Bill Text: CA SB607 | 2023-2024 | Regular Session | Amended

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

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Bill Title: Controlled substances.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Passed) 2024-09-28 - Chaptered by Secretary of State. Chapter 862, Statutes of 2024. [SB607 Detail]

Download: California-2023-SB607-Amended.html

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Amended  IN  Senate  April 17, 2023

CALIFORNIA LEGISLATURE— 2023–2024 REGULAR SESSION

Senate Bill

No. 607

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Introduced by Senator Portantino

February 15, 2023

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An act to amend Section 1343 of, and to add Section 1343.2 to, the Health and Safety Code, and to amend Section 740 of the Insurance Code, relating to health care coverage, and declaring the urgency thereof, to take effect immediately.

LEGISLATIVE COUNSEL'S DIGEST

SB 607, as amended, Portantino. Self-funded student health care coverage.

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 provides for the regulation of health insurers by the Department of Insurance. Under existing law, specified persons are exempt from that regulation by the Department of Managed Health Care or the Department of Insurance.

This bill would authorize a student health plan operated by a bona fide, private, nonprofit institution of higher learning to operate in California if the institution files a yearly report with the Director of the Department of Managed Health Care that certifies specified information under penalty of perjury. The bill would exempt a student health plan that complies with those requirements from other regulation by the Department of Managed Health Care or the Department of Insurance, except as specified. By expanding the crime of perjury, 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.

This bill would declare that it is to take effect immediately as an urgency statute.

Digest Key

Vote: 2/3   Appropriation: NO   Fiscal Committee: YES   Local Program: YES  

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Bill Text

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

SECTION 1.

 The Legislature finds and declares the following:

It is the intent of the Legislature to require that a bona fide, private, nonprofit institution of higher learning that elects to offer a self-funded student health plan in accordance with this act shall maintain or exceed coverage standards of the federal Patient Protection and Affordable Care Act, including all California-mandated benefits under the federal Patient Protection and Affordable Care Act, and to comply with the provisions of this act.

SECTION 1.SEC. 2.

 Section 1343 of the Health and Safety Code is amended to read:

1343.

 (a) This chapter shall apply to health care service plans and specialized health care service plan contracts as defined in subdivisions (f) and (o) of Section 1345.

(b) The director may by the adoption of rules or the issuance of orders deemed necessary and appropriate, either unconditionally or upon specified terms and conditions or for specified periods, exempt from this chapter any class of persons or plan contracts if the director finds the action to be in the public interest and not detrimental to the protection of subscribers, enrollees, or persons regulated under this chapter, and that the regulation of the persons or plan contracts is not essential to the purposes of this chapter.

(c) The director, upon request of the Director of Health Care Services, shall exempt from this chapter any county-operated pilot program contracting with the State Department of Health Care Services pursuant to Article 7 (commencing with Section 14490) of Chapter 8 of Part 3 of Division 9 of the Welfare and Institutions Code. The director may exempt noncounty-operated pilot programs upon request of the Director of Health Care Services. Those exemptions may be subject to conditions the Director of Health Care Services deems appropriate.

(d) Upon the request of the Director of Health Care Services, the director may exempt from this chapter any mental health plan contractor or any capitated rate contract under Chapter 8.9 (commencing with Section 14700) of Part 3 of Division 9 of the Welfare and Institutions Code. Those exemptions may be subject to conditions the Director of Health Care Services deems appropriate.

(e) This chapter shall not apply to:

(1) A person organized and operating pursuant to a certificate issued by the Insurance Commissioner unless the entity is directly providing the health care service through those entity-owned or contracting health facilities and providers, in which case this chapter shall apply to the insurer’s plan and to the insurer.

(2) A plan directly operated by a bona fide public or private institution of higher learning that directly provides health care services only to its students, faculty, staff, administration, and their respective dependents, except that a plan described in this paragraph shall be subject to Sections 1343.2 and 1367.33, and Article 5.55 (commencing with Section 1374.30), as provided in Section 1343.2.

(3) A person who does all of the following:

(A) Promises to provide care for life or for more than one year in return for a transfer of consideration from, or on behalf of, a person 60 years of age or older.

(B) Has obtained a written license pursuant to Chapter 2 (commencing with Section 1250) or Chapter 3.2 (commencing with Section 1569).

(C) Has obtained a certificate of authority from the State Department of Social Services.

(4) The Major Risk Medical Insurance Board when engaging in activities under Chapter 8 (commencing with Section 10700) of Part 2 of Division 2 of the Insurance Code, Part 6.3 (commencing with Section 12695) of Division 2 of the Insurance Code, and Part 6.5 (commencing with Section 12700) of Division 2 of the Insurance Code.

(5) The California Small Group Reinsurance Fund.

SEC. 2.SEC. 3.

 Section 1343.2 is added to the Health and Safety Code, to read:

1343.2.

 (a) A plan operated by a bona fide, private, nonprofit institution of higher learning that directly provides health care services to its students and their respective dependents may operate in the state if, on or before July 1 of each year for which the student health plan will be offered for the upcoming school year, the institution files a report with the director under penalty of perjury certifying that all of the following are true:

(1) The student health plan satisfies all applicable minimum essential coverage standards under federal law. law and the federal Centers for Medicare and Medicaid Services within the United States Department of Health and Human Services has issued a minimum essential coverage certification pursuant to Section 156.604 of Title 45 of the Code of Federal Regulations or otherwise acknowledges that the student health plan satisfies all applicable minimum essential coverage standards.

(2) The institution pledges assets sufficient to support the liabilities of the student health plan.

(3) The institution has received a report prepared by an actuary that includes both of the following:

(A) Support for the proposed premiums for the plan.

(B) The assets pledged by the institution to support the liabilities of the student health plan are sufficient for the institution to operate the student health plan.

(3)

(4) The institution operated an employer-sponsored plan in the prior calendar year with at least 10,000 enrollees, including employees and their dependents.

(4)

(5) The institution maintains at least an AA bond rating by one of the major credit rating agencies.

(5)

(6) The institution will operate the student health plan in compliance with the independent medical review system established pursuant to Article 5.55 (commencing with Section 1374.30).

(7) The institution will operate the student health plan in compliance with the grievance system established pursuant to Section 1368.

(b) A plan that has complied with subdivision (a) is exempt from this chapter, except for Section 1367.33 Sections 1367.33, 1368, and 1379 and Article 5.55 (commencing with Section 1374.30 of the Health and Safety Code).

(c) This section does not apply to a plan operated by the University of California system.

(d) As used in this section, the term “institution of higher learning” means an institution of higher education as defined in the federal Higher Education Act of 1965 (20 U.S.C Sec. 1001).

SEC. 3.SEC. 4.

 Section 740 of the Insurance Code is amended to read:

740.

 (a) Notwithstanding any other law, and except as provided in this section, a person or other entity that provides coverage in this state for medical, surgical, chiropractic, physical therapy, speech pathology, audiology, professional mental health, dental, hospital, or optometric expenses, whether the coverage is by direct payment, reimbursement, or otherwise, shall be presumed to be subject to the jurisdiction of the department unless the person or other entity shows that while providing the services it is subject to the jurisdiction of another agency of this or another state or the federal government.

(b) A person or entity may show that it is subject to the jurisdiction of another agency of this or another state or the federal government by providing to the commissioner the appropriate certificate or license issued by the other governmental agency that permits or qualifies it to provide those services for which it is licensed or certificated.

(c) A person or entity that is unable to show that it is subject to the jurisdiction of another agency of this or another state or the federal government, shall submit to an examination by the commissioner to determine the organization and solvency of the person or the entity, and to determine whether the person or entity is in compliance with the applicable provisions of this code, and shall be required to obtain a certificate of authority to do business in California and be required to meet all appropriate reserve, surplus, capital, and other necessary requirements imposed by this code for all insurers.

(d) A person or entity unable to show that it is subject to the jurisdiction of another agency of this or another state or the federal government shall be subject to all appropriate provisions of this code regarding the conduct of its business.

(e) The department shall prepare and maintain for public inspection a list of those persons or entities described in subdivision (a) that are not subject to the jurisdiction of another agency of this or another state or the federal government and that the department knows to be operating in this state. There shall be no liability of any kind on the part of the state, the department, and its employees for the accuracy of the list or for any comments made with respect to it.

(f) (1) An administrator licensed by the department who advertises or administers coverage in this state described in subdivision (a), that is provided by any person or entity described in subdivision (c), and where the coverage does not meet all pertinent requirements specified in this code and that is not provided or completely underwritten, insured or otherwise fully covered by an admitted life or disability insurer, hospital service plan or health care service plan, shall advise and disclose to any purchaser, prospective purchaser, covered person or entity, and any production agency licensed by the department involved in the transaction, all financial and operational information relative to the content and scope of the plan and, specifically, as to the lack of insurance or other coverage.

(2) A production agency obtaining knowledge of any coverage relative to the content and scope of a hospital service plan or health care service plan, as required under this subdivision, shall advise and disclose to any purchaser, prospective purchaser, covered person or entity, the knowledge regarding the content and scope of the plan and, specifically, as to the lack of insurance by an admitted carrier or other qualified plan.

(g) A health care service plan, as defined in Chapter 2.2 (commencing with Section 1340) of Division 2 of the Health and Safety Code, shall not be subject to this section.

(h) The department shall notify, in writing, the Director of the Department of Managed Health Care whenever it determines that a multiple employer trust qualifies as a health care service plan subject to Chapter 2.2 (commencing with Section 1340) of Division 2 of the Health and Safety Code.

(i) A health care service plan, including a self-insured reimbursement plan that pays for or reimburses any part of the cost of health care services, operated by any city, county, city and county, public entity, or political subdivision, or a public joint labor management trust as described in subdivision (c) of Section 1349.2 of the Health and Safety Code, that is exempt pursuant to Section 1349.2 of the Health and Safety Code from 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), is also exempt from this code.

(j) A self-funded student health plan operated by a bona fide, private, nonprofit institution of higher learning that directly provides health care services to its students and their respective dependents and that timely files the report required by Section 1343.2 of the Health and Safety Code is exempt from this code.

SEC. 4.SEC. 5.

 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.

SEC. 5.SEC. 6.

 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 California Constitution and shall go into immediate effect. The facts constituting the necessity are:

To authorize universities to implement self-funded student health plans commencing with the fall 2023 academic semester and thereby end hardship to enrollees of existing student health plans underwritten by commercial plans and insurers in the form of higher rates and limited benefits, it is necessary that this bill take effect immediately.