AB 417: Acute psychiatric hospital: County of Ventura: outpatient mental health services.
- Session Year: 2017-2018
- House: Assembly
- Latest Version Date: 2018-03-23
Existing law provides for the regulation and licensure of health facilities, as defined, including acute psychiatric hospitals, by the State Department of Public Health. Existing law defines an acute psychiatric hospital for purposes of these provisions to mean a health facility having a duly constituted governing body with overall administrative and professional responsibility and an organized medical staff that provides 24-hour inpatient care for persons with mental health disorders or other patients referred, as specified, including medical, nursing, rehabilitative, pharmacy, and dietary services. A violation of the provisions governing health facilities is a crime.
This bill would authorize, for a period of not more than 180 days, and only until November 1, 2018, the State Department of Public Health to permit an acute psychiatric hospital that was affected by a wildfire during the month of December 2017, and that is in the County of Ventura, to provide outpatient mental health services that were approved by the department and operational as supplemental services before the wildfire occurred, while the inpatient operations of the acute psychiatric hospital are voluntarily suspended.
This bill would make legislative findings and declarations as to the necessity of a special statute for the County of Ventura.
This bill would declare that it is to take effect immediately as an urgency statute.
Existing law provides for the regulation and licensure of health facilities, as defined, including acute psychiatric hospitals, by the State Department of Public Health. Existing law defines an acute psychiatric hospital for purposes of these provisions to mean a health facility having a duly constituted governing body with overall administrative and professional responsibility and an organized medical staff that provides 24-hour inpatient care for persons with mental health disorders or other patients referred, as specified, including medical, nursing, rehabilitative, pharmacy, and dietary services. A violation of the provisions governing health facilities is a crime.
This bill would authorize, for a period of not more than 180 days, and only until November 1, 2018, the State Department of Public Health to permit an acute psychiatric hospital that was affected by a wildfire during the month of December 2017, and that is in the County of Ventura, to provide outpatient mental health services that were approved by the department and operational as supplemental services before the wildfire occurred, while the inpatient operations of the acute psychiatric hospital are voluntarily suspended.
This bill would make legislative findings and declarations as to the necessity of a special statute for the County of Ventura.
This bill would declare that it is to take effect immediately as an urgency statute.
Existing law provides for the regulation and licensure of health facilities, as defined, including acute psychiatric hospitals, by the State Department of Public Health. Existing law defines an acute psychiatric hospital for purposes of these provisions to mean a health facility having a duly constituted governing body with overall administrative and professional responsibility and an organized medical staff that provides 24-hour inpatient care for persons with mental health disorders or other patients referred, as specified, including medical, nursing, rehabilitative, pharmacy, and dietary services. A violation of the provisions governing health facilities is a crime.
This bill would authorize, for a period of not more than 180 days, and only until November 1, 2018, the State Department of Public Health to permit an acute psychiatric hospital that was affected by a wildfire during the month of December 2017, and that is in the County of Ventura, to provide outpatient mental health services that were approved by the department and operational as supplemental services before the wildfire occurred, while the inpatient operations of the acute psychiatric hospital are voluntarily suspended.
This bill would make legislative findings and declarations as to the necessity of a special statute for the County of Ventura.
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 state, by January 1, 2014, to establish an American Health Benefit Exchange that facilitates the purchase of qualified health plans by qualified individuals and qualified small employers. Existing state law establishes the California Health Benefit Exchange (the Exchange) within state government for the purpose of facilitating the enrollment of qualified individuals and qualified small employers in qualified health plans, and specifies the powers and duties of the board governing the Exchange. Existing law requires the board to establish the Small Business Health Options Program, otherwise referred to as the SHOP Program, separate from the activities of the board related to the individual market, to assist qualified small employers in facilitating the enrollment of their employees in qualified health plans offered through the Exchange in the small employer market in a manner consistent with a specified provision of the federal act.This bill would change the name of the SHOP Program to the Covered California for Small Business Exchange and make related conforming changes.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 state, by January 1, 2014, to establish an American Health Benefit Exchange that facilitates the purchase of qualified health plans by qualified individuals and qualified small employers. Existing state law establishes the California Health Benefit Exchange (the Exchange) within state government for the purpose of facilitating the enrollment of qualified individuals and qualified small employers in qualified health plans, and specifies the powers and duties of the board governing the Exchange. Existing law requires the board to establish the Small Business Health Options Program, otherwise referred to as the SHOP program, Program, separate from the activities of the board related to the individual market, to assist qualified small employers in facilitating the enrollment of their employees in qualified health plans offered through the Exchange in the small employer market in a manner consistent with a specified provision of the federal act.
This bill would change the name of the SHOP program Program to the Covered California for Small Business Exchange and make related conforming changes.
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 state, by January 1, 2014, to establish an American Health Benefit Exchange that facilitates the purchase of qualified health plans by qualified individuals and qualified small employers. Existing state law establishes the California Health Benefit Exchange (the Exchange) within state government for the purpose of facilitating the enrollment of qualified individuals and qualified small employers in qualified health plans, and specifies the powers and duties of the board governing the Exchange. Existing law requires the board to establish the Small Business Health Options Program, otherwise referred to as the SHOP program, separate from the activities of the board related to the individual market, to assist qualified small employers in facilitating the enrollment of their employees in qualified health plans offered through the Exchange in the small employer market in a manner consistent with a specified provision of the federal act.
This bill would change the name of the SHOP program to Covered California for Small Business and make related conforming changes.
The Legislature finds and declares all of the following:
(a)The Aurora Vista del Mar Hospital (AVDM), located in Ventura, California, is the only private, free-standing, acute psychiatric hospital in the County of Ventura, and its 87 acute psychiatric hospital beds account for almost three-fourths of all acute psychiatric hospital beds in the County of Ventura.
(b)AVDM has been providing mental and behavioral health services under an Acute Psychiatric Hospital license issued by the State Department of Public Health.
(c)AVDM is the only acute psychiatric care provider serving adolescents in the Counties of Ventura, Santa Barbara, and San Luis Obispo.
(d)AVDM also supported emergency departments and crisis teams across southern California, including in the Counties of Ventura, Santa Barbara, Kern, Kings, Tulare, Fresno, Los Angeles, Riverside, San Luis Obispo, San Diego, Orange, Madera, Merced, and San Bernardino.
(e)The Thomas Fire destroyed two buildings on the AVDM campus and caused significant damage to powerlines and other utilities connected to the campus. As a result of the fire, AVDM ceased providing all mental health services, including both inpatient and outpatient services, on December 4, 2017.
(f)The loss of services by AVDM has had a ripple effect throughout the community, leading to longer wait times for psychiatric hospital beds and mental health services, and causing individuals to go without urgently needed treatment.
(g)AVDM is currently ready and able to commence outpatient supplemental mental health services near the facility.
(h)There is a dire need for mental health service providers in the Counties of Ventura and Santa Barbara.
SEC. 2.Section 1271.25 is added to the Health and Safety Code, to read:1271.25.(a)Notwithstanding any other law, for a period of not more than 180 days, the State Department of Public Health may permit an acute psychiatric hospital that was affected by a wildfire during the month of December 2017 and that is in the County of Ventura to provide outpatient mental health services that were approved by the department and operational as supplemental services before the wildfire occurred, while the inpatient operations of the acute psychiatric hospital are voluntarily suspended.
(b) This section shall become inoperative on November 1, 2018, and, as of January 1, 2019, is repealed.
SEC. 3.The Legislature finds and declares that a special statute is necessary and that a general statute cannot be made applicable within the meaning of Section 16 of Article IV of the California Constitution because of the unique circumstances caused by the Thomas Fire in the County of Ventura.
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 California Constitution and shall go into immediate effect. The facts constituting the necessity are:
In order to ensure, at the earliest possible time, that mental health services are available for adults and adolescents in the Counties of Ventura and Santa Barbara and other nearby communities, it is necessary that this act take effect immediately.
The Legislature finds and declares all of the following:
(a)The Aurora Vista del Mar Hospital (AVDM), located in Ventura, California, is the only private, free-standing, acute psychiatric hospital in the County of Ventura, and its 87 acute psychiatric hospital beds account for almost three-fourths of all acute psychiatric hospital beds in the County of Ventura.
(b)AVDM has been providing mental and behavioral health services under an Acute Psychiatric Hospital license issued by the State Department of Public Health.
(c)AVDM is the only acute psychiatric care provider serving adolescents in the Counties of Ventura, Santa Barbara, and San Luis Obispo.
(d)AVDM also supported emergency departments and crisis teams across southern California, including in the Counties of Ventura, Santa Barbara, Kern, Kings, Tulare, Fresno, Los Angeles, Riverside, San Luis Obispo, San Diego, Orange, Madera, Merced, and San Bernardino.
(e)The Thomas Fire destroyed two buildings on the AVDM campus and caused significant damage to powerlines and other utilities connected to the campus. As a result of the fire, AVDM ceased providing all mental health services, including both inpatient and outpatient services, on December 4, 2017.
(f)The loss of services by AVDM has had a ripple effect throughout the community, leading to longer wait times for psychiatric hospital beds and mental health services, and causing individuals to go without urgently needed treatment.
(g)AVDM is currently ready and able to commence outpatient supplemental mental health services near the facility.
(h)There is a dire need for mental health service providers in the Counties of Ventura and Santa Barbara.
SEC. 2.Section 1271.25 is added to the Health and Safety Code, to read:1271.25.(a)Notwithstanding any other law, for a period of not more than 180 days, the State Department of Public Health may permit an acute psychiatric hospital that was affected by a wildfire during the month of December 2017 and that is in the County of Ventura to provide outpatient mental health services that were approved by the department and operational as supplemental services before the wildfire occurred, while the inpatient operations of the acute psychiatric hospital are voluntarily suspended.
(b) This section shall become inoperative on November 1, 2018, and, as of January 1, 2019, is repealed.
SEC. 3.The Legislature finds and declares that a special statute is necessary and that a general statute cannot be made applicable within the meaning of Section 16 of Article IV of the California Constitution because of the unique circumstances caused by the Thomas Fire in the County of Ventura.
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 California Constitution and shall go into immediate effect. The facts constituting the necessity are:
In order to ensure, at the earliest possible time, that mental health services are available for adults and adolescents in the Counties of Ventura and Santa Barbara and other nearby communities, it is necessary that this act take effect immediately.
The Legislature finds and declares all of the following:
(a)The Aurora Vista del Mar Hospital (AVDM), located in Ventura, California, is the only private, free-standing, acute psychiatric hospital in the County of Ventura, and its 87 acute psychiatric hospital beds account for almost three-fourths of all acute psychiatric hospital beds in the County of Ventura.
(b)AVDM has been providing mental and behavioral health services under an Acute Psychiatric Hospital license issued by the State Department of Public Health.
(c)AVDM is the only acute psychiatric care provider serving adolescents in the Counties of Ventura, Santa Barbara, and San Luis Obispo.
(d)AVDM also supported emergency departments and crisis teams across southern California, including in the Counties of Ventura, Santa Barbara, Kern, Kings, Tulare, Fresno, Los Angeles, Riverside, San Luis Obispo, San Diego, Orange, Madera, Merced, and San Bernardino.
(e)The Thomas Fire destroyed two buildings on the AVDM campus and caused significant damage to powerlines and other utilities connected to the campus. As a result of the fire, AVDM ceased providing all mental health services, including both inpatient and outpatient services, on December 4, 2017.
(f)The loss of services by AVDM has had a ripple effect throughout the community, leading to longer wait times for psychiatric hospital beds and mental health services, and causing individuals to go without urgently needed treatment.
(g)AVDM is currently ready and able to commence outpatient supplemental mental health services near the facility.
(h)There is a dire need for mental health service providers in the Counties of Ventura and Santa Barbara.
SEC. 2.Section 1271.25 is added to the Health and Safety Code, to read:1271.25.(a)Notwithstanding any other law, for a period of not more than 180 days, the State Department of Public Health may permit an acute psychiatric hospital that was affected by a wildfire during the month of December 2017 and that is in the County of Ventura to provide outpatient mental health services that were approved by the department and operational as supplemental services before the wildfire occurred, while the inpatient operations of the acute psychiatric hospital are voluntarily suspended.
(b) This section shall become inoperative on November 1, 2018, and, as of January 1, 2019, is repealed.
SEC. 3.The Legislature finds and declares that a special statute is necessary and that a general statute cannot be made applicable within the meaning of Section 16 of Article IV of the California Constitution because of the unique circumstances caused by the Thomas Fire in the County of Ventura.
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 California Constitution and shall go into immediate effect. The facts constituting the necessity are:
In order to ensure, at the earliest possible time, that mental health services are available for adults and adolescents in the Counties of Ventura and Santa Barbara and other nearby communities, it is necessary that this act take effect immediately.
All matter omitted in this version of the bill appears in the bill as amended in the Assembly, April 27, 2017. (JR11)For purposes of this title, the following definitions shall apply:
(a)Board means the board described in subdivision (a) of Section 100500.
(b)Bridge plan product means an individual health benefit plan as defined in subdivision (f) of Section 1399.845 of the Health and Safety Code that is offered by a health care service plan licensed under the Knox-Keene Health Care Service Plan Act of 1975 (Chapter 2.2 (commencing with Section 1340) of Division 2 of the Health and Safety Code) or as defined in subdivision (a) of Section 10198.6 of the Insurance Code that is offered by a health insurer licensed under the Insurance Code that contracts with the Exchange pursuant to this title.
(c)Carrier means either a private health insurer holding a valid outstanding certificate of authority from the Insurance Commissioner or a health care service plan, as defined under subdivision (f) of Section 1345 of the Health and Safety Code, licensed by the Department of Managed Health Care.
(d)Covered California for Small Business Business Exchange means the program established by subdivision (m) of Section 100502.
(e)Exchange means the California Health Benefit Exchange established by Section 100500.
(f)Federal act means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any amendments to, or regulations or guidance issued under, those acts.
(g)Fund means the California Health Trust Fund established by Section 100520.
(h)Health plan and qualified health plan have the same meanings as those terms are defined in Section 1301 of the federal act.
(i)Healthy Families coverage means coverage under the Healthy Families Program pursuant to Part 6.2 (commencing with Section 12693) of Division 2 of the Insurance Code.
(j)Medi-Cal coverage means coverage under the Medi-Cal program pursuant to Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of the Welfare and Institutions Code.
(k)Modified adjusted gross income shall have the same meaning as the term is used in Section 1401(d)(2)(B) (26 U.S.C. Sec. 36B) of the federal act.
(l)Members of the modified adjusted gross income household shall mean any individual who would be included in the calculation for modified adjusted gross income pursuant to Section 1401(a) (26 U.S.C. Sec. 36B(d)) of the federal act and as otherwise determined by the Exchange as permitted by the federal act and this title.
(m)Supplemental coverage means coverage through a specialized health care service plan contract, as defined in subdivision (o) of Section 1345 of the Health and Safety Code, or a specialized health insurance policy, as defined in Section 106 of the Insurance Code.
(n)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 100501 of the Government Code, as added by Section 3 of Chapter 5 of the 1st Extraordinary Session of the Statutes of 2013, is amended to read:100501.For purposes of this title, the following definitions shall apply:
(a)Board means the board described in subdivision (a) of Section 100500.
(b)Carrier means either a private health insurer holding a valid outstanding certificate of authority from the Insurance Commissioner or a health care service plan, as defined under subdivision (f) of Section 1345 of the Health and Safety Code, licensed by the Department of Managed Health Care.
(c)Covered California for Small Business Business Exchange means the program established by subdivision (m) of Section 100502.
(d)Exchange means the California Health Benefit Exchange established by Section 100500.
(e)Federal act means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any amendments to, or regulations or guidance issued under, those acts.
(f)Fund means the California Health Trust Fund established by Section 100520.
(g)Health plan and qualified health plan have the same meanings as those terms are defined in Section 1301 of the federal act.
(h)Supplemental coverage means coverage through a specialized health care service plan contract, as defined in subdivision (o) of Section 1345 of the Health and Safety Code, or a specialized health insurance policy, as defined in Section 106 of the Insurance Code.
(i)This section shall become operative only if Section 2 of the act that added this section becomes inoperative pursuant to subdivision (n) of that Section 2.
SEC. 3.Section 100502 of the Government Code is amended to read:100502.The board shall, at a minimum, do all of the following to implement Section 1311 of the federal act:
(a)Implement procedures for the certification, recertification, and decertification, consistent with guidelines established by the United States Secretary of Health and Human Services, of health plans as qualified health plans. The board shall require health plans seeking certification as qualified health plans to do all of the following:
(1)Submit a justification for any premium increase prior to implementation of the increase. The plans shall prominently post that information on their Internet Web sites. The board shall take this information, and the information and the recommendations provided to the board by the Department of Insurance or the Department of Managed Health Care under paragraph (1) of subdivision (b) of Section 2794 of the federal Public Health Service Act, into consideration when determining whether to make the health plan available through the Exchange. The board shall take into account any excess of premium growth outside the Exchange as compared to the rate of that growth inside the Exchange, including information reported by the Department of Insurance and the Department of Managed Health Care.
(2)(A)Make available to the public and submit to the board, the United States Secretary of Health and Human Services, and the Insurance Commissioner or the Department of Managed Health Care, as applicable, accurate and timely disclosure of the following information:
(i)Claims payment policies and practices.
(ii)Periodic financial disclosures.
(iii)Data on enrollment.
(iv)Data on disenrollment.
(v)Data on the number of claims that are denied.
(vi)Data on rating practices.
(vii)Information on cost sharing and payments with respect to any out-of-network coverage.
(viii)Information on enrollee and participant rights under Title I of the federal act.
(ix)Other information as determined appropriate by the United States Secretary of Health and Human Services.
(B)The information required under subparagraph (A) shall be provided in plain language, as defined in subparagraph (B) of paragraph (3) of subdivision (e) of Section 1311 of the federal act.
(3)Permit individuals to learn, in a timely manner upon the request of the individual, the amount of cost sharing, including, but not limited to, deductibles, copayments, and coinsurance, under the individuals plan or coverage that the individual would be responsible for paying with respect to the furnishing of a specific item or service by a participating provider. At a minimum, this information shall be made available to the individual through an Internet Web site and through other means for individuals without access to the Internet.
(b)Provide for the operation of a toll-free telephone hotline to respond to requests for assistance.
(c)Maintain an Internet Web site through which enrollees and prospective enrollees of qualified health plans may obtain standardized comparative information on those plans.
(d)Assign a rating to each qualified health plan offered through the Exchange in accordance with the criteria developed by the United States Secretary of Health and Human Services.
(e)Utilize a standardized format for presenting health benefits plan options in the Exchange, including the use of the uniform outline of coverage established under Section 2715 of the federal Public Health Service Act.
(f)Inform individuals of eligibility requirements for the Medi-Cal program, the Healthy Families Program, or any applicable state or local public program and, if, through screening of the application by the Exchange, the Exchange determines that an individual is eligible for any of those programs, enroll that individual in the identified program.
(g)Establish and make available by electronic means a calculator to determine the actual cost of coverage after the application of a premium tax credit under Section 36B of the Internal Revenue Code of 1986 and any cost-sharing reduction under Section 1402 of the federal act.
(h)Grant a certification attesting that, for purposes of the individual responsibility penalty under Section 5000A of the Internal Revenue Code of 1986, an individual is exempt from the individual requirement or from the penalty imposed by that section because of either of the following:
(1)There is no affordable qualified health plan available through the Exchange or the individuals employer covering the individual.
(2)The individual meets the requirements for any other exemption from the individual responsibility requirement or penalty.
(i)Transfer to the Secretary of the Treasury all of the following:
(1)A list of the individuals who are issued a certification under subdivision (h), including the name and taxpayer identification number of each individual.
(2)The name and taxpayer identification number of each individual who was an employee of an employer but who was determined to be eligible for the premium tax credit under Section 36B of the Internal Revenue Code of 1986 because of either of the following:
(A)The employer did not provide minimum essential coverage.
(B)The employer provided the minimum essential coverage but it was determined under subparagraph (C) of paragraph (2) of subsection (c) of Section 36B of the Internal Revenue Code of 1986 to either be unaffordable to the employee or not provide the required minimum actuarial value.
(3)The name and taxpayer identification number of each individual who notifies the Exchange under paragraph (4) of subsection (b) of Section 1411 of the federal act that they have changed employers and of each individual who ceases coverage under a qualified health plan during a plan year and the effective date of that cessation.
(j)Provide to each employer the name of each employee of the employer described in paragraph (2) of subdivision (i) who ceases coverage under a qualified health plan during a plan year and the effective date of that cessation.
(k)Perform duties required of, or delegated to, the Exchange by the United States Secretary of Health and Human Services or the Secretary of the Treasury related to determining eligibility for premium tax credits, reduced cost sharing, or individual responsibility exemptions.
(l)Establish the navigator program in accordance with subdivision (i) of Section 1311 of the federal act. An entity chosen by the Exchange as a navigator shall do all of the following:
(1)Conduct public education activities to raise awareness of the availability of qualified health plans.
(2)Distribute fair and impartial information concerning enrollment in qualified health plans, and the availability of premium tax credits under Section 36B of the Internal Revenue Code of 1986 and cost-sharing reductions under Section 1402 of the federal act.
(3)Facilitate enrollment in qualified health plans.
(4)Provide referrals to any applicable office of health insurance consumer assistance or health insurance ombudsman ombudsperson established under Section 2793 of the federal Public Health Service Act, or any other appropriate state agency or agencies, for an enrollee with a grievance, complaint, or question regarding his or her health plan, coverage, or a determination under that plan or coverage.
(5)Provide information in a manner that is culturally and linguistically appropriate to the needs of the population being served by the Exchange.
(m)Establish the Covered California for Small Business program, Exchange, separate from the activities of the board related to the individual market, to assist qualified small employers in facilitating the enrollment of their employees in qualified health plans offered through the Exchange in the small employer market in a manner consistent with paragraph (2) of subdivision (a) of Section 1312 of the federal act. Any reference to the Small Business Health Options Program or the SHOP Program is deemed to refer to the Covered California for Small Business. Business Exchange.
SEC. 4.Section 100503 of the Government Code, as amended by Section 1 of Chapter 146 of the Statutes of 2016, 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)This section does 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 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 carriers, as a condition of participation in the individual market of the Exchange, 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 carriers, as a condition of participation in the Covered California for Small Business program, Exchange, to fairly and affirmatively offer, market, and sell in the Covered California for Small Business Exchange 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 Covered California for Small Business 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 Covered California for Small Business, Business Exchange, 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. 5.Section 100503 of the Government Code, as amended by Section 2 of Chapter 146 of the Statutes of 2016, 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)This section does 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 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 carriers, as a condition of participation in the Exchange, 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 carriers, as a condition of participation in the Covered California for Small Business program, Exchange, to fairly and affirmatively offer, market, and sell in the Covered California for Small Business Exchange 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 Covered California for Small Business 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 Covered California for Small Business, Business Exchange, 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. 6.Section 100522 of the Government Code is amended to read:100522.(a)(1)The Exchange shall apply to the United States Department of Health and Human Services for a waiver authorized under Section 1332 of the federal act as defined in subdivision (f) of Section 100501 in order to allow persons otherwise not able to obtain coverage by reason of immigration status through the Exchange to obtain coverage from the Exchange by waiving the requirement that the Exchange offer only qualified health plans solely for the purpose of offering coverage to persons otherwise not able to obtain coverage by reason of immigration status.
(2)The waiver of the requirement that the Exchange offer only qualified health plans as described in paragraph (1) shall be limited to requiring the Exchange to offer California qualified health plans consistent with this section only and shall not be construed to authorize the Exchange to offer any other nonqualified health plan.
(b)The Exchange shall require an issuer that offers a qualified health plan in the individual market through the Exchange to concurrently offer a California qualified health plan that meets all of the following criteria:
(1)Is subject to the requirements of this title, including all of those requirements applicable to qualified health plans.
(2)Is subject to the requirements of subdivisions (a), (b), and (d) of Section 1366.6 of the Health and Safety Code and subdivisions (a), (b), and (d) of Section 10112.3 of the Insurance Code in the same manner as qualified health plans.
(3)Is identical to the corresponding qualified health plan, except for the eligibility requirements set forth in subdivision (c).
(c)Persons eligible to purchase California qualified health plans shall pay the cost of coverage and shall not:
(1)Be eligible to receive federal advanced premium tax credit, federal cost-sharing reduction, or any other federal assistance for the payment of premiums or cost sharing for a California qualified health plan.
(2)Otherwise be eligible for enrollment in a qualified health plan offered through the Exchange by reason of immigration status.
(d)An applicant for coverage under this section shall be required to provide only the information strictly necessary to authenticate identity and determine eligibility under this section. Any person who receives information provided by an applicant under this section, whether directly or by another person at the request of the applicant, or receives information from any agency, shall use the information only for the purposes of, and to the extent necessary for, ensuring the efficient operation of the Exchange, including verifying the eligibility of an individual to enroll through the Exchange. That information shall not be disclosed to any other person except as provided in this section.
(e)Subdivisions (b) to (d), inclusive, shall become operative on January 1, 2018, for coverage effective for California qualified health plans beginning January 1, 2019, contingent upon federal approval of the waiver pursuant to subdivision (a).
SEC. 7.Section 1366.6 of the Health and Safety Code, as amended by Section 5 of Chapter 572 of the Statutes of 2014, is amended to read:1366.6.(a)For purposes of this section, the following definitions shall apply:
(1)Exchange means the California Health Benefit Exchange established in Title 22 (commencing with Section 100500) of the Government Code.
(2)Federal act means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any amendments to, or regulations or guidance issued under, those acts.
(3)Qualified health plan has the same meaning as that term is defined in Section 1301 of the federal act.
(4)Small employer has the same meaning as that term is defined in Section 1357.500.
(b)(1)Health care service plans participating in the individual market of the Exchange shall 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. Health care service plans participating in the Covered California for Small Business program of the Exchange, established pursuant to subdivision (m) of Section 100502 of the Government Code, shall fairly and affirmatively offer, market, and sell in the Covered California for Small Business Exchange at least one product within each of the four levels of coverage contained in subsection (d) of Section 1302 of the federal act.
(2)The board established under Section 100500 of the Government Code may require plans to sell additional products within each of the levels of coverage identified in paragraph (1).
(3)This subdivision shall not apply to a plan that solely offers supplemental coverage in the Exchange under paragraph (10) of subdivision (a) of Section 100504 of the Government Code.
(4)This subdivision shall not apply to a bridge plan product that meets the requirements of Section 100504.5 of the Government Code to the extent approved by the appropriate federal agency.
(c)(1)Health care service plans participating in the Exchange that sell any products outside the Exchange shall 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 health care service plans for enrolled Healthy Families beneficiaries or to 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 health care service plans for enrolled Medi-Cal beneficiaries, or for contracts with bridge plan products that meet the requirements of Section 100504.5 of the Government Code.
(d)(1)Commencing January 1, 2014, a health care service plan shall, with respect to individual plan contracts that cover hospital, medical, or surgical benefits, only sell the five levels of coverage contained in subsections (d) and (e) of Section 1302 of the federal act, except that a health care service plan that does not participate in the Exchange shall, with respect to individual plan contracts that cover hospital, medical, or surgical benefits, only sell the four levels of coverage contained in subsection (d) of Section 1302 of the federal act.
(2)Commencing January 1, 2014, a health care service plan shall, with respect to small employer plan contracts that cover hospital, medical, or surgical expenses, only sell the four levels of coverage contained in subsection (d) of Section 1302 of the federal act.
(e)Commencing January 1, 2014, a health care service plan that does not participate in the Exchange shall, with respect to individual or small employer plan contracts that cover hospital, medical, or surgical benefits, offer at least one standardized product that has been designated by the Exchange in each of the four levels of coverage contained in subsection (d) of Section 1302 of the federal act. This subdivision shall only apply if the board of the Exchange exercises its authority under subdivision (c) of Section 100504 of the Government Code. This subdivision does not require a plan that does not participate in the Exchange to offer standardized products in the small employer market if the plan only sells products in the individual market. This subdivision does not require a plan that does not participate in the Exchange to offer standardized products in the individual market if the plan only sells products in the small employer market. This subdivision shall not be construed to prohibit the plan from offering other products provided that it complies with subdivision (d).
(f)For purposes of this section, a bridge plan product shall mean an individual health benefit plan, as defined in subdivision (f) of Section 1399.845, that is offered by a health care service plan licensed under this chapter that contracts with the Exchange pursuant to Title 22 (commencing with Section 100500) of the Government Code.
(g)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. 8.Section 1366.6 of the Health and Safety Code, as amended by Section 6 of Chapter 572 of the Statutes of 2014, is amended to read:1366.6.(a)For purposes of this section, the following definitions shall apply:
(1)Exchange means the California Health Benefit Exchange established in Title 22 (commencing with Section 100500) of the Government Code.
(2)Federal act means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any amendments to, or regulations or guidance issued under, those acts.
(3)Qualified health plan has the same meaning as that term is defined in Section 1301 of the federal act.
(4)Small employer has the same meaning as that term is defined in Section 1357.500.
(b)(1)Health care service plans participating in the individual market of the Exchange shall 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. Health care service plans participating in the Covered California for Small Business program of the Exchange, established pursuant to subdivision (m) of Section 100502 of the Government Code, shall fairly and affirmatively offer, market, and sell in the Covered California for Small Business Exchange at least one product within each of the four levels of coverage contained in subsection (d) of Section 1302 of the federal act.
(2)The board established under Section 100500 of the Government Code may require plans to sell additional products within each of the levels of coverage identified in paragraph (1).
(3)This subdivision shall not apply to a plan that solely offers supplemental coverage in the Exchange under paragraph (10) of subdivision (a) of Section 100504 of the Government Code.
(c)(1)Health care service plans participating in the Exchange that sell any products outside the Exchange shall 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 health care service plans for enrolled Healthy Families beneficiaries or to 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 health care service plans for enrolled Medi-Cal beneficiaries.
(d)(1)Commencing January 1, 2014, a health care service plan shall, with respect to individual plan contracts that cover hospital, medical, or surgical benefits, only sell the five levels of coverage contained in subsections (d) and (e) of Section 1302 of the federal act, except that a health care service plan that does not participate in the Exchange shall, with respect to individual plan contracts that cover hospital, medical, or surgical benefits, only sell the four levels of coverage contained in subsection (d) of Section 1302 of the federal act.
(2)Commencing January 1, 2014, a health care service plan shall, with respect to small employer plan contracts that cover hospital, medical, or surgical expenses, only sell the four levels of coverage contained in subsection (d) of Section 1302 of the federal act.
(e)Commencing January 1, 2014, a health care service plan that does not participate in the Exchange shall, with respect to individual or small employer plan contracts that cover hospital, medical, or surgical benefits, offer at least one standardized product that has been designated by the Exchange in each of the four levels of coverage contained in subdivision (d) of Section 1302 of the federal act. This subdivision shall only apply if the board of the Exchange exercises its authority under subdivision (c) of Section 100504 of the Government Code. This subdivision does not require a plan that does not participate in the Exchange to offer standardized products in the small employer market if the plan only sells products in the individual market. This subdivision does not require a plan that does not participate in the Exchange to offer standardized products in the individual market if the plan only sells products in the small employer market. This subdivision shall not be construed to prohibit the plan from offering other products provided that it complies with subdivision (d).
(f)This section shall become operative only if Section 8 of the act that added this section becomes inoperative pursuant to subdivision (g) of that Section 8.
SEC. 9.Section 10112.3 of the Insurance Code, as amended by Section 16 of Chapter 572 of the Statutes of 2014, is amended to read:10112.3.(a)For purposes of this section, the following definitions shall apply:
(1)Exchange means the California Health Benefit Exchange established in Title 22 (commencing with Section 100500) of the Government Code.
(2)Federal act means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any amendments to, or regulations or guidance issued under, those acts.
(3)Qualified health plan has the same meaning as that term is defined in Section 1301 of the federal act.
(4)Small employer has the same meaning as that term is defined in Section 10753.
(b)(1)Health insurers participating in the individual market of the Exchange shall 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. Health insurers participating in the Covered California for Small Business program of the Exchange, established pursuant to subdivision (m) of Section 100502 of the Government Code, shall fairly and affirmatively offer, market, and sell in the Covered California for Small Business Exchange at least one product within each of the four levels of coverage contained in subsection (d) of Section 1302 of the federal act.
(2)The board established under Section 100500 of the Government Code may require insurers to sell additional products within each of the levels of coverage identified in paragraph (1).
(3)This subdivision shall not apply to an insurer that solely offers supplemental coverage in the Exchange under paragraph (10) of subdivision (a) of Section 100504 of the Government Code. This subdivision shall not apply to a bridge plan product of a Medi-Cal managed care plan that contracts with the State Department of Health Care Services pursuant to Section 14005.70 of the Welfare and Institutions Code and that meets the requirements of Section 100504.5 of the Government Code, to the extent approved by the appropriate federal agency.
(c)(1)Health insurers participating in the Exchange that sell any products outside the Exchange shall 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 between the Managed Risk Medical Insurance Board and health insurers for enrolled Healthy Families beneficiaries or to 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 health insurers for enrolled Medi-Cal beneficiaries or for contracts with bridge plan products that meet the requirements of Section 100504.5 of the Government Code.
(d)(1)Commencing January 1, 2014, a health insurer shall, with respect to individual policies that cover hospital, medical, or surgical benefits, only sell the five levels of coverage contained in subsections (d) and (e) of Section 1302 of the federal act, except that a health insurer that does not participate in the Exchange shall, with respect to individual policies that cover hospital, medical, or surgical benefits, only sell the four levels of coverage contained in subsection (d) of Section 1302 of the federal act.
(2)Commencing January 1, 2014, a health insurer shall, with respect to small employer policies that cover hospital, medical, or surgical expenses, only sell the four levels of coverage contained in subsection (d) of Section 1302 of the federal act.
(e)Commencing January 1, 2014, a health insurer that does not participate in the Exchange shall, with respect to individual or small employer policies that cover hospital, medical, or surgical expenses, offer at least one standardized product that has been designated by the Exchange in each of the four levels of coverage contained in subsection (d) of Section 1302 of the federal act. This subdivision shall only apply if the board of the Exchange exercises its authority under subdivision (c) of Section 100504 of the Government Code. This subdivision does not require an insurer that does not participate in the Exchange to offer standardized products in the small employer market if the insurer only sells products in the individual market. This subdivision does not require an insurer that does not participate in the Exchange to offer standardized products in the individual market if the insurer only sells products in the small employer market. This subdivision shall not be construed to prohibit the insurer from offering other products provided that it complies with subdivision (d).
(f)For purposes of this section, a bridge plan product shall mean an individual health benefit plan, as defined in subdivision (a) of Section 10198.6 that is offered by a health insurer that contracts with the Exchange pursuant to Section 100504.5 of the Government Code.
(g)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. 10.Section 10112.3 of the Insurance Code, as amended by Section 17 of Chapter 572 of the Statutes of 2014, is amended to read:10112.3.(a)For purposes of this section, the following definitions shall apply:
(1)Exchange means the California Health Benefit Exchange established in Title 22 (commencing with Section 100500) of the Government Code.
(2)Federal act means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any amendments to, or regulations or guidance issued under, those acts.
(3)Qualified health plan has the same meaning as that term is defined in Section 1301 of the federal act.
(4)Small employer has the same meaning as that term is defined in Section 10753.
(b)(1)Health insurers participating in the individual market of the Exchange shall 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. Health insurers participating in the Covered California for Small Business program of the Exchange, established pursuant to subdivision (m) of Section 100502 of the Government Code, shall fairly and affirmatively offer, market, and sell in the Covered California for Small Business Exchange at least one product within each of the four levels of coverage contained in subsection (d) of Section 1302 of the federal act.
(2)The board established under Section 100500 of the Government Code may require insurers to sell additional products within each of the levels of coverage identified in paragraph (1).
(3)This subdivision shall not apply to an insurer that solely offers supplemental coverage in the Exchange under paragraph (10) of subdivision (a) of Section 100504 of the Government Code.
(c)(1)Health insurers participating in the Exchange that sell any products outside the Exchange shall 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 between the Managed Risk Medical Insurance Board and health insurers for enrolled Healthy Families beneficiaries or to 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 health insurers for enrolled Medi-Cal beneficiaries.
(d)(1)Commencing January 1, 2014, a health insurer shall, with respect to individual policies that cover hospital, medical, or surgical benefits, only sell the five levels of coverage contained in subsections (d) and (e) of Section 1302 of the federal act, except that a health insurer that does not participate in the Exchange shall, with respect to individual policies that cover hospital, medical, or surgical benefits, only sell the four levels of coverage contained in subsection (d) of Section 1302 of the federal act.
(2)Commencing January 1, 2014, a health insurer shall, with respect to small employer policies that cover hospital, medical, or surgical expenses, only sell the four levels of coverage contained in subsection (d) of Section 1302 of the federal act.
(e)Commencing January 1, 2014, a health insurer that does not participate in the Exchange shall, with respect to individual or small employer policies that cover hospital, medical, or surgical expenses, offer at least one standardized product that has been designated by the Exchange in each of the four levels of coverage contained in subsection (d) of Section 1302 of the federal act. This subdivision shall only apply if the board of the Exchange exercises its authority under subdivision (c) of Section 100504 of the Government Code. This subdivision does not require an insurer that does not participate in the Exchange to offer standardized products in the small employer market if the insurer only sells products in the individual market. This subdivision does not require an insurer that does not participate in the Exchange to offer standardized products in the individual market if the insurer only sells products in the small employer market. This subdivision shall not be construed to prohibit the insurer from offering other products provided that it complies with subdivision (d).
(f)This section shall become operative only if Section 11 of the act that added this section becomes inoperative pursuant to subdivision (g) of that Section 11.
For purposes of this title, the following definitions shall apply:
(a)Board means the board described in subdivision (a) of Section 100500.
(b)Bridge plan product means an individual health benefit plan as defined in subdivision (f) of Section 1399.845 of the Health and Safety Code that is offered by a health care service plan licensed under the Knox-Keene Health Care Service Plan Act of 1975 (Chapter 2.2 (commencing with Section 1340) of Division 2 of the Health and Safety Code) or as defined in subdivision (a) of Section 10198.6 of the Insurance Code that is offered by a health insurer licensed under the Insurance Code that contracts with the Exchange pursuant to this title.
(c)Carrier means either a private health insurer holding a valid outstanding certificate of authority from the Insurance Commissioner or a health care service plan, as defined under subdivision (f) of Section 1345 of the Health and Safety Code, licensed by the Department of Managed Health Care.
(d)Covered California for Small Business means the program established by subdivision (m) of Section 100502.
(d)(e)Exchange means the California Health Benefit Exchange established by Section 100500.
(e)(f)Federal act means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any amendments to, or regulations or guidance issued under, those acts.
(f)(g)Fund means the California Health Trust Fund established by Section 100520.
(g)(h)Health plan and qualified health plan have the same meanings as those terms are defined in Section 1301 of the federal act.
(h)(i)Healthy Families coverage means coverage under the Healthy Families Program pursuant to Part 6.2 (commencing with Section 12693) of Division 2 of the Insurance Code.
(i)(j)Medi-Cal coverage means coverage under the Medi-Cal program pursuant to Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of the Welfare and Institutions Code.
(j)(k)Modified adjusted gross income shall have the same meaning as the term is used in Section 1401(d)(2)(B) (26 U.S.C. Sec. 36B) of the federal act.
(k)(l)Members of the modified adjusted gross income household shall mean any individual who would be included in the calculation for modified adjusted gross income pursuant to Section 1401(a) (26 U.S.C. Sec. 36B(d)) of the federal act and as otherwise determined by the Exchange as permitted by the federal act and this title.
(l)SHOP Program means the Small Business Health Options Program established by subdivision (m) of Section 100502.(m)Supplemental coverage means coverage through a specialized health care service plan contract, as defined in subdivision (o) of Section 1345 of the Health and Safety Code, or a specialized health insurance policy, as defined in Section 106 of the Insurance Code.
(n)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 100501 of the Government Code, as added by Section 3 of Chapter 5 of the 1st Extraordinary Session of the Statutes of 2013, is amended to read:100501.For purposes of this title, the following definitions shall apply:
(a)Board means the board described in subdivision (a) of Section 100500.
(b)Carrier means either a private health insurer holding a valid outstanding certificate of authority from the Insurance Commissioner or a health care service plan, as defined under subdivision (f) of Section 1345 of the Health and Safety Code, licensed by the Department of Managed Health Care.
(c)Covered California for Small Business means the program established by subdivision (m) of Section 100502.
(c)(d)Exchange means the California Health Benefit Exchange established by Section 100500.
(d)(e)Federal act means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any amendments to, or regulations or guidance issued under, those acts.
(e)(f)Fund means the California Health Trust Fund established by Section 100520.
(f)(g)Health plan and qualified health plan have the same meanings as those terms are defined in Section 1301 of the federal act.
(g)SHOP Program means the Small Business Health Options Program established by subdivision (m) of Section 100502.(h)Supplemental coverage means coverage through a specialized health care service plan contract, as defined in subdivision (o) of Section 1345 of the Health and Safety Code, or a specialized health insurance policy, as defined in Section 106 of the Insurance Code.
(i)This section shall become operative only if Section 2 of the act that added this section becomes inoperative pursuant to subdivision (n) of that Section 2.
SEC. 3.Section 100502 of the Government Code is amended to read:100502.The board shall, at a minimum, do all of the following to implement Section 1311 of the federal act:
(a)Implement procedures for the certification, recertification, and decertification, consistent with guidelines established by the United States Secretary of Health and Human Services, of health plans as qualified health plans. The board shall require health plans seeking certification as qualified health plans to do all of the following:
(1)Submit a justification for any premium increase prior to implementation of the increase. The plans shall prominently post that information on their Internet Web sites. The board shall take this information, and the information and the recommendations provided to the board by the Department of Insurance or the Department of Managed Health Care under paragraph (1) of subdivision (b) of Section 2794 of the federal Public Health Service Act, into consideration when determining whether to make the health plan available through the Exchange. The board shall take into account any excess of premium growth outside the Exchange as compared to the rate of that growth inside the Exchange, including information reported by the Department of Insurance and the Department of Managed Health Care.
(2)(A)Make available to the public and submit to the board, the United States Secretary of Health and Human Services, and the Insurance Commissioner or the Department of Managed Health Care, as applicable, accurate and timely disclosure of the following information:
(i)Claims payment policies and practices.
(ii)Periodic financial disclosures.
(iii)Data on enrollment.
(iv)Data on disenrollment.
(v)Data on the number of claims that are denied.
(vi)Data on rating practices.
(vii)Information on cost sharing and payments with respect to any out-of-network coverage.
(viii)Information on enrollee and participant rights under Title I of the federal act.
(ix)Other information as determined appropriate by the United States Secretary of Health and Human Services.
(B)The information required under subparagraph (A) shall be provided in plain language, as defined in subparagraph (B) of paragraph (3) of subdivision (e) of Section 1311 of the federal act.
(3)Permit individuals to learn, in a timely manner upon the request of the individual, the amount of cost sharing, including, but not limited to, deductibles, copayments, and coinsurance, under the individuals plan or coverage that the individual would be responsible for paying with respect to the furnishing of a specific item or service by a participating provider. At a minimum, this information shall be made available to the individual through an Internet Web site and through other means for individuals without access to the Internet.
(b)Provide for the operation of a toll-free telephone hotline to respond to requests for assistance.
(c)Maintain an Internet Web site through which enrollees and prospective enrollees of qualified health plans may obtain standardized comparative information on those plans.
(d)Assign a rating to each qualified health plan offered through the Exchange in accordance with the criteria developed by the United States Secretary of Health and Human Services.
(e)Utilize a standardized format for presenting health benefits plan options in the Exchange, including the use of the uniform outline of coverage established under Section 2715 of the federal Public Health Service Act.
(f)Inform individuals of eligibility requirements for the Medi-Cal program, the Healthy Families Program, or any applicable state or local public program and, if, through screening of the application by the Exchange, the Exchange determines that an individual is eligible for any such program, of those programs, enroll that individual in the identified program.
(g)Establish and make available by electronic means a calculator to determine the actual cost of coverage after the application of any a premium tax credit under Section 36B of the Internal Revenue Code of 1986 and any cost-sharing reduction under Section 1402 of the federal act.
(h)Grant a certification attesting that, for purposes of the individual responsibility penalty under Section 5000A of the Internal Revenue Code of 1986, an individual is exempt from the individual requirement or from the penalty imposed by that section because of either of the following:
(1)There is no affordable qualified health plan available through the Exchange or the individuals employer covering the individual.
(2)The individual meets the requirements for any other exemption from the individual responsibility requirement or penalty.
(i)Transfer to the Secretary of the Treasury all of the following:
(1)A list of the individuals who are issued a certification under subdivision (h), including the name and taxpayer identification number of each individual.
(2)The name and taxpayer identification number of each individual who was an employee of an employer but who was determined to be eligible for the premium tax credit under Section 36B of the Internal Revenue Code of 1986 because of either of the following:
(A)The employer did not provide minimum essential coverage.
(B)The employer provided the minimum essential coverage but it was determined under subparagraph (C) of paragraph (2) of subsection (c) of Section 36B of the Internal Revenue Code of 1986 to either be unaffordable to the employee or not provide the required minimum actuarial value.
(3)The name and taxpayer identification number of each individual who notifies the Exchange under paragraph (4) of subsection (b) of Section 1411 of the federal act that they have changed employers and of each individual who ceases coverage under a qualified health plan during a plan year and the effective date of that cessation.
(j)Provide to each employer the name of each employee of the employer described in paragraph (2) of subdivision (i) who ceases coverage under a qualified health plan during a plan year and the effective date of that cessation.
(k)Perform duties required of, or delegated to, the Exchange by the United States Secretary of Health and Human Services or the Secretary of the Treasury related to determining eligibility for premium tax credits, reduced cost sharing, or individual responsibility exemptions.
(l)Establish the navigator program in accordance with subdivision (i) of Section 1311 of the federal act. Any An entity chosen by the Exchange as a navigator shall do all of the following:
(1)Conduct public education activities to raise awareness of the availability of qualified health plans.
(2)Distribute fair and impartial information concerning enrollment in qualified health plans, and the availability of premium tax credits under Section 36B of the Internal Revenue Code of 1986 and cost-sharing reductions under Section 1402 of the federal act.
(3)Facilitate enrollment in qualified health plans.
(4)Provide referrals to any applicable office of health insurance consumer assistance or health insurance ombudsman established under Section 2793 of the federal Public Health Service Act, or any other appropriate state agency or agencies, for any an enrollee with a grievance, complaint, or question regarding his or her health plan, coverage, or a determination under that plan or coverage.
(5)Provide information in a manner that is culturally and linguistically appropriate to the needs of the population being served by the Exchange.
(m)Establish the Small Business Health Options Program, Covered California for Small Business program, separate from the activities of the board related to the individual market, to assist qualified small employers in facilitating the enrollment of their employees in qualified health plans offered through the Exchange in the small employer market in a manner consistent with paragraph (2) of subdivision (a) of Section 1312 of the federal act. Any reference to the Small Business Health Options Program or the SHOP Program is deemed to refer to Covered California for Small Business.
SEC. 4.Section 100503 of the Government Code, as amended by Section 1 of Chapter 146 of the Statutes of 2016, 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 This section does 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 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, Require carriers, 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, require carriers, as a condition of participation in the SHOP Program, carriers Covered California for Small Business program, to fairly and affirmatively offer, market, and sell in the SHOP Program Covered California for Small Business 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 Covered California for Small Business 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, Covered California for Small Business, 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. 5.Section 100503 of the Government Code, as amended by Section 2 of Chapter 146 of the Statutes of 2016, 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 This section does 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 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, Require carriers, 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, require carriers, as a condition of participation in the SHOP Program, carriers Covered California for Small Business program, to fairly and affirmatively offer, market, and sell in the SHOP Program Covered California for Small Business 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 Covered California for Small Business 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, Covered California for Small Business, 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. 6.Section 100522 of the Government Code is amended to read:100522.(a)(1)The Exchange shall apply to the United States Department of Health and Human Services for a waiver authorized under Section 1332 of the federal act as defined in subdivision (e) (f) of Section 100501 in order to allow persons otherwise not able to obtain coverage by reason of immigration status through the Exchange to obtain coverage from the Exchange by waiving the requirement that the Exchange offer only qualified health plans solely for the purpose of offering coverage to persons otherwise not able to obtain coverage by reason of immigration status.
(2)The waiver of the requirement that the Exchange offer only qualified health plans as described in paragraph (1) shall be limited to requiring the Exchange to offer California qualified health plans consistent with this section only and shall not be construed to authorize the Exchange to offer any other nonqualified health plan.
(b)The Exchange shall require an issuer that offers a qualified health plan in the individual market through the Exchange to concurrently offer a California qualified health plan that meets all of the following criteria:
(1)Is subject to the requirements of this title, including all of those requirements applicable to qualified health plans.
(2)Is subject to the requirements of subdivisions (a), (b), and (d) of Section 1366.6 of the Health and Safety Code and subdivisions (a), (b), and (d) of Section 10112.3 of the Insurance Code in the same manner as qualified health plans.
(3)Is identical to the corresponding qualified health plan, except for the eligibility requirements set forth in subdivision (c).
(c)Persons eligible to purchase California qualified health plans shall pay the cost of coverage and shall not:
(1)Be eligible to receive federal advanced premium tax credit, federal cost-sharing reduction, or any other federal assistance for the payment of premiums or cost sharing for a California qualified health plan.
(2)Otherwise be eligible for enrollment in a qualified health plan offered through the Exchange by reason of immigration status.
(d)An applicant for coverage under this section shall be required to provide only the information strictly necessary to authenticate identity and determine eligibility under this section. Any person who receives information provided by an applicant under this section, whether directly or by another person at the request of the applicant, or receives information from any agency, shall use the information only for the purposes of, and to the extent necessary for, ensuring the efficient operation of the Exchange, including verifying the eligibility of an individual to enroll through the Exchange. That information shall not be disclosed to any other person except as provided in this section.
(e)Subdivisions (b) to (d), inclusive, shall become operative on January 1, 2018, for coverage effective for California qualified health plans beginning January 1, 2019, contingent upon federal approval of the waiver pursuant to subdivision (a).
SEC. 7.Section 1366.6 of the Health and Safety Code, as amended by Section 5 of Chapter 572 of the Statutes of 2014, is amended to read:1366.6.(a)For purposes of this section, the following definitions shall apply:
(1)Exchange means the California Health Benefit Exchange established in Title 22 (commencing with Section 100500) of the Government Code.
(2)Federal act means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any amendments to, or regulations or guidance issued under, those acts.
(3)Qualified health plan has the same meaning as that term is defined in Section 1301 of the federal act.
(4)Small employer has the same meaning as that term is defined in Section 1357.500.
(b)(1)Health care service plans participating in the individual market of the Exchange shall 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. Health care service plans participating in the Small Business Health Options Program (SHOP Program) Covered California for Small Business program of the Exchange, established pursuant to subdivision (m) of Section 100504 100502 of the Government Code, shall fairly and affirmatively offer, market, and sell in the SHOP Program Covered California for Small Business at least one product within each of the four levels of coverage contained in subsection (d) of Section 1302 of the federal act.
(2)The board established under Section 100500 of the Government Code may require plans to sell additional products within each of the levels of coverage identified in paragraph (1).
(3)This subdivision shall not apply to a plan that solely offers supplemental coverage in the Exchange under paragraph (10) of subdivision (a) of Section 100504 of the Government Code.
(4)This subdivision shall not apply to a bridge plan product that meets the requirements of Section 100504.5 of the Government Code to the extent approved by the appropriate federal agency.
(c)(1)Health care service plans participating in the Exchange that sell any products outside the Exchange shall 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 health care service plans for enrolled Healthy Families beneficiaries or to 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 health care service plans for enrolled Medi-Cal beneficiaries, or for contracts with bridge plan products that meet the requirements of Section 100504.5 of the Government Code.
(d)(1)Commencing January 1, 2014, a health care service plan shall, with respect to individual plan contracts that cover hospital, medical, or surgical benefits, only sell the five levels of coverage contained in subsections (d) and (e) of Section 1302 of the federal act, except that a health care service plan that does not participate in the Exchange shall, with respect to individual plan contracts that cover hospital, medical, or surgical benefits, only sell the four levels of coverage contained in subsection (d) of Section 1302 of the federal act.
(2)Commencing January 1, 2014, a health care service plan shall, with respect to small employer plan contracts that cover hospital, medical, or surgical expenses, only sell the four levels of coverage contained in subsection (d) of Section 1302 of the federal act.
(e)Commencing January 1, 2014, a health care service plan that does not participate in the Exchange shall, with respect to individual or small employer plan contracts that cover hospital, medical, or surgical benefits, offer at least one standardized product that has been designated by the Exchange in each of the four levels of coverage contained in subsection (d) of Section 1302 of the federal act. This subdivision shall only apply if the board of the Exchange exercises its authority under subdivision (c) of Section 100504 of the Government Code. Nothing in this subdivision shall This subdivision does not require a plan that does not participate in the Exchange to offer standardized products in the small employer market if the plan only sells products in the individual market. Nothing in this subdivision shall This subdivision does not require a plan that does not participate in the Exchange to offer standardized products in the individual market if the plan only sells products in the small employer market. This subdivision shall not be construed to prohibit the plan from offering other products provided that it complies with subdivision (d).
(f)For purposes of this section, a bridge plan product shall mean an individual health benefit plan, as defined in subdivision (f) of Section 1399.845, that is offered by a health care service plan licensed under this chapter that contracts with the Exchange pursuant to Title 22 (commencing with Section 100500) of the Government Code.
(g)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. 8.Section 1366.6 of the Health and Safety Code, as amended by Section 6 of Chapter 572 of the Statutes of 2014, is amended to read:1366.6.(a)For purposes of this section, the following definitions shall apply:
(1)Exchange means the California Health Benefit Exchange established in Title 22 (commencing with Section 100500) of the Government Code.
(2)Federal act means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any amendments to, or regulations or guidance issued under, those acts.
(3)Qualified health plan has the same meaning as that term is defined in Section 1301 of the federal act.
(4)Small employer has the same meaning as that term is defined in Section 1357.500.
(b)(1)Health care service plans participating in the individual market of the Exchange shall 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. Health care service plans participating in the Small Business Health Options Program (SHOP Program) Covered California for Small Business program of the Exchange, established pursuant to subdivision (m) of Section 100504 100502 of the Government Code, shall fairly and affirmatively offer, market, and sell in the SHOP Program Covered California for Small Business at least one product within each of the four levels of coverage contained in subsection (d) of Section 1302 of the federal act.
(2)The board established under Section 100500 of the Government Code may require plans to sell additional products within each of the levels of coverage identified in paragraph (1).
(3)This subdivision shall not apply to a plan that solely offers supplemental coverage in the Exchange under paragraph (10) of subdivision (a) of Section 100504 of the Government Code.
(c)(1)Health care service plans participating in the Exchange that sell any products outside the Exchange shall 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 health care service plans for enrolled Healthy Families beneficiaries or to 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 health care service plans for enrolled Medi-Cal beneficiaries.
(d)(1)Commencing January 1, 2014, a health care service plan shall, with respect to individual plan contracts that cover hospital, medical, or surgical benefits, only sell the five levels of coverage contained in subsections (d) and (e) of Section 1302 of the federal act, except that a health care service plan that does not participate in the Exchange shall, with respect to individual plan contracts that cover hospital, medical, or surgical benefits, only sell the four levels of coverage contained in subsection (d) of Section 1302 of the federal act.
(2)Commencing January 1, 2014, a health care service plan shall, with respect to small employer plan contracts that cover hospital, medical, or surgical expenses, only sell the four levels of coverage contained in subsection (d) of Section 1302 of the federal act.
(e)Commencing January 1, 2014, a health care service plan that does not participate in the Exchange shall, with respect to individual or small employer plan contracts that cover hospital, medical, or surgical benefits, offer at least one standardized product that has been designated by the Exchange in each of the four levels of coverage contained in subdivision (d) of Section 1302 of the federal act. This subdivision shall only apply if the board of the Exchange exercises its authority under subdivision (c) of Section 100504 of the Government Code. Nothing in this subdivision shall This subdivision does not require a plan that does not participate in the Exchange to offer standardized products in the small employer market if the plan only sells products in the individual market. Nothing in this subdivision shall This subdivision does not require a plan that does not participate in the Exchange to offer standardized products in the individual market if the plan only sells products in the small employer market. This subdivision shall not be construed to prohibit the plan from offering other products provided that it complies with subdivision (d).
(f)This section shall become operative only if Section 8 of the act that added this section becomes inoperative pursuant to subdivision (g) of that Section 8.
SEC. 9.Section 10112.3 of the Insurance Code, as amended by Section 16 of Chapter 572 of the Statutes of 2014, is amended to read:10112.3.(a)For purposes of this section, the following definitions shall apply:
(1)Exchange means the California Health Benefit Exchange established in Title 22 (commencing with Section 100500) of the Government Code.
(2)Federal act means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any amendments to, or regulations or guidance issued under, those acts.
(3)Qualified health plan has the same meaning as that term is defined in Section 1301 of the federal act.
(4)Small employer has the same meaning as that term is defined in Section 10753.
(b)(1)Health insurers participating in the individual market of the Exchange shall 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. Health insurers participating in the Small Business Health Options Program (SHOP Program) Covered California for Small Business program of the Exchange, established pursuant to subdivision (m) of Section 100504 100502 of the Government Code, shall fairly and affirmatively offer, market, and sell in the SHOP Program Covered California for Small Business at least one product within each of the four levels of coverage contained in subsection (d) of Section 1302 of the federal act.
(2)The board established under Section 100500 of the Government Code may require insurers to sell additional products within each of the levels of coverage identified in paragraph (1).
(3)This subdivision shall not apply to an insurer that solely offers supplemental coverage in the Exchange under paragraph (10) of subdivision (a) of Section 100504 of the Government Code. This subdivision shall not apply to a bridge plan product of a Medi-Cal managed care plan that contracts with the State Department of Health Care Services pursuant to Section 14005.70 of the Welfare and Institutions Code and that meets the requirements of Section 100504.5 of the Government Code, to the extent approved by the appropriate federal agency.
(c)(1)Health insurers participating in the Exchange that sell any products outside the Exchange shall 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 between the Managed Risk Medical Insurance Board and health insurers for enrolled Healthy Families beneficiaries or to 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 health insurers for enrolled Medi-Cal beneficiaries or for contracts with bridge plan products that meet the requirements of Section 100504.5 of the Government Code.
(d)(1)Commencing January 1, 2014, a health insurer shall, with respect to individual policies that cover hospital, medical, or surgical benefits, only sell the five levels of coverage contained in subsections (d) and (e) of Section 1302 of the federal act, except that a health insurer that does not participate in the Exchange shall, with respect to individual policies that cover hospital, medical, or surgical benefits, only sell the four levels of coverage contained in subsection (d) of Section 1302 of the federal act.
(2)Commencing January 1, 2014, a health insurer shall, with respect to small employer policies that cover hospital, medical, or surgical expenses, only sell the four levels of coverage contained in subsection (d) of Section 1302 of the federal act.
(e)Commencing January 1, 2014, a health insurer that does not participate in the Exchange shall, with respect to individual or small employer policies that cover hospital, medical, or surgical expenses, offer at least one standardized product that has been designated by the Exchange in each of the four levels of coverage contained in subsection (d) of Section 1302 of the federal act. This subdivision shall only apply if the board of the Exchange exercises its authority under subdivision (c) of Section 100504 of the Government Code. Nothing in this subdivision shall This subdivision does not require an insurer that does not participate in the Exchange to offer standardized products in the small employer market if the insurer only sells products in the individual market. Nothing in this subdivision shall This subdivision does not require an insurer that does not participate in the Exchange to offer standardized products in the individual market if the insurer only sells products in the small employer market. This subdivision shall not be construed to prohibit the insurer from offering other products provided that it complies with subdivision (d).
(f)For purposes of this section, a bridge plan product shall mean an individual health benefit plan, as defined in subdivision (a) of Section 10198.6 that is offered by a health insurer that contracts with the Exchange pursuant to Section 100504.5 of the Government Code.
(g)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. 10.Section 10112.3 of the Insurance Code, as amended by Section 17 of Chapter 572 of the Statutes of 2014, is amended to read:10112.3.(a)For purposes of this section, the following definitions shall apply:
(1)Exchange means the California Health Benefit Exchange established in Title 22 (commencing with Section 100500) of the Government Code.
(2)Federal act means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any amendments to, or regulations or guidance issued under, those acts.
(3)Qualified health plan has the same meaning as that term is defined in Section 1301 of the federal act.
(4)Small employer has the same meaning as that term is defined in Section 10753.
(b)(1)Health insurers participating in the individual market of the Exchange shall 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. Health insurers participating in the Small Business Health Options Program (SHOP Program) Covered California for Small Business program of the Exchange, established pursuant to subdivision (m) of Section 100504 100502 of the Government Code, shall fairly and affirmatively offer, market, and sell in the SHOP Program Covered California for Small Business at least one product within each of the four levels of coverage contained in subsection (d) of Section 1302 of the federal act.
(2)The board established under Section 100500 of the Government Code may require insurers to sell additional products within each of the levels of coverage identified in paragraph (1).
(3)This subdivision shall not apply to an insurer that solely offers supplemental coverage in the Exchange under paragraph (10) of subdivision (a) of Section 100504 of the Government Code.
(c)(1)Health insurers participating in the Exchange that sell any products outside the Exchange shall 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 between the Managed Risk Medical Insurance Board and health insurers for enrolled Healthy Families beneficiaries or to 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 health insurers for enrolled Medi-Cal beneficiaries.
(d)(1)Commencing January 1, 2014, a health insurer shall, with respect to individual policies that cover hospital, medical, or surgical benefits, only sell the five levels of coverage contained in subsections (d) and (e) of Section 1302 of the federal act, except that a health insurer that does not participate in the Exchange shall, with respect to individual policies that cover hospital, medical, or surgical benefits, only sell the four levels of coverage contained in subsection (d) of Section 1302 of the federal act.
(2)Commencing January 1, 2014, a health insurer shall, with respect to small employer policies that cover hospital, medical, or surgical expenses, only sell the four levels of coverage contained in subsection (d) of Section 1302 of the federal act.
(e)Commencing January 1, 2014, a health insurer that does not participate in the Exchange shall, with respect to individual or small employer policies that cover hospital, medical, or surgical expenses, offer at least one standardized product that has been designated by the Exchange in each of the four levels of coverage contained in subsection (d) of Section 1302 of the federal act. This subdivision shall only apply if the board of the Exchange exercises its authority under subdivision (c) of Section 100504 of the Government Code. Nothing in this subdivision shall This subdivision does not require an insurer that does not participate in the Exchange to offer standardized products in the small employer market if the insurer only sells products in the individual market. Nothing in this subdivision shall This subdivision does not require an insurer that does not participate in the Exchange to offer standardized products in the individual market if the insurer only sells products in the small employer market. This subdivision shall not be construed to prohibit the insurer from offering other products provided that it complies with subdivision (d).
(f)This section shall become operative only if Section 11 of the act that added this section becomes inoperative pursuant to subdivision (g) of that Section 11.
|
Date
|
Status
|
|---|---|
| Mar 23, 2018 | Chaptered by Secretary of State - Chapter 9, Statutes of 2018. |
| Mar 23, 2018 | Approved by the Governor. |
| Mar 22, 2018 | Enrolled and presented to the Governor at 3:30 p.m. |
| Mar 22, 2018 | Urgency clause adopted. Senate amendments concurred in. To Engrossing and Enrolling. |
| Mar 20, 2018 | From committee: That the Senate amendments be concurred in. (Ayes 15. Noes 0.) (March 20). |
| Mar 19, 2018 | In Assembly. Concurrence in Senate amendments pending. May be considered on or after March 21 pursuant to Assembly Rule 77. |
| Mar 19, 2018 | Read third time. Urgency clause adopted. Passed. Ordered to the Assembly. |
| Mar 15, 2018 | Read second time. Ordered to third reading. |
| Mar 14, 2018 | From committee: Do pass and re-refer to Com. on APPR. (Ayes 9. Noes 0.) (March 14). Re-referred to Com. on APPR. |
| Mar 12, 2018 | Read second time. Ordered to third reading. |
| Mar 8, 2018 | From inactive file. |
| Sep 13, 2017 | Ordered to inactive file at the request of Senator Hernandez. |
| Aug 24, 2017 | From Consent Calendar. |
| Aug 22, 2017 | Read second time. Ordered to Consent Calendar. |
| Aug 21, 2017 | From committee: Be placed on second reading file pursuant to Senate Rule 28.8 and ordered to consent calendar. |
| Jul 13, 2017 | From committee: Do pass and re-refer to Com. on APPR. with recommendation: To Consent Calendar. (Ayes 8. Noes 0.) (July 12). Re-referred to Com. on APPR. |
| May 24, 2017 | Referred to Com. on HEALTH. |
| May 11, 2017 | In Senate. Read first time. To Com. on RLS. for assignment. |
| May 11, 2017 | Read third time. Passed. Ordered to the Senate. (Ayes 77. Noes 0. Page 1487.) |
| May 4, 2017 | Read second time. Ordered to Consent Calendar. |
| May 3, 2017 | From committee: Do pass. To Consent Calendar. (Ayes 16. Noes 0.) (May 3). |
| May 1, 2017 | Re-referred to Com. on APPR. |
| Apr 27, 2017 | Read second time and amended. |
| Apr 26, 2017 | From committee: Amend, and do pass as amended and re-refer to Com. on APPR. with recommendation: To Consent Calendar. (Ayes 15. Noes 0.) (April 25). |
| Feb 21, 2017 | Referred to Com. on HEALTH. |
| Feb 10, 2017 | From printer. May be heard in committee March 12. |
| Feb 9, 2017 | Read first time. To print. |
|
Date
|
Description
|
Location
|
Votes
|
|
|---|---|---|---|---|
| Mar 22, 2018 | AB 417 LIMÓN Concurrence - Urgency Added | Assembly Floor |
Passed |
|
| Mar 20, 2018 | With recommendation: That Senate amendments be concurred in. | Assembly Standing Committee on Health |
Passed |
|
| Mar 19, 2018 | Local Bills, Second Reading | Senate Floor |
Passed |
|
| Mar 14, 2018 | Do pass, but first be re-referred to the Committee on [Appropriations] | Senate Standing Committee on Health |
Passed |
|
| Jul 12, 2017 | Do pass, but first be re-referred to the Committee on [Appropriations] with the recommendation: To Consent Calendar | Senate Standing Committee on Health |
Passed |
|
| May 11, 2017 | AB 417 WOOD Consent Calendar Second Day Regular Session | Assembly Floor |
Passed |
|
| May 3, 2017 | Do pass. To Consent Calendar. | Assembly Standing Committee on Appropriations |
Passed |
|
| Apr 25, 2017 | Do pass as amended, and be re-referred to the Committee on [Appropriations] with recommendation: To Consent Calendar | Assembly 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
|
|---|---|---|
| Aurora Vista Del Mar | ** Support | Mar 16, 2018 |
| Aurora Vista del Mar Hospital | * Support | Mar 14, 2018 |
| Board of Supervisors county of ventura | * Support | Mar 20, 2018 |
| California Hospital Association | ** Support | Mar 16, 2018 |
| Cottage Health | ** Support | Mar 16, 2018 |
| Health Access California | ** Support | Sep 12, 2017 |
| Ventura County Board of Supervisors | ** Support | Mar 16, 2018 |
CONCURRENCE IN SENATE AMENDMENTS
CSA2 Bill Id:AB 417
Author:(Limón)
As Amended Ver:March 8, 2018
2/3 vote. Urgency
ASSEMBLY: |
| (May 11, 2017) | SENATE: | 38-0 | (March 19, 2018) |
(vote not relevant)
COMMITTEE VOTE: | 15-0 | (March 20, 2018) | RECOMMENDATION: | concur |
(Health)
Original Committee Reference: HEALTH
SUMMARY: Authorizes the Department of Public Health (DPH), for a period of no more than 180 days, to permit an acute psychiatric hospital (APH) that was affected by a wildfire during the month of December 2017 and that is in the County of Ventura to provide outpatient mental health services that were approved by DPH and operational as supplemental services before the wildfire occurred, while the inpatient operations of the APH are voluntarily suspended. Makes the provisions of this bill inoperative on November 1, 2018. Contains an urgency clause to ensure that the provisions of this bill go into immediate effect upon enactment.
The Senate amendments delete the Assembly-approved version of this bill, and instead authorize DPH to permit an APH damaged by a wildfire to resume providing outpatient mental health services.
EXISTING LAW:
- Provides for the licensure and regulation of health facilities by DPH, including APHs, which are defined as facilities that provide 24-hour inpatient care for persons with mental health disorders, including the following basic services: medical; nursing; rehabilitative; pharmacy; and, dietary services.
- Defines supplemental services in the California Code of Regulations as organized inpatient or outpatient services which are not required to be provided by law or regulation.
- Requires DPH, upon issuance and renewal of a license for a hospital, including an APH to separately identify on the license each supplemental service, including the address of where each outpatient service is provided and the type of services provided at each outpatient location.
- Permits a licensed hospital, including an APH, to provide health care services in an alternative setting if those health care services would otherwise be permitted outside of a hospital building. Requires all health care professionals providing services in alternative settings to be members of the medical staff of the hospital to the extent medical staff membership would be required for the provision of the services within the hospital.
FISCAL EFFECT: According to the Senate Appropriations Committee, pursuant to Senate Rule 28.8, negligible state costs.
COMMENTS: According to the author, Aurora Vista del Mar (AVDM) psychiatric hospital was severely damaged in the Thomas fire in December 2017. It was the only private free-standing APH in Ventura County, and its 87 acute psychiatric hospital beds account for almost three-fourths of all APH beds in Ventura County. This has led to a severe lack of mental health services in this region, particularly for adolescent services, and the outpatient mental health services are of critical need. The loss of services by AVDM has had a ripple effect throughout the community, leading to longer wait times for psychiatric beds and mental health services, and causing individuals to go without urgently-needed treatment. In the meantime, they were able to bring outpatient services back online to serve the community immediately. However, the services are on the hospital's general acute care license, and unfortunately DPH cannot approve them until the hospital beds are re-opened. This bill would provide the short-term statutory fix that is required to allow DPH to permit the services to reopen. Specifically, this bill will allow DPH to authorize outpatient services for a short period of time while the inpatient services are suspended.
- AVDM. As a result of the fire, AVDM ceased providing all mental health services, including both inpatient and outpatient services. While two buildings were destroyed, the facility is anticipating it will be able to bring approximately 50 beds back before June of this year. In the meantime, they are able to bring outpatient services back online to serve the community immediately, however, the outpatient services are part of the hospitals general acute care license, and DPH does not have statutory authority to allow them to resume providing services until some of the inpatient beds are re-opened and the hospital's license is reactivated.
The outpatient programs offered by AVDM are as follows:
- Adult utilization program. This program, also called Partial Hospitalization (PHP) provides a five day per week treatment program for individuals suffering with mild to severe psychiatric disorders. Each patient receives an individualized treatment plan helping the patient to divert crisis, stabilize, and learn tools for continued mental wellness.
- Adult intensive outpatient hospitalization program (IOP). This program is a three day a week program that can act as a step down to the adult utilization program, helping to ensure ongoing wellness and prevent illness relapse.
- Adolescent intensive outpatient hospitalization program. The adolescent program is offered as an after school program for ages 12 to 17 years of age. The program serves as a means of prevention and is designed to build awareness of triggers, coping skills, and communication.
- Existing shortage of psychiatric beds. According to a California Hospital Association (CHA) report, California's Acute Psychiatric Bed Loss, updated January 11, 2018, as of 2015, California had 29 hospitals licensed as freestanding APHs and 28 county-based Psychiatric Health Facilities, which only provide care to individuals with acute behavioral needs. An additional 80 facilities have dedicated psychiatric units within general acute care hospitals (GACHs). California has nearly 440 GACHs, of which about one-fifth have dedicated psychiatric units. Combined, these hospitals supply the 6,610 beds available around the state for individuals in need of short-term, acute level of care, psychiatric inpatient services. Of California's 58 counties, only 33 have inpatient psychiatric beds, and only 14 counties have inpatient psychiatric beds for children and adolescents. The CHA report notes that California has one psychiatric bed for every 5,922 people when the recommendation is one psychiatric bed for every 2,000 people.
Other than the 87 beds at AVDM, the only other hospital with psychiatric inpatient beds is Ventura County Medical Center with a 43 bed inpatient psychiatric unit as part of its 223 bed general acute care hospital. Additionally, AVDM had between 20 and 34 beds dedicated to adolescent psychiatric beds, which are the only dedicated adolescent psychiatric beds in Ventura County. AVDM states that it is the only acute psychiatric care provider serving adolescents in the Counties of Ventura, Santa Barbara, and San Luis Obispo.
- Current status of AVDM licensure. The Thomas fire burned two buildings at AVDM: The administration building, and a 34 bed inpatient unit. All of the 70 patients that were there were safely evacuated over the course of the night and transferred to other facilities. Some at the Ventura County Medical Center, and others as far away as Bakersfield and Pasadena.
While AVDM plans to ultimately rebuild the destroyed buildings and regain full capacity, in the shorter term it is in the process of trying to resume inpatient services in the 53 bed building that was not destroyed. Among other things, this involves replacing the destroyed administration building with a trailer, in part to house medical records, and also replacing pharmacy services, in order to have the five basic services that are required to operate an APH (medical, nursing, rehabilitative, pharmacy, and dietary services). AVDM expects to be able to resume inpatient services for a 53 bed unit in June 2018. In the meantime, AVDM leased a medical office building effective on February 1, 2018, with the intention of resuming their PHP and IOP outpatient services on February 5, 2018. However, because outpatient services are a supplemental service to the inpatient hospital, until the inpatient hospital has resumed operating with the five basic services; DPH was not able to approve the outpatient services. AVDM worked with DPH to find alternatives, exploring the possibility of providing services through a statutory exemption from laws governing primary care and specialty clinics, but AVDM would have needed to obtain new managed care contracts, and since the medical staff had been providing services under the hospital license, the medical staff would have needed to form a new provider relationship. AVDM determined this alternative would have been too time consuming, and instead is seeking this bill to provide a temporary statutory pathway to resume outpatient services.
AVDM supports this bill and states that the facility is a critically important provider of inpatient and outpatient mental health services within the county – and the state. AVDM notes that the loss of both inpatient and outpatient services has had a ripple effect throughout the community with emergency departments and crisis teams across the region experiencing longer wait times for psychiatric beds and mental health services, causing individuals to go without urgently needed treatment. Patients are seeking services as far away as San Francisco and San Diego. AVDM states that allowing access to outpatient services including licensed psychiatrists, therapist, psychologists, social workers , and other mental health professionals in nearby office space; families can seek immediate treatment for their loved ones, participate in family support therapy groups, and obtain information for resources needed in continuing care. AVDM contends that, although not published, it has been reported by local county behavioral health directors that since the fire that closed services at AVDM, there have been more successful suicides by adolescents in the service area this past quarter than in several years.
CHA supports this bill, noting that by allowing access to outpatient services in local communities, families can seek immediate treatment for their loved ones, participate in family support therapy groups and obtain information about needed continuing care resources.
Cottage Health and Los Robles Hospital & Medical Center support this bill, stating that it is narrowly crafted legislation that allows DPH to authorized outpatient behavioral health services for a short period of time, while the hospital's inpatient services are suspended because of fire damage.
The Ventura county Sheriff's Office supports this bill, stating that every day that these much-needed services remain offline because of regulatory obstacles, lives are potentially at risk.
There is no known opposition to this bill.
Analysis Prepared by: Lara Flynn / HEALTH / (916) 319-2097 FN: 0002623
CONCURRENCE IN SENATE AMENDMENTS
CSA1 Bill Id:AB 417
Author:(Limón)
As Amended Ver:March 8, 2018
2/3 vote. Urgency
ASSEMBLY: |
| (May 11, 2017) | SENATE: | 38-0 | (March 19, 2018) |
(vote not relevant)
Original Committee Reference: HEALTH
SUMMARY: Authorizes the Department of Public Health (DPH), for a period of no more than 180 days, to permit an acute psychiatric hospital (APH) that was affected by a wildfire during the month of December 2017 and that is in the County of Ventura to provide outpatient mental health services that were approved by DPH and operational as supplemental services before the wildfire occurred, while the inpatient operations of the APH are voluntarily suspended. Makes the provisions of this bill inoperative on November 1, 2018. Contains an urgency clause to ensure that the provisions of this bill go into immediate effect upon enactment.
The Senate amendments delete the Assembly-approved version of this bill, and instead authorize DPH to permit an APH damaged by a wildfire to resume providing outpatient mental health services.
EXISTING LAW:
- Provides for the licensure and regulation of health facilities by DPH, including APHs, which are defined as facilities that provide 24-hour inpatient care for persons with mental health disorders, including the following basic services: medical; nursing; rehabilitative; pharmacy; and, dietary services.
- Defines supplemental services in the California Code of Regulations as organized inpatient or outpatient services which are not required to be provided by law or regulation.
- Requires DPH, upon issuance and renewal of a license for a hospital, including an APH to separately identify on the license each supplemental service, including the address of where each outpatient service is provided and the type of services provided at each outpatient location.
- Permits a licensed hospital, including an APH, to provide health care services in an alternative setting if those health care services would otherwise be permitted outside of a hospital building. Requires all health care professionals providing services in alternative settings to be members of the medical staff of the hospital to the extent medical staff membership would be required for the provision of the services within the hospital.
FISCAL EFFECT: Unknown. As amended, this bill has not been analyzed by a fiscal committee.
COMMENTS:
- PURPOSE OF THIS BILL. According to the author, Aurora Vista del Mar (AVDM) psychiatric hospital was severely damaged in the Thomas fire in December 2017. It was the only private free-standing APH in Ventura County, and its 87 acute psychiatric hospital beds account for almost three-fourths of all APH beds in Ventura County. This has led to a severe lack of mental health services in this region, particularly for adolescent services, and the outpatient mental health services are of critical need. The loss of services by AVDM has had a ripple effect throughout the community, leading to longer wait times for psychiatric beds and mental health services, and causing individuals to go without urgently-needed treatment. In the meantime, they were able to bring outpatient services back online to serve the community immediately. However, the services are on the hospital's general acute care license, and unfortunately DPH cannot approve them until the hospital beds are re-opened. This bill would provide the short-term statutory fix that is required to allow DPH to permit the services to reopen. Specifically, this bill will allow DPH to authorize outpatient services for a short period of time while the inpatient services are suspended.
- BACKGROUND.
- AVDM. As a result of the fire, AVDM ceased providing all mental health services, including both inpatient and outpatient services. While two buildings were destroyed, the facility is anticipating it will be able to bring approximately 50 beds back before June of this year. In the meantime, they are able to bring outpatient services back online to serve the community immediately, however, the outpatient services are part of the hospitals general acute care license, and DPH does not have statutory authority to allow them to resume providing services until some of the inpatient beds are re-opened and the hospital's license is reactivated.
The outpatient programs offered by AVDM are as follows:
- Adult utilization program. This program, also called Partial Hospitalization (PHP) provides a five day per week treatment program for individuals suffering with mild to severe psychiatric disorders. Each patient receives an individualized treatment plan helping the patient to divert crisis, stabilize, and learn tools for continued mental wellness.
- Adult intensive outpatient hospitalization program (IOP). This program is a three day a week program that can act as a step down to the adult utilization program, helping to ensure ongoing wellness and prevent illness relapse.
- Adolescent intensive outpatient hospitalization program. The adolescent program is offered as an after school program for ages 12 to 17 years of age. The program serves as a means of prevention and is designed to build awareness of triggers, coping skills, and communication.
- Existing shortage of psychiatric beds. According to a California Hospital Association (CHA) report, California's Acute Psychiatric Bed Loss, updated January 11, 2018, as of 2015, California had 29 hospitals licensed as freestanding APHs and 28 county-based Psychiatric Health Facilities, which only provide care to individuals with acute behavioral needs. An additional 80 facilities have dedicated psychiatric units within General Acute Care Hospitals (GACHs). California has nearly 440 GACHs, of which about one-fifth have dedicated psychiatric units. Combined, these hospitals supply the 6,610 beds available around the state for individuals in need of short-term, acute level of care, psychiatric inpatient services. Of California's 58 counties, only 33 have inpatient psychiatric beds, and only 14 counties have inpatient psychiatric beds for children and adolescents. The CHA report notes that California has one psychiatric bed for every 5,922 people when the recommendation is one psychiatric bed for every 2,000 people.
Other than the 87 beds at AVDM, the only other hospital with psychiatric inpatient beds is Ventura County Medical Center with a 43 bed inpatient psychiatric unit as part of its 223 bed general acute care hospital. Additionally, AVDM had between 20 and 34 beds dedicated to adolescent psychiatric beds, which are the only dedicated adolescent psychiatric beds in Ventura County. AVDM states that it is the only acute psychiatric care provider serving adolescents in the Counties of Ventura, Santa Barbara, and San Luis Obispo.
- Current status of AVDM licensure. The Thomas fire burned two buildings at AVDM: The administration building, and a 34 bed inpatient unit. All of the 70 patients that were there were safely evacuated over the course of the night and transferred to other facilities. Some at the Ventura County Medical Center, and others as far away as Bakersfield and Pasadena.
While AVDM plans to ultimately rebuild the destroyed buildings and regain full capacity, in the shorter term it is in the process of trying to resume inpatient services in the 53 bed building that was not destroyed. Among other things, this involves replacing the destroyed administration building with a trailer, in part to house medical records, and also replacing pharmacy services, in order to have the five basic services that are required to operate an APH (medical, nursing, rehabilitative, pharmacy, and dietary services). AVDM expects to be able to resume inpatient services for a 53 bed unit in June 2018. In the meantime, AVDM leased a medical office building effective on February 1, 2018, with the intention of resuming their PHP and IOP outpatient services on February 5, 2018. However, because outpatient services are a supplemental service to the inpatient hospital, until the inpatient hospital has resumed operating with the five basic services; DPH was not able to approve the outpatient services. AVDM worked with DPH to find alternatives, exploring the possibility of providing services through a statutory exemption from laws governing primary care and specialty clinics, but AVDM would have needed to obtain new managed care contracts, and since the medical staff had been providing services under the hospital license, the medical staff would have needed to form a new provider relationship. AVDM determined this alternative would have been too time consuming, and instead is seeking this bill to provide a temporary statutory pathway to resume outpatient services.
- SUPPORT. AVDM supports this bill and states that the facility is a critically important provider of inpatient and outpatient mental health services within the county – and the state. AVDM notes that the loss of both inpatient and outpatient services has had a ripple effect throughout the community with emergency departments and crisis teams across the region experiencing longer wait times for psychiatric beds and mental health services, causing individuals to go without urgently needed treatment. Patients are seeking services as far away as San Francisco and San Diego. AVDM states that allowing access to outpatient services including licensed psychiatrists, therapist, psychologists, social workers , and other mental health professionals in nearby office space; families can seek immediate treatment for their loved ones, participate in family support therapy groups, and obtain information for resources needed in continuing care. AVDM contends that, although not published, it has been reported by local county behavioral health directors that since the fire that closed services at AVDM, there have been more successful suicides by adolescents in the service area this past quarter than in several years.
CHA supports this bill, noting that by allowing access to outpatient services in local communities, families can seek immediate treatment for their loved ones, participate in family support therapy groups and obtain information about needed continuing care resources.
Cottage Health and Los Robles Hospital & Medical Center support this bill, stating that it is narrowly crafted legislation that allows DPH to authorized outpatient behavioral health services for a short period of time, while the hospital's inpatient services are suspended because of fire damage. The Ventura county Sheriff's Office supports this bill, stating that every day that these much-needed services remain offline because of regulatory obstacles, lives are potentially at risk.
- OPPOSITION. None on file
- COMMENT. This bill as amended has not been heard by an Assembly policy committee.
Analysis Prepared by: Lara Flynn / HEALTH / (916) 319-2097 FN: 0002620
Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | AB |
THIRD READING
Bill No: AB 417
:
SENATE HEALTH COMMITTEE: 9-0, 3/14/18 (Pursuant to Senate Rule 29.10)
AYES: Hernandez, Nguyen, Leyva, Mitchell, Monning, Newman, Nielsen, Pan, Roth
SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8
SUBJECT: Acute psychiatric hospital: County of Ventura: outpatient mental health services
DIGEST:
This bill permits an acute psychiatric hospital in Ventura County, which was damaged by a recent fire, to resume providing outpatient mental health services for up to 180 days while the inpatient operations of the hospital are voluntarily suspended. Contains an urgency clause that will make this bill effective upon enactment.
Senate Floor Amendments of 3/8/18 delete the prior version of the bill and replace it with the current language.
Existing law:
- Licenses and regulates hospitals, including a general acute care hospital and an acute psychiatric hospital (APH), by the Department of Public Health (DPH). [HSC §1250 et. seq.]
- Defines an APH as a health facility that provides 24-hour inpatient care for persons with mental health disorders, including the following basic services: medical, nursing, rehabilitative, pharmacy, and dietary services. [HSC §1250 (b)]
- Requires DPH, upon issuance and renewal of a license for a hospital, including an APH, to separately identify on the license each supplemental service, including the address where each outpatient service is provided and the type of services provided at each outpatient location. [HSC §1253.5]
- Permits a licensed hospital, including an APH, to provide health care services in an alternative setting if those health care services would otherwise be permitted outside of a hospital building. Requires all health care professionals providing services in alternative settings to be members of the medical staff of the hospital to the extent medical staff membership would be required for the provision of the services within the hospital. [HSC §1275.6]
This bill:
- Permits DPH, notwithstanding any other law, for a period of up to 180 days, to allow an APH that was affected by a wildfire in December 2017 and is in the County of Ventura to provide outpatient mental health services that were approved by DPH and operational as supplemental services before the wildfire occurred, while the inpatient operations of the APH are voluntarily suspended.
- Makes the provision in 1) above inoperative on November 1, 2018, and repeals it on January 1, 2019.
- Makes various legislative findings and declarations, including that the loss of services by the Aurora Vista Del Mar (AVDM) hospital has had a ripple effect throughout the community, leading to longer wait times for psychiatric hospital beds and mental health services, causing individuals to go without urgently needed treatment, and that AVDM is currently ready and able to commence outpatient supplemental mental health services near the facility.
- Contains an urgency clause that will make this bill effective upon enactment.
Comments
- Author’s statement. According to the author, AVDM psychiatric hospital was severely damaged in the Thomas Fire in December 2017. It was the only private free-standing APH in Ventura County, and its 87 acute psychiatric hospital beds account for almost three-fourths of all APH beds in Ventura County. This has led to a severe lack of mental health services in this region, particularly for adolescent services, and the outpatient mental health services are of critical need. The loss of services by AVDM has had a ripple effect throughout the community, leading to longer wait times for psychiatric beds and mental health services, and causing individuals to go without urgently-needed treatment. In the meantime, they were able to bring outpatient services back online to serve the community immediately. However, the services are on the hospitals general acute care license, and unfortunately DPH cannot approve them until the beds are re-opened. This bill would provide the short-term statutory fix is required to allow DPH to permit the services to reopen. Specifically the bill will allow DPH to authorize outpatient services for a short period of time while the inpatient services are suspended.
- Background on Aurora Vista Del Mar Acute Psychiatric Hospital. AVDM is licensed as an 87 bed APH. AVDM has inpatient programs for both adults as well as adolescents aged 12 to 17. In addition to their inpatient beds, AVDM is licensed by DPH to provide intensive outpatient services called “partial hospitalization.” According to DPH, the partial hospitalization program (PHP) is a structured, comprehensive, short-term, and intensive outpatient mental health program that provides less than 24 hours treatment for individuals who are either currently discharged from an inpatient psychiatric care or are recovering from acute mental health treatment. It is a step below inpatient hospitalization but more concentrated than a traditional Intensive Outpatient Program (IOP). Clients are generally referred to PHPs when they are experiencing acute psychiatric symptoms that are difficult to manage but do not require 24-hour inpatient hospitalization. Most clients who participate in PHP attend structured therapeutic programming according to their individualized treatment schedule, and they normally attend the program during the day, and return home in the evenings. PHP services may include: structured therapeutic interventions; individual and group psychotherapy; community reintegration services; medication stabilization services; and family consultation and education. In addition to the PHP, AVDM also provides both an adult and an adolescent IOP, which is similar to a PHP except the services are generally for three days per week, and for fewer hours. AVDM’s adolescent IOP is offered as an after school program for ages 12 to 17, and serves as a means of prevention and is designed to build awareness of triggers, coping skills, and communication.
- Shortage of inpatient psychiatric services statewide and in Ventura County. California has a well-documented shortage of psychiatric inpatient beds across the state. According to data from the Office of Statewide Health Planning and Development, not counting the state hospitals where patients are only admitted by court order and are not available to the public, as of 2015 there were only about 6,610 acute psychiatric beds available in California. This is down from 9,353 beds in 1995, a drop of nearly 30%. The Treatment Advocacy Center recommends there be at least 50 psychiatric beds per 100,000 population, while California only has about 17 beds per 100,000 on a statewide average. Ventura County, with a population of about 850,000, has about 15 psychiatric inpatient beds per 100,000 people. Other than the 87 beds at AVDM, the only other hospital with psychiatric inpatient beds is Ventura County Medical Center with a 43 bed inpatient psychiatric unit as part of its 223 bed general acute care hospital. Additionally, AVDM had between 20 and 34 beds dedicated to adolescent psychiatric beds, which are the only dedicated adolescent psychiatric beds in Ventura County. AVDM states that it is the only acute psychiatric care provider serving adolescents in the Counties of Ventura, Santa Barbara and San Luis Obispo.
- Thomas Fire, impact on AVDM, and the statutory impediment to resuming outpatient services. The Thomas Fire, which began on December 4, 2017, and ultimately burned more than 280,000 acres in Ventura and Santa Barbara Counties along with more than 1,000 structures, burned two buildings at AVDM: the administration building, and a 34 bed inpatient unit. All of the 70 patients that were there on December 4 were safely evacuated over the course of the night, and transferred to other facilities. Some were accommodated at Ventura County Medical Center, but others were transferred as far as Bakersfield and Pasadena.
While AVDM plans to ultimately rebuild the destroyed buildings and regain full capacity, in the shorter term it is in the process of trying to resume inpatient services in the 53 bed building that was not destroyed. Among other things, this involves replacing the destroyed administration building with a trailer, in part to house medical records, and also replacing pharmacy services, in order to have the five basic services that are required to operate an APH (medical, nursing, rehabilitative, pharmacy, and dietary services). AVDM expects to be able to resume inpatient services for the 53 bed unit in June. In the meantime, AVDM leased a medical office building effective on February 1st, with the intention of resuming their PHP and IOP outpatient services on February 5th. However, because their outpatient services are a supplemental service to their inpatient hospital, until the inpatient hospital has resumed operating with the five basic services, DPH was not able to approve the outpatient services. AVDM worked with DPH to find alternatives, exploring the possibility of providing services through a statutory exemption from laws governing primary care and specialty clinics, but AVDM would have needed to obtain new managed care contracts, and since the medical staff had been providing services under the hospital license, the medical staff would have needed to form a new provider relationship. AVDM determined this alternative would have been too time consuming, and instead is seeking this bill to provide a temporary statutory pathway to resume outpatient services.
FISCAL EFFECT: Appropriation: Fiscal Com.: Local:
Aurora Vista Del Mar (source)
California Hospital Association
Cottage Health
Ventura County Board of Supervisors
OPPOSITION: (Verified 3/14/18)
None received
ARGUMENTS IN SUPPORT: This bill is sponsored by AVDM, which states that as a result of the Thomas Fire, it had to cease providing all mental health services, including both inpatient and outpatient services, on December 4, 2017. While buildings were destroyed, AVDM states it is working diligently to bring temporary mobile support services in order to re-open the approximately 50 beds not destroyed by the fire, which should hopefully occur by June of this year. In the meantime, AVDM states it does have the ability to bring outpatient services back online to serve the community immediately. However, the outpatient services are supplemental to AVDM’s acute psychiatric hospital license. AVDM states that without the basic services that an APH is required to provide, including pharmacy and food services, the inpatient hospital must remain closed, and those services will not be ready for approval for several months. Because the outpatient services are tied to the inpatient license, the outpatient services will also not be eligible to open until the inpatient services are completed for at least half of their licensed beds. Given the concerns related to the severe lack of mental health services in Ventura County, AVDM states that this bill is needed to allow outpatient services to continue while the inpatient services are restored.
The California Hospital Association (CHA) states that AVDM is a critically important provider of inpatient and outpatient mental health services within the county and the state. The hospital regularly accepts adult and adolescent patients from around the state, including Ventura, Santa Barbara, San Luis Obispo, Kern, Kings, Tulare, Fresno, Los Angeles, Riverside, San Diego, Orange, Madera, Merced, and San Bernardino Counties. CHA states that by allowing access to outpatient services in local communities, families can seek immediate treatment for their loved ones, participate in family support therapy groups, and obtain information about needed continuing care resources. According to CHA, local county behavioral health directors have reported that, since the fires that closed services at AVDM, more adolescents have successfully committed suicide. CHA states that every day matters, and until these services are restored, lives are at risk.
3/16/18 11:02:27
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 417
AUTHOR: | Limón | ||
VERSION: | March 8, 2018 | ||
HEARING DATE: | March 14, 2018 | ||
CONSULTANT: | Vincent D. Marchand | ||
PURSUANT TO SENATE RULE 29.10
SUBJECT: Acute psychiatric hospital: County of Ventura: outpatient mental health services.
SUMMARY:
Permits an acute psychiatric hospital in Ventura County, which was damaged by a recent fire, to resume providing outpatient mental health services for up to 180 days while the inpatient operations of the hospital are voluntarily suspended. Contains an urgency clause that will make this bill effective upon enactment.
Existing law:
- Licenses and regulates hospitals, including a general acute care hospital and an acute psychiatric hospital (APH), by the Department of Public Health (DPH). [HSC §1250 et. seq.]
- Defines an APH as a health facility that provides 24-hour inpatient care for persons with mental health disorders, including the following basic services: medical, nursing, rehabilitative, pharmacy, and dietary services. [HSC §1250 (b)]
- Requires DPH, upon issuance and renewal of a license for a hospital, including an APH, to separately identify on the license each supplemental service, including the address where each outpatient service is provided and the type of services provided at each outpatient location. [HSC §1253.5]
- Permits a licensed hospital, including an APH, to provide health care services in an alternative setting if those health care services would otherwise be permitted outside of a hospital building. Requires all health care professionals providing services in alternative settings to be members of the medical staff of the hospital to the extent medical staff membership would be required for the provision of the services within the hospital. [HSC §1275.6]
This bill:
- Permits DPH, notwithstanding any other law, for a period of up to 180 days, to allow an APH that was affected by a wildfire in December 2017 and is in the County of Ventura to provide outpatient mental health services that were approved by DPH and operational as supplemental services before the wildfire occurred, while the inpatient operations of the APH are voluntarily suspended.
- Makes the provision in 1) above inoperative on November 1, 2018, and repeals it on January 1, 2019.
- Makes various legislative findings and declarations, including that the loss of services by the Aurora Vista Del Mar (AVDM) hospital has had a ripple effect throughout the community, leading to longer wait times for psychiatric hospital beds and mental health services, causing individuals to go without urgently needed treatment, and that AVDM is currently ready and able to commence outpatient supplemental mental health services near the facility.
- Contains an urgency clause that will make this bill effective upon enactment.
FISCAL EFFECT:
This bill has not been analyzed by a fiscal committee.
PRIOR VOTES:
Prior votes not relevant.
COMMENTS:
- Author’s statement. According to the author, AVDM psychiatric hospital was severely damaged in the Thomas Fire in December 2017. It was the only private free-standing APH in Ventura County, and its 87 acute psychiatric hospital beds account for almost three-fourths of all APH beds in Ventura County. This has led to a severe lack of mental health services in this region, particularly for adolescent services, and the outpatient mental health services are of critical need. The loss of services by AVDM has had a ripple effect throughout the community, leading to longer wait times for psychiatric beds and mental health services, and causing individuals to go without urgently-needed treatment. In the meantime, they were able to bring outpatient services back online to serve the community immediately. However, the services are on the hospitals general acute care license, and unfortunately DPH cannot approve them until the beds are re-opened. This bill would provide the short-term statutory fix is required to allow DPH to permit the services to reopen. Specifically the bill will allow DPH to authorize outpatient services for a short period of time while the inpatient services are suspended.
- Background on Aurora Vista Del Mar Acute Psychiatric Hospital. AVDM is licensed as an 87 bed APH. AVDM has inpatient programs for both adults as well as adolescents aged 12 to 17. In addition to their inpatient beds, AVDM is licensed by DPH to provide intensive outpatient services called “partial hospitalization.” According to DPH, the partial hospitalization program (PHP) is a structured, comprehensive, short-term, and intensive outpatient mental health program that provides less than 24 hours treatment for individuals who are either currently discharged from an inpatient psychiatric care or are recovering from acute mental health treatment. It is a step below inpatient hospitalization but more concentrated than a traditional Intensive Outpatient Program (IOP). Clients are generally referred to PHPs when they are experiencing acute psychiatric symptoms that are difficult to manage but do not require 24-hour inpatient hospitalization. Most clients who participate in PHP attend structured therapeutic programming according to their individualized treatment schedule, and they normally attend the program during the day, and return home in the evenings. PHP services may include: structured therapeutic interventions; individual and group psychotherapy; community reintegration services; medication stabilization services; and family consultation and education. In addition to the PHP, AVDM also provides both an adult and an adolescent IOP, which is similar to a PHP except the services are generally for three days per week, and for fewer hours. AVDM’s adolescent IOP is offered as an after school program for ages 12 to 17, and serves as a means of prevention and is designed to build awareness of triggers, coping skills, and communication.
- Shortage of inpatient psychiatric services statewide and in Ventura County. California has a well-documented shortage of psychiatric inpatient beds across the state. According to data from the Office of Statewide Health Planning and Development, not counting the state hospitals where patients are only admitted by court order and are not available to the public, as of 2015 there were only about 6,610 acute psychiatric beds available in California. This is down from 9,353 beds in 1995, a drop of nearly 30%. The Treatment Advocacy Center recommends there be at least 50 psychiatric beds per 100,000 population, while California only has about 17 beds per 100,000 on a statewide average. Ventura County, with a population of about 850,000, has about 15 psychiatric inpatient beds per 100,000 people. Other than the 87 beds at AVDM, the only other hospital with psychiatric inpatient beds is Ventura County Medical Center with a 43 bed inpatient psychiatric unit as part of its 223 bed general acute care hospital. Additionally, AVDM had between 20 and 34 beds dedicated to adolescent psychiatric beds, which are the only dedicated adolescent psychiatric beds in Ventura County. AVDM states that it is the only acute psychiatric care provider serving adolescents in the Counties of Ventura, Santa Barbara and San Luis Obispo.
- Thomas Fire, impact on AVDM, and the statutory impediment to resuming outpatient services. The Thomas Fire, which began on December 4, 2017, and ultimately burned more than 280,000 acres in Ventura and Santa Barbara Counties along with more than 1,000 structures, burned two buildings at AVDM: the administration building, and a 34 bed inpatient unit. All of the 70 patients that were there on December 4 were safely evacuated over the course of the night, and transferred to other facilities. Some were accommodated at Ventura County Medical Center, but others were transferred as far as Bakersfield and Pasadena.
While AVDM plans to ultimately rebuild the destroyed buildings and regain full capacity, in the shorter term it is in the process of trying to resume inpatient services in the 53 bed building that was not destroyed. Among other things, this involves replacing the destroyed administration building with a trailer, in part to house medical records, and also replacing pharmacy services, in order to have the five basic services that are required to operate an APH (medical, nursing, rehabilitative, pharmacy, and dietary services). AVDM expects to be able to resume inpatient services for the 53 bed unit in June. In the meantime, AVDM leased a medical office building effective on February 1st, with the intention of resuming their PHP and IOP outpatient services on February 5th. However, because their outpatient services are a supplemental service to their inpatient hospital, until the inpatient hospital has resumed operating with the five basic services, DPH was not able to approve the outpatient services. AVDM worked with DPH to find alternatives, exploring the possibility of providing services through a statutory exemption from laws governing primary care and specialty clinics, but AVDM would have needed to obtain new managed care contracts, and since the medical staff had been providing services under the hospital license, the medical staff would have needed to form a new provider relationship. AVDM determined this alternative would have been too time consuming, and instead is seeking this bill to provide a temporary statutory pathway to resume outpatient services. - Support. This bill is sponsored by AVDM, which states that as a result of the Thomas Fire, it had to cease providing all mental health services, including both inpatient and outpatient services, on December 4, 2017. While buildings were destroyed, AVDM states it is working diligently to bring temporary mobile support services in order to re-open the approximately 50 beds not destroyed by the fire, which should hopefully occur by June of this year. In the meantime, AVDM states it does have the ability to bring outpatient services back online to serve the community immediately. However, the outpatient services are supplemental to AVDM’s acute psychiatric hospital license. AVDM states that without the basic services that an APH is required to provide, including pharmacy and food services, the inpatient hospital must remain closed, and those services will not be ready for approval for several months. Because the outpatient services are tied to the inpatient license, the outpatient services will also not be eligible to open until the inpatient services are completed for at least half of their licensed beds. Given the concerns related to the severe lack of mental health services in Ventura County, AVDM states that this bill is needed to allow outpatient services to continue while the inpatient services are restored.
The California Hospital Association (CHA) states that AVDM is a critically important provider of inpatient and outpatient mental health services within the county and the state. The hospital regularly accepts adult and adolescent patients from around the state, including Ventura, Santa Barbara, San Luis Obispo, Kern, Kings, Tulare, Fresno, Los Angeles, Riverside, San Diego, Orange, Madera, Merced, and San Bernardino Counties. CHA states that by allowing access to outpatient services in local communities, families can seek immediate treatment for their loved ones, participate in family support therapy groups, and obtain information about needed continuing care resources. According to CHA, local county behavioral health directors have reported that, since the fires that closed services at AVDM, more adolescents have successfully committed suicide. CHA states that every day matters, and until these services are restored, lives are at risk.
SUPPORT AND OPPOSITION:
Support: Aurora Vista Del Mar (sponsor)
California Hospital Association
Cottage Health
Ventura County Board of Supervisors
Oppose: None received
-- END --
Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | AB |
THIRD READING
Bill No: AB 417
:
SENATE HEALTH COMMITTEE: 8-0, 7/12/17
AYES: Hernandez, Nguyen, Atkins, Leyva, Mitchell, Monning, Newman, Roth
NO VOTE RECORDED: Nielsen
SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8
ASSEMBLY FLOOR: 77-0, 5/11/17 (Consent) - See last page for vote
DIGEST:
- This bill replaces references to the Small Business Health Options Program with Covered California for Small Business Exchange.
ANALYSIS: Existing federal law requires, under the Patient Protection and Affordable Care Act (ACA, Public Law 111-148), as amended by the Health Care Education and Reconciliation Act of 2010 (Public Law 111-152), each state, by January 1, 2014, establish an American Health Benefit Exchange that makes qualified health plans available to qualified individuals and qualified employers. Requires, if a state does not establish an Exchange, the federal government to administer the Exchange.
Existing state law:
- Establishes the California Health Benefit Exchange (known as Covered California) in state government, and specifies its duties and authority. Requires Covered California to be governed by a board that includes the Secretary of the California Health and Human Services Agency and four members with specified expertise who are appointed by the Governor and the Legislature.
- Establishes the Small Business Health Options Program (SHOP) separate from the activities of the Covered California board related to the individual market, to assist qualified employers in facilitating the enrollment of their employees in qualified health plans offered through the Exchange in the small employer market in a manner consistent with federal law.
This bill:
- Defines “Covered California for Small Business Exchange” as the program established by existing law, as specified.
- Replaces references to the SHOP with Covered California for Small Business Exchange.
- Deems any reference to the SHOP Program to refer to Covered California for Small Business Exchange.
Comments
- Author’s statement. According to the author, this bill changes references to the Covered California small group program SHOP to Covered California for Small Business and makes other conforming changes consistent with Covered California’s recent rebranding of SHOP.
- Covered California. Covered California is California’s state-based marketplace where individuals and small businesses can purchase qualified health plans. Covered California received more than $1 billion in federal grant funding for its launch; to build the information technology infrastructure; hire staff; undertake multicultural marketing, outreach and education efforts statewide; and work with community partners to educate target communities. Now, Covered California is a self‑sustaining entity funded through fees assessed on the participating health plans.
Through Covered California, small businesses can get health insurance from six health and seven dental carriers. There are four tiers of plans (Bronze, Silver, Gold and Platinum) with dozens of plan options. Small businesses with 25 or fewer employees may qualify for federal tax credits if they enroll through the SHOP. Offering health insurance to employees is not mandatory for small businesses with less than 50 employees. Enrollment in the SHOP is year-round. As of May 31, 2017, there were 4,468 groups totaling 34,002 members enrolled in private health plans offered through Covered California. About 64% of more than 684,000 small businesses in California employ between one to four employees. As of 2016, businesses with up to 100 employees are able to apply for coverage for their workers. Through the SHOP, employers control how much they spend on health insurance, setting the amount they will contribute to their employees’ insurance. In turn, employees have multiple insurance plans from which to choose.
Separate from the SHOP, approximately 1.5 million individuals have enrolled in Covered California in 2017. In the fourth open enrollment period 412,000 new consumers enrolled and 1.3 million went through the renewal process. In 2016, Californians received federal funds in the amounts of $4.2 billion in advanced premium tax credits and over $700 million in cost sharing subsidies. Almost 90% of Covered California enrollees benefit from receiving federal subsidies to lower their premium costs.
Related/Prior Legislation
SB 288 (Hernandez) is substantially similar to this bill.
FISCAL EFFECT: Appropriation: Fiscal Com.: Local:
Health Access California
OPPOSITION: (Verified 8/21/17)
None received
ARGUMENTS IN SUPPORT: Health Access California writes that the ACA created health care marketplaces or exchanges to make health insurance more affordable and easier to shop, compare, choose and buy. California was the first state in the nation to create its own marketplace, called Covered California. Beginning in 2014, California small business employers had the opportunity to purchase coverage for their employees through SHOP, which afforded them similar benefits offered by large employers. Through this program, Covered California assists qualified small business employers in facilitating their employees’ enrollments into qualified health plans in the small group market. This bill merely changes the name for Covered California’s small business program, SHOP, to Covered California for Small Business. It is a simple change that better reflects what the program does.
ASSEMBLY FLOOR: 77-0, 5/11/17
AYES: Acosta, Aguiar-Curry, Travis Allen, Arambula, Baker, Berman, Bigelow, Bloom, Bocanegra, Bonta, Brough, Burke, Caballero, Calderon, Cervantes, Chau, Chávez, Chen, Chiu, Choi, Chu, Cooley, Cooper, Cunningham, Dababneh, Daly, Eggman, Flora, Fong, Frazier, Friedman, Gallagher, Cristina Garcia, Eduardo Garcia, Gipson, Gloria, Gomez, Gonzalez Fletcher, Gray, Grayson, Harper, Holden, Irwin, Jones-Sawyer, Kalra, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Muratsuchi, Nazarian, Obernolte, Quirk, Quirk-Silva, Reyes, Ridley-Thomas, Rodriguez, Rubio, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Voepel, Waldron, Weber, Wood, Rendon
NO VOTE RECORDED: Dahle, O'Donnell, Patterson
Prepared by:
9/12/17 9:45:59
Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | AB |
CONSENT
Bill No: AB 417
:
SENATE HEALTH COMMITTEE: 8-0, 7/12/17
AYES: Hernandez, Nguyen, Atkins, Leyva, Mitchell, Monning, Newman, Roth
NO VOTE RECORDED: Nielsen
SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8
ASSEMBLY FLOOR: 77-0, 5/11/17 (Consent) - See last page for vote
DIGEST:
- This bill replaces references to the Small Business Health Options Program with Covered California for Small Business Exchange.
Existing federal law requires, under the Patient Protection and Affordable Care Act (ACA, Public Law 111-148), as amended by the Health Care Education and Reconciliation Act of 2010 (Public Law 111-152), each state, by January 1, 2014, establish an American Health Benefit Exchange that makes qualified health plans available to qualified individuals and qualified employers. Requires, if a state does not establish an Exchange, the federal government to administer the Exchange.
Existing state law:
- Establishes the California Health Benefit Exchange (known as Covered California) in state government, and specifies its duties and authority. Requires Covered California to be governed by a board that includes the Secretary of the California Health and Human Services Agency and four members with specified expertise who are appointed by the Governor and the Legislature.
- Establishes the Small Business Health Options Program (SHOP) separate from the activities of the Covered California board related to the individual market, to assist qualified employers in facilitating the enrollment of their employees in qualified health plans offered through the Exchange in the small employer market in a manner consistent with federal law.
This bill:
- Defines “Covered California for Small Business Exchange” as the program established by existing law, as specified.
- Replaces references to the SHOP with Covered California for Small Business Exchange.
- Deems any reference to the SHOP Program to refer to Covered California for Small Business Exchange.
Comments
- Author’s statement. According to the author, this bill changes references to the Covered California small group program SHOP to Covered California for Small Business and makes other conforming changes consistent with Covered California’s recent rebranding of SHOP.
- Covered California. Covered California is California’s state-based marketplace where individuals and small businesses can purchase qualified health plans. Covered California received more than $1 billion in federal grant funding for its launch; to build the information technology infrastructure; hire staff; undertake multicultural marketing, outreach and education efforts statewide; and work with community partners to educate target communities. Now, Covered California is a self‑sustaining entity funded through fees assessed on the participating health plans.
Through Covered California, small businesses can get health insurance from six health and seven dental carriers. There are four tiers of plans (Bronze, Silver, Gold and Platinum) with dozens of plan options. Small businesses with 25 or fewer employees may qualify for federal tax credits if they enroll through the SHOP. Offering health insurance to employees is not mandatory for small businesses with less than 50 employees. Enrollment in the SHOP is year-round. As of May 31, 2017, there were 4,468 groups totaling 34,002 members enrolled in private health plans offered through Covered California. About 64% of more than 684,000 small businesses in California employ between one to four employees. As of 2016, businesses with up to 100 employees are able to apply for coverage for their workers. Through the SHOP, employers control how much they spend on health insurance, setting the amount they will contribute to their employees’ insurance. In turn, employees have multiple insurance plans from which to choose.
Separate from the SHOP, approximately 1.5 million individuals have enrolled in Covered California in 2017. In the fourth open enrollment period 412,000 new consumers enrolled and 1.3 million went through the renewal process. In 2016, Californians received federal funds in the amounts of $4.2 billion in advanced premium tax credits and over $700 million in cost sharing subsidies. Almost 90% of Covered California enrollees benefit from receiving federal subsidies to lower their premium costs.
Related/Prior Legislation
SB 288 (Hernandez) is pending in the Assembly Committee on Health is substantially similar to this bill.
FISCAL EFFECT: Appropriation: Fiscal Com.: Local:
Health Access California
OPPOSITION: (Verified 8/21/17)
None received
ARGUMENTS IN SUPPORT: Health Access California writes that the ACA created health care marketplaces or exchanges to make health insurance more affordable and easier to shop, compare, choose and buy. California was the first state in the nation to create its own marketplace, called Covered California. Beginning in 2014, California small business employers had the opportunity to purchase coverage for their employees through SHOP, which afforded them similar benefits offered by large employers. Through this program, Covered California assists qualified small business employers in facilitating their employees’ enrollments into qualified health plans in the small group market. This bill merely changes the name for Covered California’s small business program, SHOP, to Covered California for Small Business. It is a simple change that better reflects what the program does.
ASSEMBLY FLOOR: 77-0, 5/11/17
AYES: Acosta, Aguiar-Curry, Travis Allen, Arambula, Baker, Berman, Bigelow, Bloom, Bocanegra, Bonta, Brough, Burke, Caballero, Calderon, Cervantes, Chau, Chávez, Chen, Chiu, Choi, Chu, Cooley, Cooper, Cunningham, Dababneh, Daly, Eggman, Flora, Fong, Frazier, Friedman, Gallagher, Cristina Garcia, Eduardo Garcia, Gipson, Gloria, Gomez, Gonzalez Fletcher, Gray, Grayson, Harper, Holden, Irwin, Jones-Sawyer, Kalra, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Muratsuchi, Nazarian, Obernolte, Quirk, Quirk-Silva, Reyes, Ridley-Thomas, Rodriguez, Rubio, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Voepel, Waldron, Weber, Wood, Rendon
NO VOTE RECORDED: Dahle, O'Donnell, Patterson
Prepared by:
8/22/17 11:33:03
8/22/17 11:33:03
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 417
AUTHOR: | Wood | ||
VERSION: | April 27, 2017 | ||
HEARING DATE: | July 12, 2017 | ||
CONSULTANT: | Teri Boughton | ||
SUBJECT: Health coverage: small employers
SUMMARY:
- Replaces references to the Small Business Health Options Program with Covered California for Small Business Exchange.
Existing federal law: Requires, under the Patient Protection and Affordable Care Act (ACA, Public Law 111-148), as amended by the Health Care Education and Reconciliation Act of 2010 (Public Law 111-152), each state, by January 1, 2014, establish an American Health Benefit Exchange that makes qualified health plans available to qualified individuals and qualified employers. Requires, if a state does not establish an Exchange, the federal government to administer the Exchange.
Existing state law:
- Establishes the California Health Benefit Exchange (known as Covered California) in state government, and specifies its duties and authority. Requires Covered California to be governed by a board that includes the Secretary of the California Health and Human Services Agency and four members with specified expertise who are appointed by the Governor and the Legislature.
- Establishes the Small Business Health Options Program (SHOP) separate from the activities of the Covered California board related to the individual market, to assist qualified employers in facilitating the enrollment of their employees in qualified health plans offered through the Exchange in the small employer market in a manner consistent with federal law.
This bill:
- Defines “Covered California for Small Business Exchange” as the program established by existing law, as specified.
- Replaces references to the SHOP with Covered California for Small Business Exchange.
- Deems any reference to the SHOP Program to refer to Covered California for Small Business Exchange.
FISCAL EFFECT:
According to the Assembly Appropriations Committee analysis negligible state fiscal effect.
PRIOR VOTES:
Assembly Floor: | 77 - 0 |
Assembly Appropriations Committee: | 16 - 0 |
Assembly Health Committee: | 15 - 0 |
COMMENTS:
- Author’s statement. According to the author, this bill changes references to the Covered California small group program SHOP to Covered California for Small Business and makes other conforming changes consistent with Covered California’s recent rebranding of SHOP.
- Covered California. Covered California is California’s state-based marketplace where individuals and small businesses can purchase qualified health plans. Covered California received more than $1 billion in federal grant funding for its launch; to build the information technology infrastructure; hire staff; undertake multicultural marketing, outreach and education efforts statewide; and work with community partners to educate target communities. Now, Covered California is a self‑sustaining entity funded through fees assessed on the participating health plans.
Through Covered California, small businesses can get health insurance from six health and seven dental carriers. There are four tiers of plans (Bronze, Silver, Gold and Platinum) with dozens of plan options. Small businesses with 25 or fewer employees may qualify for federal tax credits if they enroll through the SHOP. Offering health insurance to employees is not mandatory for small businesses with less than 50 employees. Enrollment in the SHOP is year-round. As of May 31, 2017, there were 4,468 groups totaling 34,002 members enrolled in private health plans offered through Covered California. About 64% of more than 684,000 small businesses in California employ between one to four employees. As of 2016, businesses with up to 100 employees are able to apply for coverage for their workers. Through the SHOP, employers control how much they spend on health insurance, setting the amount they will contribute to their employees’ insurance. In turn, employees have multiple insurance plans to choose from.
Separate from the SHOP, approximately 1.5 million individuals have enrolled in Covered California in 2017. In the fourth open enrollment period 412,000 new consumers enrolled and 1.3 million went through the renewal process. In 2016, Californians received federal funds in the amounts of $4.2 billion in advanced premium tax credits and over $700 million in cost sharing subsidies. Almost 90% of Covered California enrollees benefit from receiving federal subsidies to lower their premium costs.
- Related legislation. SB 288 (Hernandez) is pending in the Assembly Committee on Health is substantially similar to this bill.
- Prior legislation. SB 900 (Alquist, Chapter 659, Statutes of 2010) established the California Health Benefits Exchange, known as Covered California, and states that it is the intent of the Legislature to implement the provisions of the ACA that require the establishment of an American Health Benefit Exchange.
AB 1602 (Perez, Chapter 655, Statutes of 2010) implements provisions of the ACA related to the establishment of an American Health Benefit Exchange in California and its administrative authority. AB 1602 also specifies the activities related to the provision of health coverage within the Exchange, and was contingent on the enactment of SB 900.
SB 1477 (Committee on Health, Chapter 733, Statutes of 2016) requires the California Health Benefit Exchange to also be known as Covered California, replaces references from the now-repealed Healthy Families Program to the Medi-Cal program, and from the repealed AIM-Linked Infants Program to the Medi-Cal Access Program, permits the Department of Health Care Services to enter into contracts for administrative activities to help implement the new Medicaid Managed Care regulations, and makes a technical change to ensure that trade associations remain eligible for federal emergency preparedness funds.
- Support. Health Access California writes that the ACA created health care marketplaces or exchanges to make health insurance more affordable and easier to shop, compare, choose and buy. California was the first state in the nation to create its own marketplace, called Covered California. Beginning in 2014, California small business employers had the opportunity to purchase coverage for their employees through SHOP, which afforded them similar benefits offered by large employers. Through this program, Covered California assists qualified small business employers in facilitating their employees’ enrollments into qualified health plans in the small group market. This bill merely changes the name for Covered California’s small business program, SHOP, to Covered California for Small Business. It is a simple change that better reflects what the program does.
SUPPORT AND OPPOSITION:
Support: Health Access California
Oppose: None received
-- END --
Date of Hearing: May 3, 2017
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Lorena Gonzalez Fletcher, Chair
ABPCA Bill Id:AB 417
Author:(Wood) – As Amended Ver:April 27, 2017
Policy Committee: | Health | Vote: | 15 - 0 |
|
|
Urgency: No State Mandated Local Program: No Reimbursable: No
SUMMARY:
This bill changes references to the Covered California small group program from small business health options program (SHOP) to "Covered California for Small Business" and makes other conforming changes.
FISCAL EFFECT:
Negligible state fiscal effect.
COMMENTS:
- Purpose and Background. The state's Covered California board recently decided to re-brand the small business offerings with a new name. This bill conforms statute to the name change.
- Related Legislation. SB 288 (Hernandez) is similar to this bill and is pending in the Senate Appropriations Committee.
Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081
Date of Hearing: April 25, 2017
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
ABPCA Bill Id:AB 417
Author:(Wood) – As Introduced Ver:February 9, 2017
SUBJECT: Health coverage: small employers.
SUMMARY: Changes the references to the Covered California small group program from small business health options program (SHOP) to Covered California for Small Business and makes other conforming changes.
EXISTING LAW:
- Establishes the Knox-Keene Health Care Service Plan Act of 1975, which provides for the licensure and regulation of health care service plans by the Department of Managed Health Care.
- Provides for the regulation of health insurers by the California Department of Insurance under the Insurance Code.
- Establishes the federal Patient Protection and Affordable Care Act (ACA), which enacts various health care coverage market reforms including the availability of health insurance exchanges (exchanges).
- Establishes, in state government, the California Health Benefits Exchange (Exchange), referred to as Covered California, as an independent public entity not affiliated with an agency or department, and requires the Exchange 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 qualified health plans though the Exchange by qualified individuals and small employers.
- Requires the board in 4) above 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.
- Requires the board to establish the SHOP, separate from the activities of the board related to the individual market, to assist qualified small employers in facilitating the enrollment of their employees in qualified health plans offered through the Exchange in the small employer market consistent with the ACA.
FISCAL EFFECT: This bill has not yet been analyzed by a fiscal committee.
COMMENTS:
- PURPOSE OF THIS BILL. According to the author, this bill changes references to the Covered California small group program from SHOP to Covered California for Small Business and makes other conforming changes consistent with Covered California’s recent rebranding of SHOP.
- BACKGROUND. Enacted in March 2010, the ACA provides the framework, policies, regulations, and guidelines for implementation of comprehensive health care reform by the states. The ACA expands access to quality, affordable insurance and health care.
The ACA required exchanges, also known as Marketplaces, be established in every state by January 1, 2014, otherwise the federal government will establish one in the state. The central purpose of these new Marketplaces is to enable low and moderate income individuals, and small employers to obtain affordable health coverage. Individuals and small business are able to purchase private health insurance through a variety of insurance Marketplace models throughout the United States. Each state electing to establish a new Marketplace must adopt the federal standards in law and rule, and have in effect a state law or regulation that implements these standards. If a state elects not to establish a Marketplace, the ACA requires the Department of Health and Human Services (HHS) to establish and operate one in that state. This also applies in the event that HHS determines on review that state efforts to establish a Marketplace have not made sufficient progress to be fully operational by January 1, 2014. The ACA provides broad authority to the HHS Secretary to establish standards and regulations to implement the statutory requirements related to the Marketplace. The new Marketplaces are required to carry out a number of different functions, including determining eligibility and enrolling individuals in appropriate plans; conducting plan management activities; assisting consumers; ensuring plan accountability; and providing financial management.
California was the first state in the nation to enact legislation creating an Exchange under federal health care reform. Covered California operates a specific program, SHOP, that offers new health insurance choices to small businesses and their employees. SHOP is designed specifically for employers with 100 and fewer eligible employees to give them opportunities to offer a variety of health insurance plans to their employees. Through Covered California, employers and their employees can choose the plans that fit their needs and their budgets. The SHOP Marketplace is for small employers who want to provide health and dental insurance to their employees.
Additionally, small businesses may qualify for a federal tax credit to help offset the cost of providing health insurance to employees by purchasing coverage with Covered California. To qualify for a tax credit, employers must contribute at least 50% of their employee premium costs. Currently, federal tax credits are only available to small businesses that purchase health insurance through Covered California for Small Business. The maximum available tax credit is 50% of insurance premium expenses and the maximum credit for tax-exempt employers is 35%. The tax credit can depend on a number of factors, including the number of full-time-equivalent employees and the amount contributed toward premiums. The amount of the tax credit cannot exceed the total income and Medicare tax the employer is required to withhold from employees’ annual wages, plus the employer’s share of the Medicare tax.
- SUPPORT. Health Access California states that this name changes to Covered California for Small Business is a simple name change that better reflects what the program does.
- RELATED LEGISLATION. SB 288 (Hernandez) is substantially similar to this bill and is set for the Senate Health Committee on April 26, 2017.
- PREVIOUS LEGISLATION.
- AB 1602 (John A Pérez), Chapter 655, Statutes of 2010, and SB 900 (Alquist), Chapter 659, Statutes of 2010, establishes the Exchange in California and its powers and duties.
- ABX1 2 (Pan), Chapter 1, Statutes of 2013-14 First Extraordinary Session and SBX1 2 (Hernandez), Chapter 2, Statutes of 2013-14 First Extraordinary Session, establish health insurance market reforms contained in the ACA specific to individual purchasers, such as prohibiting insurers from denying coverage based on preexisting conditions; and, make conforming changes to small employer health insurance laws resulting from final federal regulations.
- SB 961 (Hernandez) and AB 1461 (Monning) of 2012 were identical bills that would have reformed California’s individual market similar to the provisions in SBX1 2. SB 961 and AB 1461 were vetoed by Governor Brown who indicated that without the strong foundation that federal law provides, a state-level mandate on insurers alone could encourage healthy people to wait until they got sick or injured before purchasing coverage and would lead to skyrocketing premiums, making coverage more unaffordable.
- AB 1083 (Monning), Chapter 854, Statutes of 2012, establishes reforms in the small group health insurance market to implement the ACA.
- TECHNICAL AMENDMENTS. The author has agreed to changing references in specified sections of this bill from Covered California for Small Business as a “program” to an “Exchange.”
REGISTERED SUPPORT / OPPOSITION:
Support
Health Access California
Opposition
None on file.
Analysis Prepared by: Kristene Mapile / HEALTH / (916) 319-2097
Bill Co-Author(s):
