Amended  IN  Senate  February 26, 2019

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Senate Bill No. 129

Introduced by Senator Pan

January 10, 2019

An act to amend Section 1348.95 of the Health and Safety Code, and to amend Section 10127.19 of the Insurance Code, relating to health care coverage.


LEGISLATIVE COUNSEL'S DIGEST


SB 129, as amended, Pan. Health care coverage reporting.
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 provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan or health insurer that covers individuals, small groups, large groups, or administrative services only business lines to report the number of covered lives by product type to the Department of Managed Health Care or the Department of Insurance. Existing law requires the Department of Managed Health Care and the Department of Insurance to publicly report that data, including posting that data on each department’s Internet Web site. internet website.
This bill would expand those health care service plan and health insurer reporting requirements to include association health plans and any other business lines. The bill would also require a multiple employer welfare arrangement or a plan or insurer that provides coverage through a multiple employer welfare arrangement to report that specified data to the Department of Managed Health Care or the Department of Insurance. Insurance, as appropriate, beginning March 1, 2020, and at least annually thereafter. The bill would require the Department of Managed Health Care and the Department of Insurance to make the reported data for the previous year available no later than April 15 of each year. 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.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: YES  

The people of the State of California do enact as follows:


SECTION 1.

 Section 1348.95 of the Health and Safety Code is amended to read:

1348.95.
 (a) Commencing March 1, 2013, and at least annually thereafter, a health care service plan, not including a health care service plan offering specialized health care service plan contracts, shall provide to the department, in a form and manner determined by the department in consultation with the Department of Insurance, the number of enrollees, by product type, as of December 31 of the prior year, that receive health care coverage under a health care service plan contract that covers individuals, small groups, individuals and small groups inside and outside of the California Health Benefit Exchange, large groups, association health plans, administrative services only business lines, and any other business lines. Health care service plans shall include the enrollment data in specific product types as determined by the department, including, but not limited to, HMO, point-of-service, PPO, grandfathered, and Medi-Cal managed care.
(b) Commencing March 1, 2020, and at least annually thereafter, a health care service plan that provides coverage through a multiple employee welfare arrangement (MEWA) that is not subject to Article 4.7 (commencing with Section 742.20) of Chapter 1 of Part 2 of Division 1 of the Insurance Code shall provide to the department, in a form and manner determined by the department in consultation with the Department of Insurance, the name of each MEWA and the number of covered persons in each MEWA as of December 31 of the prior year, divided by market segment and product type, in addition to the information provided pursuant to subdivision (a).

(b)

(c) The department shall publicly report the data provided by each health care service plan pursuant to this section, including, but not limited to, posting the data on the department’s Internet Web site. internet website. The department shall consult with the Department of Insurance to ensure that the data reported is comparable and consistent, does not duplicate existing reporting requirements, and utilizes existing reporting formats. The data for the previous calendar year shall be made available no later than April 15 of each calendar year.

SEC. 2.

 Section 10127.19 of the Insurance Code is amended to read:

10127.19.
 (a) Commencing March 1, 2013, and at least annually thereafter, a health insurer or a multiple employer welfare arrangement, insurer, not including a health insurer offering specialized health insurance policies, shall provide to the department, in a form and manner determined by the department in consultation with the Department of Managed Health Care, the number of covered lives, by product type, as of December 31 of the prior year, that receive health care coverage under a health insurance policy that covers individuals, small groups, individuals and small groups inside and outside of the California Health Benefit Exchange, large groups, association health plans, administrative services only business lines, and any other business lines. Health insurers and multiple employer welfare arrangements shall include the unduplicated enrollment data in specific product types as determined by the department, including, but not limited to, HMO, point-of-service, PPO, grandfathered, and Medi-Cal managed care.
(b) Commencing March 1, 2020, and at least annually thereafter, information specific to a multiple employee welfare arrangement (MEWA) shall be provided to the department, in a form and manner determined by the department in consultation with the Department of Managed Health Care, in addition to the information provided pursuant to subdivision (a), as follows:
(1) A health insurer that provides coverage through a MEWA that is not subject to Article 4.7 (commencing with Section 742.20) of Chapter 1 of Part 2 of Division 1 shall provide the name of each MEWA and the number of covered persons in each MEWA as of December 31 of the prior year, divided by market segment and product type.
(2) A MEWA that is subject to Article 4.7 (commencing with Section 742.20) of Chapter 1 of Part 2 of Division 1 shall provide the number of covered persons in the MEWA as of December 31 of the prior year, divided by product type.

(b)

(c) The department shall publicly report the data provided by each health insurer and multiple employer welfare arrangements MEWA pursuant to this section, including, but not limited to, posting the data on the department’s Internet Web site. internet website. The department shall consult with the Department of Managed Health Care to ensure that the data reported is comparable and consistent, does not duplicate existing reporting requirements, and utilizes existing reporting formats. The data for the previous calendar year shall be made available no later than April 15 of each calendar year.

SEC. 3.

 No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.