Bill Text: CA SB56 | 2009-2010 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

---

Bill Title: Health plans: joint ventures.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Vetoed) 2010-09-29 - In Senate. To unfinished business. (Veto) [SB56 Detail]

Download: California-2009-SB56-Amended.html

---

BILL NUMBER: SB 56	AMENDED
	BILL TEXT

	AMENDED IN SENATE  JANUARY 11, 2010
	AMENDED IN SENATE  MAY 5, 2009
	AMENDED IN SENATE  APRIL 2, 2009

INTRODUCED BY   Senator Alquist

                        JANUARY 20, 2009

    An act to add Section 1347 to, and to add Chapter 1.6
(commencing with Section 155) to Part 1 of Division 1 of, the Health
and Safety Code, relating to health benefits.   An act
to add Article 2.82 (commencing with Section 14087.98) to Chapter 7
of Part 3 of Division 9 of the Welfare and Institutions Code,
relating to health plans. 



	LEGISLATIVE COUNSEL'S DIGEST


   SB 56, as amended, Alquist.  California Health Benefits
Service Program.   Health plans: joint ventures. 

   Existing law creates various health benefits programs administered
by the State Department of Health Care Services. Existing law, the
Knox-Keene Health Care Services Plan Act of 1975, administered by the
Managed Risk Medical Insurance Board, provides for the licensure and
regulation of health care service plans.  
   This bill would authorize certain county-organized health plans
and various other health benefits programs to form joint ventures to
create integrated networks of public health plans that pool risk and
share networks or to provide for the joint or coordinated offering of
health plans to individuals and groups. The bill would require all
joint ventures and health care networks established pursuant to the
aforementioned provisions to meet all of the requirements of the
Knox-Keene Health Care Service Plan Act of 1975.  
   Existing law creates various health benefits programs administered
by the Managed Risk Medical Insurance Board and the State Department
of Health Care Services.  
   The bill would create the California Health Benefits Service
Program within the State Department of Health Care Services for the
purpose of expanding cost-effective public health coverage options to
the uninsured and purchasers of health insurance. The bill would
require the department to perform various duties, subject to the
availability of sufficient private donations, as determined by the
Department of Finance, relative to creation of joint ventures between
certain county-organized health plans and various other entities.
The bill would require these joint ventures to be licensed as health
care service plans and, subject to the availability of sufficient
private donations, as determined by the Department of Finance, would
create a stakeholder committee, as specified. The bill would also
authorize the Director of Managed Health Care to provide regulatory
and program flexibilities to facilitate licensing of specified
entities providing coverage pursuant to the bill. 
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  (a) The Legislature finds and declares as follows:
   (1) Due to the economic downturn, hundreds of thousands of
Californians are joining the ranks of the uninsured or are looking to
publicly financed programs for their health care coverage.
   (2) Compared to persons with health care coverage, the uninsured
are less likely to have a regular source of care, are likely to delay
seeing a doctor, and are less likely to receive preventive health
care services.
   (3) Based on recent data collected by the Kaiser Family
Foundation, health care costs continue to rise at a faster rate than
general inflation and average wage growth.
   (4) President Obama  has   and the Congress
of the United States have  pledged to seek the adoption of major
health care reforms at the national level, which are likely to
include, at a minimum, additional funding for states as well as
increased flexibility for states in how they administer their health
care systems. 
   (b) In light of these findings, it is the intent of the
Legislature to enact and implement comprehensive reforms in the state'
s health care delivery system by 2012 that will accomplish all of the
following:  
   (1) Ensure that all Californians have access to affordable, high
quality health care coverage.  
   (2) Ensure that the responsibility for providing and paying for
health care coverage is equitably shared between employers,
individuals, and government.  
   (3) Help contain the long-range rate of growth of health care
costs.  
   (4) Reform insurance underwriting and rating practices by reducing
the use of medical status or conditions as criteria for the offering
or rating of individual insurance products.  
   (5) Improve the health status of Californians and reduce health
disparities over time.  
   (6) Ensure fair and adequate payments to health care providers who
provide services under the state's publicly funded health care
programs.  
   (c) It is further the intent of the Legislature to enact specific
reforms by 2010 that will help provide a foundation for any
successful health care reform in California, and that will accomplish
all of the following:  
   (1) Ensure that all children in the state have access to
affordable, high quality health care coverage.  
   (2) Encourage greater use of electronic medical records and other
health information technology by health care providers. 

   (3) Make comparative health care cost and quality data more
readily available to consumers and purchasers.  
   (4) Make it easier for individuals and small employers to shop for
and compare the benefits and costs of competing health plans.
 
   (5) Allow all workers to set aside money to pay for health care
coverage on a pretax basis.  
   (6) Begin to draw down federal funds that are available for
covering low-income adults and families.  
   (7) Reduce the use of medical underwriting in the individual
health insurance market, cap health care service plans' and insurers'
administrative costs and profits, and establish minimum benefit
standards for health plans offered in the state.  
   (8) Allow health plans and employers to offer incentives for
enrollees to enroll in and use preventive health care programs that
will improve their health.  
   (9) Address health care workforce shortages and better prepare
persons for careers in the health care delivery system. 

   (10) Facilitate the formation of public insurer entities,
including through better integration of county local initiatives and
organized health systems.  
   (5) There is a continuing need for affordable health coverage
options for California's uninsured population, particularly those
with limited incomes and those who do not receive health coverage
through their employment or the employment of a family member. 

   (6) Due to their structure and design, county local initiative
health plans and county-organized health systems have the potential
to offer affordable health coverage in the individual and group
markets.  
   (7) Joint ventures involving local initiative health plans and
county-organized health systems may be a particularly promising means
of providing affordable coverage in many regions of the state. 

   (b) In light of these findings, it is the intent of the
Legislature that representatives of local initiative health plans,
county-organized health systems, and consumer, labor, and provider
groups hold stakeholder discussions for the purposes of facilitating
establishment of affordable health coverage options in the individual
and group markets. 
   SEC. 2.    Article 2.82 (commencing with Section
14087.98) is added to Chapter 7 of Part 3 of Division 9 of the 
 Welfare and Institutions Code   , to read:  

      Article 2.82.  Health Plan Joint Ventures


   14087.98.  (a) Health plans that are governed, owned, or operated
by a county board of supervisors, a county special commission, a
county-organized health system, or a county health authority that are
authorized by Section 14018.7, 14087.31, 14087.35, 14087.36,
14087.38, Article 2.8 (commencing with Section 14087.5), Article 2.81
(commencing with Section 14087.96), or Chapter 3 (commencing with
Section 101675) of Part 4 of Division 101 of the Health and Safety
Code, or the County Medical Services Program, may form joint ventures
to create integrated networks of public health plans that pool risk
and share networks or to provide for the joint or coordinated
offering of health plans to individuals and groups.
   (b) In forming joint ventures, participating health plans shall
seek to contract with designated public hospitals, county health
clinics, community health centers, and other traditional safety net
providers.
   (c) All joint ventures and health care networks established
pursuant to this section shall meet all the requirements of the
Knox-Keene Health Care Service Plan Act of 1975 (Chapter 2.2
(commencing with Section 1340) of Division 2 of the Health and Safety
Code).  All matter omitted in this version of the bill appears
in the bill as amended in the Senate, May 5, 2009. (JR11)