California Legislative Tracker

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Insurance and Exchange

This page tracks California legislation relating to insurance and exchange (Covered California) issues that impact Urban Indian clinics, including implementation of ACA and Covered California. This tracker is updated regularly and provides links to the California Legislative Information website for additional resources.

Click here to view an recently chaptered bills.


AB 533: Assembly member Bonta (District 18)

Health care coverage: out-of-network coverage

Summary: This bill would require a health care service plan contract or health insurance policy issued, amended, or renewed on or after July 1, 2016, to provide that if an enrollee or insured receives covered services from a contracting health facility, the enrollee or insured receives covered services provided by a noncontracting individual health professional, the enrollee or insured would be required to pay the noncontracting individual health professional only the same cost sharing required if the services were provided by a contracting individual health professional. The bill would prohibit an enrollee or insured from owing the noncontracting individual health professional at the contracting health facility more than the in-network cost-sharing amount if the noncontracting individual health professional receives reimbursement for services provided to the enrollee or insured at a contracting health facility from the health care service plan or health insurer. However, the bill would make an exception from this prohibition if the enrollee or insured provides written consent that satisfies specified criteria. The bill would require a noncontracting individual health professional who collects more than the in-network cost-sharing amount from the enrollee or insured to refund any overpayment to the enrollee or insured, as specified, and would provide that interest on any amount overpaid by, and not refunded to, the enrollee or insured shall accrue at 15% per annum, as specified.

Last Action: 08/31/2016 Ordered to inactive file at the request of Assembly member Bonta

For more information on this bill please check the Official California Legislative Information site here


SB 931: Senator Nguyen (District 34)

Health care service plans

Summary: Existing law requires a health care service plan to meet certain requirements, including, but not limited to, having the organizational and administrative capacity to provide services to subscribers and enrollees and providing basic health care services, as defined, to those subscribers and enrollees, and having facilities licensed, as specified. This bill would make technical, nonsubstantive changes to those provisions.

Last Action: 2/18/2016 Referred to Committee on Rules

For more information on this bill please check the Official California Legislative Information site here


SB 908: Senator Hernandez (District 22)

Health care coverage: premium rate change: notice: other health coverage

Summary: This bill would require that if the Department of Managed Health Care or the Department of Insurance determines that a group rate is unreasonable or not justified, the contractholder or policyholder would be notified by the health care service plan or health insurer in writing of the determination, and the contractholder or policyholder would be given 60 days to obtain health coverage from the existing coverage provider or another provider. During the 60- day period the contractholder or policyholder would continue to be covered at the prior rate. The bill also would exempt these circumstances from the requirement that an enrollment in or change of health care service plan contract or health insurance policy be made during an open, annual, or special enrollment period. This bill contains other related provisions and other existing laws.

Last Action: 08/03/2016 From committee: Do pass

For more information on this bill please check the Official California Legislative Information site here


SB 923: Senator Hernandez (District 22)

Health care coverage: cost-sharing changes

Summary: This bill would prohibit, for grandfathered plan contracts and policies and nongrandfathered plan contracts and policies in the individual and small group markets, a health care service plan contract or health insurance policy that is issued, amended, or renewed on or after January 1, 2017, from changing the cost-sharing design, as defined, during the plan year or policy year, except when required by a change in state or federal law. Because a willful violation of this prohibition by a health care service plan would be a crime, the bill would impose a state-mandated local program.

Last Action: 8/11/2016 Ordered to engrossing and enrolling

For more information on this bill please check the Official California Legislative Information site here


SB 932: Senator Hernandez (District 22)

Health care mergers and acquisitions

Summary: This bill would require any person that intends to merge with, consolidate, acquire, purchase, or control, directly or indirectly, any health care service plan to give notice to, and to secure the prior approval from, the Director of the Department of Managed Health Care. The bill would require the director to hold a public hearing and to make specified findings regarding the proposal prior to approving these transactions, including that the proposal does not adversely affect competition. In making this finding, the bill would require the director to request an advisory opinion from the Attorney General regarding whether competition would be adversely affected and what mitigation measures could be adopted to avoid this result. The bill would authorize the director to give conditional approval for any transaction if the parties to the transaction commit to taking action to prevent adverse impacts on competition, or health care costs, access, and quality of care in this state.


This bill would prohibit specified provisions in agreements between health care service plans or health insurers that contract with providers for alternative rates of payment and contracting providers, and agreements between network vendors, as defined, or payors, as defined, and general acute care hospitals that are contracting providers, as defined, including a requirement that the health care service plan, health insurer, or network vendor or payor include in its network any one or more providers owned or controlled by, or affiliated with, the contracting provider or general acute care hospital  that is a contracting provider. The bill would also prohibit a contracting provider from imposing these prohibited terms as a condition to its participation in a network or as a condition to more favorable contract rates.

Last Action: 05/27/2016  Held in committee and under submission

For more information on this bill please check the Official California Legislative Information site here


SB 1010: Senator Hernandez (District 22)

Health care: prescription drug costs

Summary: Existing law requires health care service plans and health insurers to file specified rate information with the Department of Managed Health Care (DMHC) or Department of Insurance (DOI), as applicable, for health care service plan contracts or health insurance policies in the individual or small group markets and for health care service plan contracts and health insurance policies in the large group market. This bill would require health care service plans or health insurers that file the above-described rate information to report to DMHC or DOI, on a date no later than the reporting of the rate information, specified cost information regarding covered prescription drugs, including generic drugs, brand name drugs, specialty drugs, and prescription drugs provided in an outpatient setting or sold in a retail setting.

This bill would require a manufacturer of a branded prescription or of a generic prescription drug to notify state purchasers, health care service plans, health insurers, and the chairs of specified Senate and Assembly committees if it is increasing the wholesale acquisition cost of the drug by more than 10% during any 12-month period or if it intends to introduce to market a prescription drug that has a wholesale acquisition cost of $10,000 or more annually or per course of treatment. The bill would require a manufacturer, within 30 days of notification of a price increase, or of the introduction to market of a prescription drug that has a wholesale acquisition cost of $10,000 or more annually or per course of treatment, to report specified information regarding the drug price to each state purchaser, health care service plan, and health insurer, and would require a manufacturer who fails to provide the required information within the 30 days to be subject to a civil penalty of $1,000 per day. The bill would also require the Legislature to conduct an annual public hearing regarding the price increases and information reported, as prescribed.

This bill would add the aggregate rate information for the large group market, the requirement for health care service plans or health insurers to disclose specified cost information regarding covered prescription drugs, including generic drugs, brand name drugs excluding specialty drugs, and specialty drugs dispensed at a pharmacy, network pharmacy, or mail order pharmacy for outpatient use.

Last Action: 08/01/2016 Do pass and re-referred to Committee on Appropriations

For more information on this bill please check the Official California Legislative Information site here


SB 1135: Senator Monning (District 17)

Health care coverage: notice of timely access to care

Summary: This bill would require a health care service plan contract or a health insurance policy that is issued, renewed, or amended on or after January 1, 2017, to provide information to enrollees and insureds regarding access to health care services and other specified health care access information, including information related to receipt of interpreter services in a timely manner, no less than annually, and would make these provisions applicable to Medi-Cal managed care plans. The bill would require a health care service plan, including a Medi-Cal managed care plan, or health insurer to provide an enrollee or an insured with information regarding consumer assistance provided by the licensing agency, as specified. The bill would also require a health care service plan or a health insurer to provide a contracting health care provider with specified information relating to the provision of referrals or health care services in a timely manner.

Last Action: 08/11/2016 From committee: Do pass. 

For more information on this bill please check the Official California Legislative Information site here


SB 1181: Senator Monning (District 17)

Health care service plan contracts

Summary: Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law regulates the manner in which a plan makes premium or coverage changes to a contract, including requiring prescribed notice to enrollees within a specified time period. This bill would make technical, nonsubstantive changes to these provisions.

Last Action: 06/22/2016 Re-referred to committee on appropriations

For more information on this bill please check the Official California Legislative Information site here


SB 1364: Senator Monning (District 17)

Health care coverage: State Innovation Waiver

Summary: Existing federal law authorizes states to seek a State Innovation Waiver of specified requirements of that coverage so the state can pursue its own legislative program that, among other things, provides its residents coverage that is at least as comprehensive and at least as affordable as the coverage that would have been provided under PPACA. This bill would declare the intent of the Legislature to enact legislation that would create a competitive marketplace for health care coverage consistent with the State Innovation Waiver requirements.

Last Action: 3/3/2016 Referred to Committee on Rules

For more information on this bill please check the Official California Legislative Information site here


SB 1471: Assemblymember Hernandez (District 51)

Health professions development: loan repayment

Summary: The bill would instead require, after the first $1,000,000 is transferred from the Managed Care Administrative Fines and Penalties Fund to the Medically Underserved Account for Physicians, $1,000,000 to be transferred each year to the Major Risk Medical Insurance Fund to be used, upon appropriation by the Legislature, for the Major Risk Medical Insurance Program. The bill would require any amount remaining over the amounts transferred to the Medically Underserved Account for Physicians and the Major Risk Medical Insurance Fund to be transferred each year to the Medically Underserved Account for Physicians to be used, upon appropriation by the Legislature, for the Steven M. Thompson Physician Corps Loan Repayment Program, and provide that one-half of these moneys may be to fund the repayment of loans for those program applicants who are trained in, and practice, psychiatry, under the Steven M. Thompson Physician Corps Loan Repayment Program.

Last Action: 4/29/2016 Hearing set for May 9

For more information on this bill please check the Official California Legislative Information site here


AB 2436: Assemblymember Hernandez (District 48)

Health care coverage: disclosures: drug pricing

Summary:Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law imposes various requirements on contracts and policies that cover prescription drug benefits. This bill would require a health care service plan contract or a policy of health insurance that is issued, amended, or renewed on or after January 1, 2017, and that provides coverage for prescription drug benefits to notify the enrollee or insured of specified information related to the cost of a prescription drug at the time that the drug is purchased or delivered. Because a willful violation of the bill’s requirements by a health care service plan would be a crime, the bill would impose a state-mandated local program. This bill contains other related provisions and other existing laws.

Last Action: 05/31/2016 Motion to reconsider made by Assemblymember Hernandez

For more information on this bill please check the Official California Legislative Information site here


AB 2424: Assemblymember Gomez (District 51)

Health Improvement and Innovation Fund

Summary: Existing law establishes the State Department of Public Health, within the California Health and Human Services Agency, vested with certain duties, powers, functions, jurisdiction, and responsibilities over specified public health programs. This bill would create the Health Improvement and Innovation Fund in the State Treasury and the moneys in the fund would be available, upon appropriation by the Legislature, for certain purposes, including, but not limited to, reducing the rates of preventable health conditions and addressing health disparities. The department would be required to award moneys from the fund to eligible applicants, as described.

Last Action: 06/20/2014  Re-referred to committee on health

For more information on this bill please check the Official California Legislative Information site here


AB 2174: Assemblymember Jones (District 71)

Ken Maddy California Cancer Registry

Summary: Existing law requires the State Department of Public Health to establish a statewide system for the collection of information determining the incidence of cancer known as the Ken Maddy California Cancer Registry.This bill would require the State Department of Public Health to ensure a patient whose name appears on the Ken Maddy California Cancer Registry has received specified notice including, among other things, that the department is authorized to release confidential patient information to health researchers, prior to any researcher contacting the patient.

Last Action: 05/27/2016  In committee and held under submission

For more information on this bill please check the Official California Legislative Information site here


AB 2115: Assemblymember Wood (District 2)

Health care service plans: levels of coverage

Summary:Existing federal law, the federal Patient Protection and Affordable Care Act (PPACA), enacts various health care coverage market reforms that take effect January 1, 2014. Among other things, PPACA establishes annual limits on deductibles for employer-sponsored plans and defines bronze, silver, gold, and platinum levels of coverage for the non-grandfathered individual and small group markets. This bill would make a technical, non-substantive change to these provisions. This bill contains other existing laws.

Last Action: 06/09/2016  Referred to Committee on Health

For more information on this bill please check the Official California Legislative Information site here


AB 2081: Assemblymember Grove (District 34)

Health care service plans: abortion coverage

Summary:Under existing law, the Director of Managed Health Care may, after appropriate notice and opportunity for a hearing, by order suspend or revoke a license issued under the act or assess administrative penalties if the director determines that the licensee has committed an act or omission constituting grounds for disciplinary action.This bill would provide that a health care service plan is not required to include abortion as a covered benefit. The bill would prohibit the director from denying a license, or disciplining a licensee, on the basis that the plan excludes coverage for abortions.

Last Action: 05/16/16 – From committee: Without further action pursuant to Joint Rule 62(a).

For more information on this bill please check the Official California Legislative Information site here


AB 1831: Assemblymember Low (District 28)

Health care coverage: Refills of prescription drugs

Summary: This bill would require a health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2017, that provides coverage for prescription drugs benefits to allow for early refills of covered topical ophthalmic products at 70% of the predicted days of use. Because a willful violation of the bill’s requirements by a health care service plan would be a crime, the bill would impose a state-mandated local program.

Last Action: 08/30/2016 Enrolled and presented to the Governor

For more information on this bill please check the Official California Legislative Information site here


SB 999: Assemblymember Pavley (District 27)

Health insurance: annual supply of contraceptives

Summary:This bill would require a health care service plan or a health insurance policy issued, amended, or renewed on or after January 1, 2017, to cover a 12-month supply of FDA-approved, self- administered hormonal contraceptives dispensed at one time by a prescriber, pharmacy, or onsite at a location licensed or authorized to dispense drugs or supplies. Because a willful violation of the bill’s requirements by a health care service plan would be a crime, the bill would impose a state-mandated local program.

Last Action: 08/03/2016 From committee: Do pass.

For more information on this bill please check the Official California Legislative Information site here


AB 2209 : Assemblymember Bonilla (District 14)

Health care coverage: clinical care pathways

Summary:This bill would prohibit, on and after January 1, 2017, a health care service plan or health insurer that provides hospital, medical, or surgical expenses from implementing clinical care pathways, as defined, for use by providers in order to manage an enrollee’s or insured’s care. Because a willful violation of this prohibition by a health care service plan would be a crime, this bill would impose a state-mandated local program. This bill contains other related provisions and other existing laws.

Last Action: 04/27/2016 Re-referred to Committee on Appropriations

For more information on this bill please check the Official California Legislative Information site here


AB 1763: Assemblymember Gipson (District 64)

Health care coverage: colorectal cancer: screening and testing.

Summary:This bill would require a health care service plan contract or a health insurance policy, except as specified, that is issued, amended, or renewed on or after January 1, 2018, to provide coverage for colorectal cancer screening examinations and laboratory tests, as specified. The bill would require the coverage to include additional colorectal cancer screening examinations and laboratory tests recommended by the treating physician if the individual is at high risk for colorectal cancer. The bill would prohibit a health care service plan contract or a health insurance policy from imposing cost sharing on this coverage for an individual who is 50 years of age or older. Because a willful violation of the bill’s requirements relative to health care service plans would be a crime, the bill would impose a state-mandated local program.

Last Action: 08/30/2016 Enrolled and presented to the Governor

For more information on this bill please check the Official California Legislative Information site here


SB 1421: Senator Nguyen (District 34)

Expanded access to primary care

Summary: Existing law, under the Expanded Access to Primary Care program, requires the State Department of Health Care Services to select primary care clinics that are licensed as community clinics or free clinics, as defined, or those that are exempt from licensure due to their connection to a federally recognized Indian tribe or tribal organization, as specified, to be reimbursed for delivering medical services to program beneficiaries. Existing law requires a clinic applying for these funds to demonstrate that it meets certain conditions, including, but not limited to, providing specified services, and either being located in an area or a facility federally designated as a health professional shortage area, medically underserved area, or medically underserved population, or being a clinic in which at least 50% of the patients served are persons with incomes at or below 200% of the federal poverty level, or both. This bill would make a technical, nonsubstantive change to one of these provisions.

Last Action: 3/10/16 Referred to Committee on Rules

For more information on this bill please check the Official California Legislative Information site here


AB 2752: Assemblymember Nazarian (District 46)

Health care coverage: continuity of care

Summary:Existing law provides for the regulation of health insurers by the Insurance Commissioner. This bill would declare the intent of the Legislature to enact legislation that would provide greater consumer protections regarding continuity of care for an enrollee or insured, and that would give relief to an enrollee or insured that would prevent an enrollee or insured from paying maximum out-of-pocket expenses twice in one year if the enrollee or insured involuntarily changes health plans or insurers.

Last Action: 05/27/2016 In committee: held under submission

For more information on this bill please check the Official California Legislative Information site here


AB 2308: Assemblymember Hernandez (District 48)

Health care coverage: enrollment assistance 

Summary:This bill would establish the California Health Care Coverage Enrollment Assistance Act of 2016 to provide uninsured students of the California State University and the California Community Colleges with information about insurance affordability programs commencing with the 2017-18 academic year. The act would, among other things, authorize each campus of the California State University and the California Community Colleges to develop an informational item or amend an existing enrollment form, or Internet Web site to provide uninsured students information about insurance affordability programs. The act would authorize each campus to also include a factsheet with its enrollment forms explaining basic information about insurance affordability programs.

Last Action: 08/31/2016 Enrolled and presented to the Governor

For more information on this bill please check the Official California Legislative Information site here


AB 1954: Assemblymember Burke (District 62)

Health care coverage: reproductive health care services

Summary: This bill would prohibit every health care service plan contract or health insurance policy issued, amended, renewed, or delivered on or after January 1, 2017, with exceptions, from requiring an enrollee or insured to receive a referral in order to receive reproductive or sexual health care services, as provided.

Last Action:08/29/2016 Senate amendments concurred in. To Engrossing and Enrolling.

For more information on this bill please check the Official California Legislative Information site here


AB 41: Assemblymember Richard Pan (D-Sacramento) 

Health care coverage: discrimination

Summary: Prohibits a health care service plan or health insurer  from discriminating against any health care provider who is acting within the scope of that provider’s license or certification.

According to the author, with the passage of the ACA, an influx of newly insured people will engage with an overburdened health care system that faces severe shortages of health care practitioners. The author states that we must utilize our health care practitioners whose scope of practice and training will allow them to perform more vital functions. The author states that while federal law bans discrimination against whole classes of health care providers, plans and insurers commonly limit the types of health care providers allowed to provide services. The author cites an example of optometrists who are permitted to provide routine vision care under a health plan or insurance contract are often prohibited from treating other conditions that are within their scope of practice. The author asserts that provider discrimination is wrong in principle, anti-competitive, limits or denies patient choice and access to a range of beneficial providers, and results in a less than optimal health care delivery system. The author concludes by stating that this bill will help eliminate provider discrimination which will lead to lower health care costs, improve quality, increase access, and mitigate provider shortages.

Last Action Date: 01/31/2016 Died pursuant to Article IV, Sec. 10(c) of the Constitution.

For more information on this bill please check the Official California Legislative Information site here


 SB 43:  Assemblymember Hernandez (District 48)

Essential health benefits

Summary: Existing law requires an individual or small group health care service plan contract or insurance policy issued, amended, or renewed on or after January 1, 2014, to cover essential health benefits. These essential benefits must include rehabilitative and habilitative (medically necessary health services and devices) services as well as the health benefits covered by benchmark plans. Habilitative services are covered under the same terms and conditions as rehabilitative services.

This bill would require an individual or small group health care service plan contract or policy issued, amended, or renewed starting January 1, 2017 to limit the combining of habilitative and rehabilitative services. This bill would also revise the definition of “habilitative services” to conform to federal regulations, and include health benefits covered by particular benchmark plans as of the first quarter of 2014 (rather than 2012), to be included in the definition of the term “essential services.”
This bill would provide that no reimbursement for the local agencies and school districts. One-time over $150,000 to revise regulations of the Insurance and Managed Care Fund. However, the Medi-Cal or CalPERS program should not receive any costs.
Last Action Date:  10/08/2015 Chaptered by the Secretary of State. Chapter 648, Statutes of 2015.

For more information on this bill please check the Official California Legislative Information site here


SB 1305:  Assemblymember Bonta (District 18)

Limitations on cost sharing: family coverage

Summary: Existing law requires that all nongrandfathered products in individual or small group markets, a health care service plan contract or health insurance policy, issued, amended or renewed on or after January 1, 2015, include a limit on annual out-of-pocket expenses on essential health benefits.

This bill would require that maximum out-of-pocket limits and deductibles for family health plans and insurance coverage be less than or equal to the maximum out-of-pocket limit and deductibles for individual health plans and insurance coverage. This bill would implement the individual deductible and out-of-pocket requirement in the large group market on contracts and policies issued, amended, or renewed on or after July 1, 2016. According to the author, this bill prohibits a health plan or insurer from imposing a higher deductible and limit on out-of-pocket costs on an individual simply because the individual is a member of a family.
This bill would provide that no reimbursement is required by the state for this act. This bill would result in reduced expenditures in the private market of up to tens of millions of dollars due to reduced premium payments for individually purchased insurance.

Last Action Date:  10/08/2015 Approved by the Governor. Chaptered by the Secretary of State – Chapter 641, Statutes 2015.

For more information on this bill please check the Official California Legislative Information site here


SB 137:  Assemblymember Hernandez (District 48)

Health care coverage: provider directories

Summary: Currently, Medi-Cal services can be provided pursuant to contracts with various managed health care plans.

This bill would require health care service plans and insurers, (collectively referred to as carriers), subject to regulation by the commissioner, to make a provider directory accessible on its website and to update it weekly. The Department of Managed Health Care and the Department of Insurance would have to jointly develop uniform provider directory standards to showcase on the site. The provider directory would include information on contracting health providers, specifically those that accept new patients.

If a patient relied on the provider directory to receive services, the carrier would have to reimburse them for any amount beyond what they would have paid for in-network services. According to the author, it is important that Californians shopping for health insurance have confidence in the provider directory upon which they are basing their decisions.

This bill would provide that no reimbursement for local agencies and school districts by the state is required by this act for a specified reason. One time costs are estimated to be around $160,000 in 2015-16 and $200,000 in 2016-17 for the Insurance Fun and between $150,000 and $300,000 for the Managed Care Fund.

Last Action Date: 10/08/2015 Approved by the Governor. Chaptered by the Secretary of the State – Chapter 649, Statutes 2015.

For more information on this bill please check the Official California Legislative Information site here


AB 339:  Assemblymember Gordon (District 24)

Outpatient Prescription Drugs

Summary: This bill would prohibit formularies for outpatient prescription drugs administered by a health care service plan or health insurer (collectively known as carriers), from discouraging the enrollment of individuals or from reducing the benefit coverage granted to patients. Until January 1, 2021, the bill would require that all forms of cost sharing for individual prescription drugs that constitute essential health benefits, not exceed $250 for a the first 30 days of supply.

The bill would require a plan contract or policy to cover all single-tablet prescription drugs that are medically necessary for treatment of AIDS/HIV.  The bill would prohibit a plan contract or policy from placing more than 50% of drugs within the same class, that are approved by the US FDA, into the 2 highest cost tiers of a drug formulary. As such, a plan contract or policy would have to create definitions for each tier of a drug formulary.

This bill would require a carrier to provide coverage for medically necessary prescription drugs, especially those that lack a therapeutic equivalent. Otherwise, all other cost sharing for outpatient prescription drugs would have to be reasonably priced. These provisions would be applicable to non grandfathered provider plans that are offered, renewed, or amended on or after July 1, 2016, and applicable to non grandfathered provider plans that are offered, renewed, or amended on or after January 1, 2017.

According to the author, Californians with cancer, HIV/AIDS, hepatitis, multiple sclerosis, epilepsy, lupus, and other serious conditions need high cost specialty drugs. This bill will help ensure access to vital medications and remove the patient from negotiations between health plans and pharmaceutical manufacturers. Ongoing fiscal costs are estimated to be around $450,000 on the Managed Care Fund and $80,000 on the Insurance Fund.

Last Action Date:  10/08/2015 Approved by the Governor. Chaptered by the Secretary of State – Chapter 619, Statutes 2015.

For more information on this bill please check the Official California Legislative Information site here


AB 1046:  Assemblymember Dababneh (District 45)

Hospitals: Community Benefits

Summary: Existing law requires certain private not-for-profit hospitals to complete a community needs assessment every 3 years, and adopt/update a community benefits plan every year. Certain hospitals, including small and rural hospitals are exempt from these requirements. However, all hospitals must file a report on and make public its community benefits plan and initiatives to address community needs with the Statewide Office of Health Planning and Development.

This bill would require all hospitals, including small and rural hospitals, to complete the new community health needs assessment (CHNA) report every 3 years, rather than the community benefits plan every year.  This bill requires the CHNA report to be made widely available to pubic.

Last Action Date:  01/31/2016 Died pursuant to Article IV, Sec. 10(c) of the Constitution.

For more information on this bill please check the Official California Legislative Information site here


AB 1460: Assemblymember Thurmond (District 15)

Hospitals: Community Benefit Plans

Summary: Existing law requires all hospitals to annually adopt and update a community benefit plan, either alone or in conjunction with other health care providers and organizations. Each hospital must include a description of the actions it has taken to address community needs, along with its financial abilities, within its updated plan that it submits annual to the Office of Statewide Health Planning and Development. Until enacted by the Legislature, the community benefit plans do not have to follow any specific format.

This bill would make technical, non substantive changes to this provision.

Last Action: 02/01/2016 Died at desk.

For more information on this bill please check the Official California Legislative Information site here


SB 783 Senator Mitchell

Health Care Coverage

Summary: The Knox-Keene Health Care Service Plan Act of 1975, licenses and regulates health care service plans through the Department of Managed Health Care.

The federal Patient Protection and Affordable Care Act require a health insurer to comply with minimum medical loss ratios (revenue expended by the carrier to the total amount of premium revenue). The insurer is required to provide an annual rebate to each member if the medical loss ratio is less then a certain percent, as specified.

This bill would make technical, non substantive changes to the latter provision.

Last Action: 02/01/2016 Returned to the Secretary of Senate pursuant to Joint Rule 56.

For more information on this bill please check the Official California Legislative Information site here


AB 533: Assemblymember Bonta (District 18)

Out-of-Network Coverage

Summary: This bill would require a health care service plan contract or policy issued, amended, or renewed on or after July 1, 2016 to cover services provided by a non contracting health professional for patients at health facilities. As a result, the patient would be required to pay the professional the same cost sharing as they would a contracted health professional. The patient would not be expected to pay more than the in-network cost sharing amount if the professional receives reimbursement for their services through the health facility. Professionals who collect more than the in-network cost-sharing amount to refund an overpayment to the patient, would provide the interest at 15% per annum, to the enrollee.

This bill would require the Department of Health Care Services (DHCS) and the commission to establish a dispute resolution process that helps all non contracting individual health professionals appeal a claim payment dispute. The bill allows DHCS and the commissioner to contract with multiple independent dispute resolution organizations to conduct this process. The bill would require an insurer to base reimbursement for covered services on the amount the individual health professional would have been reimbursed by Medicare for similar services in the general geographic area. These provisions do not apply to emergency services and care.

The bill limits the right of access to the meetings of public bodies or the writings of public officials and agencies. One time costs are estimated to be in the range of $300,000 to the Managed Care Fund and Insurance Fund. Ongoing costs in the hundreds of thousands of dollars to the Mutual Care fund and ongoing costs of around $50,000 to the Insurance Fund are expected. The objective of this bill is to protect consumers from being placed in the middle of payment disputes between health plans and providers.

Last Action: 09/12/2015 Motion to reconsider made by Assembly Member Bonta.

For more information on this bill please check the Official California Legislative Information site here