Bill Text: CA AB1877 | 2013-2014 | Regular Session | Enrolled
Bill Title: California Vision Care Access Council.
Spectrum: Bipartisan Bill
Status: (Vetoed) 2014-09-25 - Vetoed by Governor. [AB1877 Detail]
Download: California-2013-AB1877-Enrolled.html
BILL NUMBER: AB 1877 ENROLLED
BILL TEXT
PASSED THE SENATE AUGUST 21, 2014
PASSED THE ASSEMBLY AUGUST 25, 2014
AMENDED IN SENATE AUGUST 19, 2014
AMENDED IN SENATE JULY 1, 2014
AMENDED IN SENATE JUNE 17, 2014
AMENDED IN ASSEMBLY MAY 23, 2014
AMENDED IN ASSEMBLY APRIL 2, 2014
INTRODUCED BY Assembly Member Cooley
(Coauthors: Assembly Members Dickinson, Beth Gaines, and Pan)
(Coauthor: Senator Gaines)
FEBRUARY 19, 2014
An act to add Title 22.1 (commencing with Section 100600) to the
Government Code, relating to health care coverage, and declaring the
urgency thereof, to take effect immediately.
LEGISLATIVE COUNSEL'S DIGEST
AB 1877, Cooley. California Vision Care Access Council.
Existing law, the federal Patient Protection and Affordable Care
Act, requires each state to establish an American Health Benefits
Exchange to facilitate the purchase of qualified health plans by
qualified individuals and small employers. PPACA prohibits an
Exchange from making available any health plan other than a qualified
health plan, except for certain stand-alone dental plans. Existing
state law establishes the California Health Benefit Exchange within
state government, specifies the powers and duties of the board
governing the Exchange, and requires the board to facilitate the
purchase of qualified health plans through the Exchange by qualified
individuals and small employers by January 1, 2014.
This bill would establish the California Vision Care Access
Council within state government and would require that the Council be
governed by the executive board that governs the California Health
Benefit Exchange. The bill would require the Council to establish an
interagency agreement with the California Health Benefit Exchange
allowing the Council to utilize the executive, administrative, and
other related resources of the Exchange and would prohibit the use of
specified Exchange funds for purposes of the Council. The bill would
require the Council to construct, manage, and maintain an Internet
Web site to inform consumers about individual and employer-based
vision plans offered by participating carriers. The bill would
require the Council to work with the Exchange to establish a direct
link between that Internet Web site and the Internet Web site of the
Exchange. The bill would require the Council to refer consumer
questions regarding health care eligibility and enrollment options to
the Exchange and to licensed insurance agents, as specified.
This bill would impose specified requirements on participating
carriers and would also require the Council to establish other
requirements for carrier participation and the standards and criteria
for participating vision plans that are in the best interests of
individuals and employers eligible to purchase coverage through the
Exchange. The bill would require participating vision plans to be
issued on a guarantee issue basis without preexisting condition
provisions and would require a participating carrier to make
available to consumers an electronic directory of contracting vision
care providers. The bill would also enact other related provisions.
This bill would create the California Vision Care Access Trust
Fund, the moneys of which would be available to the board for
purposes of the bill's provisions upon appropriaton by the
Legislature, would authorize the Council to assess a charge on
participating vision plans that is reasonable and necessary to
support the development, operations, and prudent cash management of
the Council, and would make the implementation of the bill's
provisions contingent on a determination by the board that sufficient
moneys exist in the fund to implement the bill's provisions. The
bill would prohibit General Fund moneys from being used for any of
these purposes and would require that any costs associated with the
implementation of these provisions be paid from the California Vision
Care Access Trust Fund.
This bill would declare that it is to take effect immediately as
an urgency statute.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. This act shall be known and may be cited as the
California Vision Care Access Act.
SEC. 2. It is the intent of the Legislature to make the statutory
changes to California law necessary to establish a Vision Care Access
Council in California in a manner that is consistent with the rules,
regulations, and guidance implementing 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), hereafter the federal act. In doing so, it is
the intent of the Legislature to do both of the following:
(a) Provide Californians an organized, transparent Internet Web
site to provide information about affordable, quality vision care
coverage, augmenting and supplementing the essential health benefits
available through the California Health Benefit Exchange.
(b) Meet the requirements of the federal act and all applicable
federal guidance, rules, and regulations.
SEC. 3. Title 22.1 (commencing with Section 100600) is added to
the Government Code, to read:
TITLE 22.1. CALIFORNIA VISION CARE ACCESS COUNCIL
100600. For purposes of this title, the following definitions
shall apply:
(a) "Board" means the board described in subdivision (a) of
Section 100601.
(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) "Council" means the Vision Care Access Council created by
Section 100601.
(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 Vision Care Access Trust Fund
established by Section 100620.
(g) "Licensed agent" means an individual licensed by the
Department of Insurance pursuant to Section 1626 of the Insurance
Code.
(h) "Preexisting condition provision" means a policy provision
that excludes coverage for charges or expenses incurred during a
specified period following the insured's effective date of coverage,
as to a condition for which medical advice, diagnosis, care, or
treatment relating to vision was recommended or received during a
specified period immediately preceding the effective date of
coverage.
(i) "Qualified individual" means an individual who is eligible to
purchase coverage through the Exchange.
(j) "Qualified employer" means an employer that is eligible to
purchase coverage through the Exchange.
(k) "Vision plan" means a specialized health care service plan
contract, as defined in Section 1345 of the Health and Safety Code,
covering vision care services or a specialized health insurance
policy, as defined in Section 106 of the Insurance Code, covering
vision care services.
100601. (a) There is in the state government the California
Vision Care Access Council, an independent public entity not
affiliated with an agency or department, which shall be known as the
Council. The Council shall be governed by the executive board
established pursuant to Section 100500. The board shall be subject to
Section 100500.
(b) (1) To the extent permitted by the federal act, the Council
shall establish an interagency agreement with the Exchange allowing
the Council to utilize the executive, administrative, and other
related resources of the Exchange, including, but not limited to, the
staff employed by the Exchange and the programming and information
technology infrastructure supporting the Exchange.
(2) In addition to establishing an interagency agreement under
paragraph (1), the Council may establish interagency agreements with
other agencies for the purposes of contracting for executive,
administrative, and other related services, if necessary.
(c) Each member of the board shall have the responsibility and
duty to meet the requirements of this title, the federal act, and all
applicable state and federal laws and regulations, to serve the
public interest of the individuals and small businesses seeking
health care coverage through the Council, and to ensure the
operational well-being and fiscal solvency of the Council.
(d) There shall not be any liability in a private capacity on the
part of the board or any member of the board, or any officer or
employee of the board, for or on account of any act performed or
obligation entered into in an official capacity, when done in good
faith, without the intent to defraud, and in connection with the
administration, management, or conduct of this title or affairs
related to this title.
(e) A member of the board or staff of the Council shall not be
employed by, a consultant to, a member of the board of directors of,
affiliated with, or otherwise a representative of, an optical company
that manufactures, sells, or distributes lenses, frames, or other
vision care appliances.
100603. The Council shall, at a minimum, do all of the following:
(a) Construct, manage, and maintain an Internet Web site, separate
from the Internet Web site established by the Exchange, to inform
consumers about participating individual and employer-based vision
plans that are available to qualified individuals and qualified
employers. The Internet Web site shall offer full and complete
carrier information to consumers and shall allow enrollees and
prospective enrollees to obtain standardized comparative information
on the participating vision plans.
(b) Work cooperatively with the Exchange to establish a direct
link from the Internet Web site maintained by the Exchange to the
Internet Web site described in subdivision (a).
(c) Determine the minimum requirements a carrier shall meet to be
considered for participation in the Internet Web site described in
subdivision (a), and the standards and criteria for participating
vision plans that are in the best interests of qualified individuals
and qualified employers. The board shall consistently and uniformly
apply these requirements, standards, and criteria to all carriers.
The requirements adopted pursuant to this subdivision shall, at a
minimum, include the following:
(1) A requirement that a carrier meet a minimum net asset
threshold as determined by the Council to ensure that it is both well
established and can demonstrate that it offers a proven model for
providing vision care coverage in California. The Council may also
consider the usefulness of setting a minimum annual premium revenue
as evidence of the soundness of the carrier.
(2) A requirement that a carrier have, and continuously maintain,
an established Internet Web site.
(3) A requirement that a carrier demonstrate to the Council
adequate vision care coverage networks sufficient to ensure
convenient geographic access to vision care in California.
(4) A requirement that a carrier demonstrate to the Council
adequate, multilingual consumer service and benefit delivery
capabilities.
(5) Any other requirements determined necessary by the board based
on input from health care consumer advocacy organizations,
representatives of the optometry and ophthalmology industries, health
insurers, health care service plans, and licensed agents.
(d) Require participating vision plans to do both of the
following:
(1) (A) Make available to the public, 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) Information on cost sharing and payments with respect to any
out-of-network coverage.
(B) The information required under subparagraph (A) shall be
provided in plain language.
(2) 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, through licensed agents, and through other means
for individuals without access to the Internet.
(e) Distribute fair and impartial information concerning
enrollment in participating vision plans.
(f) Provide referrals to any applicable office of health insurance
consumer assistance or health insurance ombudsman, or any other
appropriate state agency or agencies, for any enrollee with a
grievance, complaint, or question regarding a participating carrier,
coverage purchased pursuant to this title, or a determination by the
carrier or under that coverage.
(g) Provide information in a manner that is culturally and
linguistically appropriate to the needs of the population being
served by the Council using the services of licensed agents.
(h) Employ necessary staff to the extent not provided pursuant to
the interagency agreements established under Section 100601.
(i) Assess a charge on the participating vision plans that is
reasonable and necessary to support the development, operations, and
prudent cash management of the Council.
(j) Authorize expenditures, as necessary, from the fund to pay
program expenses to administer the Council.
(k) Keep an accurate accounting of all activities, receipts, and
expenditures, and annually publish a report concerning that
accounting.
(l) (1) Annually publish a report on the implementation and
performance of the Council functions during the preceding fiscal
year, that shall be made available to the public on the Internet Web
site of the Council.
(2) In addition to the report described in paragraph (1), the
Council shall be responsive to requests for additional information
from the Legislature, including providing testimony and commenting on
proposed state legislation or policy issues.
(m) Exercise all powers reasonably necessary to carry out and
comply with the duties, responsibilities, and requirements of this
title.
(n) 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 vision plans.
(2) Individuals and entities with experience in facilitating
enrollment in vision plans.
(3) Representatives of small businesses and self-employed
individuals.
(4) Licensed agents.
(o) Require participating carriers to regularly, as determined by
the Council, provide the Council with enrollment or disenrollment
data.
(p) Ensure that written information made available by the Council
is presented in a plainly worded, easily understandable format and
made available in California's prevalent languages.
(q) Provide a choice of carrier in each region of the state.
(r) Require, as a condition of participation in the Council, a
vision plan to do the following:
(1) Not impose any preexisting condition provision upon any
enrollee.
(2) With respect to an individual vision plan, be offered,
marketed, and sold to all individuals and dependents in each service
area in which the carrier provides or arranges for vision care
services.
(3) With respect to an employer-based vision plan, be offered,
marketed, and sold to all employers and eligible employees and
dependents in the applicable group market in each service area in
which the carrier provides or arranges for vision care services.
(s) Share information with relevant state departments, consistent
with the confidentiality provisions in Section 1411 of the federal
act, necessary for the administration of the Council.
(t) Collect only that information from individuals or designees of
individuals as is necessary to administer the Council and consistent
with the federal act.
100605. The Council may do any of the following:
(a) Enter into contracts.
(b) Adopt an official seal.
(c) Sue and be sued.
(d) Receive and accept gifts, grants, or donations of moneys from
any agency of the United States, any agency of the state, any
municipality, county, or other political subdivision of the state.
(e) Receive and accept gifts, grants, or donations from
individuals, associations, private foundations, or corporations, in
compliance with the conflict-of-interest provisions to be adopted by
the board at a public meeting.
(f) Adopt rules and regulations as necessary.
100606. (a) A participating carrier shall utilize a standardized
format for presenting vision plan options to the Council.
(b) The Council shall refer questions from consumers regarding
eligibility and enrollment options for Medi-Cal or through the
Exchange to the Exchange and to licensed agents.
(c) The Council shall require a participating carrier to make
available to consumers and regularly update an electronic directory
of contracting vision care providers in the carrier's network.
100607. (a) Notwithstanding any other law, the Council shall not
be subject to licensure or regulation by the Department of Insurance
or the Department of Managed Health Care.
(b) Participating carriers shall have and maintain a license or
certificate of authority from, and shall be in good standing with,
their respective regulatory agencies.
(c) Nothing in this title shall be construed to require a
qualified health plan offered through the Exchange to contract with
the Council in order to offer coverage for adult vision through the
Exchange.
100609. Records of the Council that reveal any of the following
shall be exempt from disclosure under the California Public Records
Act (Chapter 3.5 (commencing with Section 6250) of Division 7 of
Title 1):
(a) The deliberative processes, discussions, communications, or
any other portion of the negotiations with entities contracting or
seeking to contract with the Council, entities with which the Council
is considering a contract, or entities with which the Council is
considering or enters into any other arrangement under which the
Council provides, receives, or arranges services or reimbursement.
(b) The impressions, opinions, recommendations, meeting minutes,
research, work product, theories, or strategy of the board or its
staff, or records that provide instructions, advice, or training to
employees.
100620. (a) The California Vision Care Access Trust Fund is
hereby created in the State Treasury for the purpose of this title.
Moneys collected pursuant to this title shall be deposited in the
fund and, upon appropriation by the Legislature, shall be available
to the board for purposes of this title. Any moneys in the fund that
are unexpended or unencumbered at the end of a fiscal year may be
carried forward to the next succeeding fiscal year.
(b) Notwithstanding any other law, moneys deposited in the fund
shall not be loaned to, or borrowed by, any other special fund or the
General Fund, or a county general fund or any other county fund.
(c) The Council shall establish and maintain a prudent reserve in
the fund.
(d) The board or staff of the Council shall not utilize any funds
intended for the administrative and operational expenses of the
Council for staff retreats, promotional giveaways, excessive
executive compensation, or promotion of federal or state legislative
or regulatory modifications.
(e) Notwithstanding Section 16305.7, all interest earned on the
moneys that have been deposited into the fund shall be retained in
the fund and used for purposes consistent with the fund.
(f) (1) State General Fund moneys shall not be used for any
purpose under this title.
(2) Federal money paid to the state for the purpose of
establishing an American Health Benefit Exchange, as described in
Section 1311 of the federal act, and charges assessed by the Exchange
pursuant to subdivision (n) of Section 100503 of the Government
Code, shall not be used for purposes of this title.
(3) Any costs associated with the implementation of this title,
including, but not limited to, the proportionate cost of Exchange
resources used for purposes of this title, shall be paid from the
fund.
100621. (a) The implementation of the provisions of this title,
other than this section and Sections 100601, 100605, and 100620,
shall be contingent on a determination by the board that sufficient
moneys exist in the fund to implement this title.
(b) The board shall provide notice to the Joint Legislative Budget
Committee and the Director of Finance when the financial threshold
set forth in subdivision (a) has been reached.
SEC. 4. The Legislature finds and declares that Section 3 of this
act, which adds Section 100609 to the Government Code, imposes a
limitation on the public's right of access to the meetings of public
bodies or the writings of public officials and agencies within the
meaning of Section 3 of Article I of the California Constitution.
Pursuant to that constitutional provision, the Legislature makes the
following findings to demonstrate the interest protected by this
limitation and the need for protecting that interest:
In order to ensure that the California Vision Care Access Council
is not constrained in exercising its fiduciary powers and obligations
to provide consumers with the most accessible and affordable
information regarding vision care benefits that augment the benefits
available through the California Health Benefit Exchange, the
limitations on the public's right of access imposed by Section 3 of
this act are necessary.
SEC. 5. This act is an urgency statute necessary for the immediate
preservation of the public peace, health, or safety within the
meaning of Article IV of the Constitution and shall go into immediate
effect. The facts constituting the necessity are:
In order to provide Californians an organized, transparent
Internet Web site to inform consumers about affordable, quality
vision care coverage, augmenting and supplementing the essential
health benefits available through the California Health Benefit
Exchange in a manner consistent with evolving federal rules,
regulations, and official guidance implementing 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), it is necessary that this act take effect
immediately.
