant labor pools.
(B)The salaries established by the board under subparagraph (A) shall not exceed the highest comparable salary for a position of that type, as determined by the surveys conducted pursuant to subparagraph (A).
(C)The Department of Human Resources shall review the methodology used in the surveys conducted pursuant to subparagraph (A).
(3)The positions described in paragraph (1) and subdivision (i) of Section 100500 shall not be subject to otherwise applicable provisions of the Government Code or the Public Contract Code and, for those purposes, the Exchange shall not be considered a state agency or public entity.
(n)Assess a charge on the qualified health plans offered by carriers that is reasonable and necessary to support the development, operations, and prudent cash management of the Exchange. This charge shall not affect the requirement under Section 1301 of the federal act that carriers charge the same premium rate for each qualified health plan whether offered inside or outside the Exchange.
(o)Authorize expenditures, as necessary, from the California Health Trust Fund to pay program expenses to administer the Exchange.
(p)Keep an accurate accounting of all activities, receipts, and expenditures, and annually submit to the United States Secretary of Health and Human Services a report concerning that accounting. Commencing January 1, 2016, the board shall conduct an annual audit.
(q)(1)Annually prepare a written report on the implementation and performance of the Exchange functions during the preceding fiscal year, including, at a minimum, the manner in which funds were expended and the progress toward, and the achievement of, the requirements of this title. This report shall be transmitted to the Legislature and the Governor and shall be made available to the public on the Internet Web site of the Exchange. A report made to the Legislature pursuant to this subdivision shall be submitted pursuant to Section 9795.
(2)In addition to the report described in paragraph (1), the board shall be responsive to requests for additional information from the Legislature, including providing testimony and commenting on proposed state legislation or policy issues. The Legislature finds and declares that activities including, but not limited to, responding to legislative or executive inquiries, tracking and commenting on legislation and regulatory activities, and preparing reports on the implementation of this title and the performance of the Exchange, are necessary state requirements and are distinct from the promotion of legislative or regulatory modifications referred to in subdivision (d) of Section 100520.
(r)Maintain enrollment and expenditures to ensure that expenditures do not exceed the amount of revenue in the fund, and if sufficient revenue is not available to pay estimated expenditures, institute appropriate measures to ensure fiscal solvency.
(s)Exercise all powers reasonably necessary to carry out and comply with the duties, responsibilities, and requirements of this act and the federal act.
(t)Consult with stakeholders relevant to carrying out the activities under this title, including, but not limited to, all of the following:
(1)Health care consumers who are enrolled in health plans.
(2)Individuals and entities with experience in facilitating enrollment in health plans.
(3)Representatives of small businesses and self-employed individuals.
(4)The Chief Deputy Director of Health Care Programs.
(5)Advocates for enrolling hard-to-reach populations.
(u)Facilitate the purchase of qualified health plans in the Exchange by qualified individuals and qualified small employers no later than January 1, 2014.
(v)Report, or contract with an independent entity to report, to the Legislature by December 1, 2018, on whether to adopt the option in Section 1312(c)(3) of the federal act to merge the individual and small employer markets. In its report, the board shall provide information, based on at least two years of data from the Exchange, on the potential impact on rates paid by individuals and by small employers in a merged individual and small employer market, as compared to the rates paid by individuals and small employers if a separate individual and small employer market is maintained. A report made pursuant to this subdivision shall be submitted pursuant to Section 9795.
(w)With respect to the SHOP Program, collect premiums and administer all other necessary and related tasks, including, but not limited to, enrollment and plan payment, in order to make the offering of employee plan choice as simple as possible for qualified small employers.
(x)Require carriers participating in the Exchange to immediately notify the Exchange, under the terms and conditions established by the board when an individual is or will be enrolled in or disenrolled from any qualified health plan offered by the carrier.
(y)Ensure that the Exchange provides oral interpretation services in any language for individuals seeking coverage through the Exchange and makes available a toll-free telephone number for the hearing and speech impaired. The board shall ensure that written information made available by the Exchange is presented in a plainly worded, easily understandable format and made available in prevalent languages.
(z)This section shall become operative only if Section 4 of the act that added this section becomes inoperative pursuant to subdivision (z) of that Section 4.
SEC. 3.Sections 1 and 2 of this bill shall become operative on October 1, 2016.
SEC. 4.This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the Constitution and shall go into immediate effect. The facts constituting the necessity are:
Protecting Californians privacy rights is of the utmost importance, and in order to protect the privacy rights of individuals applying for health care coverage through the California Health Benefit Exchange at the earliest possible time, it is necessary that this act take effect immediately.
In addition to meeting the minimum requirements of Section 1311 of the federal act, the board shall do all of the following:
(a)(1)Determine the criteria and process for eligibility, enrollment, and disenrollment of enrollees and potential enrollees in the Exchange and coordinate that process with the state and local government entities administering other health care coverage programs, including the State Department of Health Care Services, the Managed Risk Medical Insurance Board, and California counties, in order to ensure consistent eligibility and enrollment processes and seamless transitions between coverage.
(2)(A)The Exchange shall not disclose personal information obtained from an application for health care coverage to a certified insurance agent or certified enrollment counselor without the consent of the applicant.
(B)Nothing in this section shall preclude the Exchange from sharing the information of current enrollees or applicants with the same certified enrollment counselor or certified insurance agent of record that provided the applicant assistance with an existing application, or their successor or authorized staff, as otherwise permitted by federal and state laws and regulations.
(C)For purposes of this section, the term personal information has the same meaning as set forth in Section 1798.3 of the Civil Code.
(b)Develop processes to coordinate with the county entities that administer eligibility for the Medi-Cal program and the entity that determines eligibility for the Healthy Families Program, including, but not limited to, processes for case transfer, referral, and enrollment in the Exchange of individuals applying for assistance to those entities, if allowed or required by federal law.
(c)Determine the minimum requirements a carrier must meet to be considered for participation in the Exchange, and the standards and criteria for selecting qualified health plans to be offered through the Exchange that are in the best interests of qualified individuals and qualified small employers. The board shall consistently and uniformly apply these requirements, standards, and criteria to all carriers. In the course of selectively contracting for health care coverage offered to qualified individuals and qualified small employers through the Exchange, the board shall seek to contract with carriers so as to provide health care coverage choices that offer the optimal combination of choice, value, quality, and service.
(d)Provide, in each region of the state, a choice of qualified health plans at each of the five levels of coverage contained in subsections (d) and (e) of Section 1302 of the federal act, subject to subdivision (e) of this section, paragraph (2) of subdivision (d) of Section 1366.6 of the Health and Safety Code, and paragraph (2) of subdivision (d) of Section 10112.3 of the Insurance Code.
(e)Require, as a condition of participation in the individual market of the Exchange, carriers to fairly and affirmatively offer, market, and sell in the individual market of the Exchange at least one product within each of the five levels of coverage contained in subsections (d) and (e) of Section 1302 of the federal act and require, as a condition of participation in the SHOP Program, carriers to fairly and affirmatively offer, market, and sell in the SHOP Program at least one product within each of the four levels of coverage contained in subsection (d) of Section 1302 of the federal act. The board may require carriers to offer additional products within each of those levels of coverage. This subdivision shall not apply to a carrier that solely offers supplemental coverage in the Exchange under paragraph (10) of subdivision (a) of Section 100504.
(f)(1)Except as otherwise provided in this section and Section 100504.5, require, as a condition of participation in the Exchange, carriers that sell any products outside the Exchange to do both of the following:
(A)Fairly and affirmatively offer, market, and sell all products made available to individuals in the Exchange to individuals purchasing coverage outside the Exchange.
(B)Fairly and affirmatively offer, market, and sell all products made available to small employers in the Exchange to small employers purchasing coverage outside the Exchange.
(2)For purposes of this subdivision, product does not include contracts entered into pursuant to Part 6.2 (commencing with Section 12693) of Division 2 of the Insurance Code between the Managed Risk Medical Insurance Board and carriers for enrolled Healthy Families beneficiaries or contracts entered into pursuant to Chapter 7 (commencing with Section 14000) of, or Chapter 8 (commencing with Section 14200) of, Part 3 of Division 9 of the Welfare and Institutions Code between the State Department of Health Care Services and carriers for enrolled Medi-Cal beneficiaries. Product also does not include a bridge plan product offered pursuant to Section 100504.5.
(3)Except as required by Section 1301(a)(1)(C)(ii) of the federal act, a carrier offering a bridge plan product in the Exchange may limit the products it offers in the Exchange solely to a bridge plan product contract.
(g)Determine when an enrollees coverage commences and the extent and scope of coverage.
(h)Provide for the processing of applications and the enrollment and disenrollment of enrollees.
(i)Determine and approve cost-sharing provisions for qualified health plans.
(j)Establish uniform billing and payment policies for qualified health plans offered in the Exchange to ensure consistent enrollment and disenrollment activities for individuals enrolled in the Exchange.
(k)Undertake activities necessary to market and publicize the availability of health care coverage and federal subsidies through the Exchange. The board shall also undertake outreach and enrollment activities that seek to assist enrollees and potential enrollees with enrolling and reenrolling in the Exchange in the least burdensome manner, including populations that may experience barriers to enrollment, such as the disabled and those with limited English language proficiency.
(l)Select and set performance standards and compensation for navigators selected under subdivision (l) of Section 100502.
(m)Employ necessary staff.
(1)The board shall hire a chief fiscal officer, a chief operations officer, a director for the SHOP Exchange, a director of health plan contracting, a chief technology and information officer, a general counsel, and other key executive positions, as determined by the board, who shall be exempt from civil service.
(2)(A)The board shall set the salaries for the exempt positions described in paragraph (1) and subdivision (i) of Section 100500 in amounts that are reasonably necessary to attract and retain individuals of superior qualifications. The salaries shall be published by the board in the boards annual budget. The boards annual budget shall be posted on the Internet Web site of the Exchange. To determine the compensation for these positions, the board shall cause to be conducted, through the use of independent outside advisors, salary surveys of both of the following:
(i)Other state and federal health insurance exchanges that are most comparable to the Exchange.
(ii)Other relevant labor pools.
(B)The salaries established by the board under subparagraph (A) shall not exceed the highest comparable salary for a position of that type, as determined by the surveys conducted pursuant to subparagraph (A).
(C)The Department of Human Resources shall review the methodology used in the surveys conducted pursuant to subparagraph (A).
(3)The positions described in paragraph (1) and subdivision (i) of Section 100500 shall not be subject to otherwise applicable provisions of the Government Code or the Public Contract Code and, for those purposes, the Exchange shall not be considered a state agency or public entity.
(n)Assess a charge on the qualified health plans offered by carriers that is reasonable and necessary to support the development, operations, and prudent cash management of the Exchange. This charge shall not affect the requirement under Section 1301 of the federal act that carriers charge the same premium rate for each qualified health plan whether offered inside or outside the Exchange.
(o)Authorize expenditures, as necessary, from the California Health Trust Fund to pay program expenses to administer the Exchange.
(p)Keep an accurate accounting of all activities, receipts, and expenditures, and annually submit to the United States Secretary of Health and Human Services a report concerning that accounting. Commencing January 1, 2016, the board shall conduct an annual audit.
(q)(1)Annually prepare a written report on the implementation and performance of the Exchange functions during the preceding fiscal year, including, at a minimum, the manner in which funds were expended and the progress toward, and the achievement of, the requirements of this title. The report shall also include data provided by health care service plans and health insurers offering bridge plan products regarding the extent of health care provider and health facility overlap in their Medi-Cal networks as compared to the health care provider and health facility networks contracting with the plan or insurer in their bridge plan contracts. This report shall be transmitted to the Legislature and the Governor and shall be made available to the public on the Internet Web site of the Exchange. A report made to the Legislature pursuant to this subdivision shall be submitted pursuant to Section 9795.
(2)The Exchange shall prepare, or contract for the preparation of, an evaluation of the bridge plan program using the first three years of experience with the program. The evaluation shall be provided to the health policy and fiscal committees of the Legislature in the fourth year following federal approval of the bridge plan option. The evaluation shall include, but not be limited to, all of the following:
(A)The number of individuals eligible to participate in the bridge plan program each year by category of eligibility.
(B)The number of eligible individuals who elect a bridge plan option each year by category of eligibility.
(C)The average length of time, by region and statewide, that individuals remain in the bridge plan option each year by category of eligibility.
(D)The regions of the state with a bridge plan option, and the carriers in each region that offer a bridge plan, by year.
(E)The premium difference each year, by region, between the bridge plan and the first and second lowest cost plan for individuals in the Exchange who are not eligible for the bridge plan.
(F)The effect of the bridge plan on the premium subsidy amount for bridge plan eligible individuals each year by each region.
(G)Based on a survey of individuals enrolled in the bridge plan:
(i)Whether individuals enrolling in the bridge plan product are able to keep their existing health care providers.
(ii)Whether individuals would want to retain their bridge plan product, buy a different Exchange product, or decline to purchase health insurance if there was no bridge plan product available. The Exchange may include questions designed to elicit the information in this subparagraph as part of an existing survey of individuals receiving coverage in the Exchange.
(3)In addition to the evaluation required by paragraph (2), the Exchange shall post the items in subparagraphs (A) to (F), inclusive, on its Internet Web site each year.
(4)In addition to the report described in paragraph (1), the board shall be responsive to requests for additional information from the Legislature, including providing testimony and commenting on proposed state legislation or policy issues. The Legislature finds and declares that activities including, but not limited to, responding to legislative or executive inquiries, tracking and commenting on legislation and regulatory activities, and preparing reports on the implementation of this title and the performance of the Exchange, are necessary state requirements and are distinct from the promotion of legislative or regulatory modifications referred to in subdivision (d) of Section 100520.
(r)Maintain enrollment and expenditures to ensure that expenditures do not exceed the amount of revenue in the fund, and if sufficient revenue is not available to pay estimated expenditures, institute appropriate measures to ensure fiscal solvency.
(s)Exercise all powers reasonably necessary to carry out and comply with the duties, responsibilities, and requirements of this act and the federal act.
(t)Consult with stakeholders relevant to carrying out the activities under this title, including, but not limited to, all of the following:
(1)Health care consumers who are enrolled in health plans.
(2)Individuals and entities with experience in facilitating enrollment in health plans.
(3)Representatives of small businesses and self-employed individuals.
(4)The Chief Deputy Director of Health Care Programs.
(5)Advocates for enrolling hard-to-reach populations.
(u)Facilitate the purchase of qualified health plans in the Exchange by qualified individuals and qualified small employers no later than January 1, 2014.
(v)Report, or contract with an independent entity to report, to the Legislature by December 1, 2018, on whether to adopt the option in Section 1312(c)(3) of the federal act to merge the individual and small employer markets. In its report, the board shall provide information, based on at least two years of data from the Exchange, on the potential impact on rates paid by individuals and by small employers in a merged individual and small employer market, as compared to the rates paid by individuals and small employers if a separate individual and small employer market is maintained. A report made pursuant to this subdivision shall be submitted pursuant to Section 9795.
(w)With respect to the SHOP Program, collect premiums and administer all other necessary and related tasks, including, but not limited to, enrollment and plan payment, in order to make the offering of employee plan choice as simple as possible for qualified small employers.
(x)Require carriers participating in the Exchange to immediately notify the Exchange, under the terms and conditions established by the board when an individual is or will be enrolled in or disenrolled from any qualified health plan offered by the carrier.
(y)Ensure that the Exchange provides oral interpretation services in any language for individuals seeking coverage through the Exchange and makes available a toll-free telephone number for the hearing and speech impaired. The board shall ensure that written information made available by the Exchange is presented in a plainly worded, easily understandable format and made available in prevalent languages.
(z)This section shall become inoperative on the October 1 that is five years after the date that federal approval of the bridge plan option occurs, and, as of the second January 1 thereafter, is repealed, unless a later enacted statute that is enacted before that date deletes or extends the dates on which it becomes inoperative and is repealed.
SEC. 2.Section 100503 of the Government Code, as amended by Section 2 of Chapter 572 of the Statutes of 2014, is amended to read:100503.In addition to meeting the minimum requirements of Section 1311 of the federal act, the board shall do all of the following:
(a)(1)Determine the criteria and process for eligibility, enrollment, and disenrollment of enrollees and potential enrollees in the Exchange and coordinate that process with the state and local government entities administering other health care coverage programs, including the State Department of Health Care Services, the Managed Risk Medical Insurance Board, and California counties, in order to ensure consistent eligibility and enrollment processes and seamless transitions between coverage.
(2)(A)The Exchange shall not disclose personal information obtained from an application for health care coverage to a certified insurance agent or certified enrollment counselor without the consent of the applicant.
(B)Nothing in this section shall preclude the Exchange from sharing the information of current enrollees or applicants with the same certified enrollment counselor or certified insurance agent of record that provided the applicant assistance with an existing application, or their successor or authorized staff, as otherwise permitted by federal and state laws and regulations.
(C)For purposes of this section, the term personal information has the same meaning as set forth in Section 1798.3 of the Civil Code.
(b)Develop processes to coordinate with the county entities that administer eligibility for the Medi-Cal program and the entity that determines eligibility for the Healthy Families Program, including, but not limited to, processes for case transfer, referral, and enrollment in the Exchange of individuals applying for assistance to those entities, if allowed or required by federal law.
(c)Determine the minimum requirements a carrier must meet to be considered for participation in the Exchange, and the standards and criteria for selecting qualified health plans to be offered through the Exchange that are in the best interests of qualified individuals and qualified small employers. The board shall consistently and uniformly apply these requirements, standards, and criteria to all carriers. In the course of selectively contracting for health care coverage offered to qualified individuals and qualified small employers through the Exchange, the board shall seek to contract with carriers so as to provide health care coverage choices that offer the optimal combination of choice, value, quality, and service.
(d)Provide, in each region of the state, a choice of qualified health plans at each of the five levels of coverage contained in subsections (d) and (e) of Section 1302 of the federal act, subject to subdivision (e) of this section, paragraph (2) of subdivision (d) of Section 1366.6 of the Health and Safety Code, and paragraph (2) of subdivision (d) of Section 10112.3 of the Insurance Code.
(e)Require, as a condition of participation in the Exchange, carriers to fairly and affirmatively offer, market, and sell in the Exchange at least one product within each of the five levels of coverage contained in subsections (d) and (e) of Section 1302 of the federal act and require, as a condition of participation in the SHOP Program, carriers to fairly and affirmatively offer, market, and sell in the SHOP Program at least one product within each of the four levels of coverage contained in subsection (d) of Section 1302 of the federal act. The board may require carriers to offer additional products within each of those levels of coverage. This subdivision shall not apply to a carrier that solely offers supplemental coverage in the Exchange under paragraph (10) of subdivision (a) of Section 100504.
(f)(1)Require, as a condition of participation in the Exchange, carriers that sell any products outside the Exchange to do both of the following:
(A)Fairly and affirmatively offer, market, and sell all products made available to individuals in the Exchange to individuals purchasing coverage outside the Exchange.
(B)Fairly and affirmatively offer, market, and sell all products made available to small employers in the Exchange to small employers purchasing coverage outside the Exchange.
(2)For purposes of this subdivision, product does not include contracts entered into pursuant to Part 6.2 (commencing with Section 12693) of Division 2 of the Insurance Code between the Managed Risk Medical Insurance Board and carriers for enrolled Healthy Families beneficiaries or contracts entered into pursuant to Chapter 7 (commencing with Section 14000) of, or Chapter 8 (commencing with Section 14200) of, Part 3 of Division 9 of the Welfare and Institutions Code between the State Department of Health Care Services and carriers for enrolled Medi-Cal beneficiaries.
(g)Determine when an enrollees coverage commences and the extent and scope of coverage.
(h)Provide for the processing of applications and the enrollment and disenrollment of enrollees.
(i)Determine and approve cost-sharing provisions for qualified health plans.
(j)Establish uniform billing and payment policies for qualified health plans offered in the Exchange to ensure consistent enrollment and disenrollment activities for individuals enrolled in the Exchange.
(k)Undertake activities necessary to market and publicize the availability of health care coverage and federal subsidies through the Exchange. The board shall also undertake outreach and enrollment activities that seek to assist enrollees and potential enrollees with enrolling and reenrolling in the Exchange in the least burdensome manner, including populations that may experience barriers to enrollment, such as the disabled and those with limited English language proficiency.
(l)Select and set performance standards and compensation for navigators selected under subdivision (l) of Section 100502.
(m)Employ necessary staff.
(1)The board shall hire a chief fiscal officer, a chief operations officer, a director for the SHOP Exchange, a director of health plan contracting, a chief technology and information officer, a general counsel, and other key executive positions, as determined by the board, who shall be exempt from civil service.
(2)(A)The board shall set the salaries for the exempt positions described in paragraph (1) and subdivision (i) of Section 100500 in amounts that are reasonably necessary to attract and retain individuals of superior qualifications. The salaries shall be published by the board in the boards annual budget. The boards annual budget shall be posted on the Internet Web site of the Exchange. To determine the compensation for these positions, the board shall cause to be conducted, through the use of independent outside advisors, salary surveys of both of the following:
(i)Other state and federal health insurance exchanges that are most comparable to the Exchange.
(ii)Other relevant labor pools.
(B)The salaries established by the board under subparagraph (A) shall not exceed the highest comparable salary for a position of that type, as determined by the surveys conducted pursuant to subparagraph (A).
(C)The Department of Human Resources shall review the methodology used in the surveys conducted pursuant to subparagraph (A).
(3)The positions described in paragraph (1) and subdivision (i) of Section 100500 shall not be subject to otherwise applicable provisions of the Government Code or the Public Contract Code and, for those purposes, the Exchange shall not be considered a state agency or public entity.
(n)Assess a charge on the qualified health plans offered by carriers that is reasonable and necessary to support the development, operations, and prudent cash management of the Exchange. This charge shall not affect the requirement under Section 1301 of the federal act that carriers charge the same premium rate for each qualified health plan whether offered inside or outside the Exchange.
(o)Authorize expenditures, as necessary, from the California Health Trust Fund to pay program expenses to administer the Exchange.
(p)Keep an accurate accounting of all activities, receipts, and expenditures, and annually submit to the United States Secretary of Health and Human Services a report concerning that accounting. Commencing January 1, 2016, the board shall conduct an annual audit.
(q)(1)Annually prepare a written report on the implementation and performance of the Exchange functions during the preceding fiscal year, including, at a minimum, the manner in which funds were expended and the progress toward, and the achievement of, the requirements of this title. This report shall be transmitted to the Legislature and the Governor and shall be made available to the public on the Internet Web site of the Exchange. A report made to the Legislature pursuant to this subdivision shall be submitted pursuant to Section 9795.
(2)In addition to the report described in paragraph (1), the board shall be responsive to requests for additional information from the Legislature, including providing testimony and commenting on proposed state legislation or policy issues. The Legislature finds and declares that activities including, but not limited to, responding to legislative or executive inquiries, tracking and commenting on legislation and regulatory activities, and preparing reports on the implementation of this title and the performance of the Exchange, are necessary state requirements and are distinct from the promotion of legislative or regulatory modifications referred to in subdivision (d) of Section 100520.
(r)Maintain enrollment and expenditures to ensure that expenditures do not exceed the amount of revenue in the fund, and if sufficient revenue is not available to pay estimated expenditures, institute appropriate measures to ensure fiscal solvency.
(s)Exercise all powers reasonably necessary to carry out and comply with the duties, responsibilities, and requirements of this act and the federal act.
(t)Consult with stakeholders relevant to carrying out the activities under this title, including, but not limited to, all of the following:
(1)Health care consumers who are enrolled in health plans.
(2)Individuals and entities with experience in facilitating enrollment in health plans.
(3)Representatives of small businesses and self-employed individuals.
(4)The Chief Deputy Director of Health Care Programs.
(5)Advocates for enrolling hard-to-reach populations.
(u)Facilitate the purchase of qualified health plans in the Exchange by qualified individuals and qualified small employers no later than January 1, 2014.
(v)Report, or contract with an independent entity to report, to the Legislature by December 1, 2018, on whether to adopt the option in Section 1312(c)(3) of the federal act to merge the individual and small employer markets. In its report, the board shall provide information, based on at least two years of data from the Exchange, on the potential impact on rates paid by individuals and by small employers in a merged individual and small employer market, as compared to the rates paid by individuals and small employers if a separate individual and small employer market is maintained. A report made pursuant to this subdivision shall be submitted pursuant to Section 9795.
(w)With respect to the SHOP Program, collect premiums and administer all other necessary and related tasks, including, but not limited to, enrollment and plan payment, in order to make the offering of employee plan choice as simple as possible for qualified small employers.
(x)Require carriers participating in the Exchange to immediately notify the Exchange, under the terms and conditions established by the board when an individual is or will be enrolled in or disenrolled from any qualified health plan offered by the carrier.
(y)Ensure that the Exchange provides oral interpretation services in any language for individuals seeking coverage through the Exchange and makes available a toll-free telephone number for the hearing and speech impaired. The board shall ensure that written information made available by the Exchange is presented in a plainly worded, easily understandable format and made available in prevalent languages.
(z)This section shall become operative only if Section 4 of the act that added this section becomes inoperative pursuant to subdivision (z) of that Section 4.
SEC. 3.Sections 1 and 2 of this bill shall become operative on October 1, 2016.
SEC. 4.This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the Constitution and shall go into immediate effect. The facts constituting the necessity are:
Protecting Californians privacy rights is of the utmost importance, and in order to protect the privacy rights of individuals applying for health care coverage through the California Health Benefit Exchange at the earliest possible time, it is necessary that this act take effect immediately.
In addition to meeting the minimum requirements of Section 1311 of the federal act, the board shall do all of the following:
(a)(1)Determine the criteria and process for eligibility, enrollment, and disenrollment of enrollees and potential enrollees in the Exchange and coordinate that process with the state and local government entities administering other health care coverage programs, including the State Department of Health Care Services, the Managed Risk Medical Insurance Board, and California counties, in order to ensure consistent eligibility and enrollment processes and seamless transitions between coverage.
(2)(A)No later than September 30, 2016, allow an applicant to indicate whether or not the applicant would like assistance with completing the application from an Exchange certified insurance agent or certified enrollment counselor.
(B)Until the Exchange has complied with subparagraph (A), the Exchange shall not disclose any personal information, as defined in Section 1798.3 of the Civil Code, that was obtained from the application for health care coverage to a certified insurance agent or certified enrollment counselor.
(C)The Exchange shall not disclose personal information, as defined in Section 1798.3 of the Civil Code, that was obtained from the application for health care coverage to a certified insurance agent or certified enrollment counselor if the applicant indicates that the applicant does not want assistance from an Exchange certified insurance agent or certified enrollment counselor.
(2)(A)The Exchange shall not disclose personal information obtained from an application for health care coverage to a certified insurance agent or certified enrollment counselor without the consent of the applicant.
(D)
(B)Nothing in this section shall preclude the Exchange from sharing the information of current enrollees or applicants with the same certified enrollment counselor or certified insurance agent of record that provided the applicant assistance with an existing application, or their successor or authorized staff, as otherwise permitted by federal and state laws and regulations.
(C)For purposes of this section, the term personal information has the same meaning as set forth in Section 1798.3 of the Civil Code.
(b)Develop processes to coordinate with the county entities that administer eligibility for the Medi-Cal program and the entity that determines eligibility for the Healthy Families Program, including, but not limited to, processes for case transfer, referral, and enrollment in the Exchange of individuals applying for assistance to those entities, if allowed or required by federal law.
(c)Determine the minimum requirements a carrier must meet to be considered for participation in the Exchange, and the standards and criteria for selecting qualified health plans to be offered through the Exchange that are in the best interests of qualified individuals and qualified small employers. The board shall consistently and uniformly apply these requirements, standards, and criteria to all carriers. In the course of selectively contracting for health care coverage offered to qualified individuals and qualified small employers through the Exchange, the board shall seek to contract with carriers so as to provide health care coverage choices that offer the optimal combination of choice, value, quality, and service.
(d)Provide, in each region of the state, a choice of qualified health plans at each of the five levels of coverage contained in subsections (d) and (e) of Section 1302 of the federal act, subject to subdivision (e) of this section, paragraph (2) of subdivision (d) of Section 1366.6 of the Health and Safety Code, and paragraph (2) of subdivision (d) of Section 10112.3 of the Insurance Code.
(e)Require, as a condition of participation in the individual market of the Exchange, carriers to fairly and affirmatively offer, market, and sell in the individual market of the Exchange at least one product within each of the five levels of coverage contained in subsections (d) and (e) of Section 1302 of the federal act and require, as a condition of participation in the SHOP Program, carriers to fairly and affirmatively offer, market, and sell in the SHOP Program at least one product within each of the four levels of coverage contained in subsection (d) of Section 1302 of the federal act. The board may require carriers to offer additional products within each of those levels of coverage. This subdivision shall not apply to a carrier that solely offers supplemental coverage in the Exchange under paragraph (10) of subdivision (a) of Section 100504.
(f)(1)Except as otherwise provided in this section and Section 100504.5, require, as a condition of participation in the Exchange, carriers that sell any products outside the Exchange to do both of the following:
(A)Fairly and affirmatively offer, market, and sell all products made available to individuals in the Exchange to individuals purchasing coverage outside the Exchange.
(B)Fairly and affirmatively offer, market, and sell all products made available to small employers in the Exchange to small employers purchasing coverage outside the Exchange.
(2)For purposes of this subdivision, product does not include contracts entered into pursuant to Part 6.2 (commencing with Section 12693) of Division 2 of the Insurance Code between the Managed Risk Medical Insurance Board and carriers for enrolled Healthy Families beneficiaries or contracts entered into pursuant to Chapter 7 (commencing with Section 14000) of, or Chapter 8 (commencing with Section 14200) of, Part 3 of Division 9 of the Welfare and Institutions Code between the State Department of Health Care Services and carriers for enrolled Medi-Cal beneficiaries. Product also does not include a bridge plan product offered pursuant to Section 100504.5.
(3)Except as required by Section 1301(a)(1)(C)(ii) of the federal act, a carrier offering a bridge plan product in the Exchange may limit the products it offers in the Exchange solely to a bridge plan product contract.
(g)Determine when an enrollees coverage commences and the extent and scope of coverage.
(h)Provide for the processing of applications and the enrollment and disenrollment of enrollees.
(i)Determine and approve cost-sharing provisions for qualified health plans.
(j)Establish uniform billing and payment policies for qualified health plans offered in the Exchange to ensure consistent enrollment and disenrollment activities for individuals enrolled in the Exchange.
(k)Undertake activities necessary to market and publicize the availability of health care coverage and federal subsidies through the Exchange. The board shall also undertake outreach and enrollment activities that seek to assist enrollees and potential enrollees with enrolling and reenrolling in the Exchange in the least burdensome manner, including populations that may experience barriers to enrollment, such as the disabled and those with limited English language proficiency.
(l)Select and set performance standards and compensation for navigators selected under subdivision (l) of Section 100502.
(m)Employ necessary staff.
(1)The board shall hire a chief fiscal officer, a chief operations officer, a director for the SHOP Exchange, a director of health plan contracting, a chief technology and information officer, a general counsel, and other key executive positions, as determined by the board, who shall be exempt from civil service.
(2)(A)The board shall set the salaries for the exempt positions described in paragraph (1) and subdivision (i) of Section 100500 in amounts that are reasonably necessary to attract and retain individuals of superior qualifications. The salaries shall be published by the board in the boards annual budget. The boards annual budget shall be posted on the Internet Web site of the Exchange. To determine the compensation for these positions, the board shall cause to be conducted, through the use of independent outside advisors, salary surveys of both of the following:
(i)Other state and federal health insurance exchanges that are most comparable to the Exchange.
(ii)Other relevant labor pools.
(B)The salaries established by the board under subparagraph (A) shall not exceed the highest comparable salary for a position of that type, as determined by the surveys conducted pursuant to subparagraph (A).
(C)The Department of Human Resources shall review the methodology used in the surveys conducted pursuant to subparagraph (A).
(3)The positions described in paragraph (1) and subdivision (i) of Section 100500 shall not be subject to otherwise applicable provisions of the Government Code or the Public Contract Code and, for those purposes, the Exchange shall not be considered a state agency or public entity.
(n)Assess a charge on the qualified health plans offered by carriers that is reasonable and necessary to support the development, operations, and prudent cash management of the Exchange. This charge shall not affect the requirement under Section 1301 of the federal act that carriers charge the same premium rate for each qualified health plan whether offered inside or outside the Exchange.
(o)Authorize expenditures, as necessary, from the California Health Trust Fund to pay program expenses to administer the Exchange.
(p)Keep an accurate accounting of all activities, receipts, and expenditures, and annually submit to the United States Secretary of Health and Human Services a report concerning that accounting. Commencing January 1, 2016, the board shall conduct an annual audit.
(q)(1)Annually prepare a written report on the implementation and performance of the Exchange functions during the preceding fiscal year, including, at a minimum, the manner in which funds were expended and the progress toward, and the achievement of, the requirements of this title. The report shall also include data provided by health care service plans and health insurers offering bridge plan products regarding the extent of health care provider and health facility overlap in their Medi-Cal networks as compared to the health care provider and health facility networks contracting with the plan or insurer in their bridge plan contracts. This report shall be transmitted to the Legislature and the Governor and shall be made available to the public on the Internet Web site of the Exchange. A report made to the Legislature pursuant to this subdivision shall be submitted pursuant to Section 9795.
(2)The Exchange shall prepare, or contract for the preparation of, an evaluation of the bridge plan program using the first three years of experience with the program. The evaluation shall be provided to the health policy and fiscal committees of the Legislature in the fourth year following federal approval of the bridge plan option. The evaluation shall include, but not be limited to, all of the following:
(A)The number of individuals eligible to participate in the bridge plan program each year by category of eligibility.
(B)The number of eligible individuals who elect a bridge plan option each year by category of eligibility.
(C)The average length of time, by region and statewide, that individuals remain in the bridge plan option each year by category of eligibility.
(D)The regions of the state with a bridge plan option, and the carriers in each region that offer a bridge plan, by year.
(E)The premium difference each year, by region, between the bridge plan and the first and second lowest cost plan for individuals in the Exchange who are not eligible for the bridge plan.
(F)The effect of the bridge plan on the premium subsidy amount for bridge plan eligible individuals each year by each region.
(G)Based on a survey of individuals enrolled in the bridge plan:
(i)Whether individuals enrolling in the bridge plan product are able to keep their existing health care providers.
(ii)Whether individuals would want to retain their bridge plan product, buy a different Exchange product, or decline to purchase health insurance if there was no bridge plan product available. The Exchange may include questions designed to elicit the information in this subparagraph as part of an existing survey of individuals receiving coverage in the Exchange.
(3)In addition to the evaluation required by paragraph (2), the Exchange shall post the items in subparagraphs (A) to (F), inclusive, on its Internet Web site each year.
(4)In addition to the report described in paragraph (1), the board shall be responsive to requests for additional information from the Legislature, including providing testimony and commenting on proposed state legislation or policy issues. The Legislature finds and declares that activities including, but not limited to, responding to legislative or executive inquiries, tracking and commenting on legislation and regulatory activities, and preparing reports on the implementation of this title and the performance of the Exchange, are necessary state requirements and are distinct from the promotion of legislative or regulatory modifications referred to in subdivision (d) of Section 100520.
(r)Maintain enrollment and expenditures to ensure that expenditures do not exceed the amount of revenue in the fund, and if sufficient revenue is not available to pay estimated expenditures, institute appropriate measures to ensure fiscal solvency.
(s)Exercise all powers reasonably necessary to carry out and comply with the duties, responsibilities, and requirements of this act and the federal act.
(t)Consult with stakeholders relevant to carrying out the activities under this title, including, but not limited to, all of the following:
(1)Health care consumers who are enrolled in health plans.
(2)Individuals and entities with experience in facilitating enrollment in health plans.
(3)Representatives of small businesses and self-employed individuals.
(4)The Chief Deputy Director of Health Care Programs.
(5)Advocates for enrolling hard-to-reach populations.
(u)Facilitate the purchase of qualified health plans in the Exchange by qualified individuals and qualified small employers no later than January 1, 2014.
(v)Report, or contract with an independent entity to report, to the Legislature by December 1, 2018, on whether to adopt the option in Section 1312(c)(3) of the federal act to merge the individual and small employer markets. In its report, the board shall provide information, based on at least two years of data from the Exchange, on the potential impact on rates paid by individuals and by small employers in a merged individual and small employer market, as compared to the rates paid by individuals and small employers if a separate individual and small employer market is maintained. A report made pursuant to this subdivision shall be submitted pursuant to Section 9795.
(w)With respect to the SHOP Program, collect premiums and administer all other necessary and related tasks, including, but not limited to, enrollment and plan payment, in order to make the offering of employee plan choice as simple as possible for qualified small employers.
(x)Require carriers participating in the Exchange to immediately notify the Exchange, under the terms and conditions established by the board when an individual is or will be enrolled in or disenrolled from any qualified health plan offered by the carrier.
(y)Ensure that the Exchange provides oral interpretation services in any language for individuals seeking coverage through the Exchange and makes available a toll-free telephone number for the hearing and speech impaired. The board shall ensure that written information made available by the Exchange is presented in a plainly worded, easily understandable format and made available in prevalent languages.
(z)This section shall become inoperative on the October 1 that is five years after the date that federal approval of the bridge plan option occurs, and, as of the second January 1 thereafter, is repealed, unless a later enacted statute that is enacted before that date deletes or extends the dates on which it becomes inoperative and is repealed.
SEC. 2.Section 100503 of the Government Code, as amended by Section 2 of Chapter 572 of the Statutes of 2014, is amended to read:100503.In addition to meeting the minimum requirements of Section 1311 of the federal act, the board shall do all of the following:
(a)(1)Determine the criteria and process for eligibility, enrollment, and disenrollment of enrollees and potential enrollees in the Exchange and coordinate that process with the state and local government entities administering other health care coverage programs, including the State Department of Health Care Services, the Managed Risk Medical Insurance Board, and California counties, in order to ensure consistent eligibility and enrollment processes and seamless transitions between coverage.
(2)(A)No later than September 30, 2016, allow an applicant to indicate whether or not the applicant would like assistance with completing that application from an Exchange certified insurance agent or certified enrollment counselor.
(B)Until the Exchange has complied with subparagraph (A), the Exchange shall not disclose any personal information, as defined in Section 1798.3 of the Civil Code, that was obtained from the application for health care coverage to a certified insurance agent or certified enrollment counselor.
(C)The Exchange shall not disclose personal information, as defined in Section 1798.3 of the Civil Code, that was obtained from the application for health care coverage to a certified insurance agent or certified enrollment counselor if the applicant indicates that the applicant does not want assistance from an Exchange certified insurance agent or certified enrollment counselor.
(2)(A)The Exchange shall not disclose personal information obtained from an application for health care coverage to a certified insurance agent or certified enrollment counselor without the consent of the applicant.
(D)
(B)Nothing in this section shall preclude the Exchange from sharing the information of current enrollees or applicants with the same certified enrollment counselor or certified insurance agent of record that provided the applicant assistance with an existing application, or their successor or authorized staff, as otherwise permitted by federal and state laws and regulations.
(C)For purposes of this section, the term personal information has the same meaning as set forth in Section 1798.3 of the Civil Code.
(b)Develop processes to coordinate with the county entities that administer eligibility for the Medi-Cal program and the entity that determines eligibility for the Healthy Families Program, including, but not limited to, processes for case transfer, referral, and enrollment in the Exchange of individuals applying for assistance to those entities, if allowed or required by federal law.
(c)Determine the minimum requirements a carrier must meet to be considered for participation in the Exchange, and the standards and criteria for selecting qualified health plans to be offered through the Exchange that are in the best interests of qualified individuals and qualified small employers. The board shall consistently and uniformly apply these requirements, standards, and criteria to all carriers. In the course of selectively contracting for health care coverage offered to qualified individuals and qualified small employers through the Exchange, the board shall seek to contract with carriers so as to provide health care coverage choices that offer the optimal combination of choice, value, quality, and service.
(d)Provide, in each region of the state, a choice of qualified health plans at each of the five levels of coverage contained in subsections (d) and (e) of Section 1302 of the federal act, subject to subdivision (e) of this section, paragraph (2) of subdivision (d) of Section 1366.6 of the Health and Safety Code, and paragraph (2) of subdivision (d) of Section 10112.3 of the Insurance Code.
(e)Require, as a condition of participation in the Exchange, carriers to fairly and affirmatively offer, market, and sell in the Exchange at least one product within each of the five levels of coverage contained in subsections (d) and (e) of Section 1302 of the federal act and require, as a condition of participation in the SHOP Program, carriers to fairly and affirmatively offer, market, and sell in the SHOP Program at least one product within each of the four levels of coverage contained in subsection (d) of Section 1302 of the federal act. The board may require carriers to offer additional products within each of those levels of coverage. This subdivision shall not apply to a carrier that solely offers supplemental coverage in the Exchange under paragraph (10) of subdivision (a) of Section 100504.
(f)(1)Require, as a condition of participation in the Exchange, carriers that sell any products outside the Exchange to do both of the following:
(A)Fairly and affirmatively offer, market, and sell all products made available to individuals in the Exchange to individuals purchasing coverage outside the Exchange.
(B)Fairly and affirmatively offer, market, and sell all products made available to small employers in the Exchange to small employers purchasing coverage outside the Exchange.
(2)For purposes of this subdivision, product does not include contracts entered into pursuant to Part 6.2 (commencing with Section 12693) of Division 2 of the Insurance Code between the Managed Risk Medical Insurance Board and carriers for enrolled Healthy Families beneficiaries or contracts entered into pursuant to Chapter 7 (commencing with Section 14000) of, or Chapter 8 (commencing with Section 14200) of, Part 3 of Division 9 of the Welfare and Institutions Code between the State Department of Health Care Services and carriers for enrolled Medi-Cal beneficiaries.
(g)Determine when an enrollees coverage commences and the extent and scope of coverage.
(h)Provide for the processing of applications and the enrollment and disenrollment of enrollees.
(i)Determine and approve cost-sharing provisions for qualified health plans.
(j)Establish uniform billing and payment policies for qualified health plans offered in the Exchange to ensure consistent enrollment and disenrollment activities for individuals enrolled in the Exchange.
(k)Undertake activities necessary to market and publicize the availability of health care coverage and federal subsidies through the Exchange. The board shall also undertake outreach and enrollment activities that seek to assist enrollees and potential enrollees with enrolling and reenrolling in the Exchange in the least burdensome manner, including populations that may experience barriers to enrollment, such as the disabled and those with limited English language proficiency.
(l)Select and set performance standards and compensation for navigators selected under subdivision (l) of Section 100502.
(m)Employ necessary staff.
(1)The board shall hire a chief fiscal officer, a chief operations officer, a director for the SHOP Exchange, a director of health plan contracting, a chief technology and information officer, a general counsel, and other key executive positions, as determined by the board, who shall be exempt from civil service.
(2)(A)The board shall set the salaries for the exempt positions described in paragraph (1) and subdivision (i) of Section 100500 in amounts that are reasonably necessary to attract and retain individuals of superior qualifications. The salaries shall be published by the board in the boards annual budget. The boards annual budget shall be posted on the Internet Web site of the Exchange. To determine the compensation for these positions, the board shall cause to be conducted, through the use of independent outside advisors, salary surveys of both of the following:
(i)Other state and federal health insurance exchanges that are most comparable to the Exchange.
(ii)Other relevant labor pools.
(B)The salaries established by the board under subparagraph (A) shall not exceed the highest comparable salary for a position of that type, as determined by the surveys conducted pursuant to subparagraph (A).
(C)The Department of Human Resources shall review the methodology used in the surveys conducted pursuant to subparagraph (A).
(3)The positions described in paragraph (1) and subdivision (i) of Section 100500 shall not be subject to otherwise applicable provisions of the Government Code or the Public Contract Code and, for those purposes, the Exchange shall not be considered a state agency or public entity.
(n)Assess a charge on the qualified health plans offered by carriers that is reasonable and necessary to support the development, operations, and prudent cash management of the Exchange. This charge shall not affect the requirement under Section 1301 of the federal act that carriers charge the same premium rate for each qualified health plan whether offered inside or outside the Exchange.
(o)Authorize expenditures, as necessary, from the California Health Trust Fund to pay program expenses to administer the Exchange.
(p)Keep an accurate accounting of all activities, receipts, and expenditures, and annually submit to the United States Secretary of Health and Human Services a report concerning that accounting. Commencing January 1, 2016, the board shall conduct an annual audit.
(q)(1)Annually prepare a written report on the implementation and performance of the Exchange functions during the preceding fiscal year, including, at a minimum, the manner in which funds were expended and the progress toward, and the achievement of, the requirements of this title. This report shall be transmitted to the Legislature and the Governor and shall be made available to the public on the Internet Web site of the Exchange. A report made to the Legislature pursuant to this subdivision shall be submitted pursuant to Section 9795.
(2)In addition to the report described in paragraph (1), the board shall be responsive to requests for additional information from the Legislature, including providing testimony and commenting on proposed state legislation or policy issues. The Legislature finds and declares that activities including, but not limited to, responding to legislative or executive inquiries, tracking and commenting on legislation and regulatory activities, and preparing reports on the implementation of this title and the performance of the Exchange, are necessary state requirements and are distinct from the promotion of legislative or regulatory modifications referred to in subdivision (d) of Section 100520.
(r)Maintain enrollment and expenditures to ensure that expenditures do not exceed the amount of revenue in the fund, and if sufficient revenue is not available to pay estimated expenditures, institute appropriate measures to ensure fiscal solvency.
(s)Exercise all powers reasonably necessary to carry out and comply with the duties, responsibilities, and requirements of this act and the federal act.
(t)Consult with stakeholders relevant to carrying out the activities under this title, including, but not limited to, all of the following:
(1)Health care consumers who are enrolled in health plans.
(2)Individuals and entities with experience in facilitating enrollment in health plans.
(3)Representatives of small businesses and self-employed individuals.
(4)The Chief Deputy Director of Health Care Programs.
(5)Advocates for enrolling hard-to-reach populations.
(u)Facilitate the purchase of qualified health plans in the Exchange by qualified individuals and qualified small employers no later than January 1, 2014.
(v)Report, or contract with an independent entity to report, to the Legislature by December 1, 2018, on whether to adopt the option in Section 1312(c)(3) of the federal act to merge the individual and small employer markets. In its report, the board shall provide information, based on at least two years of data from the Exchange, on the potential impact on rates paid by individuals and by small employers in a merged individual and small employer market, as compared to the rates paid by individuals and small employers if a separate individual and small employer market is maintained. A report made pursuant to this subdivision shall be submitted pursuant to Section 9795.
(w)With respect to the SHOP Program, collect premiums and administer all other necessary and related tasks, including, but not limited to, enrollment and plan payment, in order to make the offering of employee plan choice as simple as possible for qualified small employers.
(x)Require carriers participating in the Exchange to immediately notify the Exchange, under the terms and conditions established by the board when an individual is or will be enrolled in or disenrolled from any qualified health plan offered by the carrier.
(y)Ensure that the Exchange provides oral interpretation services in any language for individuals seeking coverage through the Exchange and makes available a toll-free telephone number for the hearing and speech impaired. The board shall ensure that written information made available by the Exchange is presented in a plainly worded, easily understandable format and made available in prevalent languages.
(z)This section shall become operative only if Section 4 of the act that added this section becomes inoperative pursuant to subdivision (z) of that Section 4.
SEC. 3.Sections 1 and 2 of this bill shall become operative on October 1, 2015. 2016.
SEC. 4.This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the Constitution and shall go into immediate effect. The facts constituting the necessity are:
Protecting Californians privacy rights is of the utmost importance, and in order to protect the privacy rights of individuals applying for health care coverage through the California Health Benefit Exchange at the earliest possible time, it is necessary that this act take effect immediately.
In addition to meeting the minimum requirements of Section 1311 of the federal act, the board shall do all of the following:
(a)(1)Determine the criteria and process for eligibility, enrollment, and disenrollment of enrollees and potential enrollees in the Exchange and coordinate that process with the state and local government entities administering other health care coverage programs, including the State Department of Health Care Services, the Managed Risk Medical Insurance Board, and California counties, in order to ensure consistent eligibility and enrollment processes and seamless transitions between coverage.
(2)(A)Without unreasonable delay, No later than September 30, 2016, allow an applicant to indicate in an application for health care coverage whether or not the applicant would like assistance with completing the application from an Exchange certified insurance agent or certified enrollment counselor.
(B)Until the Exchange has complied with subparagraph (A), the Exchange shall not disclose any personal information, as defined in Section 1798.3 of the Civil Code, that was obtained from the application for health care coverage to a certified insurance agent or certified enrollment counselor.
(C)The Exchange shall not disclose personal information, as defined in Section 1798.3 of the Civil Code, that was obtained from the application for health care coverage to a certified insurance agent or certified enrollment counselor if the applicant indicates that the applicant does not want assistance from an Exchange certified insurance agent or certified enrollment counselor.
(D)Nothing in this section shall preclude the Exchange from sharing the information of current enrollees or applicants with the same certified enrollment counselor or certified insurance agent of record that provided the applicant assistance with an existing application, or their successor or authorized staff, as otherwise permitted by federal and state laws and regulations.
(b)Develop processes to coordinate with the county entities that administer eligibility for the Medi-Cal program and the entity that determines eligibility for the Healthy Families Program, including, but not limited to, processes for case transfer, referral, and enrollment in the Exchange of individuals applying for assistance to those entities, if allowed or required by federal law.
(c)Determine the minimum requirements a carrier must meet to be considered for participation in the Exchange, and the standards and criteria for selecting qualified health plans to be offered through the Exchange that are in the best interests of qualified individuals and qualified small employers. The board shall consistently and uniformly apply these requirements, standards, and criteria to all carriers. In the course of selectively contracting for health care coverage offered to qualified individuals and qualified small employers through the Exchange, the board shall seek to contract with carriers so as to provide health care coverage choices that offer the optimal combination of choice, value, quality, and service.
(d)Provide, in each region of the state, a choice of qualified health plans at each of the five levels of coverage contained in subsections (d) and (e) of Section 1302 of the federal act, subject to subdivision (e) of this section, paragraph (2) of subdivision (d) of Section 1366.6 of the Health and Safety Code, and paragraph (2) of subdivision (d) of Section 10112.3 of the Insurance Code.
(e)Require, as a condition of participation in the individual market of the Exchange, carriers to fairly and affirmatively offer, market, and sell in the individual market of the Exchange at least one product within each of the five levels of coverage contained in subsections (d) and (e) of Section 1302 of the federal act and require, as a condition of participation in the SHOP Program, carriers to fairly and affirmatively offer, market, and sell in the SHOP Program at least one product within each of the four levels of coverage contained in subsection (d) of Section 1302 of the federal act. The board may require carriers to offer additional products within each of those levels of coverage. This subdivision shall not apply to a carrier that solely offers supplemental coverage in the Exchange under paragraph (10) of subdivision (a) of Section 100504.
(f)(1)Except as otherwise provided in this section and Section 100504.5, require, as a condition of participation in the Exchange, carriers that sell any products outside the Exchange to do both of the following:
(A)Fairly and affirmatively offer, market, and sell all products made available to individuals in the Exchange to individuals purchasing coverage outside the Exchange.
(B)Fairly and affirmatively offer, market, and sell all products made available to small employers in the Exchange to small employers purchasing coverage outside the Exchange.
(2)For purposes of this subdivision, product does not include contracts entered into pursuant to Part 6.2 (commencing with Section 12693) of Division 2 of the Insurance Code between the Managed Risk Medical Insurance Board and carriers for enrolled Healthy Families beneficiaries or contracts entered into pursuant to Chapter 7 (commencing with Section 14000) of, or Chapter 8 (commencing with Section 14200) of, Part 3 of Division 9 of the Welfare and Institutions Code between the State Department of Health Care Services and carriers for enrolled Medi-Cal beneficiaries. Product also does not include a bridge plan product offered pursuant to Section 100504.5.
(3)Except as required by Section 1301(a)(1)(C)(ii) of the federal act, a carrier offering a bridge plan product in the Exchange may limit the products it offers in the Exchange solely to a bridge plan product contract.
(g)Determine when an enrollees coverage commences and the extent and scope of coverage.
(h)Provide for the processing of applications and the enrollment and disenrollment of enrollees.
(i)Determine and approve cost-sharing provisions for qualified health plans.
(j)Establish uniform billing and payment policies for qualified health plans offered in the Exchange to ensure consistent enrollment and disenrollment activities for individuals enrolled in the Exchange.
(k)Undertake activities necessary to market and publicize the availability of health care coverage and federal subsidies through the Exchange. The board shall also undertake outreach and enrollment activities that seek to assist enrollees and potential enrollees with enrolling and reenrolling in the Exchange in the least burdensome manner, including populations that may experience barriers to enrollment, such as the disabled and those with limited English language proficiency.
(l)Select and set performance standards and compensation for navigators selected under subdivision (l) of Section 100502.
(m)Employ necessary staff.
(1)The board shall hire a chief fiscal officer, a chief operations officer, a director for the SHOP Exchange, a director of Health Plan Contracting, health plan contracting, a chief technology and information officer, a general counsel, and other key executive positions, as determined by the board, who shall be exempt from civil service.
(2)(A)The board shall set the salaries for the exempt positions described in paragraph (1) and subdivision (i) of Section 100500 in amounts that are reasonably necessary to attract and retain individuals of superior qualifications. The salaries shall be published by the board in the boards annual budget. The boards annual budget shall be posted on the Internet Web site of the Exchange. To determine the compensation for these positions, the board shall cause to be conducted, through the use of independent outside advisors, salary surveys of both of the following:
(i)Other state and federal health insurance exchanges that are most comparable to the Exchange.
(ii)Other relevant labor pools.
(B)The salaries established by the board under subparagraph (A) shall not exceed the highest comparable salary for a position of that type, as determined by the surveys conducted pursuant to subparagraph (A).
(C)The Department of Human Resources shall review the methodology used in the surveys conducted pursuant to subparagraph (A).
(3)The positions described in paragraph (1) and subdivision (i) of Section 100500 shall not be subject to otherwise applicable provisions of the Government Code or the Public Contract Code and, for those purposes, the Exchange shall not be considered a state agency or public entity.
(n)Assess a charge on the qualified health plans offered by carriers that is reasonable and necessary to support the development, operations, and prudent cash management of the Exchange. This charge shall not affect the requirement under Section 1301 of the federal act that carriers charge the same premium rate for each qualified health plan whether offered inside or outside the Exchange.
(o)Authorize expenditures, as necessary, from the California Health Trust Fund to pay program expenses to administer the Exchange.
(p)Keep an accurate accounting of all activities, receipts, and expenditures, and annually submit to the United States Secretary of Health and Human Services a report concerning that accounting. Commencing January 1, 2016, the board shall conduct an annual audit.
(q)(1)Annually prepare a written report on the implementation and performance of the Exchange functions during the preceding fiscal year, including, at a minimum, the manner in which funds were expended and the progress toward, and the achievement of, the requirements of this title. The report shall also include data provided by health care service plans and health insurers offering bridge plan products regarding the extent of health care provider and health facility overlap in their Medi-Cal networks as compared to the health care provider and health facility networks contracting with the plan or insurer in their bridge plan contracts. This report shall be transmitted to the Legislature and the Governor and shall be made available to the public on the Internet Web site of the Exchange. A report made to the Legislature pursuant to this subdivision shall be submitted pursuant to Section 9795.
(2)The Exchange shall prepare, or contract for the preparation of, an evaluation of the bridge plan program using the first three years of experience with the program. The evaluation shall be provided to the health policy and fiscal committees of the Legislature in the fourth year following federal approval of the bridge plan option. The evaluation shall include, but not be limited to, all of the following:
(A)The number of individuals eligible to participate in the bridge plan program each year by category of eligibility.
(B)The number of eligible individuals who elect a bridge plan option each year by category of eligibility.
(C)The average length of time, by region and statewide, that individuals remain in the bridge plan option each year by category of eligibility.
(D)The regions of the state with a bridge plan option, and the carriers in each region that offer a bridge plan, by year.
(E)The premium difference each year, by region, between the bridge plan and the first and second lowest cost plan for individuals in the Exchange who are not eligible for the bridge plan.
(F)The effect of the bridge plan on the premium subsidy amount for bridge plan eligible individuals each year by each region.
(G)Based on a survey of individuals enrolled in the bridge plan:
(i)Whether individuals enrolling in the bridge plan product are able to keep their existing health care providers.
(ii)Whether individuals would want to retain their bridge plan product, buy a different Exchange product, or decline to purchase health insurance if there was no bridge plan product available. The Exchange may include questions designed to elicit the information in this subparagraph as part of an existing survey of individuals receiving coverage in the Exchange.
(3)In addition to the evaluation required by paragraph (2), the Exchange shall post the items in subparagraphs (A) to (F), inclusive, on its Internet Web site each year.
(4)In addition to the report described in paragraph (1), the board shall be responsive to requests for additional information from the Legislature, including providing testimony and commenting on proposed state legislation or policy issues. The Legislature finds and declares that activities including, but not limited to, responding to legislative or executive inquiries, tracking and commenting on legislation and regulatory activities, and preparing reports on the implementation of this title and the performance of the Exchange, are necessary state requirements and are distinct from the promotion of legislative or regulatory modifications referred to in subdivision (d) of Section 100520.
(r)Maintain enrollment and expenditures to ensure that expenditures do not exceed the amount of revenue in the fund, and if sufficient revenue is not available to pay estimated expenditures, institute appropriate measures to ensure fiscal solvency.
(s)Exercise all powers reasonably necessary to carry out and comply with the duties, responsibilities, and requirements of this act and the federal act.
(t)Consult with stakeholders relevant to carrying out the activities under this title, including, but not limited to, all of the following:
(1)Health care consumers who are enrolled in health plans.
(2)Individuals and entities with experience in facilitating enrollment in health plans.
(3)Representatives of small businesses and self-employed individuals.
(4)The State Medi-Cal Director. Chief Deputy Director of Health Care Programs.
(5)Advocates for enrolling hard-to-reach populations.
(u)Facilitate the purchase of qualified health plans in the Exchange by qualified individuals and qualified small employers no later than January 1, 2014.
(v)Report, or contract with an independent entity to report, to the Legislature by December 1, 2018, on whether to adopt the option in Section 1312(c)(3) of the federal act to merge the individual and small employer markets. In its report, the board shall provide information, based on at least two years of data from the Exchange, on the potential impact on rates paid by individuals and by small employers in a merged individual and small employer market, as compared to the rates paid by individuals and small employers if a separate individual and small employer market is maintained. A report made pursuant to this subdivision shall be submitted pursuant to Section 9795.
(w)With respect to the SHOP Program, collect premiums and administer all other necessary and related tasks, including, but not limited to, enrollment and plan payment, in order to make the offering of employee plan choice as simple as possible for qualified small employers.
(x)Require carriers participating in the Exchange to immediately notify the Exchange, under the terms and conditions established by the board when an individual is or will be enrolled in or disenrolled from any qualified health plan offered by the carrier.
(y)Ensure that the Exchange provides oral interpretation services in any language for individuals seeking coverage through the Exchange and makes available a toll-free telephone number for the hearing and speech impaired. The board shall ensure that written information made available by the Exchange is presented in a plainly worded, easily understandable format and made available in prevalent languages.
(z)This section shall become inoperative on the October 1 that is five years after the date that federal approval of the bridge plan option occurs, and, as of the second January 1 thereafter, is repealed, unless a later enacted statute that is enacted before that date deletes or extends the dates on which it becomes inoperative and is repealed.
SEC. 2.Section 100503 of the Government Code, as amended by Section 2 of Chapter 572 of the Statutes of 2014, is amended to read:100503.In addition to meeting the minimum requirements of Section 1311 of the federal act, the board shall do all of the following:
(a)(1)Determine the criteria and process for eligibility, enrollment, and disenrollment of enrollees and potential enrollees in the Exchange and coordinate that process with the state and local government entities administering other health care coverage programs, including the State Department of Health Care Services, the Managed Risk Medical Insurance Board, and California counties, in order to ensure consistent eligibility and enrollment processes and seamless transitions between coverage.
(2)(A)Without unreasonable delay, No later than September 30, 2016, allow an applicant to indicate in an application for health care coverage whether or not the applicant would like assistance with completing that application from an Exchange certified insurance agent or certified enrollment counselor.
(B)Until the Exchange has complied with subparagraph (A), the Exchange shall not disclose any personal information, as defined in Section 1798.3 of the Civil Code, that was obtained from the application for health care coverage to a certified insurance agent or certified enrollment counselor.
(C)The Exchange shall not disclose personal information, as defined in Section 1798.3 of the Civil Code, that was obtained from the application for health care coverage to a certified insurance agent or certified enrollment counselor if the applicant indicates that the applicant does not want assistance from an Exchange certified insurance agent or certified enrollment counselor.
(D)Nothing in this section shall preclude the Exchange from sharing the information of current enrollees or applicants with the same certified enrollment counselor or certified insurance agent of record that provided the applicant assistance with an existing application, or their successor or authorized staff, as otherwise permitted by federal and state laws and regulations.
(b)Develop processes to coordinate with the county entities that administer eligibility for the Medi-Cal program and the entity that determines eligibility for the Healthy Families Program, including, but not limited to, processes for case transfer, referral, and enrollment in the Exchange of individuals applying for assistance to those entities, if allowed or required by federal law.
(c)Determine the minimum requirements a carrier must meet to be considered for participation in the Exchange, and the standards and criteria for selecting qualified health plans to be offered through the Exchange that are in the best interests of qualified individuals and qualified small employers. The board shall consistently and uniformly apply these requirements, standards, and criteria to all carriers. In the course of selectively contracting for health care coverage offered to qualified individuals and qualified small employers through the Exchange, the board shall seek to contract with carriers so as to provide health care coverage choices that offer the optimal combination of choice, value, quality, and service.
(d)Provide, in each region of the state, a choice of qualified health plans at each of the five levels of coverage contained in subsections (d) and (e) of Section 1302 of the federal act, subject to subdivision (e) of this section, paragraph (2) of subdivision (d) of Section 1366.6 of the Health and Safety Code Code, and paragraph (2) of subdivision (d) of Section 10112.3 of the Insurance Code.
(e)Require, as a condition of participation in the Exchange, carriers to fairly and affirmatively offer, market, and sell in the Exchange at least one product within each of the five levels of coverage contained in subsections (d) and (e) of Section 1302 of the federal act and require, as a condition of participation in the SHOP Program, carriers to fairly and affirmatively offer, market, and sell in the SHOP Program at least one product within each of the four levels of coverage contained in subsection (d) of Section 1302 of the federal act. The board may require carriers to offer additional products within each of those levels of coverage. This subdivision shall not apply to a carrier that solely offers supplemental coverage in the Exchange under paragraph (10) of subdivision (a) of Section 100504.
(f)(1)Require, as a condition of participation in the Exchange, carriers that sell any products outside the Exchange to do both of the following:
(A)Fairly and affirmatively offer, market, and sell all products made available to individuals in the Exchange to individuals purchasing coverage outside the Exchange.
(B)Fairly and affirmatively offer, market, and sell all products made available to small employers in the Exchange to small employers purchasing coverage outside the Exchange.
(2)For purposes of this subdivision, product does not include contracts entered into pursuant to Part 6.2 (commencing with Section 12693) of Division 2 of the Insurance Code between the Managed Risk Medical Insurance Board and carriers for enrolled Healthy Families beneficiaries or contracts entered into pursuant to Chapter 7 (commencing with Section 14000) of, or Chapter 8 (commencing with Section 14200) of, Part 3 of Division 9 of the Welfare and Institutions Code between the State Department of Health Care Services and carriers for enrolled Medi-Cal beneficiaries.
(g)Determine when an enrollees coverage commences and the extent and scope of coverage.
(h)Provide for the processing of applications and the enrollment and disenrollment of enrollees.
(i)Determine and approve cost-sharing provisions for qualified health plans.
(j)Establish uniform billing and payment policies for qualified health plans offered in the Exchange to ensure consistent enrollment and disenrollment activities for individuals enrolled in the Exchange.
(k)Undertake activities necessary to market and publicize the availability of health care coverage and federal subsidies through the Exchange. The board shall also undertake outreach and enrollment activities that seek to assist enrollees and potential enrollees with enrolling and reenrolling in the Exchange in the least burdensome manner, including populations that may experience barriers to enrollment, such as the disabled and those with limited English language proficiency.
(l)Select and set performance standards and compensation for navigators selected under subdivision (l) of Section 100502.
(m)Employ necessary staff.
(1)The board shall hire a chief fiscal officer, a chief operations officer, a director for the SHOP Exchange, a director of Health Plan Contracting, health plan contracting, a chief technology and information officer, a general counsel, and other key executive positions, as determined by the board, who shall be exempt from civil service.
(2)(A)The board shall set the salaries for the exempt positions described in paragraph (1) and subdivision (i) of Section 100500 in amounts that are reasonably necessary to attract and retain individuals of superior qualifications. The salaries shall be published by the board in the boards annual budget. The boards annual budget shall be posted on the Internet Web site of the Exchange. To determine the compensation for these positions, the board shall cause to be conducted, through the use of independent outside advisors, salary surveys of both of the following:
(i)Other state and federal health insurance exchanges that are most comparable to the Exchange.
(ii)Other relevant labor pools.
(B)The salaries established by the board under subparagraph (A) shall not exceed the highest comparable salary for a position of that type, as determined by the surveys conducted pursuant to subparagraph (A).
(C)The Department of Human Resources shall review the methodology used in the surveys conducted pursuant to subparagraph (A).
(3)The positions described in paragraph (1) and subdivision (i) of Section 100500 shall not be subject to otherwise applicable provisions of the Government Code or the Public Contract Code and, for those purposes, the Exchange shall not be considered a state agency or public entity.
(n)Assess a charge on the qualified health plans offered by carriers that is reasonable and necessary to support the development, operations, and prudent cash management of the Exchange. This charge shall not affect the requirement under Section 1301 of the federal act that carriers charge the same premium rate for each qualified health plan whether offered inside or outside the Exchange.
(o)Authorize expenditures, as necessary, from the California Health Trust Fund to pay program expenses to administer the Exchange.
(p)Keep an accurate accounting of all activities, receipts, and expenditures, and annually submit to the United States Secretary of Health and Human Services a report concerning that accounting. Commencing January 1, 2016, the board shall conduct an annual audit.
(q)(1)Annually prepare a written report on the implementation and performance of the Exchange functions during the preceding fiscal year, including, at a minimum, the manner in which funds were expended and the progress toward, and the achievement of, the requirements of this title. This report shall be transmitted to the Legislature and the Governor and shall be made available to the public on the Internet Web site of the Exchange. A report made to the Legislature pursuant to this subdivision shall be submitted pursuant to Section 9795.
(2)In addition to the report described in paragraph (1), the board shall be responsive to requests for additional information from the Legislature, including providing testimony and commenting on proposed state legislation or policy issues. The Legislature finds and declares that activities including, but not limited to, responding to legislative or executive inquiries, tracking and commenting on legislation and regulatory activities, and preparing reports on the implementation of this title and the performance of the Exchange, are necessary state requirements and are distinct from the promotion of legislative or regulatory modifications referred to in subdivision (d) of Section 100520.
(r)Maintain enrollment and expenditures to ensure that expenditures do not exceed the amount of revenue in the fund, and if sufficient revenue is not available to pay estimated expenditures, institute appropriate measures to ensure fiscal solvency.
(s)Exercise all powers reasonably necessary to carry out and comply with the duties, responsibilities, and requirements of this act and the federal act.
(t)Consult with stakeholders relevant to carrying out the activities under this title, including, but not limited to, all of the following:
(1)Health care consumers who are enrolled in health plans.
(2)Individuals and entities with experience in facilitating enrollment in health plans.
(3)Representatives of small businesses and self-employed individuals.
(4)The State Medi-Cal Director. Chief Deputy Director of Health Care Programs.
(5)Advocates for enrolling hard-to-reach populations.
(u)Facilitate the purchase of qualified health plans in the Exchange by qualified individuals and qualified small employers no later than January 1, 2014.
(v)Report, or contract with an independent entity to report, to the Legislature by December 1, 2018, on whether to adopt the option in Section 1312(c)(3) of the federal act to merge the individual and small employer markets. In its report, the board shall provide information, based on at least two years of data from the Exchange, on the potential impact on rates paid by individuals and by small employers in a merged individual and small employer market, as compared to the rates paid by individuals and small employers if a separate individual and small employer market is maintained. A report made pursuant to this subdivision shall be submitted pursuant to Section 9795.
(w)With respect to the SHOP Program, collect premiums and administer all other necessary and related tasks, including, but not limited to, enrollment and plan payment, in order to make the offering of employee plan choice as simple as possible for qualified small employers.
(x)Require carriers participating in the Exchange to immediately notify the Exchange, under the terms and conditions established by the board when an individual is or will be enrolled in or disenrolled from any qualified health plan offered by the carrier.
(y)Ensure that the Exchange provides oral interpretation services in any language for individuals seeking coverage through the Exchange and makes available a toll-free telephone number for the hearing and speech impaired. The board shall ensure that written information made available by the Exchange is presented in a plainly worded, easily understandable format and made available in prevalent languages.
(z)This section shall become operative only if Section 4 of the act that added this section becomes inoperative pursuant to subdivision (z) of that Section 4.
SEC. 3.Sections 1 and 2 of this bill shall become operative on October 1, 2015.
SEC. 4.This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the Constitution and shall go into immediate effect. The facts constituting the necessity are:
Protecting Californians privacy rights is of the utmost importance, and in order to protect the privacy rights of individuals applying for health care coverage through the California Health Benefit Exchange at the earliest possible time, it is necessary that this act take effect immediately.
In addition to meeting the minimum requirements of Section 1311 of the federal act, the board shall do all of the following:
(a)(1)Determine the criteria and process for eligibility, enrollment, and disenrollment of enrollees and potential enrollees in the Exchange and coordinate that process with the state and local government entities administering other health care coverage programs, including the State Department of Health Care Services, the Managed Risk Medical Insurance Board, and California counties, in order to ensure consistent eligibility and enrollment processes and seamless transitions between coverage.
(2)(A)Without unreasonable delay, allow an applicant to indicate in an application for health care coverage whether or not the applicant would like assistance with completing the application from an Exchange certified insurance agent or certified enrollment counselor.
(B)Until the Exchange has complied with subparagraph (A), the Exchange shall not disclose any personal information, as defined in Section 1798.3 of the Civil Code, that was obtained from the application for health care coverage to a certified insurance agent or certified enrollment counselor.
(C)The Exchange shall not disclose personal information, as defined in Section 1798.3 of the Civil Code, that was obtained from the application for health care coverage to a certified insurance agent or certified enrollment counselor if the applicant indicates that the applicant does not want assistance from an Exchange certified insurance agent or certified enrollment counselor.
(D)Nothing in this section shall preclude the Exchange from sharing the information of current enrollees or applicants with the same certified enrollment counselor or certified insurance agent of record that provided the applicant assistance with an existing application, or their successor or authorized staff, as otherwise permitted by federal and state laws and regulations.
(b)Develop processes to coordinate with the county entities that administer eligibility for the Medi-Cal program and the entity that determines eligibility for the Healthy Families Program, including, but not limited to, processes for case transfer, referral, and enrollment in the Exchange of individuals applying for assistance to those entities, if allowed or required by federal law.
(c)Determine the minimum requirements a carrier must meet to be considered for participation in the Exchange, and the standards and criteria for selecting qualified health plans to be offered through the Exchange that are in the best interests of qualified individuals and qualified small employers. The board shall consistently and uniformly apply these requirements, standards, and criteria to all carriers. In the course of selectively contracting for health care coverage offered to qualified individuals and qualified small employers through the Exchange, the board shall seek to contract with carriers so as to provide health care coverage choices that offer the optimal combination of choice, value, quality, and service.
(d)Provide, in each region of the state, a choice of qualified health plans at each of the five levels of coverage contained in subsections (d) and (e) of Section 1302 of the federal act, subject to subdivision (e) of this section, paragraph (2) of subdivision (d) of Section 1366.6 of the Health and Safety Code, and paragraph (2) of subdivision (d) of Section 10112.3 of the Insurance Code.
(e)Require, as a condition of participation in the individual market of the Exchange, carriers to fairly and affirmatively offer, market, and sell in the individual market of the Exchange at least one product within each of the five levels of coverage contained in subsections (d) and (e) of Section 1302 of the federal act and require, as a condition of participation in the SHOP Program, carriers to fairly and affirmatively offer, market, and sell in the SHOP Program at least one product within each of the four levels of coverage contained in subsection (d) of Section 1302 of the federal act. The board may require carriers to offer additional products within each of those levels of coverage. This subdivision shall not apply to a carrier that solely offers supplemental coverage in the Exchange under paragraph (10) of subdivision (a) of Section 100504.
(f)(1)Except as otherwise provided in this section and Section 100504.5, require, as a condition of participation in the Exchange, carriers that sell any products outside the Exchange to do both of the following:
(A)Fairly and affirmatively offer, market, and sell all products made available to individuals in the Exchange to individuals purchasing coverage outside the Exchange.
(B)Fairly and affirmatively offer, market, and sell all products made available to small employers in the Exchange to small employers purchasing coverage outside the Exchange.
(2)For purposes of this subdivision, product does not include contracts entered into pursuant to Part 6.2 (commencing with Section 12693) of Division 2 of the Insurance Code between the Managed Risk Medical Insurance Board and carriers for enrolled Healthy Families beneficiaries or contracts entered into pursuant to Chapter 7 (commencing with Section 14000) of, or Chapter 8 (commencing with Section 14200) of, Part 3 of Division 9 of the Welfare and Institutions Code between the State Department of Health Care Services and carriers for enrolled Medi-Cal beneficiaries. Product also does not include a bridge plan product offered pursuant to Section 100504.5.
(3)Except as required by Section 1301(a)(1)(C)(ii) of the federal act, a carrier offering a bridge plan product in the Exchange may limit the products it offers in the Exchange solely to a bridge plan product contract.
(g)Determine when an enrollees coverage commences and the extent and scope of coverage.
(h)Provide for the processing of applications and the enrollment and disenrollment of enrollees.
(i)Determine and approve cost-sharing provisions for qualified health plans.
(j)Establish uniform billing and payment policies for qualified health plans offered in the Exchange to ensure consistent enrollment and disenrollment activities for individuals enrolled in the Exchange.
(k)Undertake activities necessary to market and publicize the availability of health care coverage and federal subsidies through the Exchange. The board shall also undertake outreach and enrollment activities that seek to assist enrollees and potential enrollees with enrolling and reenrolling in the Exchange in the least burdensome manner, including populations that may experience barriers to enrollment, such as the disabled and those with limited English language proficiency.
(l)Select and set performance standards and compensation for navigators selected under subdivision (l) of Section 100502.
(m)Employ necessary staff.
(1)The board shall hire a chief fiscal officer, a chief operations officer, a director for the SHOP Exchange, a director of Health Plan Contracting, a chief technology and information officer, a general counsel, and other key executive positions, as determined by the board, who shall be exempt from civil service.
(2)(A)The board shall set the salaries for the exempt positions described in paragraph (1) and subdivision (i) of Section 100500 in amounts that are reasonably necessary to attract and retain individuals of superior qualifications. The salaries shall be published by the board in the boards annual budget. The boards annual budget shall be posted on the Internet Web site of the Exchange. To determine the compensation for these positions, the board shall cause to be conducted, through the use of independent outside advisors, salary surveys of both of the following:
(i)Other state and federal health insurance exchanges that are most comparable to the Exchange.
(ii)Other relevant labor pools.
(B)The salaries established by the board under subparagraph (A) shall not exceed the highest comparable salary for a position of that type, as determined by the surveys conducted pursuant to subparagraph (A).
(C)The Department of Human Resources shall review the methodology used in the surveys conducted pursuant to subparagraph (A).
(3)The positions described in paragraph (1) and subdivision (i) of Section 100500 shall not be subject to otherwise applicable provisions of the Government Code or the Public Contract Code and, for those purposes, the Exchange shall not be considered a state agency or public entity.
(n)Assess a charge on the qualified health plans offered by carriers that is reasonable and necessary to support the development, operations, and prudent cash management of the Exchange. This charge shall not affect the requirement under Section 1301 of the federal act that carriers charge the same premium rate for each qualified health plan whether offered inside or outside the Exchange.
(o)Authorize expenditures, as necessary, from the California Health Trust Fund to pay program expenses to administer the Exchange.
(p)Keep an accurate accounting of all activities, receipts, and expenditures, and annually submit to the United States Secretary of Health and Human Services a report concerning that accounting. Commencing January 1, 2016, the board shall conduct an annual audit.
(q)(1)Annually prepare a written report on the implementation and performance of the Exchange functions during the preceding fiscal year, including, at a minimum, the manner in which funds were expended and the progress toward, and the achievement of, the requirements of this title. The report shall also include data provided by health care service plans and health insurers offering bridge plan products regarding the extent of health care provider and health facility overlap in their Medi-Cal networks as compared to the health care provider and health facility networks contracting with the plan or insurer in their bridge plan contracts. This report shall be transmitted to the Legislature and the Governor and shall be made available to the public on the Internet Web site of the Exchange. A report made to the Legislature pursuant to this subdivision shall be submitted pursuant to Section 9795.
(2)The Exchange shall prepare, or contract for the preparation of, an evaluation of the bridge plan program using the first three years of experience with the program. The evaluation shall be provided to the health policy and fiscal committees of the Legislature in the fourth year following federal approval of the bridge plan option. The evaluation shall include, but not be limited to, all of the following:
(A)The number of individuals eligible to participate in the bridge plan program each year by category of eligibility.
(B)The number of eligible individuals who elect a bridge plan option each year by category of eligibility.
(C)The average length of time, by region and statewide, that individuals remain in the bridge plan option each year by category of eligibility.
(D)The regions of the state with a bridge plan option, and the carriers in each region that offer a bridge plan, by year.
(E)The premium difference each year, by region, between the bridge plan and the first and second lowest cost plan for individuals in the Exchange who are not eligible for the bridge plan.
(F)The effect of the bridge plan on the premium subsidy amount for bridge plan eligible individuals each year by each region.
(G)Based on a survey of individuals enrolled in the bridge plan:
(i)Whether individuals enrolling in the bridge plan product are able to keep their existing health care providers.
(ii)Whether individuals would want to retain their bridge plan product, buy a different Exchange product, or decline to purchase health insurance if there was no bridge plan product available. The Exchange may include questions designed to elicit the information in this subparagraph as part of an existing survey of individuals receiving coverage in the Exchange.
(3)In addition to the evaluation required by paragraph (2), the Exchange shall post the items in subparagraphs (A) to (F), inclusive, on its Internet Web site each year.
(4)In addition to the report described in paragraph (1), the board shall be responsive to requests for additional information from the Legislature, including providing testimony and commenting on proposed state legislation or policy issues. The Legislature finds and declares that activities including, but not limited to, responding to legislative or executive inquiries, tracking and commenting on legislation and regulatory activities, and preparing reports on the implementation of this title and the performance of the Exchange, are necessary state requirements and are distinct from the promotion of legislative or regulatory modifications referred to in subdivision (d) of Section 100520.
(r)Maintain enrollment and expenditures to ensure that expenditures do not exceed the amount of revenue in the fund, and if sufficient revenue is not available to pay estimated expenditures, institute appropriate measures to ensure fiscal solvency.
(s)Exercise all powers reasonably necessary to carry out and comply with the duties, responsibilities, and requirements of this act and the federal act.
(t)Consult with stakeholders relevant to carrying out the activities under this title, including, but not limited to, all of the following:
(1)Health care consumers who are enrolled in health plans.
(2)Individuals and entities with experience in facilitating enrollment in health plans.
(3)Representatives of small businesses and self-employed individuals.
(4)The State Medi-Cal Director.
(5)Advocates for enrolling hard-to-reach populations.
(u)Facilitate the purchase of qualified health plans in the Exchange by qualified individuals and qualified small employers no later than January 1, 2014.
(v)Report, or contract with an independent entity to report, to the Legislature by December 1, 2018, on whether to adopt the option in Section 1312(c)(3) of the federal act to merge the individual and small employer markets. In its report, the board shall provide information, based on at least two years of data from the Exchange, on the potential impact on rates paid by individuals and by small employers in a merged individual and small employer market, as compared to the rates paid by individuals and small employers if a separate individual and small employer market is maintained. A report made pursuant to this subdivision shall be submitted pursuant to Section 9795.
(w)With respect to the SHOP Program, collect premiums and administer all other necessary and related tasks, including, but not limited to, enrollment and plan payment, in order to make the offering of employee plan choice as simple as possible for qualified small employers.
(x)Require carriers participating in the Exchange to immediately notify the Exchange, under the terms and conditions established by the board when an individual is or will be enrolled in or disenrolled from any qualified health plan offered by the carrier.
(y)Ensure that the Exchange provides oral interpretation services in any language for individuals seeking coverage through the Exchange and makes available a toll-free telephone number for the hearing and speech impaired. The board shall ensure that written information made available by the Exchange is presented in a plainly worded, easily understandable format and made available in prevalent languages.
(z)This section shall become inoperative on the October 1 that is five years after the date that federal approval of the bridge plan option occurs, and, as of the second January 1 thereafter, is repealed, unless a later enacted statute that is enacted before that date deletes or extends the dates on which it becomes inoperative and is repealed.
SEC. 2.Section 100503 of the Government Code, as amended by Section 2 of Chapter 572 of the Statutes of 2014, is amended to read:100503.In addition to meeting the minimum requirements of Section 1311 of the federal act, the board shall do all of the following:
(a)(1)Determine the criteria and process for eligibility, enrollment, and disenrollment of enrollees and potential enrollees in the Exchange and coordinate that process with the state and local government entities administering other health care coverage programs, including the State Department of Health Care Services, the Managed Risk Medical Insurance Board, and California counties, in order to ensure consistent eligibility and enrollment processes and seamless transitions between coverage.
(2)(A)Without unreasonable delay, allow an applicant to indicate in an application for health care coverage whether or not the applicant would like assistance with completing that application from an Exchange certified insurance agent or certified enrollment counselor.
(B)Until the Exchange has complied with subparagraph (A), the Exchange shall not disclose any personal information, as defined in Section 1798.3 of the Civil Code, that was obtained from the application for health care coverage to a certified insurance agent or certified enrollment counselor.
(C)The Exchange shall not disclose personal information, as defined in Section 1798.3 of the Civil Code, that was obtained from the application for health care coverage to a certified insurance agent or certified enrollment counselor if the applicant indicates that the applicant does not want assistance from an Exchange certified insurance agent or certified enrollment counselor.
(D)Nothing in this section shall preclude the Exchange from sharing the information of current enrollees or applicants with the same certified enrollment counselor or certified insurance agent of record that provided the applicant assistance with an existing application, or their successor or authorized staff, as otherwise permitted by federal and state laws and regulations.
(b)Develop processes to coordinate with the county entities that administer eligibility for the Medi-Cal program and the entity that determines eligibility for the Healthy Families Program, including, but not limited to, processes for case transfer, referral, and enrollment in the Exchange of individuals applying for assistance to those entities, if allowed or required by federal law.
(c)Determine the minimum requirements a carrier must meet to be considered for participation in the Exchange, and the standards and criteria for selecting qualified health plans to be offered through the Exchange that are in the best interests of qualified individuals and qualified small employers. The board shall consistently and uniformly apply these requirements, standards, and criteria to all carriers. In the course of selectively contracting for health care coverage offered to qualified individuals and qualified small employers through the Exchange, the board shall seek to contract with carriers so as to provide health care coverage choices that offer the optimal combination of choice, value, quality, and service.
(d)Provide, in each region of the state, a choice of qualified health plans at each of the five levels of coverage contained in subsections (d) and (e) of Section 1302 of the federal act, subject to subdivision (e) of this section, paragraph (2) of subdivision (d) of Section 1366.6 of the Health and Safety Code and paragraph (2) of subdivision (d) of Section 10112.3 of the Insurance Code.
(e)Require, as a condition of participation in the Exchange, carriers to fairly and affirmatively offer, market, and sell in the Exchange at least one product within each of the five levels of coverage contained in subsections (d) and (e) of Section 1302 of the federal act and require, as a condition of participation in the SHOP Program, carriers to fairly and affirmatively offer, market, and sell in the SHOP Program at least one product within each of the four levels of coverage contained in subsection (d) of Section 1302 of the federal act. The board may require carriers to offer additional products within each of those levels of coverage. This subdivision shall not apply to a carrier that solely offers supplemental coverage in the Exchange under paragraph (10) of subdivision (a) of Section 100504.
(f)(1)Require, as a condition of participation in the Exchange, carriers that sell any products outside the Exchange to do both of the following:
(A)Fairly and affirmatively offer, market, and sell all products made available to individuals in the Exchange to individuals purchasing coverage outside the Exchange.
(B)Fairly and affirmatively offer, market, and sell all products made available to small employers in the Exchange to small employers purchasing coverage outside the Exchange.
(2)For purposes of this subdivision, product does not include contracts entered into pursuant to Part 6.2 (commencing with Section 12693) of Division 2 of the Insurance Code between the Managed Risk Medical Insurance Board and carriers for enrolled Healthy Families beneficiaries or contracts entered into pursuant to Chapter 7 (commencing with Section 14000) of, or Chapter 8 (commencing with Section 14200) of, Part 3 of Division 9 of the Welfare and Institutions Code between the State Department of Health Care Services and carriers for enrolled Medi-Cal beneficiaries.
(g)Determine when an enrollees coverage commences and the extent and scope of coverage.
(h)Provide for the processing of applications and the enrollment and disenrollment of enrollees.
(i)Determine and approve cost-sharing provisions for qualified health plans.
(j)Establish uniform billing and payment policies for qualified health plans offered in the Exchange to ensure consistent enrollment and disenrollment activities for individuals enrolled in the Exchange.
(k)Undertake activities necessary to market and publicize the availability of health care coverage and federal subsidies through the Exchange. The board shall also undertake outreach and enrollment activities that seek to assist enrollees and potential enrollees with enrolling and reenrolling in the Exchange in the least burdensome manner, including populations that may experience barriers to enrollment, such as the disabled and those with limited English language proficiency.
(l)Select and set performance standards and compensation for navigators selected under subdivision (l) of Section 100502.
(m)Employ necessary staff.
(1)The board shall hire a chief fiscal officer, a chief operations officer, a director for the SHOP Exchange, a director of Health Plan Contracting, a chief technology and information officer, a general counsel, and other key executive positions, as determined by the board, who shall be exempt from civil service.
(2)(A)The board shall set the salaries for the exempt positions described in paragraph (1) and subdivision (i) of Section 100500 in amounts that are reasonably necessary to attract and retain individuals of superior qualifications. The salaries shall be published by the board in the boards annual budget. The boards annual budget shall be posted on the Internet Web site of the Exchange. To determine the compensation for these positions, the board shall cause to be conducted, through the use of independent outside advisors, salary surveys of both of the following:
(i)Other state and federal health insurance exchanges that are most comparable to the Exchange.
(ii)Other relevant labor pools.
(B)The salaries established by the board under subparagraph (A) shall not exceed the highest comparable salary for a position of that type, as determined by the surveys conducted pursuant to subparagraph (A).
(C)The Department of Human Resources shall review the methodology used in the surveys conducted pursuant to subparagraph (A).
(3)The positions described in paragraph (1) and subdivision (i) of Section 100500 shall not be subject to otherwise applicable provisions of the Government Code or the Public Contract Code and, for those purposes, the Exchange shall not be considered a state agency or public entity.
(n)Assess a charge on the qualified health plans offered by carriers that is reasonable and necessary to support the development, operations, and prudent cash management of the Exchange. This charge shall not affect the requirement under Section 1301 of the federal act that carriers charge the same premium rate for each qualified health plan whether offered inside or outside the Exchange.
(o)Authorize expenditures, as necessary, from the California Health Trust Fund to pay program expenses to administer the Exchange.
(p)Keep an accurate accounting of all activities, receipts, and expenditures, and annually submit to the United States Secretary of Health and Human Services a report concerning that accounting. Commencing January 1, 2016, the board shall conduct an annual audit.
(q)(1)Annually prepare a written report on the implementation and performance of the Exchange functions during the preceding fiscal year, including, at a minimum, the manner in which funds were expended and the progress toward, and the achievement of, the requirements of this title. This report shall be transmitted to the Legislature and the Governor and shall be made available to the public on the Internet Web site of the Exchange. A report made to the Legislature pursuant to this subdivision shall be submitted pursuant to Section 9795.
(2)In addition to the report described in paragraph (1), the board shall be responsive to requests for additional information from the Legislature, including providing testimony and commenting on proposed state legislation or policy issues. The Legislature finds and declares that activities including, but not limited to, responding to legislative or executive inquiries, tracking and commenting on legislation and regulatory activities, and preparing reports on the implementation of this title and the performance of the Exchange, are necessary state requirements and are distinct from the promotion of legislative or regulatory modifications referred to in subdivision (d) of Section 100520.
(r)Maintain enrollment and expenditures to ensure that expenditures do not exceed the amount of revenue in the fund, and if sufficient revenue is not available to pay estimated expenditures, institute appropriate measures to ensure fiscal solvency.
(s)Exercise all powers reasonably necessary to carry out and comply with the duties, responsibilities, and requirements of this act and the federal act.
(t)Consult with stakeholders relevant to carrying out the activities under this title, including, but not limited to, all of the following:
(1)Health care consumers who are enrolled in health plans.
(2)Individuals and entities with experience in facilitating enrollment in health plans.
(3)Representatives of small businesses and self-employed individuals.
(4)The State Medi-Cal Director.
(5)Advocates for enrolling hard-to-reach populations.
(u)Facilitate the purchase of qualified health plans in the Exchange by qualified individuals and qualified small employers no later than January 1, 2014.
(v)Report, or contract with an independent entity to report, to the Legislature by December 1, 2018, on whether to adopt the option in Section 1312(c)(3) of the federal act to merge the individual and small employer markets. In its report, the board shall provide information, based on at least two years of data from the Exchange, on the potential impact on rates paid by individuals and by small employers in a merged individual and small employer market, as compared to the rates paid by individuals and small employers if a separate individual and small employer market is maintained. A report made pursuant to this subdivision shall be submitted pursuant to Section 9795.
(w)With respect to the SHOP Program, collect premiums and administer all other necessary and related tasks, including, but not limited to, enrollment and plan payment, in order to make the offering of employee plan choice as simple as possible for qualified small employers.
(x)Require carriers participating in the Exchange to immediately notify the Exchange, under the terms and conditions established by the board when an individual is or will be enrolled in or disenrolled from any qualified health plan offered by the carrier.
(y)Ensure that the Exchange provides oral interpretation services in any language for individuals seeking coverage through the Exchange and makes available a toll-free telephone number for the hearing and speech impaired. The board shall ensure that written information made available by the Exchange is presented in a plainly worded, easily understandable format and made available in prevalent languages.
(z)This section shall become operative only if Section 4 of the act that added this section becomes inoperative pursuant to subdivision (z) of that Section 4.
SEC. 3.Sections 1 and 2 of this bill shall become operative on October 1, 2015.
SEC. 4.This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the Constitution and shall go into immediate effect. The facts constituting the necessity are:
Protecting Californians privacy rights is of the utmost importance, and in order to protect the privacy rights of individuals applying for health care coverage through the California Health Benefit Exchange at the earliest possible time, it is necessary that this act take effect immediately.
SECTION 1.Section 11344.1 of the Government Code is amended to read:11344.1.The office shall do all of the following:
(a)Provide for the publication of the California Regulatory Notice Register, which shall be an official publication of the State of California and which shall contain the following:
(1)Notices of proposed action prepared by regulatory agencies, subject to the notice requirements of this chapter, and which have been approved by the office.
(2)A summary of all regulations filed with the Secretary of State in the previous week.
(3)Summaries of all regulation decisions issued in the previous week detailing the reasons for disapproval of a regulation, the reasons for not filing an emergency regulation, and the reasons for repealing an emergency regulation. The California Regulatory Notice Register shall also include a quarterly index of regulation decisions.
(4)Material that is required to be published under Sections 11349.5, 11349.7, and 11349.9.
(5)Determinations issued pursuant to Section 11340.5.
(b)Establish the publication dates and manner and form in which the California Regulatory Notice Register shall be prepared and published and ensure that it is published and distributed in a timely manner to the presiding officer and rules committee of each house of the Legislature and to all subscribers.
(c)Post on its Internet Web site, on a weekly basis:
(1)The California Regulatory Notice Register. Each issue of the California Regulatory Notice Register on the offices Internet Web site shall remain posted for a minimum of 18 months.
(2)One or more Internet Web site links to assist the public to gain access to the text of regulations proposed by state agencies.
The office shall do all of the following:
(a)Provide for the publication of the California Regulatory Notice Register, which shall be an official publication of the State of California and which shall contain the following:
(1)Notices of proposed action prepared by regulatory agencies, subject to the notice requirements of this chapter, and which have been approved by the office.
(2)A summary of all regulations filed with the Secretary of State in the previous week.
(3)Summaries of all regulation decisions issued in the previous week detailing the reasons for disapproval of a regulation, the reasons for not filing an emergency regulation, and the reasons for repealing an emergency regulation. The California Regulatory Notice Register shall also include a quarterly index of regulation decisions.
(4)Material that is required to be published under Sections 11349.5, 11349.7, and 11349.9.
(5)Determinations issued pursuant to Section 11340.5.
(b)Establish the publication dates and manner and form in which the California Regulatory Notice Register shall be prepared and published and ensure that it is published and distributed in a timely manner to the presiding officer and rules committee of each house of the Legislature and to all subscribers.
(c)Post on its website, Internet Web site, on a weekly basis:
(1)The California Regulatory Notice Register. Each issue of the California Regulatory Notice Register on the offices website Internet Web site shall remain posted for a minimum of 18 months.
(2)One or more Internet Web site links to assist the public to gain access to the text of regulations proposed by state agencies.
|
Date
|
Status
|
|---|---|
| Jan 25, 2016 | From committee: Do pass as amended. (Ayes 7. Noes 0. Page 2934.) (January 21). |
| Aug 19, 2016 | Chaptered by Secretary of State. Chapter 146, Statutes of 2016. |
| Aug 19, 2016 | Approved by the Governor. |
| Aug 10, 2016 | Enrolled and presented to the Governor at 10 a.m. |
| Aug 4, 2016 | Read third time. Urgency clause adopted. Passed. (Ayes 77. Noes 0. Page 5718.) Ordered to the Senate. |
| Aug 4, 2016 | Read third time. Urgency clause adopted. Passed. Ordered to the Senate. |
| Aug 4, 2016 | In Senate. Ordered to engrossing and enrolling. |
| Jun 30, 2016 | Read second time. Ordered to consent calendar. |
| Jun 29, 2016 | From committee: Do pass. Ordered to consent calendar. (Ayes 18. Noes 0.) (June 29). |
| Jun 21, 2016 | From committee: Do pass and re-refer to Com. on APPR. with recommendation: To consent calendar. (Ayes 11. Noes 0.) (June 21). Re-referred to Com. on APPR. |
| Jun 15, 2016 | From committee: Do pass and re-refer to Com. on P. & C.P. with recommendation: To consent calendar. (Ayes 15. Noes 0.) (June 14). Re-referred to Com. on P. & C.P. |
| Apr 28, 2016 | Referred to Coms. on HEALTH and P. & C.P. |
| Jan 27, 2016 | Read third time. Urgency clause adopted. Passed. (Ayes 39. Noes 0. Page 2962.) Ordered to the Assembly. |
| Jan 27, 2016 | In Assembly. Read first time. Held at Desk. |
| Jan 26, 2016 | Read second time and amended. Ordered to third reading. |
| Feb 26, 2015 | Introduced. Read first time. To Com. on RLS. for assignment. To print. |
| Jan 20, 2016 | Set for hearing January 21. |
| Jan 19, 2016 | January 19 hearing: Placed on APPR. suspense file. |
| Jan 15, 2016 | Set for hearing January 19 in APPR. pending receipt. |
| Jan 15, 2016 | Read second time and amended. Re-referred to Com. on APPR. |
| Jan 14, 2016 | From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 6. Noes 0. Page 2901.) (January 13). |
| Jan 6, 2016 | Set for hearing January 13. |
| Jun 10, 2015 | June 10 set for second hearing canceled at the request of author. |
| May 14, 2015 | Set for hearing June 10. |
| Apr 30, 2015 | April 29 set for first hearing canceled at the request of author. |
| Apr 24, 2015 | Set for hearing April 29. |
| Apr 22, 2015 | Re-referred to Com. on HEALTH. |
| Apr 20, 2015 | From committee with author's amendments. Read second time and amended. Re-referred to Com. on RLS. |
| Mar 12, 2015 | Referred to Com. on RLS. |
| Feb 27, 2015 | From printer. May be acted upon on or after March 29. |
|
Date
|
Description
|
Location
|
Votes
|
|
|---|---|---|---|---|
| Aug 4, 2016 | SB 514 Anderson Consent Calendar Second Day Regular Session | Assembly Floor |
Passed |
|
| Jun 29, 2016 | Do pass. To Consent Calendar. | Assembly Standing Committee on Appropriations |
Passed |
|
| Jun 21, 2016 | Do pass and be re-referred to the Committee on [Appropriations] with recommendation: To Consent Calendar | Assembly Standing Committee on Privacy and Consumer Protection |
Passed |
|
| Jun 14, 2016 | Do pass and be re-referred to the Committee on [Privacy and Consumer Protection] with recommendation: To Consent Calendar | Assembly Standing Committee on Health |
Passed |
|
| Jan 27, 2016 | Senate 3rd Reading SB514 Anderson Urgency Clause | Senate Floor |
Passed |
|
| Jan 21, 2016 | Do pass as amended | Senate Standing Committee on Appropriations |
Passed |
|
| Jan 19, 2016 | Placed on suspense file | Senate Standing Committee on Appropriations |
Passed |
|
| Jan 13, 2016 | Do pass as amended, but first amend, and re-refer to the Committee on [Appropriations] | Senate Standing Committee on Health |
Passed |
This list shows positions taken on this bill by organizations on the date displayed, which is linked to the original source.
Positions by individuals are not included.
|
Organization
|
Position
|
Date
|
|---|---|---|
| California Association Of Health Underwriters | ** Support | Jan 27, 2016 |
| Independent Insurance Agents and Brokers of California | ** Support | Jan 27, 2016 |
Date of Hearing: June 29, 2016
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Lorena Gonzalez, Chair
SBPCA Bill Id:SB 514
Author:(Anderson) – As Amended Ver:January 26, 2016
Policy Committee: | Health | Vote: | 15 - 0 |
Privacy and Consumer Protection | 11 - 0 | ||
|
|
Urgency: Yes State Mandated Local Program: No Reimbursable: No
SUMMARY:
This bill prohibits Covered California (CoveredCA) from disclosing personal information obtained from an application for health care coverage to a certified insurance agent or certified enrollment counselor without the consent of the applicant, unless the agent or counselor is assisting the applicant.
FISCAL EFFECT:
Negligible fiscal impact. CoveredCA is currently compliant with this bill, and the bill does not appear to impact CoveredCA's business practices.
COMMENTS:
- Purpose. This bill is intended to protect consumers applying for health coverage through Covered California from being contacted by an insurance agent or certified enrollment counselor for assistance with their application without their consent. SB 514 is author-sponsored and supported by insurance industry groups.
- Background. CoveredCA is a state-run health insurance marketplace where Californians can purchase health care and enroll in health care affordability programs. In 2013, concerns were expressed about actions by CoveredCA to release identifying information to certified insurance agents about individuals with pending applications, in order to allow outreach to assist potential applicants in completing their applications for health coverage. Although CoveredCA maintained the outreach program complied with privacy laws, negative feedback from consumers about perceived privacy violations led CoveredCA to discontinue the data-sharing practice. CoveredCA currently does not share information with external agents. In the future, if the choice was made to begin such data-sharing, this bill would limit such data-sharing to circumstances in which the applicant consented to such sharing.
- Prior legislation. There were several bills addressing the disclosure of personal information by CoveredCA that failed in various Assembly committees in 2014.
AB 1602 (John A. Pérez), Chapter 655, Statutes of 2010, and SB 900 (Alquist), Chapter 659, Statutes of 2010, established CoveredCA and its powers and duties.
Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081
Date of Hearing: June 21, 2016
ASSEMBLY COMMITTEE ON PRIVACY AND CONSUMER PROTECTION
Ed Chau, Chair
SBPCA Bill Id:SB 514
Author:(Anderson) – As Amended Ver:January 26, 2016
SENATE VOTE: 39-0
SUBJECT: California Health Benefit Exchange
SUMMARY: Prohibits the California Health Benefit Exchange (Covered California), from disclosing personal information obtained from an application for health care coverage to a certified insurance agent or certified enrollment counselor without the consent of the applicant. Specifically, this bill:
- Prohibits Covered California from disclosing personal information obtained from an application for health care coverage to a certified insurance agent or certified enrollment counselor without the consent of the applicant.
- Clarifies that Covered California is not precluded from sharing the information of current enrollees or applicants with the same certified enrollment counselor or certified insurance agent of record that has already provided the applicant assistance with an existing application.
- Defines “personal information” to mean "any information that is maintained by an agency that identifies or describes an individual, including, but not limited to, his or her name, social security number, physical description, home address, home telephone number, education, financial matters, and medical or employment history. It includes statements made by, or attributed to, the individual."
- Contains an urgency clause making this bill operative on October 1, 2016.
- Makes other technical or clarifying amendments.
EXISTING LAW:
- Establishes, pursuant to the federal Patient Protection and Affordable Care Act of 2010 (ACA), protections for individuals with their health insurance coverage, standards for care by doctors and hospitals, and an expansion of health coverage. The ACA also requires every American to have health insurance coverage through individual, employer-based, or government policies, or pay a fine on their federal income tax filing. (Public Law 111-148).
- Establishes, pursuant to the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA), protections related to the privacy of individual medical information. (Public Law 104-191)
- Establishes Covered California in state government as a state-based marketplace where individuals and small businesses can purchase qualified health plans. (Government Code Section 10050)
- Places, pursuant to the Information Practices Act of 1977 (IPA), specific requirements on state agencies in the collection, use, maintenance and dissemination of information relating to individuals. The IPA permits individuals to review, obtain copies, request amendments and corrections, and dispute information pertaining to them in state records, with some exceptions. The IPA also provides civil remedies and penalties for violations which adversely affect individuals who are the subjects of state agency records. (Civil Code (CC) Section 1798, et seq.)
- Prohibits, under the California Confidentiality of Medical Information Act (CMIA), the use or disclosure of medical information for any purpose not necessary to provide health care services to the patient unless the individual authorizes it or is otherwise permitted by the CMIA. (CC 56, et seq.)
FISCAL EFFECT: According to the Senate Appropriations Committee:
- Potential one-time costs of about $300,000 to modify information technology systems by Covered California to allow applicants to indicate whether they would like assistance (special fund). The bill, as amended, does not require Covered California to develop a process for allowing an applicant to indicate whether personal information can be shared. If Covered California does develop such a system, it would incur the costs above.
- Unknown potential costs to develop the systems and procedures to pass along consumer information (upon consumer request) to certified insurance agents or enrollment counsellors (special fund). In addition to the system changes needed to allow a consumer to consent to having contact information shared with insurance agents or enrollment counsellors, Covered California will need to develop systems and procedures for taking the appropriate information and sharing it with the appropriate partners. Covered California does not yet have a plan for how that process would work, so no cost estimates are available at this time. It is likely that the costs to create those “back end” systems would be in the low hundreds of thousands. As noted above, those costs would only occur if Covered California decided to implement a system to allow the sharing of applicant information, with consumer consent.
- Potential minor costs to revise paper applications for health care coverage by the Department of Health Care Services (General Fund and federal funds). The state uses a single paper application for the Medi-Cal program and coverage through Covered California. In order to comply with the requirements of this bill, the Department would likely need to update the paper application to opt out of future contacts. The costs to do so are not expected to be significant since the Department regularly revises those forms.
COMMENTS:
- Purpose of this bill. This bill is intended to protect consumers applying for health coverage through Covered California from being contacted by an insurance agent or certified enrollment counselor for assistance with their application without their consent. SB 514 is author-sponsored.
- Author’s statement. According to the author, “the ACA has directed states to provide marketplaces, or exchanges, for consumers seeking health insurance. Covered California, the health benefit exchange in California, has provided this platform for individuals shopping for a plan. Unfortunately, due to a security loophole in the law, shoppers on the Web site have suffered a disclosure of their data to outside companies without having given their permission. This bill is an effort to close that loophole, so that consumers may shop free from fear of losing their privacy to unknown, outside entities.”
- Past concerns about consumer privacy. According to a December 2013 Los Angeles Times article, the names and contact information for tens of thousands of people who started applications with Covered California, but didn’t request that they be contacted, were released to insurance agents affiliated with four major insurance agencies that were coordinating ACA enrollment efforts. As a result, there were reports of consumers who received unsolicited offers for insurance products based on the information provided by Covered California – a situation some consumers felt was a violation of their privacy.
At the same time, some consumers also became the victims of fraudulent websites imitating Covered California in order to lure customers to purchase insurance from private insurance brokers that were not necessarily in compliance with the coverage standards required by the ACA. The California Attorney General’s office shut down at least ten such imitation sites in 2013. However, because consumer data was simultaneously being released to certified insurance agents and also being procured through fraudulent websites, it was difficult for the consumer to know whether or not an agent contacting them was legitimate.
In the same Los Angeles Times article, Covered California stated that they provided certified insurance agents with the names, addresses, phone numbers and email addresses of those with incomplete applications in an effort to help consumers complete their applications to meet the deadline to have insurance in place by January 1, 2013. According to the article, “Peter Lee, executive director of Covered California, acknowledged that these consumers did not ask to be contacted by the state or its certified insurance agents. But he said the outreach program still complies with privacy laws and it was reviewed by the exchange’s legal counsel.”
As a result of the negative feedback from consumers after this incident, Covered California stopped providing consumer contact information to external insurance agents, and it has told Committee staff that it has no plans to reinstate the program. This bill would therefore have no obvious impact on Covered California's current business practices.
- How Covered California uses personal information. According to Covered California, consumers with incomplete applications receive follow-up contacts directly from internal enrollment representatives who are not insurance agents.
According to Covered California’s privacy policy, effective June 1, 2015, the personal information it collects is strictly limited to that which is both relevant and necessary to fulfill the functions required under the ACA and applicable state law, and includes any information provided within an application for health insurance. This type of information includes Social Security number, contact information, demographic data, health or financial information and alien status. The policy does state that, “by submitting personal information to us or by using our Sites, you agree that we may collect, use and disclose any such personal information in accordance with the Privacy Policy or as permitted or required by law."
According to the policy, Covered California enrollment representatives are each required to undergo a fingerprint and background check and receive specialized training to ensure that personal information is kept confidential.
- Arguments in support. A coalition representing insurance underwriters, agents, brokers and advisors writes that “licensed health insurance agents are already mandated to comply with extensive privacy laws, undergo substantial education on handling of consumer information and ethics, plus annual continuing education in both areas. Agents are also subject to extensive background checks…”
The coalition also states that they “strongly support professional handling of private health information using the best professional practices that meet the many confidentiality requirements of federal and state law.” - Prior legislation: AB 1560 (Gorell) of 2014, would have prohibited Covered California from disclosing an individual’s personal information to third parties. Would have required Covered California to immediately notify the public of any breach of the security of personal information, regardless of severity and regardless of whether the information was actually accessed by an unauthorized person. AB 1560 was subsequently amended to address an unrelated issue.
AB 1829 (Conway) of 2014 would have prohibited Covered California from hiring or contracting with individuals who have been convicted of certain felonies or violations if the person would be facilitating enrollment or have access to financial or medical information. AB 1829 failed passage in the Assembly Health Committee.
AB 1830 (Conway) of 2014 would have prohibited Covered California from using or disclosing personal information except as necessary to carry out Covered California’s functions under the ACA and would have created a civil penalty of up to $25,000 per individual or entity, per use or disclosure. AB 1830 failed passage the Assembly Health Committee
AB 2147 (Melendez) of 2014 would have required agencies to obtain an individual’s prior written consent before releasing the individual’s personal information to an independent contractor or other worker who is not an agency employee. AB 2147 was held in the Assembly Appropriations Committee.
SB 974 (Anderson) of 2014 would have required Covered California to allow consumers to indicate whether they would like assistance from an agent or enrollment counselor, and would have prohibited Covered California from disclosing personal information if applicants indicate they do not want assistance. SB 974 was held in the Assembly Appropriations Committee.
AB 1428 (Conway), Chapter 561, Statutes of 2013, clarified criminal background check requirements for employees, contractors, and vendors who facilitate enrollment in Covered California.
SB 509 (DeSaulnier and Emmerson), Chapter 10, Statutes of 2013, required fingerprint-based background checks for all Covered California employees, contractors, volunteers, or vendors with access to enrollees’ personal information.
AB 1602 (John A. Pérez), Chapter 655, Statutes of 2010, and SB 900 (Alquist), Chapter 659, Statutes of 2010, established Covered California and its powers and duties.
- Urgency clause. This measure contains an urgency clause, meaning that passage on the Assembly Floor will require a 2/3rd vote, and would go in to effect on October 1, 2016, if signed into law.
- Double-referral This bill was double-referred to the Assembly Health Committee where it was passed on a 15-0 vote on June 14, 2016.
REGISTERED SUPPORT / OPPOSITION:
Support
California Association of Health Underwriters
Independent Insurance Agents and Brokers of California
National Association of Insurance and Financial Advisors California
Opposition
None on file.
Analysis Prepared by: Jessica Langtry & Jennie Bretschneider / P. & C.P. / (916) 319-2200
Date of Hearing: June 14, 2016
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
SBPCA Bill Id:SB 514
Author:(Anderson) – As Amended Ver:January 26, 2016
SENATE VOTE: 39-0
SUBJECT: California Health Benefit Exchange.
SUMMARY: Prohibits the California Health Benefit Exchange (the Exchange), now known as Covered California, from disclosing personal information obtained from an application for health care coverage to a certified insurance agent or Certified Enrollment Counselor (CEC) without the consent of the applicant. Defines personal information consistent with existing law. Contains an urgency clause to ensure that the provisions of this bill go into immediate effect upon enactment.
EXISTING LAW:
- Establishes the federal Patient Protection and Affordable Care Act (ACA), which enacts various health care coverage market reforms. Requires each state by January 1, 2014, to establish an Exchange that makes qualified health plans (QHPs) available to qualified individuals and qualified employers. Requires, if a state does not establish an Exchange, the federal government to administer the Exchange. Establishes requirements for the Exchange and for QHPs participating in the Exchange, and defines who is eligible to purchase coverage in the Exchange.
- Establishes Covered California within state government, as an independent public entity not affiliated with an agency or department, and requires it to compare and make available through selective contracting health insurance for individual and small business purchasers as authorized under the ACA. Specifies the powers and duties of the board governing the Exchange, and requires the board to facilitate the purchase of QHPs though the Exchange by qualified individuals and small employers.
- Authorizes under federal regulations an Exchange to only use or disclose such personally identifiable information for the purposes of determining eligibility in a QHP, for other insurance affordability programs, or for exemptions from the individual responsibility provisions, as specified, to the extent such information is necessary to carry out the functions of the exchange, as specified. For other uses which the Secretary of Health and Human Services determines are in compliance with the ACA, but are not to carry out the exchange functions, requires individual consent. To carry out other functions, requires consent and substantive and procedural requirements, as specified.
- Requires, under the ACA, an applicant for insurance coverage or for an Advanced Premium Tax Credit (APTC) or cost-sharing reduction to be required to provide only the information strictly necessary to authenticate identity, determine eligibility, and determine the amount of the APTC or reduction. Requires, under the ACA, any person who receives such information provided by an applicant to use the information only for ensuring the efficient operation of the Exchange.
- Requires, under federal regulations, each Exchange to establish and implement written privacy and security standards including: allowing individuals to access and correct their own personal information; maintaining openness and transparency of policies; ensuring data quality and integrity, and protection of personal information with reasonable safeguards; and, appropriate monitoring to detect and mitigate non-adherence and breaches.
- Requires, under federal regulations, entities such as navigators, agents, and brokers that have access to applicants’ or enrollees’ personal information in the course of performing their functions to be subject to the same privacy or security provisions that govern the Exchange.
- Creates, under the ACA, a civil penalty of not more than $25,000 per person or entity, per use or disclosure, for use or disclosure of personal information in violation of the ACA.
- Requires the Exchange to perform fingerprint-based background checks of all employees, prospective employees, contractors, subcontractors, employees of contractors, volunteers, or vendors whose duties include access to confidential, personal, or financial information, or any other information as required by federal law or guidance.
- Under the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA), provides protections for individually identifiable health information held by covered entities and their business associates and gives patients an array of rights with respect to that information. HIPAA also permits the disclosure of certain health information as needed for patient care and certain other purposes, including: public health activities; research; prevention of a serious threat to health or safety; law enforcement purposes; and, judicial and administrative proceedings. Covered entities under the HIPAA Privacy Rule are health care providers, health plans, and health care clearinghouses.
- Establishes the Information Practices Act of 1977 (IPA), which prohibits state agencies from disclosing personal information, unless the information is disclosed according to one of a specified list of provisions, such as:
- With prior voluntary written consent, not more than 30 days in advance of the disclosure, or in the time limit agreed to by the individual; or,
- To those officers, employees, attorneys, agents, or volunteers of the agency who have custody of the information, if the disclosure is relevant and necessary in the ordinary course of the performance of their official duties and is related to the purpose for which the information was acquired.
- Defines, under the IPA, “personal information” as any information that is maintained by an agency that identifies or describes an individual, including, but not limited to, his or her name, social security number, physical description, home address, home telephone number, education, financial matters, and medical or employment history. Includes statements made by, or attributed to, the individual.
FISCAL EFFECT: According to the Senate Appropriations Committee:
- Potential one-time costs of about $300,000 to modify information technology systems by Covered California to allow applicants to indicate whether they would like assistance (special fund). This bill, as amended, does not require Covered California to develop a process for allowing an applicant to indicate whether personal information can be shared. If Covered California does develop such a system, it would incur the costs above.
- Unknown potential costs to develop the systems and procedures to pass along consumer information (upon consumer request) to certified insurance agents or CECs (special fund). In addition to the system changes needed to allow a consumer to consent to having contact information shared with insurance agents or CECs, Covered California will need to develop systems and procedures for taking the appropriate information and sharing it with the appropriate partners. Covered California does not yet have a plan for how that process would work, so no cost estimates are available at this time. It is likely that the costs to create those “back end” systems would be in the low hundreds of thousands. As noted above, those costs would only occur if Covered California decided to implement a system to allow the sharing of applicant information, with consumer consent.
- Potential minor costs to revise paper applications for health care coverage by the Department of Health Care Services (DHCS) (General Fund and federal funds). The state uses a single paper application for the Medi-Cal program and coverage through Covered California. In order to comply with the requirements of this bill, DHCS would likely need to update the paper application to opt out of future contacts. The costs to do so are not expected to be significant since DHCS regularly revises those forms.
COMMENTS:
- PURPOSE OF THIS BILL. According to the author, the ACA has directed states to provide marketplaces, or Exchanges, for consumers seeking health insurance. Covered California has provided this platform for individuals shopping for a health plan. Unfortunately, due to a security loophole in the law, shoppers on the Website have suffered a disclosure of their data to outside companies without having given their permission. The author states that this bill is an effort to close that loophole, so that consumers may shop free from fear of losing their privacy to unknown, outside entities.
- BACKGROUND.
- ACA. To expand health insurance coverage and make health care more accessible and affordable, the U.S. Congress enacted the ACA in March 2010. California enacted legislation creating a state-operated Exchange, one of the provisions of the ACA. The Exchange is a competitive insurance marketplace in which eligible individuals and small businesses have been able to purchase QHPs since October 2013.
- Covered California.
- Enrollment. According to Covered California, an estimated 5.3 million uninsured Californians are eligible for coverage through the Covered California marketplace. Of that total, 2.6 million qualify for federal subsidies only available through the Covered California marketplace, and 2.7 million who may or may not qualify for subsidies but will benefit from guaranteed coverage whether or not they enroll through the marketplace. The Enrollment Assistance Program (EAP) is critical in providing in-person help to consumers purchasing Covered California health plans. The EAP is comprised of enrollment counselors and enrollment entities. Certified Enrollment Entities (CEEs) are entities and organizations that are eligible to be trained and registered to provide in-person assistance to consumers and help them apply for Covered California health plans. The role of a CEE is to conduct public education activities to raise awareness about the availability of Covered California health plans. CEEs will distribute fair and impartial information concerning enrollment into QHPs as well as facilitate enrollment into QHPs available through Covered California. CEE must provide information that is culturally and linguistically appropriate. In order to be a CEE, organizations must demonstrate to Covered California that they have existing relationships, or could easily establish relationships, with consumers or self-employed individuals likely to be eligible for enrollment in a Covered California health plan. Organizations must also meet any licensing, certification, or other standards prescribed by the state or Exchange. Certified Enrollment Counselors (CECs) are trained individuals who are available to provide in-person counseling and assistance to consumers in need of help with applying for Covered California programs. CEEs will provide assistance in culturally and linguistic appropriate manners to consumers throughout California.
- CalHEERS. The California Health Eligibility Enrollment and Retention System (CalHEERS) is the computer system behind the Exchange and is sponsored by Covered California and DHCS. It is a computer program that allows prospective consumers to enter their personal and income data and receive information about plans they are eligible for and what they cost. It also determines preliminary eligibility for APTCs, Modified Adjusted Gross Income (MAGI) Medi-Cal, and Non-MAGI Medi-Cal. According to the chief of the CalHEERS project management office, consumers can either complete the application process themselves or seek assistance from certified enrollment representatives, such as insurance agents; Covered California’s service center representatives; or county eligibility workers. Once eligibility is determined, consumers can shop and enroll in QHPs or be electronically transferred for assistance to their local county office for confirmation of eligibility and enrollment in Medi-Cal. CalHEERS consists of three major system components that provide eligibility determination, enrollment functionality, and financial accounting in conjunction with other entities that interface, or communicate, with CalHEERS. According to the CalHEERS project management office, these entities include the Centers for Medicare and Medicaid Services, the Internal Revenue Service, and the California Employment Development Department.
- Covered California’s Privacy Policy. Covered California’s Privacy Policy (Policy) states that Covered California strictly limits personal information it collects to that which is both relevant and necessary to fulfill the functions required of them under the ACA and applicable California state law. Additionally, Covered California may exchange personal information with other government agencies to determine eligibility for premium assistance or other insurance affordability programs. For example, Covered California may share personal information with the Internal Revenue Service to determine eligibility for APTCs or with DHCS to determine Medi-Cal eligibility. The Policy also states that Covered California may share personal information for the purpose of enrolling an individual into either a health plan or Medi-Cal by sharing it with other government agencies or CECs. Covered California enrollment representatives are required to undergo a fingerprint and background check and receive specialized training to ensure personal information is kept confidential. Furthermore, Covered California may share personal information to the extent it is necessary to comply with federal or state law or to fulfill an Exchange function as required by the ACA. For example, Covered California may share personal information with the U.S. Department of Health and Human Services, which oversees state-based exchanges, to ensure Covered California’s compliance with federal privacy laws.
- PREVIOUS LEGISLATION.
- SB 974 (Anderson) of 2014 would have required Covered California to allow consumers to indicate whether they would like assistance from an agent or enrollment counselor, and prohibit Covered California from disclosing personal information if applicants indicate they do not want assistance. SB 974 was held in the Assembly Appropriations Committee.
- AB 1560 (Gorell) of 2014, would have prohibited Covered California from disclosing an individual’s personal information to third parties. Would have required the Exchange to immediately notify the public of any breach of the security of personal information, regardless of severity and regardless of whether the information was actually accessed by an unauthorized person. AB 1560 was referred to this Committee but was not heard, at the request of the author.
- AB 1428 (Conway), Chapter 561, Statutes of 2013, clarifies criminal background check requirements for employees, contractors, and vendors who facilitate enrollment in the Exchange.
- AB 1829 (Conway) of 2014 would have prohibited the Exchange from hiring or contracting with individuals who have been convicted of certain felonies or violations if the person would be facilitating enrollment or have access to financial or medical information. AB 1829 failed passage in this Committee.
- AB 1830 (Conway) of 2014 would have prohibited the Exchange from using or disclosing personal information except as necessary to carry out the Exchange’s functions under the ACA and creates a civil penalty of up to $25,000 per individual or entity, per use or disclosure. AB 1830 failed passage in this Committee.
- AB 2147 (Melendez) of 2014 would have required agencies to obtain an individual’s prior written voluntary consent before releasing the individual’s personal information to an independent contractor or other worker who is not an agency employee. AB 2147 was held on the Suspense File in the Assembly Appropriations Committee.
- SB 509 (DeSaulnier and Emmerson), Chapter 10, Statutes of 2013, requires fingerprint-based background checks for all Exchange employees, contractors, volunteers, or vendors with access to enrollees’ personal information.
- AB 1602 (John A. Pérez), Chapter 655, Statutes of 2010, and SB 900 (Alquist), Chapter 659, Statutes of 2010, establish the Exchange and its powers and duties.
- AB 1296 (Bonilla), Chapter 641, Statutes of 2011, enacts the Health Care Reform Eligibility, Enrollment, and Retention Planning Act (Act), which would require the California Health and Human Services Agency (CHHSA), in consultation with specified entities, to establish standardized single, accessible application forms and related renewal procedures for state health subsidy programs, as defined, in accordance with specified requirements. AB 1296 specifies the duties of the CHHSA and DHCS under the Act, and requires CHHSA to provide specified information to the Legislature by July 1, 2012, regarding policy changes needed to implement the Act.
- DOUBLE REFERRAL. This bill is double referred; upon passage in this Committee, this bill will be referred to the Assembly Privacy and Consumer Protection Committee.
REGISTERED SUPPORT / OPPOSITION:
Support
None on file.
Opposition
None on file.
Analysis Prepared by: Kristene Mapile / HEALTH / (916) 319-2097
Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | SB 514 |
THIRD READING
Bill No: SB 514
Amended: 1/26/16
SENATE HEALTH COMMITTEE: 6-0, 1/13/16
AYES: Hernandez, Nguyen, Monning, Nielsen, Roth, Wolk
NO VOTE RECORDED: Hall, Mitchell, Pan
SENATE APPROPRIATIONS COMMITTEE: 7-0, 1/21/16
AYES: Lara, Bates, Beall, Hill, Leyva, Mendoza, Nielsen
SUBJECT: California Health Benefit Exchange
DIGEST: This bill prohibits the California Health Benefit Exchange, known as Covered California, from disclosing personal information obtained from an application for health care coverage to a certified insurance agent or certified enrollment counselor without the consent of the applicant. Contains an urgency clause that will make this bill effective upon enactment and operative on October 1, 2016.
Existing law:
- Establishes Covered California in state government as a state-based marketplace where individuals and small businesses can purchase qualified health plans.
- Establishes the Information Practices Act of 1977 (IPA), which prohibits state agencies from disclosing personal information unless the information is disclosed according to one of a specified list of provisions, such as:
- With prior voluntary written consent, not more than 30 days in advance of the disclosure, or in the time limit agreed to by the individual; or,
- To those officers, employees, attorneys, agents, or volunteers of the agency that has custody of the information if the disclosure is relevant and necessary in the ordinary course of the performance of their official duties and is related to the purpose for which the information was acquired.
- Defines, under the IPA, “personal information” as any information that is maintained by an agency that identifies or describes an individual, including, but not limited to, his or her name, social security number, physical description, home address, home telephone number, education, financial matters, and medical or employment history.
- Establishes, under the federal Affordable Care Act (ACA), the procedures for determining eligibility requirements for participation in an exchange, premium tax credits, cost sharing reductions, and the individual responsibility exemption.
- Requires, under the ACA, any person who receives information provided by an applicant for insurance coverage to use the information only for the purposes of, and to the extent necessary in, ensuring the efficient operation of the exchange, including verifying eligibility of an individual to enroll through an exchange or to claim a premium tax credit or cost sharing reduction or the amount of the credit or reduction, and not disclose the information to any other person except as provided.
- Authorizes under federal regulations an exchange to only use or disclose such personally identifiable information for the purposes of determining eligibility in a qualified health plan, for other insurance affordability programs, or for exemptions from the individual responsibility provisions, as specified, to the extent such information is necessary to carry out the functions of the exchange, as specified. For other uses which the Secretary of Health and Human Services determines are in compliance with the ACA but are not to carry out the exchange functions, requires individual consent. To carry out other functions, requires consent and substantive and procedural requirements, as specified.
This bill:
- Prohibits Covered California from disclosing personal information, as defined in existing law, obtained from an application for health care coverage to a certified insurance agent or certified enrollment counselor without the consent of the applicant.
- Defines personal information as the same meaning set forth in the IPA.
- Contains an urgency clause that will make this bill effective upon enactment, however, establishes October 1, 2016, as the operative date of this bill’s provisions.
Comments
- Author’s statement. According to the author, the ACA has directed states to provide marketplaces, or exchanges, for consumers seeking health insurance. Covered California, the health benefit exchange in California, has provided this platform for individuals shopping for a plan. Unfortunately, due to a security loophole in the law, shoppers on the Web site have suffered a disclosure of their data to outside companies without having given their permission. This bill is an effort to close that loophole, so that consumers may shop free from fear of losing their privacy to unknown, outside entities.
- Covered California Launch. Covered California opened for enrollment October 1, 2013. While the California launch was a success, it was not without issues. Many found the overall enrollment process difficult to complete. Covered California identified challenges and opportunities for improvement. Due to technical system issues, Covered California allowed people who started applications to complete those applications until April 15th. According to Covered California, to follow-up on applications started to ensure coverage effective January 1, 2014, Covered California enlisted the help of roughly 2,100 of its Certified Insurance Agent subcontractors to offer additional assistance to roughly 41,000 households. The basic contact information (name, telephone number, etc.) was securely transmitted to Certified Insurance Agents by General Agent partners, with instructions to quickly touch as many of these consumers as possible to ensure that they were offered additional assistance to complete their enrollments. Consumer information was carefully protected: each Certified Insurance Agent who participated in the program was given only a small batch of “leads” at a time, according to their capacity to reach consumers, and results were reported back to the General Agents. The program was put on hold when some consumers were surprised to be contacted by someone they did not realize was calling on behalf of Covered California.
- Covered California Privacy Practices. Covered California Notice of Privacy Practices, Use and Disclosure explain that Covered California may use and disclose a consumer’s personal information with contractors to help with enrollment and contact the consumer when necessary. Additionally, all contractors with whom Covered California shares information for these purposes undergo a fingerprint and background check, receive specialized training on keeping information confidential, and must sign confidentiality agreements that require contractors to follow the safeguards applicable to Covered California and prohibit the use of the information for any purposes outside the scope of the contract.
According to Covered California, both the paper and online application include disclosures about Covered California’s privacy policy and require the consumer to agree that they are aware of those privacy policies and practices, which is required under the IPA and the ACA. On the paper application, the privacy policy is described immediately above the “rights and responsibilities” section of the application, and is referenced in the declaration and signature which are submitted under penalty of perjury. Specifically, the paper application states, “We will share your information with other state, federal and local agencies, contractors, health plans, and programs only to enroll you in a plan or program or to administer programs, and with other state and federal agencies as required by law.” For the Web-based application, in order to initially set up an online application a user is first presented with two separate links: one for Covered California’s Terms and Conditions, and the other to Covered California’s privacy policy. In order to continue, a consumer must actively consent by clicking a box to agree to the Terms of Conditions and the privacy policy. The privacy policy discloses that Covered California maintains administrative, physical, technical, electronic and procedural safeguards to protect the confidentiality and security of the personal information. It allows links to additional information about how data is collected online and used, and how to request restrictions on the use and disclosure of information, among other information.
- California Healthcare Eligibility, Enrollment and Retention System (CalHEERS). CalHEERS is a web-based system that streamlines the eligibility and enrollment process for all products and programs available through Covered California. Covered California has a CalHEERS change request with the title, “Consumer Consent to Share Personally Identifiable Information with Covered California Certified Representative.” According to the document, Covered California needs to obtain more explicit consumer consent before it shares any personally identifiable information (namely, contact information) to any of its certified representatives. The goal of this change request is to implement a business policy that allows consumers the opportunity to opt in or out of having their information shared for program purposes. The background associated with this change request indicates that most consumers appreciated the help from certified representatives but a few consumers were surprised that they were being contacted by an agent since they had not delegated their application. According to the document, while this use of consumer information was legally authorized, Covered California wants to make sure consumers always have a clear expectation about how their information may be shared. If the change request is implemented there will be two boxes for consumers to consent to Covered California’s privacy policies and information sharing practices. The first for the consumer to agree to the privacy policy and the second to agree to have information shared with the certified representative for follow-up assistance. Consumer advocates have requested that this change allow for an opt-in not an opt-out of having their information shared.
According to Covered California, the change request is under consideration for their next batch of changes, to be implemented in September 2016. Currently, that batch still needs to be prioritized. The prioritization process is under way and will be finalized around April. Covered California has been looking at ways that express consumer consent without changing the application. Covered California is considering options that might be more cost-effective and have the added benefit of being a system that can actively check in with consumers, even existing ones who may not be coming back to the application any time soon to update their preferences.
Prior legislation. SB 974 (Anderson, 2014) would have required Covered California to allow consumers to indicate whether they would like assistance from an agent or enrollment counselor, and prohibit Covered California from disclosing personal information if applicants indicate they do not want assistance. SB 974 was held in the Assembly Appropriations Committee.
FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No
According to the Senate Appropriations Committee:
- Potential one-time costs of about $300,000 to modify information technology systems by Covered California to allow applicants to indicate whether they would like assistance (special fund). This bill, as amended, does not require Covered California to develop a process for allowing an applicant to indicate whether personal information can be shared. If Covered California does develop such a system, it would incur the costs above.
- Unknown potential costs to develop the systems and procedures to pass along consumer information (upon consumer request) to certified insurance agents or enrollment counselors (special fund). In addition to the system changes needed to allow a consumer to consent to having contact information shared with insurance agents or enrollment counselors, Covered California will need to develop systems and procedures for taking the appropriate information and sharing it with the appropriate partners. Covered California does not yet have a plan for how that process would work, so no cost estimates are available at this time. It is likely that the costs to create those “back end” systems would be in the low hundreds of thousands. As noted above, those costs would only occur if Covered California decided to implement a system to allow the sharing of applicant information, with consumer consent.
- Potential minor costs to revise paper applications for health care coverage by the Department of Health Care Services (DHCS) (General Fund and federal funds). The state uses a single paper application for the Medi-Cal program and coverage through Covered California. In order to comply with the requirements of this bill, DHCS would likely need to update the paper application to opt out of future contacts. The costs to do so are not expected to be significant since the Department regularly revises those forms.
California Association of Health Underwriters
Independent Insurance Agents and Brokers of California
National Association of Insurance and Financial Advisors of California
OPPOSITION: (Verified 1/22/16)
None received
ARGUMENTS IN SUPPORT: According to the California Association of Health Underwriters, the National Association of Insurance and Financial Advisors of California, and the Independent Insurance Agents and Brokers of California licensed health insurance agents are already mandated to comply with extensive privacy laws, undergo substantial education on handling of consumer information and ethics, plus annual continuing education. These proponents support this bill because it provides a simple, tailored approach to permit individuals needing assistance in the Covered California enrollment process to affirmatively indicate they need additional help with their applications.
Prepared by: Teri Boughton / HEALTH /
1/26/16 16:39:30
**** END ****
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
SB 514 (Anderson) - California Health Benefit Exchange
Version: January 15, 2016 | Policy Vote: HEALTH 6-0 |
Urgency: Yes | Mandate: No |
Hearing Date: January 21, 2016 | Consultant: Brendan McCarthy |
*********** ANALYSIS ADDENDUM – SUSPENSE FILE ***********
The following information is revised to reflect amendments
adopted by the committee on January 21, 2016
Bill Summary:
SB 514 would prohibit the California Health Benefit Exchange (Covered California) from sharing personal information from an applicant for health care coverage with a certified insurance agent or certified enrollment counsellor without the consent of the applicant.
Fiscal Impact:
- Potential one-time costs of about $300,000 to modify information technology systems by Covered California to allow applicants to indicate whether they would like assistance (special fund). The bill, as amended, does not require Covered California to develop a process for allowing an applicant to indicate whether personal information can be shared. If Covered California does develop such a system, it would incur the costs above.
- Unknown potential costs to develop the systems and procedures to pass along consumer information (upon consumer request) to certified insurance agents or enrollment counsellors (special fund). In addition to the system changes needed to allow a consumer to consent to having contact information shared with insurance agents or enrollment counsellors, Covered California will need to develop systems and procedures for taking the appropriate information and sharing it with the appropriate partners. Covered California does not yet have a plan for how that process would work, so no cost estimates are available at this time. It is likely that the costs to create those “back end” systems would be in the low hundreds of thousands. As noted above, those costs would only occur if Covered California decided to implement a system to allow the sharing of applicant information, with consumer consent.
- Potential minor costs to revise paper applications for health care coverage by the Department of Health Care Services (General Fund and federal funds). The state uses a single paper application for the Medi-Cal program and coverage through Covered California. In order to comply with the requirements of this bill, the Department would likely need to update the paper application to opt out of future contacts. The costs to do so are not expected to be significant since the Department regularly revises those forms.
Committee Amendments:
Eliminate the requirement that Covered California allow an applicant to indicate whether or not the applicant would like his or her personal information shared with a certified insurance agent or enrollment counsellor. (The bill would continue to prohibit such information sharing without the consent of an applicant.)
-- END --
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
SB 514 (Anderson) - California Health Benefit Exchange
Version: April 20, 2015 | Policy Vote: Health X - XX |
Urgency: Yes | Mandate: No |
Hearing Date: January 19, 2016 | Consultant: Brendan McCarthy |
This bill meets the criteria for referral to the Suspense File.
Bill Summary:
SB 514 would require the California Health Benefit Exchange (Covered California) to allow an applicant to indicate whether he or she would like assistance in completing the application from a certified insurance agent or enrollment counselor. If an applicant opts not to receive assistance, the bill would prohibit Covered California from sharing the applicant’s personal information with a certified insurance agent or certified enrollment counselor.
Fiscal Impact:
- One-time costs of about $300,000 to modify information technology systems by Covered California to allow applicants to indicate whether they would like assistance (special fund).
- Unknown costs to develop the systems and procedures to pass along consumer information (upon consumer request) to certified insurance agents or enrollment counsellors (special fund). In addition to the system changes needed to allow a consumer to consent to having contact information shared with insurance agents or enrollment counsellors, Covered California will need to develop systems and procedures for taking the appropriate information and sharing it with the appropriate partners. Covered California does not yet have a plan for how that process would work, so no cost estimates are available at this time. It is likely that the costs to create those “back end” systems would be in the low hundreds of thousands.
- Potential minor costs to revise paper applications for health care coverage by the Department of Health Care Services (General Fund and federal funds). The state uses a single paper application for the Medi-Cal program and coverage through Covered California. In order to comply with the requirements of this bill, the Department would likely need to update the paper application to opt out of future contacts. The costs to do so are not expected to be significant since the Department regularly revises those forms.
Background:
Under the federal Affordable Care Act, states are required to establish American Health Benefit Exchanges. If a state does not create an Exchange, the federal government will do so. Within the Exchanges, individuals are able to purchase health care coverage with standardized benefit packages and actuarial values. In addition, individuals with incomes between 100 percent and 400 percent of the federal poverty level are eligible for subsidies for coverage purchased in the Exchanges.
California has established its own California Health Benefit Exchange (referred to as “Covered California”). In order to establish eligibility for subsidies, Covered California operates call centers, contracts with counties, and utilizes certified insurance agents and certified enrollment counsellors to help consumers navigate the eligibility and enrollment process.
Federal guidance requires state-run Exchanges to screen employees, vendors, volunteers, and anyone who will have access to sensitive medical or financial information for previous criminal convictions or arrests.
In general, consumers can select health care coverage through Covered California during open enrollment periods. (Open enrollment periods apply to qualifying health plans sold through Covered California and on the individual market. Individuals may apply for, and if eligible, gain coverage through the state’s Medi-Cal program year-round). The next open enrollment period in Covered California begins on October 1, 2014.
During the 2013 open enrollment period, Covered California shared applicant contact information (such as a name, phone number, and email address) for about 40,000 applicants who had not completed their application with certified insurance agents or enrollment counsellors. Covered California implemented this policy to utilize insurance brokers and enrollment counsellors to contact potential enrollees to assist the enrollees with completing the enrollment process. After receiving complaints from consumers who were contacted by certified insurance agents, Covered California put this information sharing program on hold and has not used it in the following open enrollment periods.
Currently, Covered California is considering a change to its information technology system (CalHEERS) to allow consumers to consent to having their contact information shared with certified insurance agents or enrollment counsellors. It is important to note that this change is one of many system changes that must be made to CalHEERS to facilitate application and enrollment into Covered California and/or Medi-Cal coverage.
Proposed Law:
SB 514 would require the California Health Benefit Exchange (Covered California) to allow an applicant to indicate whether he or she would like assistance in completing the application from a certified insurance agent or enrollment counselor. Covered California would have to implement this change by September 30, 2016. If an applicant opts not to receive assistance, the bill would prohibit Covered California from sharing the applicant’s personal information with a certified insurance agent or certified enrollment counselor.
This bill is an urgency measure.
Related Legislation:
- SB 974 (Anderson, 2014) was substantially similar to this bill. That bill was held in the Assembly Appropriations Committee.
- AB 1560 (Gorell, 2014) was substantially similar to this bill. That bill failed passage in the Assembly Health Committee.
Staff Comments:
As noted above, there are a large number of system changes that must be made to the CalHEERS system to allow for the accurate assessment of eligibility for enrollment into either coverage through Covered California or Medi-Cal. The bill’s requirement that this specific change be made by September 30, 2016 may result in other system changes being delayed. Covered California and the Department of Health Care Services are planning to develop a priority list by April 2016 for system changes to be made in the Fall of 2016.
-- END --
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 514
AUTHOR: | Anderson | ||
VERSION: | April 20, 2015 | ||
HEARING DATE: | January 16, 2016 | ||
CONSULTANT: | Teri Boughton | ||
SUBJECT: California Health Benefit Exchange
SUMMARY:
- Requires the California Health Benefit Exchange, known as Covered California, to allow an applicant to indicate in an application for health care coverage whether or not the applicant would like assistance with completing the application from a Covered California certified insurance agent or certified enrollment counselor and prohibits the release of personally identifiable information without permission. Contains an urgency clause that will make this bill effective upon enactment.
Existing law:
- Establishes the Covered California in state government as a state-based marketplace where individuals and small businesses can purchase qualified health plans.
- Establishes the Information Practices Act of 1977 (IPA), which prohibits every state office, officer, department, division, bureau, board, commission or other state agency from disclosing personal information unless the information is disclosed according to one of a specified list of provisions, such as:
- With prior voluntary written consent, not more than 30 days in advance of the disclosure, or in the time limit agreed to by the individual; or,
- To those officers, employees, attorneys, agents, or volunteers of the agency that has custody of the information if the disclosure is relevant and necessary in the ordinary course of the performance of their official duties and is related to the purpose for which the information was acquired.
- Defines, under the IPA, “personal information” as any information that is maintained by an agency that identifies or describes an individual, including, but not limited to, his or her name, social security number, physical description, home address, home telephone number, education, financial matters, and medical or employment history.
- Makes, under the IPA, any person who willfully requests or obtains any record containing personal information from an agency under false pretenses guilty of a misdemeanor and fined not more than $5,000, or imprisoned not more than one year, or both, and also under the IPA subject to civil action for invasion of privacy, in addition to any special or general damages awarded, awarded a minimum of $2,500 in exemplary damages as well as attorney’s fees and other litigation costs reasonably incurred in the suit.
- Establishes, under federal law, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which among various provisions, mandates industry-wide standards for health care information on electronic billing and other processes; and, requires the protection and confidential handling of protected health information.
- Establishes, under the federal Affordable Care Act, (ACA), the procedures for determining eligibility requirements for participation in an exchange, premium tax credits, cost sharing reductions, and the individual responsibility exemption. Requires an applicant for coverage or for a premium tax credit or cost sharing reduction to be required to provide only the information strictly necessary to authenticate identity, determine eligibility, and determine the amount of the credit or reduction.
- Requires under the ACA any person who receives information provided by an applicant for insurance coverage to use the information only for the purposes of, and to the extent necessary in, ensuring the efficient operation of the exchange, including verifying eligibility of an individual to enroll through an exchange or to claim a premium tax credit or cost sharing reduction or the amount of the credit or reduction, and not disclose the information to any other person except as provided.
- Authorizes under federal regulations an exchange to only use or disclose such personally identifiable information for the purposes of determining eligibility in a qualified health plan, for other insurance affordability programs, or for exemptions from the individual responsibility provisions, as specified, to the extent such information is necessary to carry out the functions of the exchange, as specified. For other uses which the Secretary of Health and Human Services (HHS) determines are in compliance with the ACA but are not to carry out the exchange functions, requires individual consent. To carry out other functions, requires consent and substantive and procedural requirements, as specified.
This bill:
- Requires Covered California to allow an applicant to indicate in an application for health care coverage whether or not the applicant would like assistance with completing the application from a Covered California certified insurance agent or certified enrollment counselor.
- Prohibits Covered California from disclosing any personal information, as defined in existing law, that was obtained from the application for health care coverage to a certified insurance agent or certified enrollment counselor until Covered California has complied with 1) above.
- Prohibits Covered California from disclosing any personal information, as defined in existing law that was obtained from the application for health care coverage to a certified insurance agent or certified enrollment counselor if the applicant indicates that the applicant does not want assistance from a Covered California certified insurance agent or certified enrollment counselor.
- Permits Covered California to share the information of current enrollees or applicants with the same certified enrollment counselor or certified insurance agent of record that provided the applicant assistance with an existing application, or their successor or authorized staff, as otherwise permitted by federal and state laws and regulations.
- Contains an urgency clause that will make this bill effective upon enactment.
FISCAL EFFECT:
This bill has not been analyzed by a fiscal committee.
COMMENTS:
- Author’s statement. According to the author, the ACA has directed states to provide marketplaces, or exchanges, for consumers seeking health insurance. Covered California, the health benefit exchange in California, has provided this platform for individuals shopping for a plan. Unfortunately, due to a security loophole in the law, shoppers on the website have suffered a disclosure of their data to outside companies without having given their permission. This bill is an effort to close that loophole, so that consumers may shop free from fear of losing their privacy to unknown, outside entities.
- Covered California Launch. Covered California opened for enrollment October 1, 2013. While the California launch was a success, it was not without issues. Many found the overall enrollment process difficult to complete. Covered California identified challenges and opportunities for improvement. Due to technical system issues, Covered California allowed people who started applications to complete those applications until April 15th. According to Covered California, to follow-up on applications started to ensure coverage effective January 1, 2014, Covered California enlisted the help of roughly 2,100 of its Certified Insurance Agent subcontractors to offer additional assistance to roughly 41,000 households. The basic contact information (name, telephone number, etc.) was securely transmitted to Certified Insurance Agents by General Agent partners, with instructions to quickly touch as many of these consumers as possible to ensure that they were offered additional assistance to complete their enrollments. Consumer information was carefully protected: each Certified Insurance Agent who participated in the program was given only a small batch of “leads” at a time, according to their capacity to reach consumers, and results were reported back to the General Agents. The program was put on hold when some consumers were surprised to be contacted by someone they did not realize was calling on behalf of Covered California.
- Covered California Privacy Practices. Covered California Notice of Privacy Practices, Use and Disclosure explain that Covered California may use and disclose a consumer’s personal information with contractors to help with enrollment and contact the consumer when necessary. Additionally, all contractors with whom Covered California shares information for these purposes undergo a fingerprint and background check, receive specialized training on keeping information confidential, and must sign confidentiality agreements that require contractors to follow the safeguards applicable to Covered California and prohibit the use of the information for any purposes outside the scope of the contract.
According to Covered California, both the paper and online application include disclosures about Covered California’s privacy policy and require the consumer to agree that they are aware of those privacy policies and practices, which is required under the IPA and the ACA. On the paper application, the privacy policy is described immediately above the “rights and responsibilities” section of the application, and is referenced in the declaration and signature which are submitted under penalty of perjury. Specifically, the paper application states, “We will share your information with other state, federal and local agencies, contractors, health plans, and programs only to enroll you in a plan or program or to administer programs, and with other state and federal agencies as required by law.” For the web-based application, in order to initially set up an online application a user is first presented with two separate links: one for Covered California’s Terms and Conditions, and the other to Covered California’s privacy policy. In order to continue, a consumer must actively consent by clicking a box to agree to the Terms of Conditions and the privacy policy. The privacy policy discloses that Covered California maintains administrative, physical, technical, electronic and procedural safeguards to protect the confidentiality and security of the personal information. It allows links to additional information about how data is collected online and used, and how to request restrictions on the use and disclosure of information, among other information. - California Healthcare Eligibility, Enrollment and Retention System (CalHEERS). CalHEERS is a web-based system that streamlines the eligibility and enrollment process for all products and programs available through Covered California. Covered California has a CalHEERS change request with the title, “Consumer Consent to Share Personally Identifiable Information with Covered California Certified Representative.” According to the document, Covered California needs to obtain more explicit consumer consent before it shares any personally identifiable information (namely, contact information) to any of its certified representatives. The goal of this change request is to implement a business policy that allows consumers the opportunity to opt in or out of having their information shared for program purposes. The background associated with this change request indicates that most consumers appreciated the help from certified representatives but a few consumers were surprised that they were being contacted by an agent since they had not delegated their application. According to the document, while this use of consumer information was legally authorized, Covered California wants to make sure consumers always have a clear expectation about how their information may be shared. If the change request is implemented there will be two boxes for consumers to consent to Covered California’s privacy policies and information sharing practices. The first for the consumer to agree to the privacy policy and the second to agree to have information shared with the certified representative for follow-up assistance. Consumer advocates have requested that this change allow for an opt-in not an opt-out of having their information shared.
According to Covered California, the change request is under consideration for their next batch of changes, to be implemented in September 2016. Currently, that batch still needs to be prioritized. The prioritization process is under way and will be finalized around April. Additionally, Covered California has determined that changing the application as called for in this bill is a costly, time-intensive process. As such, Covered California has been looking at ways that express consumer consent without changing the application. Covered California is considering options that might be more cost-effective and have the added benefit of being a system that can actively check in with consumers, even existing ones who may not be coming back to the application any time soon to update their preferences. Covered California indicates that if this bill were to become effective as is they would be strictly limited to amending the application as indicated in this bill. Furthermore, Covered California indicates that this bill is duplicative of federal requirements and actually less rigorous, as a check box would not be sufficient consent as required by federal requirements.
- Prior legislation. SB 974 (Anderson of 2014), would have required Covered California to allow consumers to indicate whether they would like assistance from an agent or enrollment counselor, and prohibit Covered California from disclosing personal information if applicants indicate they do not want assistance. SB 974 was held in the Assembly Appropriations Committee.
AB 1560 (Gorell of 2014), would have prohibited Covered California from disclosing an individual’s personal information, as defined, to third parties for the purpose of determining eligibility for, or enrolling the individual in, health care coverage unless, prior to the disclosure, and would have required Covered California to immediately notify the public of any breach of the security of personal information created, collected, or maintained by Covered California, regardless of the severity of the breach and regardless of whether personal information was acquired by an unauthorized person during the breach. AB 1560 failed passage in the Assembly Health Committee.
SB 900 (Alquist, Chapter 659, Statutes of 2010), and AB 1602 (Perez, Chapter 655, Statutes of 2010), established the California Health Benefit Exchange.
- Support. According to the California Association of Health Underwriters, the National Association of Insurance and Financial Advisors of California, and the Independent Insurance Agents and Brokers of California indicate that licensed health insurance agents are already mandated to comply with extensive privacy laws, undergo substantial education on handling of consumer information and ethics, plus annual continuing education. These proponents support this bill because it provides a simple, tailored approach to permit individuals needing assistance in the Covered California enrollment process to affirmatively indicate they need additional help with their applications.
- Policy Comment. The author and Committee may wish to keep the pressure on Covered California to maintain as a priority a technological solution which allows an applicant or renewing enrollee to consent to sharing information with contractors to assist with enrollment and eligibility assistance, but may not want to limit Covered California’s ability to develop a solution that is cost-effective and more beneficial to enrollees. If this is the case, amendments may be needed to provide Covered California some flexibility in developing the specific solution to the identified problem. Amendments could also include a timeline for implementation.
SUPPORT AND OPPOSITION:
Support: California Association of Health Underwriters
Independent Insurance Agents and Brokers of California
National Association of Insurance and Financial Advisors of California
Oppose: None received
-- END --
SB 514 (Anderson) Page 5 of 5
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 514
AUTHOR: |
Anderson |
||
VERSION: |
April 20, 2015 |
||
HEARING DATE: |
June 10, 2015 |
|
|
CONSULTANT: |
Teri Boughton |
||
SUBJECT: California Health Benefit Exchange
SUMMARY:
Requires the California Health Benefit Exchange, known as Covered California, to allow an applicant to indicate in an application for health care coverage whether or not the applicant would like assistance with completing the application from a Covered California certified insurance agent or certified enrollment counselor and prohibits the release of personally identifiable information without permission. Contains an urgency clause that will make this bill effective upon enactment.
Existing law:
Establishes the Covered California in state government as a state-based marketplace where individuals and small businesses can purchase qualified health plans.
Establishes the Information Practices Act of 1977 (IPA), which prohibits every state office, officer, department, division, bureau, board, commission or other state agency from disclosing personal information unless the information is disclosed according to one of a specified list of provisions, such as:
With prior voluntary written consent, not more than 30 days in advance of the disclosure, or in the time limit agreed to by the individual; or,
To those officers, employees, attorneys, agents, or volunteers of the agency that has custody of the information if the disclosure is relevant and necessary in the ordinary course of the performance of their official duties and is related to the purpose for which the information was acquired.
Defines, under the IPA, “personal information” as any information that is maintained by an agency that identifies or describes an individual, including, but not limited to, his or her name, social security number, physical description, home address, home telephone number, education, financial matters, and medical or employment history.
Makes, under the IPA, any person who willfully requests or obtains any record containing personal information from an agency under false pretenses guilty of a misdemeanor and fined not more than $5,000, or imprisoned not more than one year, or both, and also under the IPA subject to civil action for invasion of privacy, in addition to any special or general damages awarded, awarded a minimum of $2,500 in exemplary damages as well as attorney’s fees and other litigation costs reasonably incurred in the suit.
Establishes, under federal law, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which among various provisions, mandates industry-wide standards for health care information on electronic billing and other processes; and, requires the protection and confidential handling of protected health information.
Establishes, under the federal Affordable Care Act, (ACA), the procedures for determining eligibility requirements for participation in an exchange, premium tax credits, cost sharing reductions, and the individual responsibility exemption. Requires an applicant for coverage or for a premium tax credit or cost sharing reduction to be required to provide only the information strictly necessary to authenticate identity, determine eligibility, and determine the amount of the credit or reduction.
Requires under the ACA any person who receives information provided by an applicant for insurance coverage to use the information only for the purposes of, and to the extent necessary in, ensuring the efficient operation of the exchange, including verifying eligibility of an individual to enroll through an exchange or to claim a premium tax credit or cost sharing reduction or the amount of the credit or reduction, and not disclose the information to any other person except as provided.
Authorizes under federal regulations an exchange to only use or disclose such personally identifiable information for the purposes of determining eligibility in a qualified health plan, for other insurance affordability programs, or for exemptions from the individual responsibility provisions, as specified, to the extent such information is necessary to carry out the functions of the exchange, as specified. For other uses which the Secretary of Health and Human Services (HHS) determines are in compliance with the ACA but are not to carry out the exchange functions, requires individual consent. To carry out other functions, requires consent and substantive and procedural requirements, as specified.
This bill:
Requires Covered California to allow an applicant to indicate in an application for health care coverage whether or not the applicant would like assistance with completing the application from a Covered California certified insurance agent or certified enrollment counselor.
Prohibits Covered California from disclosing any personal information, as defined in existing law, that was obtained from the application for health care coverage to a certified insurance agent or certified enrollment counselor until Covered California has complied with 1) above.
Prohibits Covered California from disclosing any personal information, as defined in existing law that was obtained from the application for health care coverage to a certified insurance agent or certified enrollment counselor if the applicant indicates that the applicant does not want assistance from a Covered California certified insurance agent or certified enrollment counselor.
Permits Covered California to share the information of current enrollees or applicants with the same certified enrollment counselor or certified insurance agent of record that provided the applicant assistance with an existing application, or their successor or authorized staff, as otherwise permitted by federal and state laws and regulations.
Contains an urgency clause that will make this bill effective upon enactment.
FISCAL EFFECT:
This bill has not been analyzed by a fiscal committee.
COMMENTS:
Author’s statement. According to the author, the ACA has directed states to provide marketplaces, or exchanges, for consumers seeking health insurance. Covered California, the health benefit exchange in California, has provided this platform for individuals shopping for a plan. Unfortunately, due to a security loophole in the law, shoppers on the website have suffered a disclosure of their data to outside companies without having given their permission. This bill is an effort to close that loophole, so that consumers may shop free from fear of losing their privacy to unknown, outside entities.
Covered California Launch. Covered California opened for enrollment October 1, 2013. While the California launch was a success, it was not without issues. Many found the overall enrollment process difficult to complete. Covered California identified challenges and opportunities for improvement. Due to technical system issues, Covered California allowed people who started applications to complete those applications until April 15th. According to Covered California, to follow-up on applications started to ensure coverage effective January 1, 2014, Covered California enlisted the help of roughly 2,100 of its Certified Insurance Agent subcontractors to offer additional assistance to roughly 41,000 households. The basic contact information (name, telephone number, etc.) was securely transmitted to Certified Insurance Agents by General Agent partners, with instructions to quickly touch as many of these consumers as possible to ensure that they were offered additional assistance to complete their enrollments. Consumer information was carefully protected: each Certified Insurance Agent who participated in the program was given only a small batch of “leads” at a time, according to their capacity to reach consumers, and results were reported back to the General Agents. The program was put on hold when some consumers were surprised to be contacted by someone they did not realize was calling on behalf of Covered California.
Covered California Privacy Practices. Covered California Notice of Privacy Practices, Use and Disclosure explain that Covered California may use and disclose a consumer’s personal information with contractors to help with enrollment and contact the consumer when necessary. Additionally, all contractors who Covered California shares information with for these purposes undergo a fingerprint and background check, receive specialized training on keeping information confidential, and require signed confidentiality agreements that requires contractors to follow the safeguards applicable to Covered California, and prohibit the use of the information for any purposes outside the scope of the contract.
According to Covered California, both the paper and online application include disclosures about Covered California’s privacy policy and require the consumer to agree that they are aware of those privacy policies and practices, which is required under the IPA and the ACA. On the paper application, the privacy policy is described immediately above the “rights and responsibilities” section of the application, and is referenced in the declaration and signature which are submitted under penalty of perjury. Specifically, the paper application states, “We will share your information with other state, federal and local agencies, contractors, health plans, and programs only to enroll you in a plan or program or to administer programs, and with other state and federal agencies as required by law.” For the web-based application, in order to initially set up an online application a user must actively consent by clicking a box to agree to the Terms of Conditions. The Terms and Conditions direct users to information on the privacy policy that applies to personal information collected on the site. It discloses that Covered California maintains administrative, physical, technical, electronic and procedural safeguards to protect the confidentiality and security of the personal information. It allows links to additional information about how data is collected online and used, and how to request restrictions on the use and disclosure of information, among other information.
California Healthcare Eligibility, Enrollment and Retention System (CalHEERS). CalHEERS is a web-based system that streamlines the eligibility and enrollment process for all products and programs available through Covered California. Covered California has included on the CalHEERS 24 Month Road Map a change request with the title, “Consumer Consent to Share Personally Identifiable Information with Covered California Certified Representative.” According to the document, Covered California needs to obtain more explicit consumer consent before it shares any personally identifiable information (namely, contact information) to any of its certified representatives. The goal of this change request is to implement a business policy that allows consumers the opportunity to opt in or out of having their information shared for program purposes. The change is scheduled for April 2016. The background associated with this change request indicates that most consumers appreciated the help from certified representatives but a few consumers were surprised that they were being contacted by an agent since they had not delegated their application. According to the document, while this use of consumer information was legally authorized, Covered California wants to make sure consumers always have a clear expectation about how their information may be shared. There will be two boxes for consumers to consent to Covered California’s privacy policies and information sharing practices. The first for the consumer to agree to the privacy policy and the second to agree to have information shared with the certified representative for follow-up assistance. Consumer advocates have requested that this change allow for an opt-in not an opt-out of having their information shared.
Prior legislation. SB 974 (Anderson, 2014), would have required Covered California to allow consumers to indicate whether they would like assistance from an agent or enrollment counselor, and prohibit Covered California from disclosing personal information if applicants indicate they do not want assistance. SB 974 was held in the Assembly Appropriations Committee.
AB 1560 (Gorell, 2014), would
have prohibited Covered California from disclosing an individual’s
personal information, as defined, to third parties for the purpose of
determining eligibility for, or enrolling the individual in, health
care coverage unless,
prior to the disclosure, and would have required
Covered California to immediately notify the public of any breach of
the security of personal information created, collected, or
maintained by Covered California, regardless of the severity of the
breach and regardless of whether personal information was acquired by
an unauthorized person during the breach. AB
1560 failed passage in the Assembly Health Committee.
SB 900 (Alquist, Chapter 659,
Statutes of 2010), and AB 1602 (Perez, Chapter 655, Statutes of
2010), established the California Health Benefit Exchange.
Support. According to the California Association of Health Underwriters, the National Association of Insurance and Financial Advisors of California, and the Independent Insurance Agents and Brokers of California indicate that licensed health insurance agents are already mandated to comply with extensive privacy laws, undergo substantial education on handling of consumer information and ethics, plus annual continuing education. These proponents support this bill because it provides a simple, tailored approach to permit individuals needing assistance in the Covered California enrollment process to affirmatively indicate they need additional help with their applications.
SUPPORT AND OPPOSITION:
Support: California Association of Health Underwriters
Independent Insurance Agents and Brokers of California
National Association of Insurance and Financial Advisors of California
Oppose: None received
-- END --
SB 514 (Anderson) Page 4 of 4
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 514
AUTHOR: |
Anderson |
||
VERSION: |
April 20, 2015 |
||
HEARING DATE: |
April 29, 2015 |
|
|
CONSULTANT: |
Teri Boughton |
||
SUBJECT: California Health Benefit Exchange
SUMMARY:
Requires Covered California to allow an applicant to indicate in an application for health care coverage whether or not the applicant would like assistance with completing the application from a Covered California certified insurance agent or certified enrollment counselor and prohibits the release of personally identifiable information without permission.
Existing law:
Establishes the Health Benefit Exchange (Covered California) in state government as a state-based marketplace where individuals and small businesses can purchase qualified health plans.
Establishes the Information Practices Act of 1977 (IPA), which prohibits every state office, officer, department, division, bureau, board, commission or other state agency from disclosing personal information unless the information is disclosed according to one of a specified list of provisions, such as:
With prior voluntary written consent, not more than 30 days in advance of the disclosure, or in the time limit agreed to by the individual; or,
To those officers, employees, attorneys, agents, or volunteers of the agency that has custody of the information if the disclosure is relevant and necessary in the ordinary course of the performance of their official duties and is related to the purpose for which the information was acquired.
Defines, under the IPA, “personal information” as any information that is maintained by an agency that identifies or describes an individual, including, but not limited to, his or her name, social security number, physical description, home address, home telephone number, education, financial matters, and medical or employment history.
Makes, under the IPA, any person who willfully requests or obtains any record containing personal information from an agency under false pretenses guilty of a misdemeanor and fined not more than $5,000, or imprisoned not more than one year, or both, and also under the IPA subject to civil action for invasion of privacy, in addition to any special or general damages awarded, awarded a minimum of $2,500 in exemplary damages as well as attorney’s fees and other litigation costs reasonably incurred in the suit.
Establishes, under federal law, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which among various provisions, mandates industry-wide standards for health care information on electronic billing and other processes; and, requires the protection and confidential handling of protected health information.
Establishes, under the federal Affordable Care Act, (ACA), the procedures for determining eligibility for Exchange participation, premium tax credits and reduced cost sharing, and individual responsibility exemption. Requires an applicant for coverage or for a premium tax credit or cost sharing reduction to be required to provide only the information strictly necessary to authenticate identity, determine eligibility, and determine the amount of the credit or reduction.
Requires under the ACA any person who receives information provided by an applicant for insurance coverage to use the information only for the purposes of, and to the extent necessary in, ensuring the efficient operation of the Exchange, including verifying eligibility of an individual to enroll through an Exchange or to claim a premium tax credit or cost sharing reduction or the amount of the credit or reduction, and not disclose the information to any other person except as provided.
Authorizes under federal regulations an Exchange to only use or disclose such personally identifiable information for the purposes of determining eligibility in a qualified health plan, for other insurance affordability programs, or for exemptions from the individual responsibility provisions, as specified, to the extent such information is necessary to carry out the functions of the Exchange, as specified. For other uses which the Secretary of Health and Human Services (HHS) determines are in compliance with the ACA but are not to carry out the Exchange functions, requires individual consent. To carry out other functions, requires consent and substantive and procedural requirements, as specified.
This bill:
Requires Covered California to allow an applicant to indicate in an application for health care coverage whether or not the applicant would like assistance with completing the application from a Covered California certified insurance agent or certified enrollment counselor.
Prohibits Covered California from disclosing any personal information, as defined in existing law that was obtained from the application for health care coverage to a certified insurance agent or certified enrollment counselor until Covered California has complied with 1) above.
Prohibits Covered California from disclosing any personal information, as defined in existing law that was obtained from the application for health care coverage to a certified insurance agent or certified enrollment counselor if the applicant indicates that the applicant does not want assistance from a Covered California certified insurance agent or certified enrollment counselor.
Permits Covered California to share the information of current enrollees or applicants with the same certified enrollment counselor or certified insurance agent of record that provided the applicant assistance with an existing application, or their successor or authorized staff, as otherwise permitted by federal and state laws and regulations.
FISCAL EFFECT:
This bill has not been analyzed by a fiscal committee.
COMMENTS:
Author’s statement. According to the author, the ACA has directed states to provide marketplaces, or exchanges, for consumers seeking health insurance. Covered California, the health benefit exchange in our state, has provided this platform for individuals shopping for a plan. Unfortunately, due to a security loophole in the law, shoppers on the website have suffered a disclosure of their data to outside companies without having given their permission. This bill is an effort to close that loophole, so that consumers may shop free from fear of losing their privacy to unknown, outside entities.
Covered California Launch. Covered California opened for enrollment October 1, 2013. While the California launch was a success it was not without issues. Many found the overall enrollment process difficult to complete. Covered California identified challenges and opportunities for improvement. Because of technical system issues, Covered California allowed people who started applications to complete those applications until April 15th. According to Covered California, to follow-up on applications started to ensure coverage effective January 1, 2014, Covered California enlisted the help of roughly 2,100 of its Certified Insurance Agent subcontractors to offer additional assistance to roughly 41,000 households. The basic contact information (name, telephone number, etc.) was securely transmitted to Certified Insurance Agents by General Agent partners, with instructions to quickly touch as many of these consumers as possible to ensure that they were offered additional assistance to complete their enrollments. Consumer information was carefully protected: each Certified Insurance Agent who participated in the program was given only a small batch of “leads” at a time, according to their capacity to reach consumers, and results were reported back to the General Agents. The program was put on hold when some consumers were surprised to be contacted by someone they did not realize was calling on behalf of Covered California.
Covered California Privacy Practices. Covered California Notice of Privacy Practices, Use and Disclosure explain that Covered California may use and disclose a consumer’s personal information with contractors to help with enrollment and contact the consumer when necessary. Additionally, all contractors who Covered California shares information with for these purposes undergo a fingerprint and background check, receive specialized training on keeping information confidential, and require signed confidentiality agreements that requires contractors to follow the safeguards applicable to Covered California, and prohibit the use for any purposes outside the scope of the contract.
According to Covered California, both the paper and online application include disclosures about Covered California’s privacy policy, and require the consumer to agree that they are aware of those privacy policies and practices. This is required under the IPA and the ACA. On the paper application, the privacy policy is described immediately above the “rights and responsibilities” section of the application, and is referenced in the declaration and signature which are submitted under penalty of perjury. Specifically, the paper application states, “We will share your information with other state, federal and local agencies, contractors, health plans, and programs only to enroll you in a plan or program or to administer programs, and with other state and federal agencies as required by law.” For the web-based application, in order to initially set up an online application a user must actively consent by clicking a box to agree to the Terms of Conditions. The Terms and Conditions direct users to information on the privacy policy that applies to personal information collected on the site. It discloses that Covered California maintains administrative, physical, technical, electronic and procedural safeguards to protect the confidentiality and security of the personal information. It allows links to additional information about how data is collected online and used, and how to request restrictions on the use and disclosure of information, among other information.
California Healthcare Eligibility, Enrollment and Retention System (CalHEERS). CalHEERS is a web-based system that streamlines the eligibility and enrollment process for all products and programs available through Covered California. Covered California has included on the CalHEERS 24 Month Road Map a change request with the title, “Consumer Consent to Share Personally Identifiable Information with Covered California Certified Representative.” According to the document, Covered California needs to obtain more explicit consumer consent before it shares any personally identifiable information (namely, contact information) to any of its certified representatives. The goal of this change request is to implement a business policy that allows consumers the opportunity to opt in or out of having their information shared for program purposes. The change is scheduled for April 2016. The background associated with this change request indicates that most consumers appreciated the help from certified representatives but a few consumers were surprised that they were being contacted by an agent since they had not delegated their application. According to the document, while this use of consumer information was legally authorized, Covered California wants to make sure consumers always have a clear expectation about how their information may be shared. There will be two boxes for consumers to consent to Covered California’s privacy policies and information sharing practices. The first for the consumer to agree to the privacy policy and the second to agree to have information shared with the certified representative for follow-up assistance. Consumer advocates have requested that this change allow for an opt-in not an opt-out of having their information shared.
Prior legislation. SB 974 (Anderson), of 2014, would have required Covered California to allow consumers to indicate whether they would like assistance from an agent or enrollment counselor, and prohibit Covered California from disclosing personal information if applicants indicate they do not want assistance. SB 974 was held in the Assembly Appropriations Committee.
AB 1560 (Gorell), of 2014, would
have prohibited Covered California from disclosing an individual’s
personal information, as defined, to third parties for the purpose of
determining eligibility for, or enrolling the individual in, health
care coverage unless,
prior to the disclosure, and would have required
Covered California to immediately notify the public of any breach of
the security of personal information created, collected, or
maintained by Covered California, regardless of the severity of the
breach and regardless of whether personal information was acquired by
an unauthorized person during the breach. AB
1560 failed passage in the Assembly Health Committee.
SB 900 (Alquist), Chapter 659, Statutes of 2010, and AB 1602 (Perez), Chapter 655, Statutes of 2010, established the California Health Benefit Exchange.
SUPPORT AND OPPOSITION:
Support: None received
Oppose: None received
-- END --
Discussed in Hearing
2MIN
Senate Floor
43SEC
Senate Standing Committee on Appropriations
1MIN
Senate Standing Committee on Appropriations
1MIN
Senate Standing Committee on Health
Bill Author
Bill Co-Author(s):