Bill Text: CA SB977 | 2019-2020 | Regular Session | Amended
Bill Title: Health care system consolidation: Attorney General approval and enforcement.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Engrossed - Dead) 2020-08-24 - Ordered to third reading. [SB977 Detail]
Download: California-2019-SB977-Amended.html
Amended
IN
Senate
March 16, 2020 |
Introduced by Senator Monning |
February 11, 2020 |
LEGISLATIVE COUNSEL'S DIGEST
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 requires a health care service plan to meet specified requirements, and requires a health care service plan contract to provide to subscribers and enrollees certain basic health care services, as specified.
This bill would make technical, nonsubstantive changes to those provisions.
Digest Key
Vote: MAJORITY Appropriation: NO Fiscal Committee:Bill Text
The people of the State of California do enact as follows:
SECTION 1.
Division 1.7 (commencing with Section 1190) is added to the Health and Safety Code, to read:DIVISION 1.7. HEALTH CARE SYSTEM CONSOLIDATION
1190.
For purposes of this division, the following definitions shall apply:1190.5.
(a) Beginning July 1, 2021, the Attorney General shall establish the Health Policy Advisory Board for the purpose of evaluating and analyzing health care markets in California and providing recommendations to the Attorney General’s office, for purposes of this division.1190.10.
(a) A health care system shall provide written notice to, and obtain the written consent of, the Attorney General prior to an affiliation or acquisition between the health care system and a health care facility or provider. The notice shall contain information sufficient to evaluate the nature of the acquisition or affiliation and information sufficient for the Attorney General to determine that the criteria set forth in paragraph (1) of subdivision (b) of Section 1190.25 have been met or that a waiver may be granted pursuant to paragraph (2) of subdivision (d) of Section 1190.25.1190.15.
The Health Advisory Policy Board, upon request by the Attorney General or otherwise in its discretion, may review a written notification submitted by a health care system pursuant to Section 1190.10 and provide the Attorney General with written information with regard to whether to grant or deny consent to the affiliation or acquisition. The Attorney General may consider the recommendation of the board.1190.20.
The Attorney General may adopt regulations to implement this division, including, but not limited to, regulations that extend the time periods in Section 1190.10, or regulations to provide a process for requesting a waiver pursuant to Section 1190.25.1190.25.
(a) Except as provided in subdivision (b), the Attorney General shall deny consent to an affiliation or acquisition between a health care system and a nonhospital health care facility, provider, or both, unless the health care system demonstrates that the affiliation or acquisition will result in a substantial likelihood of clinical integration, a substantial likelihood of increasing the availability and access of services to an underserved population, or both.1190.30.
(a) The Attorney General shall make the determination required by Section 1190.25 in writing that provides the basis for the determination.1190.35.
This division does not operate to alter, amend, modify, invalidate, impair, or supersede any other law.1190.40.
If a health facility is subject to Section 5914 or 5920 of the Corporations Code, the review under those sections shall be concurrent with the review under this division, to the extent practicable.1191.
(a) It is unlawful for one or more health care systems, either independently or dependently, to use their market power as set forth in this section.A health care service plan and, if applicable, a specialized health care service plan shall meet the following requirements:
(a)Facilities located in this state, including, but not limited to, clinics, hospitals, and skilled nursing facilities to be utilized by the plan shall be licensed by the State Department of Public Health, where licensure is required by law. Facilities not located in this state shall conform to all licensing and other requirements of the jurisdiction in which they are located.
(b)Personnel employed by or under contract to the plan shall be licensed or certified by their respective board or agency, where licensure
or certification is required by law.
(c)Equipment required to be licensed or registered by law shall be so licensed or registered, and the operating personnel for that equipment shall be licensed or certified as required by law.
(d)The plan shall furnish services in a manner providing continuity of care and ready referral of patients to other providers at times as may be appropriate consistent with good professional practice.
(e)(1)All services shall be readily available at reasonable times to each enrollee consistent with good professional practice. To the extent feasible, the plan shall make all services readily accessible to all enrollees consistent with Section 1367.03.
(2)To the extent that telehealth services are appropriately provided through telehealth, as defined in subdivision (a) of Section 2290.5 of the Business and Professions Code, these services shall be
considered in determining compliance with Section 1300.67.2 of Title 28 of the California Code of Regulations.
(3)The plan shall make all services accessible and appropriate consistent with Section 1367.04.
(f)The plan shall employ and utilize allied health manpower for the furnishing of services to the extent permitted by law and consistent with good medical practice.
(g)The plan shall have the organizational and administrative capacity to provide services to subscribers and enrollees. The plan shall be able to demonstrate to the department that medical decisions are rendered by qualified medical providers, unhindered by fiscal and administrative management.
(h)(1)Contracts with subscribers and enrollees, including group contracts, and contracts with providers, and other persons furnishing services, equipment, or facilities to or in connection with the plan, shall be
fair, reasonable, and consistent with the objectives of this chapter. All contracts with providers shall contain provisions requiring a fast, fair, and cost-effective dispute resolution mechanism under which providers may submit disputes to the plan, and requiring the plan to inform its providers upon contracting with the plan, or upon change to these provisions, of the procedures for processing and resolving disputes, including the location and telephone number where information regarding disputes may be submitted.
(2)A health care service plan shall ensure that a dispute resolution mechanism is accessible to noncontracting providers for the purpose of resolving billing and claims disputes.
(3)On and after January 1, 2002, a health care service plan shall annually submit a report to the department regarding its dispute resolution mechanism. The report shall include information on the number of providers who utilized the dispute resolution mechanism
and a summary of the disposition of those disputes.
(i)A health care service plan contract shall provide to subscribers and enrollees all of the basic health care services included in subdivision (b) of Section 1345, except that the director may, for good cause, by rule or order exempt a plan contract or a class of plan contracts from that requirement. The director shall by rule define the scope of each basic health care service that health care service plans are required to provide as a minimum for licensure under this chapter. This chapter does not prohibit a health
care service plan from charging subscribers or enrollees a copayment or a deductible for a basic health care service consistent with Section 1367.006 or 1367.007, provided that the copayments, deductibles, or other cost sharing are reported to the director and set forth to the subscriber or enrollee pursuant to the disclosure provisions of Section 1363. This chapter does not prohibit a health care service plan from setting forth, by contract, limitations on maximum coverage of basic health care services, provided that the limitations are reported to, and held unobjectionable by, the director and set forth to the subscriber or enrollee pursuant to the disclosure provisions of Section 1363.
(j)A health care service plan shall not require registration under the
federal Controlled Substances Act (21 U.S.C. Sec. 801 et seq.) as a condition for participation by an optometrist certified to use therapeutic pharmaceutical agents pursuant to Section 3041.3 of the Business and Professions Code.
(k)(1)This section shall not be construed to permit the director to establish the rates charged subscribers and enrollees for contractual health care services.
(2)The director’s enforcement of Article 3.1 (commencing with Section 1357) shall not be deemed to establish the rates charged subscribers and enrollees for contractual health care services.
(3)The obligation of the plan to comply with this chapter shall not be waived when the plan
delegates any services that it is required to perform to its medical groups, independent practice associations, or other contracting entities.