Bill Text: CA AB507 | 2021-2022 | Regular Session | Introduced
Bill Title: Health care service plans: review of rate increases.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Failed) 2022-02-01 - Died at Desk. [AB507 Detail]
Download: California-2021-AB507-Introduced.html
CALIFORNIA LEGISLATURE—
2021–2022 REGULAR SESSION
Assembly Bill
No. 507
| Introduced by Assembly Member Kalra |
February 09, 2021 |
An act to amend Section 1385.07 of the Health and Safety Code, relating to health care service plans.
LEGISLATIVE COUNSEL'S DIGEST
AB 507, as introduced, Kalra.
Health care service plans: review of rate increases.
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. Existing law requires a health care service plan in the individual, small group, or large group markets to file rate information with the Department of Managed Health Care, as specified. Existing law requires the information submitted to be made publicly available, except as specified, and requires the department and the health care service plan to make specified information, including justification for an unreasonable rate increase, readily available to the public on their internet websites in plain language.
This bill would make technical, nonsubstantive changes to those provisions.
Digest Key
Vote: MAJORITY Appropriation: NO Fiscal Committee: NO Local Program: NOBill Text
The people of the State of California do enact as follows:
SECTION 1.
Section 1385.07 of the Health and Safety Code is amended to read:1385.07.
(a) Notwithstanding Chapter 3.5 (commencing with Section 6250) of Division 7 of Title 1 of the Government Code, all information submitted under this article shall be made publicly available by the department except as provided in subdivision (b).(b) (1) The contracted rates between a health care service plan and a provider shall be deemed confidential information that shall not be made public by the department and are exempt from disclosure under the California Public Records Act (Chapter 3.5 (commencing with Section 6250) of Division 7 of Title 1 of the Government Code). The contracted rates between a health care service plan and a provider shall not be disclosed by a health care service plan to a large group purchaser that receives
information pursuant to Section 1385.10.
(2) The contracted rates between a health care service plan, including those submitted to the department pursuant to Section 1385.046, and a large group shall be deemed confidential information that shall not be made public by the department and are exempt from disclosure under the California Public Records Act (Chapter 3.5 (commencing with Section 6250) of Division 7 of Title 1 of the Government Code). Information provided to a large group purchaser pursuant to Section 1385.10 shall be deemed confidential information that shall not be made public by the department and shall be exempt from disclosure under the California Public Records Act (Chapter 3.5 (commencing with Section 6250) of Division 7 of Title 1 of the Government Code).
(c) All information submitted to the department under this article shall be submitted electronically in order
to facilitate review by the department and the public.
(d) In addition, the department and the health care service plan shall, at a minimum, make the following information readily available to the public on their internet websites in plain language and in a manner and format specified by the department, except as provided in subdivision (b). For individual and small group health care service plan contracts, the information shall be made public for 120 days prior to before the implementation of the rate increase. For large group health care service plan contracts, the information shall be made public for 60 days prior to
before the implementation of the rate increase. The information shall include:
(1) Justifications for any unreasonable rate increases, Justification for an unreasonable rate increase, including all information and supporting documentation as to why the rate increase is justified.
(2) A plan’s overall annual medical trend factor assumptions in each rate filing for all benefits.
(3) A health care service plan’s actual costs, by aggregate benefit category to include
category, including hospital inpatient, hospital outpatient, physician services, prescription drugs and other ancillary services, laboratory, and radiology.
(4) The amount of the projected trend attributable to the use of services, price inflation, or fees and risk for annual plan contract trends by aggregate benefit category, such as hospital inpatient, hospital outpatient, physician services, prescription drugs and other ancillary services, laboratory, and radiology.
