Bill Text: CA AB1766 | 2011-2012 | Regular Session | Amended
Bill Title: California Health Benefit Exchange.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2012-04-17 - In committee: Set, first hearing. Hearing canceled at the request of author. [AB1766 Detail]
Download: California-2011-AB1766-Amended.html
BILL NUMBER: AB 1766 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY APRIL 9, 2012
INTRODUCED BY Assembly Member Bonilla
FEBRUARY 17, 2012
An act to amend Section 100502 of the Government Code, relating to
health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
AB 1766, as amended, Bonilla. California Health Benefit Exchange.
Existing law establishes the California Health Benefit Exchange
(Exchange) for the purpose of facilitating the purchase of qualified
health plans by qualified individuals and qualified small employers
by January 1, 2014. Existing law specifies the duties of the
board of the Exchange with respect to implementing a specified
provision of the federal Patient Protection and Affordable Care Act.
Existing law requires the board of the Exchange to
inform individuals of eligibility requirements for state or local
public programs and to enroll eligible individuals in those programs,
as specified, and to perform duties relating to determining
eligibility for premium tax credits, among other things. Existing law
also requires the Exchange to establish the Small
Business Health Options Program 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.
This bill would prohibit the Small Business Health Options Program
from informing an eligible employee or dependent thereof about, or
screening that employee or dependent for eligibility for, a premium
tax credit, the Medi-Cal program, the Healthy Families Program, or
any other state or local public program.
This bill would make technical, nonsubstantive changes to those
duties.
Vote: majority. Appropriation: no. Fiscal committee: no
yes . State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. 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 the 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
subsection (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 subsection
(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
individual's 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 (42 U.S.C. Sec. 300gg-15).
(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, enroll that individual
in the program.
(g) Establish and make available by electronic means a calculator
to determine the actual cost of coverage after the application of any
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 individual's 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 subsection (i) of Section 1311 of
the federal act. Any 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 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, 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 subsection
(a) of Section 1312 of the federal act. Notwithstanding any
other provision of this section, the Small Business Health Options
Program shall not inform an eligible employee or dependent thereof
about, or screen that employee or dependent for eligibility for, the
Medi-Cal program, the Healthy Families Program, or any other state or
local public program, or a premium tax credit under Section 36B of
the Internal Revenue Code. For purposes of this subdivision,
"eligible employee or dependent thereof" means an employee of a
qualified small employer, or dependent thereof, who is eligible for
coverage through that small employer.
