BILL NUMBER: SB 750 CHAPTERED
BILL TEXT
CHAPTER 835
FILED WITH SECRETARY OF STATE SEPTEMBER 25, 1998
APPROVED BY GOVERNOR SEPTEMBER 24, 1998
PASSED THE SENATE AUGUST 27, 1998
PASSED THE ASSEMBLY AUGUST 24, 1998
AMENDED IN ASSEMBLY AUGUST 20, 1998
AMENDED IN ASSEMBLY SEPTEMBER 5, 1997
AMENDED IN ASSEMBLY AUGUST 25, 1997
INTRODUCED BY Senator Rosenthal
FEBRUARY 26, 1997
An act to amend Section 1367.10 of the Health and Safety Code,
relating to health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
SB 750, Rosenthal. Health care coverage.
Existing law provides for the licensure and regulation of health
care service plans by the Department of Corporations, and provides
that a willful violation of these provisions is subject to criminal
sanction. Existing law requires every health care service plan that
will affect the choice of physician, hospital, or other health care
providers to clearly inform prospective enrollees of this restriction
of choice, as prescribed.
This bill would require every health care service plan, medical
group, independent practice association, or participating health care
provider that uses or receives financial bonuses or any other
incentives to provide a written summary to any person who requests it
that includes a general description of the bonus or incentive
arrangements used in its compensation agreements and how bonus or
incentive arrangements may relate to a provider's use of referral
services.
By imposing this requirement on health care service plans, this
bill would change the definition of a crime, thereby imposing 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.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 1367.10 of the Health and Safety Code is
amended to read:
1367.10. (a) Every health care service plan shall include within
its disclosure form and within its evidence of coverage a statement
clearly describing how participation in the plan may affect the
choice of physician, hospital, or other health care providers, the
basic method of reimbursement, including the scope and general
methods of payment made to its contracting providers of health care
services, and whether financial bonuses or any other incentives are
used. The disclosure form and evidence of coverage shall indicate
that if an enrollee wishes to know more about these issues, the
enrollee may request additional information from the health care
service plan, the enrollee's provider, or the provider's medical
group or independent practice association regarding the information
required pursuant to subdivision (b).
(b) If a plan, medical group, independent practice association, or
participating health care provider uses or receives financial
bonuses or any other incentives, the plan, medical group, independent
practice association, or health care provider shall provide a
written summary to any person who requests it that includes all of
the following:
(1) A general description of the bonus and any other incentive
arrangements used in its compensation agreements. Nothing in this
section shall be construed to require disclosure of trade secrets or
commercial or financial information that is privileged or
confidential, such as payment rates, as determined by the
commissioner, pursuant to state law.
(2) A description regarding whether, and in what manner, the
bonuses and any other incentives are related to a provider's use of
referral services.
(c) The statements and written information provided pursuant to
subdivisions (a) and (b) shall be communicated in clear and simple
language that enables consumers to evaluate and compare health care
service plans.
(d) The plan shall clearly inform prospective enrollees that
participation in that plan will affect the person's choice of
provider by placing the following statement in a conspicuous place on
all material required to be given to prospective enrollees including
promotional and descriptive material, disclosure forms, and
certificates and evidences of coverage:
PLEASE READ THE FOLLOWING INFORMATION SO YOU WILL KNOW FROM
WHOM OR WHAT GROUP OF PROVIDERS HEALTH CARE MAY BE OBTAINED
It is not the intent of this section to require that the names of
individual health care providers be enumerated to prospective
enrollees.
If the health care service plan provides a list of providers to
patients or contracting providers, the plan shall include within the
provider listing a notification that enrollees may contact the plan
in order to obtain a list of the facilities with which the health
care service plan is contracting for subacute care and/or
transitional inpatient care.
SEC. 2. No reimbursement is required by this act pursuant to
Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
Notwithstanding Section 17580 of the Government Code, unless
otherwise specified, the provisions of this act shall become
operative on the same date that the act takes effect pursuant to the
California Constitution.