Bill Text: CA SB690 | 2011-2012 | Regular Session | Amended

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Bill Title: Health care coverage: discrimination.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Engrossed - Dead) 2012-08-16 - Set, second hearing. Held in committee and under submission. [SB690 Detail]

Download: California-2011-SB690-Amended.html

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BILL NUMBER: SB 690	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  JUNE 18, 2012
	AMENDED IN SENATE  JANUARY 10, 2012
	AMENDED IN SENATE  MAY 10, 2011

INTRODUCED BY   Senator Hernandez

                        FEBRUARY 18, 2011

   An act to add Section 1373.15 to the Health and Safety Code, and
to add Section 10177.15 to the Insurance Code, relating to health
care coverage.



	LEGISLATIVE COUNSEL'S DIGEST


   SB 690, as amended, Hernandez. Health care coverage:
discrimination.
   Existing law, the Knox-Keene Health Care Service Plan Act of 1975,
provides for the 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 prohibits
certain discriminatory acts by health care service plans and health
insurers. Existing federal law, beginning January 1, 2014, prohibits
a group health plan and a health insurance issuer offering group or
individual health insurance coverage from discriminating with respect
to participation under the plan or coverage against any health care
provider who is acting within the scope of that provider's license or
certification under applicable state law.
   Beginning January 1, 2014, this bill would prohibit a health care
service plan or health insurer from discriminating against any health
care provider who is acting within the scope of that provider's
license, as specified.
   Because a willful violation of the bill's provisions 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.
State-mandated local program: yes.


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

  SECTION 1.  Section 1373.15 is added to the Health and Safety Code,
to read:
   1373.15.  (a) Beginning January 1, 2014, no health care service
plan shall discriminate with respect to provider participation or
coverage under the plan against any health care provider who is
acting within the scope of that provider's license or certification
 under applicable state law including initiative act  .
   (b) Notwithstanding subdivision (a), this section shall not be
construed to require that a health care service plan contract with
any health care provider willing to abide by the terms and conditions
for participation established by the plan or issuer.
   (c) Nothing in this section shall be construed as preventing a
health care service plan from establishing varying reimbursement
rates based on quality or performance measures.
   (d) This section shall be implemented only to the extent required
by the provider nondiscrimination provisions established in Section
2706 of the federal Public Health Service Act (42 U.S.C. Sec.
300gg-5), and any federal rules or regulations issued under that
section.
  SEC. 2.  Section 10177.15 is added to the Insurance Code, to read:
   10177.15.  (a) Beginning January 1, 2014, no health insurer shall
discriminate with respect to provider participation or coverage under
the policy against any health care provider who is acting within the
scope of that provider's license or certification  under
applicable state law including initiative act  .
   (b) Notwithstanding subdivision (a), this section shall not be
construed to require that a health insurer contract with any health
care provider willing to abide by the terms and conditions for
participation established by the insurer or issuer.
   (c) Nothing in this section shall be construed as preventing a
health insurer from establishing varying reimbursement rates based on
quality or performance measures.
   (d) This section shall be implemented only to the extent required
by the provider nondiscrimination provisions established in Section
2706 of the federal Public Health Service Act (42 U.S.C. Sec.
300gg-5), and any federal rules or regulations issued under that
section.
  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.