Bill Text: CA AB1869 | 2011-2012 | Regular Session | Chaptered
Bill Title: Office of Patient Advocate: federal veterans health
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Passed) 2012-07-24 - Chaptered by Secretary of State - Chapter 167, Statutes of 2012. [AB1869 Detail]
Download: California-2011-AB1869-Chaptered.html
BILL NUMBER: AB 1869 CHAPTERED
BILL TEXT
CHAPTER 167
FILED WITH SECRETARY OF STATE JULY 24, 2012
APPROVED BY GOVERNOR JULY 24, 2012
PASSED THE SENATE JULY 6, 2012
PASSED THE ASSEMBLY APRIL 26, 2012
INTRODUCED BY Assembly Member John A. Pérez
(Principal coauthor: Assembly Member Pan)
FEBRUARY 22, 2012
An act to amend Section 136000 of the Health and Safety Code,
relating to health care.
LEGISLATIVE COUNSEL'S DIGEST
AB 1869, John A. Pérez. Office of Patient Advocate: federal
veterans health benefits.
Existing law requires the Office of Patient Advocate to provide
assistance to, and advocate on behalf of, individuals served by
health care service plans regulated by the Department of Management
Health Care, insureds covered by health insurers regulated by the
Department of Insurance, and individuals who receive or are eligible
for other health care coverage in California. Under existing law,
commencing January 1, 2013, the office is required to provide, and
assist in the provision of, outreach and education about health care
coverage options, including information and assistance regarding
public programs such as Medi-Cal, the Healthy Families Program, and
Medicare.
This bill would require the Office of Patient Advocate, commencing
January 1, 2013, to also provide, and assist in the provision of,
outreach and education about federal veterans health benefits.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 136000 of the Health and Safety Code is amended
to read:
136000. (a) (1) Effective July 1, 2012, there is hereby
transferred from the Department of Managed Health Care the Office of
Patient Advocate to be established within the California Health and
Human Services Agency, to provide assistance to, and advocate on
behalf of, individuals served by health care service plans regulated
by the Department of Managed Health Care, insureds covered by health
insurers regulated by the Department of Insurance, and individuals
who receive or are eligible for other health care coverage in
California, including coverage available through the Medi-Cal
program, the California Health Benefit Exchange, the Healthy Families
Program, or any other county or state health care program. The goal
of the office shall be to help those individuals secure the health
care services to which they are entitled or for which they are
eligible under the law. Notwithstanding any provision of this
division, each regulator and health coverage program shall retain its
respective authority, including its authority to resolve complaints,
grievances, and appeals.
(2) The office shall be headed by a patient advocate appointed by
the Governor. The patient advocate shall serve at the pleasure of the
Governor.
(3) The provisions of this division affecting insureds covered by
health insurers regulated by the Department of Insurance and
individuals who receive or are eligible for coverage available
through the Medi-Cal program, the California Health Benefit Exchange,
the Healthy Families Program, or any other county or state health
care program shall commence on January 1, 2013, except that for the
period July 1, 2012, to January 1, 2013, the office shall continue
with any duties, responsibilities, or activities of the office
authorized as of July 1, 2011, which shall continue to be authorized.
(b) (1) The duties of the office shall include, but not be limited
to, all of the following:
(A) Developing, in consultation with the Managed Risk Medical
Insurance Board, the State Department of Health Care Services, the
California Health Benefit Exchange, the Department of Managed Health
Care, and the Department of Insurance, educational and informational
guides for consumers describing their rights and responsibilities,
and informing them on effective ways to exercise their rights to
secure health care coverage. The guides shall be easy to read and
understand and shall be made available in English and other threshold
languages, using an appropriate literacy level, and in a culturally
competent manner. The informational guides shall be made available to
the public by the office, including being made accessible on the
office's Internet Web site and through public outreach and
educational programs.
(B) Compiling an annual publication, to be made available on the
office's Internet Web site, of a quality of care report card,
including, but not limited to, health care service plans.
(C) Rendering assistance to consumers regarding procedures,
rights, and responsibilities related to the filing of complaints,
grievances, and appeals, including appeals of coverage denials and
information about any external appeal process.
(D) Making referrals to the appropriate state agency regarding
studies, investigations, audits, or enforcement that may be
appropriate to protect the interests of consumers.
(E) Coordinating and working with other government and
nongovernment patient assistance programs and health care
ombudsperson programs.
(2) The office shall employ necessary staff. The office may employ
or contract with experts when necessary to carry out the functions
of the office. The patient advocate shall make an annual budget
request for the office which shall be identified in the annual Budget
Act.
(3) Until January 1, 2013, the office shall have access to records
of the Department of Managed Health Care, including, but not limited
to, information related to health care service plan or health
insurer audits, surveys, and enrollee or insured grievances.
(4) The patient advocate shall annually issue a public report on
the activities of the office, and shall appear before the appropriate
policy and fiscal committees of the Senate and Assembly, if
requested, to report and make recommendations on the activities of
the office.
(5) The office shall adopt standards for the organizations with
which it contracts pursuant to this section to ensure compliance with
the privacy and confidentiality laws of this state, including, but
not limited to, the Information Practices Act of 1977 (Chapter 1
(commencing with Section 1798) of Division 3 of the Civil Code). The
office shall conduct privacy trainings as necessary, and regularly
verify that the organizations have measures in place to ensure
compliance with this provision.
(c) In enacting this act, the Legislature recognizes that, because
of the enactment of federal health care reform on March 23, 2010,
and the implementation of various provisions by January 1, 2014, it
is appropriate to transfer the Office of Patient Advocate and to
confer new responsibilities on the Office of Patient Advocate,
including assisting consumers in obtaining health care coverage and
obtaining health care through health coverage that is regulated by
multiple regulators, both state and federal. The new responsibilities
include assisting consumers in navigating both public and private
health care coverage and assisting consumers in determining which
regulator regulates the health care coverage of a particular
consumer. In order to assist in implementing federal health care
reform in California, commencing January 1, 2013, the office, in
addition to the duties set forth in subdivision (b), shall also do
all of the following:
(1) Receive and respond to all inquiries, complaints, and requests
for assistance from individuals concerning health care coverage
available in California.
(2) Provide, and assist in the provision of, outreach and
education about health care coverage options as set forth in
subparagraph (A) of paragraph (1) of subdivision (b), including, but
not limited to:
(A) Information regarding applying for coverage; the cost of
coverage; and renewal in, and transitions between, health coverage
programs.
(B) Information and assistance regarding public programs, such as
Medi-Cal, the Healthy Families Program, federal veterans health
benefits, and Medicare; and private coverage, including
employer-sponsored coverage, Exchange coverage; and other sources of
care if the consumer is not eligible for coverage, such as county
services, community clinics, discounted hospital care, or charity
care.
(3) Coordinate with other state and federal agencies engaged in
outreach and education regarding the implementation of federal health
care reform.
(4) Render assistance to, and advocate on behalf of, consumers
with problems related to health care services, including care and
service problems and claims or payment problems.
(5) Refer consumers to the appropriate regulator of their health
coverage programs for filing complaints, grievances, or claims, or
for payment problems.
(d) (1) Commencing January 1, 2013, the office shall track and
analyze data on problems and complaints by, and questions from,
consumers about health care coverage for the purpose of providing
public information about problems faced and information needed by
consumers in obtaining coverage and care. The data collected shall
include demographic data, source of coverage, regulator, and
resolution of complaints, including timeliness of resolution.
(2) The Department of Managed Health Care, the Department of
Health Care Services, the Department of Insurance, the Managed Risk
Medical Insurance Board, the California Health Benefit Exchange, and
other public coverage programs shall provide to the office data in
the aggregate concerning consumer complaints and grievances. For the
purpose of publicly reporting information about the problems faced by
consumers in obtaining care and coverage, the office shall analyze
data on consumer complaints and grievances resolved by these
agencies, including demographic data, source of coverage, insurer or
plan, resolution of complaints and other information intended to
improve health care and coverage for consumers. The office shall
develop and provide comprehensive and timely data and analysis based
on the information provided by other agencies.
(3) The office shall collect and report data to the United States
Secretary of Health and Human Services on complaints and consumer
assistance as required to comply with requirements of the federal
Patient Protection and Affordable Care Act (Public Law 111-148).
(e) Commencing in January 1, 2013, in order to assist consumers in
understanding the impact of federal health care reform as well as
navigating and resolving questions and problems with health care
coverage and programs, the office shall ensure that either the office
or a state agency contracting with the office shall do the
following:
(1) Operate a toll-free telephone hotline number that can route
callers to the proper regulating body or public program for their
question, their health plan, or the consumer assistance program in
their area.
(2) Operate a Internet Web site, other social media, and
up-to-date communication systems to give information regarding the
consumer assistance programs.
(f) (1) The office may contract with community-based consumer
assistance organizations to assist in any or all of the duties of
subdivision (c) in accordance with Section 19130 of the Government
Code or provide grants to community-based consumer assistance
organizations for portions of these purposes.
(2) Commencing on January 1, 2013, any local community-based
nonprofit consumer assistance program with which the office contracts
shall include in its mission the assistance of, and duty to, health
care consumers. Contracting consumer assistance programs shall have
experience in the following areas:
(A) Assisting consumers in navigating the local health care
system.
(B) Advising consumers regarding their health care coverage
options and helping consumers enroll in and retain health care
coverage.
(C) Assisting consumers with problems in accessing health care
services.
(D) Serving consumers with special needs, including, but not
limited to, consumers with limited-English language proficiency,
consumers requiring culturally competent services, low-income
consumers, consumers with disabilities, consumers with low literacy
rates, and consumers with multiple health conditions, including
behavioral health.
(E) Collecting and reporting data, including demographic data,
source of coverage, regulator, and resolution of complaints,
including timeliness of resolution.
(3) Commencing on January 1, 2013, the office shall develop
protocols, procedures, and training modules for organizations with
which it contracts.
(4) Commencing on January 1, 2013, the office shall adopt
standards for organizations with which it contracts regarding
confidentiality and conduct.
(5) Commencing on January 1, 2013, the office may contract with
consumer assistance programs to develop a series of appropriate
literacy level and culturally and linguistically appropriate
educational materials in all threshold languages for consumers
regarding health care coverage options and how to resolve problems.
(g) (1) Commencing on January 1, 2013, the office shall develop
protocols and procedures for assisting in the resolution of consumer
complaints, including both of the following:
(1) A procedure for referral of complaints and grievances to the
appropriate regulator or health coverage program for resolution by
the relevant regulator or public program.
(2) A protocol or procedure for reporting to the appropriate
regulator and health coverage program regarding complaints and
grievances relevant to that agency that the office received and was
able to resolve without further action or referral.
(h) For purposes of this section, the following definitions shall
apply:
(1) "Consumer" or "individual" includes the individual or his or
her parent, guardian, conservator, or authorized representative.
(2) "Exchange" means the California Health Benefit Exchange
established pursuant to Title 22 (commencing with Section 100500) of
the Government Code.
(3) "Health care" includes behavioral health, including both
mental health and substance abuse treatment.
(4) "Health care service plan" has the same meaning as that set
forth in subdivision (f) of Section 1345. Health care service plan
includes "specialized health care service plans," including
behavioral health plans.
(5) "Health coverage program" includes the Medi-Cal program,
Healthy Families Program, tax subsidies and premium credits under the
Exchange, the Basic Health Program, if enacted, county health
coverage programs, and the Access for Infants and Mothers Program.
(6) "Health insurance" has the same meaning as set forth in
Section 106 of the Insurance Code.
(7) "Health insurer" means an insurer that issues policies of
health insurance.
(8) "Office" means the Office of Patient Advocate.
(9) "Threshold languages" shall have the same meaning as for
Medi-Cal managed care.
