BILL NUMBER: AB 8 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY MAY 17, 2007
AMENDED IN ASSEMBLY MAY 1, 2007
AMENDED IN ASSEMBLY APRIL 18, 2007
AMENDED IN ASSEMBLY MARCH 29, 2007
INTRODUCED BY Assembly Member Nunez
(Coauthors: Assembly Members Bass, Berg, De Leon, DeSaulnier,
Dymally, Hayashi, Hernandez, and Jones)
DECEMBER 4, 2006
An act to amend Section 6254 of, and to add Section 12803.2 to,
the Government Code, to amend Sections 1363 and 1378 of, and to add
Article 3.11 (commencing with Section 1357.20) to Chapter 2.2 of
Division 2 of, the Health and Safety Code, to amend Sections 10607,
12693.43, 12693.70, 12693.73, and 12693.755 of, to add Sections
10293.5 , 12693.55, and 12711.1 to, to add Chapter
8.1 (commencing with Section 10760) to Part 2 of Division 2 of, and
to add Part 6.45 (commencing with Section 12699.201) to Division 2
of, the Insurance Code, to add Part 8.8 (commencing with Section
2200) to Division 2 of the Labor Code, to add Chapter 11 (commencing
with Section 19900) to Part 10.2 of Division 2 of the Revenue and
Taxation Code, to amend Section 131 of, and to add Section 976.7 to,
the Unemployment Insurance Code, and to amend Sections 14005.23,
14005.30, and 14008.85 of, to add Sections 14005.33 ,
14005.34, and 14124.915 and 14005.34 to, and to
add Article 7 (commencing with Section 14199.10) to Chapter 7 of Part
3 of Division 9 of, the Welfare and Institutions Code, relating to
health care coverage, and making an appropriation therefor.
LEGISLATIVE COUNSEL'S DIGEST
AB 8, as amended, Nunez. Health care coverage: employers and
employees.
(1) Existing law creates the California Health and Human Services
Agency.
This bill would require the agency to encourage fitness, wellness,
and health promotion programs and to evaluate and monitor the state'
s progress on increasing the coverage of uninsured persons. The bill
would also require the agency, in consultation with the Board of
Administration of the Public Employees' Retirement System and health
provider groups, to develop health care provider performance
measurement benchmarks, as specified.
(2) Existing law does not provide a system of health care coverage
for all California residents. Existing law does not require
employers to provide health care coverage for employees and
dependents, other than coverage provided as part of the workers'
compensation system for work-related employee injuries, and does not
require individuals to maintain health care coverage. Existing law
provides for the creation of various programs to provide health care
coverage to persons who have limited incomes and meet various
eligibility requirements. These programs include the Healthy Families
Program, administered by the Managed Risk Medical Insurance Board,
and the Medi-Cal program, administered by the State Department of
Health Care Services. Existing law provides for the regulation of
health care service plans by the Department of Managed Health Care
and health insurers by the Department of Insurance.
This bill would, as of January 1, 2009, create the California
Cooperative Health Insurance Purchasing Program (Cal-CHIPP), which
would function as a purchasing pool for health care coverage by
employers and be administered by the Managed Risk Medical Insurance
Board. The bill would generally require employers to make health care
expenditures, as specified, in an amount that is equivalent ,
at a minimum, to an unspecified percentage
7.5% of the employer's total social security
wages for either full-time or part-time employees, or both, or,
alternatively, to elect to pay an employer fee of that
equivalent minimum amount for the applicable
group of employees, who would be required to enroll in Cal-CHIPP,
subject to certain exceptions. The bill would require employers to
set up a pretax Section 125 account under federal law for each
employee to pay health insurance premiums. Revenues from the employer
fees would be collected by the Employment Development Department for
deposit in the California Health Trust Fund created by the bill, and
moneys in the fund would be continuously appropriated to the board
for the purposes of the bill. The bill would require the board to
offer Cal-CHIPP enrollees a choice of various health plans. The bill
would exempt certain writings of the board from disclosure under the
Public Records Act.
The bill, subject to future appropriation of funds, would expand
the number of children eligible for coverage under the Healthy
Families Program. The bill would also expand the number of persons
eligible for the Medi-Cal Program program
. The bill would delete as an eligibility requirement for a
child under the Healthy Families Program and the Medi-Cal program
that the child must meet citizen and immigration status requirements
applicable to the program under federal law, thereby creating a
state-only element of the programs. The bill would require the State
Department of Health Care Services to seek any necessary federal
approval to enable the state to receive federal Medicaid funds for
specified persons who could otherwise be made eligible for Medi-Cal
benefits, with the state share of funds to be provided from the
California Health Trust Fund. The bill would require the
Healthy Families Program and the Medi-Cal program, as of July 1,
2008, and subject to available funding, to offer a premium assistance
benefit and a wraparound benefit to certain persons who are eligible
for either of the programs and who are offered employer-provided
health coverage. The bill would enact other related
provisions. Because each county is required to determine eligibility
for the Medi-Cal program, expansion of program eligibility would
impose a state-mandated local program.
(3) The bill would enact various health insurance market reforms,
to be operative July 1, 2008, including requirements for limited
guaranteed issue, simplified benefit designs, modified small employer
coverage, modified disclosures, and other related changes. The
bill would require health care service plans and health insurers
offering group plans to offer a benchmark plan or policy at a rate
negotiated with and approved by the Managed Risk Medical Insurance
Board that is available to group members and dependents eligible for
coverage through the Medi-Cal or Healthy Families
Programs, or to otherwise arrange for coverage through Cal-CHIPP.
The bill would require the Director of the Department of
Managed Health Care and the Insurance Commissioner to adopt
regulations by July 1, 2008, to require at least 85% of full-service
health care service plan dues, fees, and other periodic payments and
health insurance premiums to be spent on health care services and not
on administrative costs. Because a willful violation of the bill's
requirements relative to health care service plans would be a crime,
the bill would impose a state-mandated local program. The bill would
also state the intent of the Legislature that all health care service
plans and health insurers and providers shall adopt standard
electric electronic medical records by
January 1, 2012.
(4) 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 with regard to certain mandates no
reimbursement is required by this act for a specified reason.
With regard to any other mandates, this bill would provide that,
if the Commission on State Mandates determines that the bill contains
costs so mandated by the state, reimbursement for those costs shall
be made pursuant to the statutory provisions noted above.
Vote: majority. Appropriation: yes. Fiscal committee: yes.
State-mandated local program: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. It is the intent of the Legislature to accomplish the
goal of universal health care coverage for all California residents
within five years. To accomplish this goal, the Legislature proposes
to take all of the following steps:
(a) Ensure that Californians have access to affordable,
comprehensive health care coverage, including all California children
regardless of immigration status, with subsidies for Californians
with low incomes.
(b) Leverage available federal funds to the greatest extent
possible through existing federal programs such as Medicaid and the
State Children's Health Insurance Program in support of health care
coverage for low-income and disabled populations.
(c) Maintain and strengthen the health insurance system and
improve availability and affordability of private health care
coverage for all purchasers through (1) insurance market reforms; (2)
enhanced access to effective primary and preventive services,
including management of chronic illnesses; (3) promotion of
cost-effective health technologies, and (4) implementation of
meaningful, systemwide cost containment strategies.
(d) Engage in early and systematic evaluation at each step of the
implementation process to identify the impacts on state costs, the
costs of coverage, employment and insurance markets, health delivery
systems, quality of care, and overall progress in moving toward
universal coverage.
SEC. 2. Section 6254 of the Government Code is amended to read:
6254. Except as provided in Sections 6254.7 and 6254.13, nothing
in this chapter shall be construed to require disclosure of records
that are any of the following:
(a) Preliminary drafts, notes, or interagency or intra-agency
memoranda that are not retained by the public agency in the ordinary
course of business, if the public interest in withholding those
records clearly outweighs the public interest in disclosure.
(b) Records pertaining to pending litigation to which the public
agency is a party, or to claims made pursuant to Division 3.6
(commencing with Section 810), until the pending litigation or claim
has been finally adjudicated or otherwise settled.
(c) Personnel, medical, or similar files, the disclosure of which
would constitute an unwarranted invasion of personal privacy.
(d) Contained in or related to any of the following:
(1) Applications filed with any state agency responsible for the
regulation or supervision of the issuance of securities or of
financial institutions, including, but not limited to, banks, savings
and loan associations, industrial loan companies, credit unions, and
insurance companies.
(2) Examination, operating, or condition reports prepared by, on
behalf of, or for the use of, any state agency referred to in
paragraph (1).
(3) Preliminary drafts, notes, or interagency or intra-agency
communications prepared by, on behalf of, or for the use of, any
state agency referred to in paragraph (1).
(4) Information received in confidence by any state agency
referred to in paragraph (1).
(e) Geological and geophysical data, plant production data, and
similar information relating to utility systems development, or
market or crop reports, that are obtained in confidence from any
person.
(f) Records of complaints to, or investigations conducted by, or
records of intelligence information or security procedures of, the
office of the Attorney General and the Department of Justice, and any
state or local police agency, or any investigatory or security files
compiled by any other state or local police agency, or any
investigatory or security files compiled by any other state or local
agency for correctional, law enforcement, or licensing purposes.
However, state and local law enforcement agencies shall disclose the
names and addresses of persons involved in, or witnesses other than
confidential informants to, the incident, the description of any
property involved, the date, time, and location of the incident, all
diagrams, statements of the parties involved in the incident, the
statements of all witnesses, other than confidential informants, to
the victims of an incident, or an authorized representative thereof,
an insurance carrier against which a claim has been or might be made,
and any person suffering bodily injury or property damage or loss,
as the result of the incident caused by arson, burglary, fire,
explosion, larceny, robbery, carjacking, vandalism, vehicle theft, or
a crime as defined by subdivision (b) of Section 13951, unless the
disclosure would endanger the safety of a witness or other person
involved in the investigation, or unless disclosure would endanger
the successful completion of the investigation or a related
investigation. However, nothing in this division shall require the
disclosure of that portion of those investigative files that reflects
the analysis or conclusions of the investigating officer.
Customer lists provided to a state or local police agency by an
alarm or security company at the request of the agency shall be
construed to be records subject to this subdivision.
Notwithstanding any other provision of this subdivision, state and
local law enforcement agencies shall make public the following
information, except to the extent that disclosure of a particular
item of information would endanger the safety of a person involved in
an investigation or would endanger the successful completion of the
investigation or a related investigation:
(1) The full name and occupation of every individual arrested by
the agency, the individual's physical description including date of
birth, color of eyes and hair, sex, height and weight, the time and
date of arrest, the time and date of booking, the location of the
arrest, the factual circumstances surrounding the arrest, the amount
of bail set, the time and manner of release or the location where the
individual is currently being held, and all charges the individual
is being held upon, including any outstanding warrants from other
jurisdictions and parole or probation holds.
(2) Subject to the restrictions imposed by Section 841.5 of the
Penal Code, the time, substance, and location of all complaints or
requests for assistance received by the agency and the time and
nature of the response thereto, including, to the extent the
information regarding crimes alleged or committed or any other
incident investigated is recorded, the time, date, and location of
occurrence, the time and date of the report, the name and age of the
victim, the factual circumstances surrounding the crime or incident,
and a general description of any injuries, property, or weapons
involved. The name of a victim of any crime defined by Section 220,
261, 261.5, 262, 264, 264.1, 273a, 273d, 273.5, 286, 288, 288a, 289,
422.6, 422.7, 422.75, or 646.9 of the Penal Code may be withheld at
the victim's request, or at the request of the victim's parent or
guardian if the victim is a minor. When a person is the victim of
more than one crime, information disclosing that the person is a
victim of a crime defined by Section 220, 261, 261.5, 262, 264,
264.1, 273a, 273d, 286, 288, 288a, 289, 422.6, 422.7, 422.75, or
646.9 of the Penal Code may be deleted at the request of the victim,
or the victim's parent or guardian if the victim is a minor, in
making the report of the crime, or of any crime or incident
accompanying the crime, available to the public in compliance with
the requirements of this paragraph.
(3) Subject to the restrictions of Section 841.5 of the Penal Code
and this subdivision, the current address of every individual
arrested by the agency and the current address of the victim of a
crime, where the requester declares under penalty of perjury that the
request is made for a scholarly, journalistic, political, or
governmental purpose, or that the request is made for investigation
purposes by a licensed private investigator as described in Chapter
11.3 (commencing with Section 7512) of Division 3 of the Business and
Professions Code. However, the address of the victim of any crime
defined by Section 220, 261, 261.5, 262, 264, 264.1, 273a, 273d,
273.5, 286, 288, 288a, 289, 422.6, 422.7, 422.75, or 646.9 of the
Penal Code shall remain confidential. Address information obtained
pursuant to this paragraph may not be used directly or indirectly, or
furnished to another, to sell a product or service to any individual
or group of individuals, and the requester shall execute a
declaration to that effect under penalty of perjury. Nothing in this
paragraph shall be construed to prohibit or limit a scholarly,
journalistic, political, or government use of address information
obtained pursuant to this paragraph.
(g) Test questions, scoring keys, and other examination data used
to administer a licensing examination, examination for employment, or
academic examination, except as provided for in Chapter 3
(commencing with Section 99150) of Part 65 of the Education Code.
(h) The contents of real estate appraisals or engineering or
feasibility estimates and evaluations made for or by the state or
local agency relative to the acquisition of property, or to
prospective public supply and construction contracts, until all of
the property has been acquired or all of the contract agreement
obtained. However, the law of eminent domain shall not be affected by
this provision.
(i) Information required from any taxpayer in connection with the
collection of local taxes that is received in confidence and the
disclosure of the information to other persons would result in unfair
competitive disadvantage to the person supplying the information.
(j) Library circulation records kept for the purpose of
identifying the borrower of items available in libraries, and library
and museum materials made or acquired and presented solely for
reference or exhibition purposes. The exemption in this subdivision
shall not apply to records of fines imposed on the borrowers.
(k) Records, the disclosure of which is exempted or prohibited
pursuant to federal or state law, including, but not limited to,
provisions of the Evidence Code relating to privilege.
(l) Correspondence of and to the Governor or employees of the
Governor's office or in the custody of or maintained by the Governor'
s Legal Affairs Secretary. However, public records shall not be
transferred to the custody of the Governor's Legal Affairs Secretary
to evade the disclosure provisions of this chapter.
(m) In the custody of or maintained by the Legislative Counsel,
except those records in the public database maintained by the
Legislative Counsel that are described in Section 10248.
(n) Statements of personal worth or personal financial data
required by a licensing agency and filed by an applicant with the
licensing agency to establish his or her personal qualification for
the license, certificate, or permit applied for.
(o) Financial data contained in applications for financing under
Division 27 (commencing with Section 44500) of the Health and Safety
Code, where an authorized officer of the California Pollution Control
Financing Authority determines that disclosure of the financial data
would be competitively injurious to the applicant and the data is
required in order to obtain guarantees from the United States Small
Business Administration. The California Pollution Control Financing
Authority shall adopt rules for review of individual requests for
confidentiality under this section and for making available to the
public those portions of an application that are subject to
disclosure under this chapter.
(p) Records of state agencies related to activities governed by
Chapter 10.3 (commencing with Section 3512), Chapter 10.5 (commencing
with Section 3525), and Chapter 12 (commencing with Section 3560) of
Division 4 of Title 1, that reveal a state agency's deliberative
processes, impressions, evaluations, opinions, recommendations,
meeting minutes, research, work products, theories, or strategy, or
that provide instruction, advice, or training to employees who do not
have full collective bargaining and representation rights under
these chapters. Nothing in this subdivision shall be construed to
limit the disclosure duties of a state agency with respect to any
other records relating to the activities governed by the employee
relations acts referred to in this subdivision.
(q) Records of state agencies related to activities governed by
Article 2.6 (commencing with Section 14081), Article 2.8 (commencing
with Section 14087.5), and Article 2.91 (commencing with Section
14089) of Chapter 7 of Part 3 of Division 9 of the Welfare and
Institutions Code, that reveal the special negotiator's deliberative
processes, discussions, communications, or any other portion of the
negotiations with providers of health care services, impressions,
opinions, recommendations, meeting minutes, research, work product,
theories, or strategy, or that provide instruction, advice, or
training to employees.
Except for the portion of a contract containing the rates of
payment, contracts for inpatient services entered into pursuant to
these articles, on or after April 1, 1984, shall be open to
inspection one year after they are fully executed. If a contract for
inpatient services that is entered into prior to April 1, 1984, is
amended on or after April 1, 1984, the amendment, except for any
portion containing the rates of payment, shall be open to inspection
one year after it is fully executed. If the California Medical
Assistance Commission enters into contracts with health care
providers for other than inpatient hospital services, those contracts
shall be open to inspection one year after they are fully executed.
Three years after a contract or amendment is open to inspection
under this subdivision, the portion of the contract or amendment
containing the rates of payment shall be open to inspection.
Notwithstanding any other provision of law, the entire contract or
amendment shall be open to inspection by the Joint Legislative Audit
Committee and the Legislative Analyst's Office. The committee and
that office shall maintain the confidentiality of the contracts and
amendments until the time a contract or amendment is fully open to
inspection by the public.
(r) Records of Native American graves, cemeteries, and sacred
places and records of Native American places, features, and objects
described in Sections 5097.9 and 5097.993 of the Public Resources
Code maintained by, or in the possession of, the Native American
Heritage Commission, another state agency, or a local agency.
(s) A final accreditation report of the Joint Commission on
Accreditation of Hospitals that has been transmitted to the State
Department of Public Health pursuant to subdivision (b) of Section
1282 of the Health and Safety Code.
(t) Records of a local hospital district, formed pursuant to
Division 23 (commencing with Section 32000) of the Health and Safety
Code, or the records of a municipal hospital, formed pursuant to
Article 7 (commencing with Section 37600) or Article 8 (commencing
with Section 37650) of Chapter 5 of Division 3 of Title 4 of this
code, that relate to any contract with an insurer or nonprofit
hospital service plan for inpatient or outpatient services for
alternative rates pursuant to Section 10133 or 11512 of the Insurance
Code. However, the record shall be open to inspection within one
year after the contract is fully executed.
(u) (1) Information contained in applications for licenses to
carry firearms issued pursuant to Section 12050 of the Penal Code by
the sheriff of a county or the chief or other head of a municipal
police department that indicates when or where the applicant is
vulnerable to attack or that concerns the applicant's medical or
psychological history or that of members of his or her family.
(2) The home address and telephone number of peace officers,
judges, court commissioners, and magistrates that are set forth in
applications for licenses to carry firearms issued pursuant to
Section 12050 of the Penal Code by the sheriff of a county or the
chief or other head of a municipal police department.
(3) The home address and telephone number of peace officers,
judges, court commissioners, and magistrates that are set forth in
licenses to carry firearms issued pursuant to Section 12050 of the
Penal Code by the sheriff of a county or the chief or other head of a
municipal police department.
(v) (1) Records of the Major Risk Medical Insurance Program
related to activities governed by Part 6.3 (commencing with Section
12695) and Part 6.5 (commencing with Section 12700) of Division 2 of
the Insurance Code, and that reveal the deliberative processes,
discussions, communications, or any other portion of the negotiations
with health plans, or the impressions, opinions, recommendations,
meeting minutes, research, work product, theories, or strategy of the
board or its staff, or records that provide instructions, advice, or
training to employees.
(2) (A) Except for the portion of a contract that contains the
rates of payment, contracts for health coverage entered into pursuant
to Part 6.3 (commencing with Section 12695) or Part 6.5 (commencing
with Section 12700) of Division 2 of the Insurance Code, on or after
July 1, 1991, shall be open to inspection one year after they have
been fully executed.
(B) If a contract for health coverage that is entered into prior
to July 1, 1991, is amended on or after July 1, 1991, the amendment,
except for any portion containing the rates of payment, shall be open
to inspection one year after the amendment has been fully executed.
(3) Three years after a contract or amendment is open to
inspection pursuant to this subdivision, the portion of the contract
or amendment containing the rates of payment shall be open to
inspection.
(4) Notwithstanding any other provision of law, the entire
contract or amendments to a contract shall be open to inspection by
the Joint Legislative Audit Committee. The committee shall maintain
the confidentiality of the contracts and amendments thereto, until
the contract or amendments to a contract is open to inspection
pursuant to paragraph (3).
(w) (1) Records of the Major Risk Medical Insurance Program
related to activities governed by Chapter 14 (commencing with Section
10700) of Part 2 of Division 2 of the Insurance Code, and that
reveal the deliberative processes, discussions, communications, or
any other portion of the negotiations with health plans, or the
impressions, opinions, recommendations, meeting minutes, research,
work product, theories, or strategy of the board or its staff, or
records that provide instructions, advice, or training to employees.
(2) Except for the portion of a contract that contains the rates
of payment, contracts for health coverage entered into pursuant to
Chapter 14 (commencing with Section 10700) of Part 2 of Division 2 of
the Insurance Code, on or after January 1, 1993, shall be open to
inspection one year after they have been fully executed.
(3) Notwithstanding any other provision of law, the entire
contract or amendments to a contract shall be open to inspection by
the Joint Legislative Audit Committee. The committee shall maintain
the confidentiality of the contracts and amendments thereto, until
the contract or amendments to a contract is open to inspection
pursuant to paragraph (2).
(x) Financial data contained in applications for registration, or
registration renewal, as a service contractor filed with the Director
of Consumer Affairs pursuant to Chapter 20 (commencing with Section
9800) of Division 3 of the Business and Professions Code, for the
purpose of establishing the service contractor's net worth, or
financial data regarding the funded accounts held in escrow for
service contracts held in force in this state by a service
contractor.
(y) (1) Records of the Managed Risk Medical Insurance Board
related to activities governed by Part 6.2 (commencing with Section
12693) or Part 6.4 (commencing with Section 12699.50) of Division 2
of the Insurance Code, and that reveal the deliberative processes,
discussions, communications, or any other portion of the negotiations
with health plans, or the impressions, opinions, recommendations,
meeting minutes, research, work product, theories, or strategy of the
board or its staff, or records that provide instructions, advice, or
training to employees.
(2) (A) Except for the portion of a contract that contains the
rates of payment, contracts entered into pursuant to Part 6.2
(commencing with Section 12693) or Part 6.4 (commencing with Section
12699.50) of Division 2 of the Insurance Code, on or after January 1,
1998, shall be open to inspection one year after they have been
fully executed.
(B) In the event that a contract entered into pursuant to Part 6.2
(commencing with Section 12693) or Part 6.4 (commencing with Section
12699.50) of Division 2 of the Insurance Code is amended, the
amendment shall be open to inspection one year after the amendment
has been fully executed.
(3) Three years after a contract or amendment is open to
inspection pursuant to this subdivision, the portion of the contract
or amendment containing the rates of payment shall be open to
inspection.
(4) Notwithstanding any other provision of law, the entire
contract or amendments to a contract shall be open to inspection by
the Joint Legislative Audit Committee. The committee shall maintain
the confidentiality of the contracts and amendments thereto until the
contract or amendments to a contract are open to inspection pursuant
to paragraph (2) or (3).
(5) The exemption from disclosure provided pursuant to this
subdivision for the contracts, deliberative processes, discussions,
communications, negotiations with health plans, impressions,
opinions, recommendations, meeting minutes, research, work product,
theories, or strategy of the board or its staff shall also apply to
the contracts, deliberative processes, discussions, communications,
negotiations with health plans, impressions, opinions,
recommendations, meeting minutes, research, work product, theories,
or strategy of applicants pursuant to Part 6.4 (commencing with
Section 12699.50) of Division 2 of the Insurance Code.
(z) Records obtained pursuant to paragraph (2) of subdivision (c)
of Section 2891.1 of the Public Utilities Code.
(aa) A document prepared by or for a state or local agency that
assesses its vulnerability to terrorist attack or other criminal acts
intended to disrupt the public agency's operations and that is for
distribution or consideration in a closed session.
(bb) Critical infrastructure information, as defined in Section
131(3) of Title 6 of the United States Code, that is voluntarily
submitted to the California Office of Homeland Security for use by
that office, including the identity of the person who or entity that
voluntarily submitted the information. As used in this subdivision,
"voluntarily submitted" means submitted in the absence of the office
exercising any legal authority to compel access to or submission of
critical infrastructure information. This subdivision shall not
affect the status of information in the possession of any other state
or local governmental agency.
(cc) All information provided to the Secretary of State by a
person for the purpose of registration in the Advance Health Care
Directive Registry, except that those records shall be released at
the request of a health care provider, a public guardian, or the
registrant's legal representative.
(dd) (1) Records of the Managed Risk Medical Insurance Board
relating to activities governed by Part 6.45 (commencing with Section
12699.201) of Division 2 of the Insurance Code, and that reveal the
deliberative processes, discussions, communications, or any other
portion of the negotiations with entities contracting or seeking to
contract with the board, or the impressions, opinions,
recommendations, meeting minutes, research, work product, theories,
or strategy of the board or its staff, or records that provide
instructions, advice, or training to employees.
(2) (A) Except for the portion of a contract that contains the
rates of payment, contracts entered into pursuant to Part 6.45
(commencing with Section 12699.201) of Division 2 of the Insurance
Code on or after January 1, 2008, shall be open to inspection one
year after they have been fully executed.
(B) If a contract entered into pursuant to Part 6.45 (commencing
with Section 12699.201) of Division 2 of the Insurance Code is
amended, the amendment shall be open to inspection one year after the
amendment has been fully executed.
(3) Three years after a contract or amendment is open to
inspection pursuant to this subdivision, the portion of the contract
or amendment containing the rates of payment shall be open to
inspection.
(4) Notwithstanding any other provision of law, the entire
contract or amendments to a contract shall be open to inspection by
the Joint Legislative Audit Committee and the Legislative Analyst's
Office. The committee and the office shall maintain the
confidentiality of the contracts and amendments thereto until the
contract or amendments to a contract are open to inspection pursuant
to paragraph (2) or (3).
Nothing in this section prevents any agency from opening its
records concerning the administration of the agency to public
inspection, unless disclosure is otherwise prohibited by law.
Nothing in this section prevents any health facility from
disclosing to a certified bargaining agent relevant financing
information pursuant to Section 8 of the National Labor Relations Act
(29 U.S.C. Sec. 158).
SEC. 3. Section 12803.2 is added to the Government Code, to read:
12803.2. (a) The California Health and Human Services Agency
shall encourage fitness, wellness, and health promotion programs that
promote safe workplaces, healthy employer practices, and individual
efforts to improve health.
(b) The California Health and Human Services Agency shall
establish an aggressive and timely evaluation and oversight effort to
carefully monitor progress on key benchmarks and indicators relative
to extending health care coverage to uninsured individuals under the
act enacting this section in the 2007-08 Regular Session of the
Legislature. Key indicators shall include, but need not be limited
to, annual assessment of the impacts on coverage, the cost of
coverage, state costs, employment and insurance markets, health care
delivery systems, and quality of care. In 2013, the agency shall
conduct a comprehensive evaluation to determine if the goals are
being met and what adjustments or additional steps are necessary. The
agency shall keep the Legislature informed on a regular basis of its
efforts pursuant to this
subdivision.
(c) The California Health and Human Services Agency, in
consultation with the Board of Administration of the Public Employees'
Retirement System, and after consultation with affected health care
provider groups, shall develop health care provider performance
measurement benchmarks and incorporate these benchmarks into a common
pay for performance model to be offered in every state-administered
health care program, including, but not limited to, the Public
Employees' Medical and Hospital Care Act, Healthy Families, the Major
Risk Medical Insurance Program, Medi-Cal, and Cal-CHIPP. These
benchmarks shall be developed to advance a common statewide framework
for health care quality measurement and reporting, including, but
not limited to, measures that have been approved by the National
Quality Forum (NQF) such as the Health Plan Employer Data and
Information Set (HEDIS) and the Joint Commission on Accreditation of
Health Care Organizations (JCAHO), and that have been adopted by the
Hospitals Quality Alliance and other national and statewide groups
concerned with quality.
SEC. 4. Article 3.11 (commencing with Section 1357.20) is added to
Chapter 2.2 of Division 2 of the Health and Safety Code, to read:
Article 3.11. Insurance Market Reform
1357.20. Effective July 1, 2008, every full-service health care
service plan that offers, markets, and sells health plan contracts to
individuals and conducts medical underwriting to determine whether
to issue coverage to a specific individual shall use a standardized
health questionnaire developed by the Managed Risk Medical Insurance
Board in consultation with the Department of Insurance and the
Department of Managed Health Care. A health care service plan subject
to this section may not exclude a potential enrollee from any
individual coverage on the basis of an actual or expected health
condition, type of illness, treatment, medical condition, or
accident, or for a preexisting condition, except as provided by the
board pursuant to Section 12711.1 of the Insurance Code.
1357.21. (a) Every full-service health care service plan shall
offer, market, and sell all of the uniform benefit plan designs made
available through Cal-CHIPP pursuant to Part 6.45 (commencing with
Section 12699.201) of Division 2 of the Insurance Code to purchasers
in each region and in all individual and group markets where the plan
offers, markets, and sells health care service plan contracts,
consistent with statutory and regulatory rating and underwriting
requirements applicable to the respective individual and group
markets.
(b) This section shall not preclude a plan from offering other
benefit plan designs in addition to those required to be offered
under subdivision (a).
1357.22. It is the intent of the Legislature that all health care
providers shall participate in an Internet-based personal health
record system under which patients have access to their own health
care records. A patient's personal health care record shall only be
accessible to that patient or other individual as authorized by the
patient. It is the intent of the Legislature that all health care
service plans and providers shall adopt standard electronic medical
records by January 1, 2012.
1357.23. Effective January 1, 2008, all requirements in Article
3.1 (commencing with Section 1357) applicable to offering, marketing,
and selling health care service plan contracts to small employers as
defined in that article, including, but not limited to, the
obligation to fairly and affirmatively offer, market, and sell all of
the plan's contracts to all employers, guaranteed renewal of all
health care service plan contracts, use of the risk adjustment
factor, and the restriction of risk categories to age, geographic
region, and family composition as described in that article, shall be
applicable to all health care service plan contracts offered to all
employers with 250 or fewer eligible employees, except as follows:
(a) For small employers with 2 to 50, inclusive, eligible
employees, all requirements in that article shall apply.
(b) For employers with 51 to 250, inclusive, eligible employees,
all requirements in that article shall apply, except that the health
care service plan may develop health care coverage benefit plan
designs to fairly and affirmatively market only to employer groups of
51 to 250, inclusive, eligible employees.
1357.24. (a) Every group health care service plan shall obtain
from each employer or group subscriber contracting with the health
care service plan the premium contribution amounts the group makes
for each enrolled group member and dependent.
(b) (1) Every health care service plan offering group health plan
contracts shall provide as one coverage option of each group contract
a benchmark plan established by the board so that group members and
their dependents with family incomes at or below 300 percent of the
federal poverty level that are determined eligible for coverage
through the Medi-Cal or Healthy Families Programs can enroll in the
benchmark plan. The benchmark plan of a group health care service
plan shall be provided at a rate negotiated with and approved by the
board. The health care service plan shall collect the employer's
applicable dollar premium contribution for employees, and if
applicable, dependents, in the benchmark plan and credit that amount
toward the cost of the benchmark plan.
(2) In lieu of meeting the requirements of paragraph (1), for
employees, and, if applicable, dependents eligible for coverage
through the Medi-Cal or Healthy Families Programs who have elected to
enroll in benchmark coverage, the health care service plan shall
collect the employer's applicable dollar premium contribution and
credit that amount to the board towards the premium cost of a
benchmark plan in Cal-CHIPP.
(c) Every health care service plan shall include in the plan's
evidence of coverage notice of the ability of employees and
dependents with family incomes at or below 300 percent of the federal
poverty level to enroll in Medi-Cal or Healthy Families coverage
through a benchmark plan, with instructions on how to apply for
coverage.
(d) Employees and dependents receiving coverage through the
Medi-Cal or Healthy Families Programs pursuant to this section shall
make any required premium payments for enrollment in those programs
required under the applicable laws governing those programs.
(e) As used in this section, the following terms have the
following meanings:
(1) "Board" means the Managed Risk Medical Insurance Board.
(2) "California Cooperative Health Insurance Purchasing Program"
or "Cal-CHIPP" shall have the same meaning as in subdivision (c) of
Section 12699.201 of the Insurance Code.
(3) "Benchmark plan" shall mean coverage equivalent to coverage
provided through the Healthy Families Program established pursuant to
Part 6.2 (commencing with Section 12693) of Division 2 of the
Insurance Code.
(f) This section shall apply to health care service plan contracts
issued, amended or renewed on or after July 1, 2008.
1357.24. 1357.25. The requirements
of this article shall not apply to a specialized health care service
plan or a Medicare supplement contract.
SEC. 5. Section 1363 of the Health and Safety Code is amended to
read:
1363. (a) The director shall require the use by each plan of
disclosure forms or materials containing information regarding the
benefits, services, and terms of the plan contract as the director
may require, so as to afford the public, subscribers, and enrollees
with a full and fair disclosure of the provisions of the plan in
readily understood language and in a clearly organized manner. The
director may require that the materials be presented in a reasonably
uniform manner so as to facilitate comparisons between plan contracts
of the same or other types of plans. Nothing contained in this
chapter shall preclude the director from permitting the disclosure
form to be included with the evidence of coverage or plan contract.
The disclosure form shall provide for at least the following
information, in concise and specific terms, relative to the plan,
together with additional information as may be required by the
director, in connection with the plan or plan contract:
(1) The principal benefits and coverage of the plan, including
coverage for acute care and subacute care.
(2) The exceptions, reductions, and limitations that apply to the
plan.
(3) The full premium cost of the plan.
(4) Any copayment, coinsurance, or deductible requirements that
may be incurred by the member or the member's family in obtaining
coverage under the plan.
(5) The terms under which the plan may be renewed by the plan
member, including any reservation by the plan of any right to change
premiums.
(6) A statement that the disclosure form is a summary only, and
that the plan contract itself should be consulted to determine
governing contractual provisions. The first page of the disclosure
form shall contain a notice that conforms with all of the following
conditions:
(A) (i) States that the evidence of coverage discloses the terms
and conditions of coverage.
(ii) States, with respect to individual plan contracts, small
group plan contracts, and any other group plan contracts for which
health care services are not negotiated, that the applicant has a
right to view the evidence of coverage prior to enrollment, and, if
the evidence of coverage is not combined with the disclosure form,
the notice shall specify where the evidence of coverage can be
obtained prior to enrollment.
(B) Includes a statement that the disclosure and the evidence of
coverage should be read completely and carefully and that individuals
with special health care needs should read carefully those sections
that apply to them.
(C) Includes the plan's telephone number or numbers that may be
used by an applicant to receive additional information about the
benefits of the plan or a statement where the telephone number or
numbers are located in the disclosure form.
(D) For individual contracts, and small group plan contracts as
defined in Article 3.1 (commencing with Section 1357), the disclosure
form shall state where the health plan benefits and coverage matrix
is located.
(E) Is printed in type no smaller than that used for the remainder
of the disclosure form and is displayed prominently on the page.
(7) A statement as to when benefits shall cease in the event of
nonpayment of the prepaid or periodic charge and the effect of
nonpayment upon an enrollee who is hospitalized or undergoing
treatment for an ongoing condition.
(8) To the extent that the plan permits a free choice of provider
to its subscribers and enrollees, the statement shall disclose the
nature and extent of choice permitted and the financial liability
that is, or may be, incurred by the subscriber, enrollee, or a third
party by reason of the exercise of that choice.
(9) A summary of the provisions required by subdivision (g) of
Section 1373, if applicable.
(10) If the plan utilizes arbitration to settle disputes, a
statement of that fact.
(11) A summary of, and a notice of the availability of, the
process the plan uses to authorize, modify, or deny health care
services under the benefits provided by the plan, pursuant to
Sections 1363.5 and 1367.01.
(12) A description of any limitations on the patient's choice of
primary care physician, specialty care physician, or nonphysician
health care practitioner, based on service area and limitations on
the patient's choice of acute care hospital care, subacute or
transitional inpatient care, or skilled nursing facility.
(13) General authorization requirements for referral by a primary
care physician to a specialty care physician or a nonphysician health
care practitioner.
(14) Conditions and procedures for disenrollment.
(15) A description as to how an enrollee may request continuity of
care as required by Section 1373.96 and request a second opinion
pursuant to Section 1383.15.
(16) Information concerning the right of an enrollee to request an
independent review in accordance with Article 5.55 (commencing with
Section 1374.30).
(17) A notice as required by Section 1364.5.
(b) (1) As of July 1, 1999, the director shall require each plan
offering a contract to an individual or small group to provide with
the disclosure form for individual and small group plan contracts a
uniform health plan benefits and coverage matrix containing the plan'
s major provisions in order to facilitate comparisons between plan
contracts. The uniform matrix shall include the following category
descriptions together with the corresponding copayments and
limitations in the following sequence:
(A) Deductibles.
(B) Lifetime maximums.
(C) Professional services.
(D) Outpatient services.
(E) Hospitalization services.
(F) Emergency health coverage.
(G) Ambulance services.
(H) Prescription drug coverage.
(I) Durable medical equipment.
(J) Mental health services.
(K) Chemical dependency services.
(L) Home health services.
(M) Other.
(2) The following statement shall be placed at the top of the
matrix in all capital letters in at least 10-point boldface type:
THIS MATRIX IS INTENDED TO BE USED TO HELP YOU COMPARE COVERAGE
BENEFITS AND IS A SUMMARY ONLY. THE EVIDENCE OF COVERAGE AND PLAN
CONTRACT SHOULD BE CONSULTED FOR A DETAILED DESCRIPTION OF COVERAGE
BENEFITS AND LIMITATIONS.
(c) Nothing in this section shall prevent a plan from using
appropriate footnotes or disclaimers to reasonably and fairly
describe coverage arrangements in order to clarify any part of the
matrix that may be unclear.
(d) All plans, solicitors, and representatives of a plan shall,
when presenting any plan contract for examination or sale to an
individual prospective plan member, provide the individual with a
properly completed disclosure form, as prescribed by the director
pursuant to this section for each plan so examined or sold.
(e) In the case of group contracts, the completed disclosure form
and evidence of coverage shall be presented to the contractholder
upon delivery of the completed health care service plan agreement.
(f) Group contractholders shall disseminate copies of the
completed disclosure form to all persons eligible to be a subscriber
under the group contract at the time those persons are offered the
plan. If the individual group members are offered a choice of plans,
separate disclosure forms shall be supplied for each plan available.
Each group contractholder shall also disseminate or cause to be
disseminated copies of the evidence of coverage to all applicants,
upon request, prior to enrollment and to all subscribers enrolled
under the group contract.
(g) In the case of conflicts between the group contract and the
evidence of coverage, the provisions of the evidence of coverage
shall be binding upon the plan notwithstanding any provisions in the
group contract that may be less favorable to subscribers or
enrollees.
(h) In addition to the other disclosures required by this section,
every health care service plan and any agent or employee of the plan
shall, when presenting a plan for examination or sale to any
individual purchaser or the representative of a group, disclose in
writing the ratio of premium costs to health services paid for plan
contracts with individuals and with groups of the same or similar
size for the plan's preceding fiscal year. A plan may report that
information by geographic area, provided the plan identifies the
geographic area and reports information applicable to that geographic
area.
(i) Subdivision (b) shall not apply to any coverage provided by a
plan for the Medi-Cal program or the Medicare program pursuant to
Title XVIII and Title XIX of the Social Security Act.
SEC. 6. Section 1378 of the Health and Safety Code is amended to
read:
1378. No plan shall expend for administrative costs in any fiscal
year an excessive amount of the aggregate dues, fees and other
periodic payments received by the plan for providing health care
services to its subscribers or enrollees. The term "administrative
costs," as used herein, includes costs incurred in connection with
the solicitation of subscribers or enrollees for the plan. The
director shall adopt regulations no later than July 1, 2008, to
define "administrative costs" and "health care services" so that at
least 85 percent of aggregate dues, fees, and other periodic payments
received by a full-service plan are spent on health care services.
This section shall not apply to Medicare supplement contracts.
This section shall not preclude a plan from expending additional
sums of money for administrative costs provided such money is not
derived from revenue obtained from subscribers or enrollees of the
plan.
SEC. 7. Section 10293.5 is added to the Insurance Code, to read:
10293.5. (a) The commissioner shall adopt regulations no later
than July 1, 2008, to define "administrative costs" and "health care
services" so that at least 85 percent of health insurance premium
revenue received by a health insurer is spent on health care
services.
(b) As used in this section, health insurance shall have the same
meaning as in subdivision (b) of Section 106.
(c) The requirements of this chapter shall not apply to a Medicare
supplement, vision-only, dental-only, or Champus-supplement
insurance or to hospital indemnity, hospital-only, accident-only, or
specified disease insurance that does not pay benefits on a fixed
benefit, cash payment only basis.
SEC. 8. Section 10607 of the Insurance Code is amended to read:
10607. In addition to the other disclosures required by this
chapter, every insurer and their employees or agents shall, when
presenting a plan for examination or sale to any individual or the
representative of a group, disclose in writing the ratio of incurred
claims to earned premiums (loss-ratio) for the insurer's preceding
calendar year for policies with individuals and with groups of the
same or similar size for the plan's preceding fiscal year.
SEC. 9. Chapter 8.1 (commencing with Section 10760) is added to
Part 2 of Division 2 of the Insurance Code, to read:
CHAPTER 8.1. INSURANCE MARKET REFORM
10760. Effective July 1, 2008, every insurer that offers,
markets, and sells health insurance to individuals and conducts
medical underwriting to determine whether to issue coverage to a
specific individual shall use a standardized health questionnaire
developed by the Managed Risk Medical Insurance Board. A health
insurer subject to this section may not exclude a potential insured
from any individual coverage on the basis of an actual or expected
health condition, type of illness, treatment, medical condition, or
accident, or for a preexisting condition, except as provided by the
board pursuant to Section 12711.1.
10761. (a) Every insurer that provides health insurance to
residents of this state shall offer, market, and sell all of the
uniform benefit plan designs made available through Cal-CHIPP
pursuant to Part 6.45 (commencing with Section 12699.201) to
purchasers in each region and all individual and group markets where
the insurer offers, markets, and sells health insurance policies,
consistent with statutory and regulatory rating and underwriting
requirements applicable to the respective individual and group
markets.
(b) This section shall not preclude an insurer from offering other
benefit plan designs in addition to those required to be offered
under subdivision (a).
10762. It is the intent of the Legislature that all health care
providers shall participate in an Internet-based personal health
record system under which patients have access to their own health
care records. A patient's personal health care record shall only be
accessible to that patient or other individual as authorized by the
patient. It is the intent of the Legislature that all health insurers
and providers shall adopt standard electronic medical records by
January 1, 2012.
10763. On and after January 1, 2008, all requirements in Chapter
8 (commencing with Section 10700) applicable to offering, marketing,
and selling health benefit plans to small employers as defined in
that chapter, including, but not limited to, the obligation to fairly
and affirmatively offer, market, and sell all of the carrier's
health benefit plan designs to all employers, guaranteed renewal of
all health benefit plan designs, use of the risk adjustment factor,
and the restriction of risk categories to age, geographic region, and
family composition as described in that chapter, shall be applicable
to all health benefit plan designs offered to all employers with 250
or fewer eligible employees, except as follows:
(a) For small employers with 2 to 50, inclusive, eligible
employees, all requirements in that chapter shall apply.
(b) For employers with 51 to 250, inclusive, eligible employees,
all requirements in that chapter shall apply, except that the carrier
may develop health care coverage benefit plan designs to fairly and
affirmatively market only to employer groups of 51 to 250 eligible
employees.
10764. (a) Every health insurer shall obtain from each employer
or group policyholder the premium contribution amounts for each
insured group member and dependent.
(b) (1) Every health insurer offering group health plan contracts
shall provide as one coverage option of each group policy a benchmark
policy established by the board so that group members and their
dependents with family incomes at or below 300 percent of the federal
poverty level that are determined eligible for coverage through the
Medi-Cal or Healthy Families Programs can enroll in the benchmark
policy. The benchmark policy of a group health insurer shall be
provided at a rate negotiated with and approved by the board. The
health insurer shall collect the employer's applicable dollar premium
contribution for employees, and if applicable, dependents, in the
benchmark policy and credit that amount toward the cost of the
benchmark policy.
(2) In lieu of meeting the requirements of paragraph (1), for
employees and, if applicable, dependents eligible for coverage
through the Medi-Cal or Healthy Families Programs who have elected to
enroll in benchmark coverage, the health insurer shall collect the
employer's applicable dollar premium contribution and credit that
amount to the board towards the premium cost of a benchmark policy in
Cal-CHIPP.
(c) Every group health insurer shall include notice in the
evidence of coverage of the ability of employees and dependents with
family incomes at or below 300 percent of the federal poverty level
to enroll in Medi-Cal or Healthy Families coverage through a
benchmark plan, with instructions on how to apply for coverage.
(d) Employees and dependents receiving coverage through Medi-Cal
or Healthy Families Programs pursuant to this section shall make any
required premium payments for enrollment in those programs required
under the applicable laws governing those programs.
(e) As used in this section, the following terms have the
following meanings:
(1) "Board" means the Managed Risk Medical Insurance Board.
(2) "California Cooperative Health Insurance Purchasing Program"
or "Cal-CHIPP" shall have the same meaning as in subdivision (c) of
Section 12699.201.
(3) "Benchmark policy" shall mean coverage equivalent to coverage
provided through the Healthy Families Program established pursuant to
Part 6.2 (commencing with Section 12693) of Division 2 of the
Insurance Code.
10765. (a) As used in this chapter, "health insurance" shall have
the same meaning as in subdivision (b) of Section 106.
(b) The requirements of this chapter shall not apply to a Medicare
supplement, vision-only, dental-only, or Champus-supplement
insurance or to hospital indemnity, hospital-only, accident-only, or
specified disease insurance that does not pay benefits on a fixed
benefit, cash payment only basis.
SEC. 10. Section 12693.43 of the Insurance Code is amended to
read:
12693.43. (a) Applicants applying to the purchasing pool shall
agree to pay family contributions, unless the applicant has a family
contribution sponsor. Family contribution amounts consist of the
following two components:
(1) The flat fees described in subdivision (b) or (d).
(2) Any amounts that are charged to the program by participating
health, dental, and vision plans selected by the applicant that
exceed the cost to the program of the highest cost family value
package in a given geographic area.
(b) In each geographic area, the board shall designate one or more
family value packages for which the required total family
contribution is:
(1) Seven dollars ($7) per child with a maximum required
contribution of fourteen dollars ($14) per month per family for
applicants with annual household incomes up to and including 150
percent of the federal poverty level.
(2) Nine dollars ($9) per child with a maximum required
contribution of twenty-seven dollars ($27) per month per family for
applicants with annual household incomes greater than 150 percent and
up to and including 200 percent of the federal poverty level and for
applicants on behalf of children described in clause (ii) of
subparagraph (A) of paragraph (6) of subdivision (a) of Section
12693.70.
(3) On and after July 1, 2005, fifteen dollars ($15) per child
with a maximum required contribution of forty-five dollars ($45) per
month per family for applicants with annual household income to which
subparagraph (B) of paragraph (6) of subdivision (a) of Section
12693.70 is applicable. Notwithstanding any other provision of law,
if an application with an effective date prior to July 1, 2005, was
based on annual household income to which subparagraph (B) of
paragraph (6) of subdivision (a) of Section 12693.70 is applicable,
then this paragraph
shall be applicable to the applicant on July 1, 2005, unless
subparagraph (B) of paragraph (6) of subdivision (a) of Section
12693.70 is no longer applicable to the relevant family income. The
program shall provide prior notice to any applicant for currently
enrolled subscribers whose premium will increase on July 1, 2005,
pursuant to this paragraph and, prior to the date the premium
increase takes effect, shall provide that applicant with an
opportunity to demonstrate that subparagraph (B) of paragraph (6) of
subdivision (a) of Section 12693.70 is no longer applicable to the
relevant family income.
(4) On and after July 1, 2008, twenty-five dollars ($25) per child
with a maximum required contribution of seventy-five dollars ($75)
per month per family for applicants with annual household incomes
greater than 250 percent and up to and including 300 percent of the
federal poverty level.
(c) Combinations of health, dental, and vision plans that are more
expensive to the program than the highest cost family value package
may be offered to and selected by applicants. However, the cost to
the program of those combinations that exceeds the price to the
program of the highest cost family value package shall be paid by the
applicant as part of the family contribution.
(d) The board shall provide a family contribution discount to
those applicants who select the health plan in a geographic area that
has been designated as the Community Provider Plan. The discount
shall reduce the portion of the family contribution described in
subdivision (b) to the following:
(1) A family contribution of four dollars ($4) per child with a
maximum required contribution of eight dollars ($8) per month per
family for applicants with annual household incomes up to and
including 150 percent of the federal poverty level.
(2) Six dollars ($6) per child with a maximum required
contribution of eighteen dollars ($18) per month per family for
applicants with annual household incomes greater than 150 percent and
up to and including 200 percent of the federal poverty level and for
applicants on behalf of children described in clause (ii) of
subparagraph (A) of paragraph (6) of subdivision (a) of Section
12693.70.
(3) On and after July 1, 2005, twelve dollars ($12) per child with
a maximum required contribution of thirty-six dollars ($36) per
month per family for applicants with annual household income to which
subparagraph (B) of paragraph (6) of subdivision (a) of Section
12693.70 is applicable. Notwithstanding any other provision of law,
if an application with an effective date prior to July 1, 2005, was
based on annual household income to which subparagraph (B) of
paragraph (6) of subdivision (a) of Section 12693.70 is applicable,
then this paragraph shall be applicable to the applicant on July 1,
2005, unless subparagraph (B) of paragraph (6) of subdivision (a) of
Section 12693.70 is no longer applicable to the relevant family
income. The program shall provide prior notice to any applicant for
currently enrolled subscribers whose premium will increase on July 1,
2005, pursuant to this paragraph and, prior to the date the premium
increase takes effect, shall provide that applicant with an
opportunity to demonstrate that subparagraph (B) of paragraph (6) of
subdivision (a) of Section 12693.70 is no longer applicable to the
relevant family income.
(4) On and after July 1, 2008, twenty-two dollars ($22) per child
with a maximum required contribution of sixty-six dollars ($66) per
month per family for applicants with annual household incomes greater
than 250 percent and up to and including 300 percent of the federal
poverty level.
(e) Applicants, but not family contribution sponsors, who pay
three months of required family contributions in advance shall
receive the fourth consecutive month of coverage with no family
contribution required.
(f) Applicants, but not family contribution sponsors, who pay the
required family contributions by an approved means of electronic fund
transfer shall receive a 25-percent discount from the required
family contributions.
(g) It is the intent of the Legislature that the family
contribution amounts described in this section comply with the
premium cost sharing limits contained in Section 2103 of Title XXI of
the Social Security Act. If the amounts described in subdivision (a)
are not approved by the federal government, the board may adjust
these amounts to the extent required to achieve approval of the state
plan.
(h) The adoption and one readoption of regulations to implement
paragraph (3) of subdivision (b) and paragraph (3) of subdivision (d)
shall be deemed to be an emergency and necessary for the immediate
preservation of public peace, health, and safety, or general welfare
for purposes of Sections 11346.1 and 11349.6 of the Government Code,
and the board is hereby exempted from the requirement that it
describe specific facts showing the need for immediate action and
from review by the Office of Administrative Law. For purposes of
subdivision (e) of Section 11346.1 of the Government Code, the
120-day period, as applicable to the effective period of an emergency
regulatory action and submission of specified materials to the
Office of Administrative law, is hereby extended to 180 days.
SEC. 11. Section 12693.55 is added to the
Insurance Code, to read:
12693.55. (a) The board shall establish a premium assistance
benefit for all individuals eligible under the program with incomes
at or below 300 percent of the federal poverty level that maximizes
federal financial participation, as follows:
(1) An individual eligible for benefits under the program who is
offered health coverage by his or her employer shall enroll in the
employer-offered health coverage on his or her own behalf and on
behalf of his or her dependents, if any.
(2) Individuals and dependents enrolling in employer-offered
health coverage pursuant to this section shall not be responsible for
any premium, deductible, or copayment requirements that are greater
than any premium, deductible, or copayment that the individual or
dependent would be required to pay under the program, if any.
(3) Individuals and dependents enrolling in employer-offered
health coverage pursuant to this section shall be eligible for a
wraparound benefit that covers any gap between the employer-offered
health coverage and the benefits provided by the program.
(b) Notwithstanding subdivision (a), an employer of one or more
employees who are required to enroll in employer-offered health
coverage pursuant to this section may elect to pay the full premium
cost of the program on behalf of all employees and their dependents
who are eligible for the program. An employee whose employer elects
to make this payment shall not be required to enroll in the
employer-offered health coverage and shall instead enroll in the
program.
(c) The premium assistance benefit under subdivision (a) shall
only apply to individuals and their dependents if the board
determines that it is cost effective for the state.
(d) Notwithstanding any other provision of law, this section may
only be implemented on or after July 1, 2008, and only to the extent
funds are appropriated for the purposes of this section in another
statute.
SEC. 12. SEC. 11. Section 12693.70
of the Insurance Code is amended to read:
12693.70. To be eligible to participate in the program, an
applicant shall meet all of the following requirements:
(a) Be an applicant applying on behalf of an eligible child, which
means a child who is all of the following:
(1) Less than 19 years of age. An application may be made on
behalf of a child not yet born up to three months prior to the
expected date of delivery. Coverage shall begin as soon as
administratively feasible, as determined by the board, after the
board receives notification of the birth. However, no child less than
12 months of age shall be eligible for coverage until 90 days after
the enactment of the Budget Act of 1999.
(2) Not eligible for no-cost full-scope Medi-Cal or Medicare
coverage at the time of application.
(3) In compliance with Sections 12693.71 and 12693.72.
(4) (Reserved).
(5) A resident of the State of California pursuant to Section 244
of the Government Code; or, if not a resident pursuant to Section 244
of the Government Code, is physically present in California and
entered the state with a job commitment or to seek employment,
whether or not employed at the time of application to or after
acceptance in, the program.
(6) (A) In either of the following:
(i) In a family with an annual or monthly household income equal
to or less than 200 percent of the federal poverty level.
(ii) When implemented by the board, subject to subdivision (b) of
Section 12693.765 and pursuant to this section, a child under the age
of two years who was delivered by a mother enrolled in the Access
for Infants and Mothers Program as described in Part 6.3 (commencing
with Section 12695). Commencing July 1, 2007, eligibility under this
subparagraph shall not include infants during any time they are
enrolled in employer-sponsored health insurance or are subject to an
exclusion pursuant to Section 12693.71 or 12693.72, or are enrolled
in the full scope of benefits under the Medi-Cal program at no share
of cost. For purposes of this clause, any infant born to a woman
whose enrollment in the Access for Infants and Mothers Program begins
after June 30, 2004, shall be automatically enrolled in the Healthy
Families Program, except during any time on or after July 1, 2007,
that the infant is enrolled in employer-sponsored health insurance or
is subject to an exclusion pursuant to Section 12693.71 or 12693.72,
or is enrolled in the full scope of benefits under the Medi-Cal
program at no share of cost. Except as otherwise specified in this
section, this enrollment shall cover the first 12 months of the
infant's life. At the end of the 12 months, as a condition of
continued eligibility, the applicant shall provide income
information. The infant shall be disenrolled if the gross annual
household income exceeds the income eligibility standard that was in
effect in the Access for Infants and Mothers Program at the time the
infant's mother became eligible, or following the two-month period
established in Section 12693.981 if the infant is eligible for
Medi-Cal with no share of cost. At the end of the second year,
infants shall again be screened for program eligibility pursuant to
this section, with income eligibility evaluated pursuant to clause
(i), subparagraphs (B) and (C), and paragraph (2) of subdivision (a).
(B) All income over 200 percent of the federal poverty level but
less than or equal to 300 percent of the federal poverty level shall
be disregarded in calculating annual or monthly household income.
(C) In a family with an annual or monthly household income greater
than 300 percent of the federal poverty level, any income deduction
that is applicable to a child under Medi-Cal shall be applied in
determining the annual or monthly household income. If the income
deductions reduce the annual or monthly household income to 300
percent or less of the federal poverty level, subparagraph (B) shall
be applied.
(b) The applicant shall agree to remain in the program for six
months, unless other coverage is obtained and proof of the coverage
is provided to the program.
(c) An applicant shall enroll all of the applicant's eligible
children in the program.
(d) In filing documentation to meet program eligibility
requirements, if the applicant's income documentation cannot be
provided, as defined in regulations promulgated by the board, the
applicant's signed statement as to the value or amount of income
shall be deemed to constitute verification.
(e) An applicant shall pay in full any family contributions owed
in arrears for any health, dental, or vision coverage provided by the
program within the prior 12 months.
(f) By January 2008, the board, in consultation with stakeholders,
shall implement processes by which applicants for subscribers may
certify income at the time of annual eligibility review, including
rules concerning which applicants shall be permitted to certify
income and the circumstances in which supplemental information or
documentation may be required. The board may terminate using these
processes not sooner than 90 days after providing notification to the
Chair of the Joint Legislative Budget Committee. This notification
shall articulate the specific reasons for the termination and shall
include all relevant data elements that are applicable to document
the reasons for the termination. Upon the request of the Chair of the
Joint Legislative Budget Committee, the board shall promptly provide
any additional clarifying information regarding implementation of
the processes required by this subdivision.
(g) Notwithstanding any other provision of law, the changes to
this section made by the act adding this subdivision in the 2007-08
Regular Session of the Legislature may only be implemented on or
after July 1, 2008, and only to the extent funds are appropriated for
those purposes in another statute.
SEC. 13. SEC. 12 .
Section 12693.73 of the Insurance Code is amended to read:
12693.73. Notwithstanding any other provision of law, children
excluded from coverage under Title XXI of the Social Security Act are
not eligible for coverage under the program, except as specified in
clause (ii) of subparagraph (A) of paragraph (6) of subdivision (a)
of Section 12693.70 and Section 12693.76, or except children who
otherwise meet eligibility requirements for the program but for their
immigration status.
SEC. 14. SEC. 13. Section 12693.755
of the Insurance Code is amended to read:
12693.755. (a) Subject to subdivision (b), but no later than July
1, 2008, the board shall expand eligibility under this part to
uninsured parents of, and as defined by the board, adults responsible
for, children enrolled to receive coverage under this part whose
income does not exceed 300 percent of the federal poverty level,
before applying the income disregard provided for in subparagraph (B)
of paragraph (6) of subdivision (a) of Section 12693.70.
(b) (1) The board shall implement a program to provide coverage
under this part to any uninsured parent or responsible adult who is
eligible pursuant to subdivision (a), pursuant to the waiver or
approval identified in paragraph (2).
(2) The program shall be implemented only in accordance with a
State Child Health Insurance Program waiver or other federal approval
pursuant to Section 1397gg(e)(2)(A) of Title 42 of the United States
Code, or pursuant to the Deficit Reduction Act of 2005, Section 6044
of Public Law 109-171, to provide coverage to uninsured parents and
responsible adults, and shall be subject to the terms, conditions,
and duration of the waiver or other federal approval. The services
shall be provided under the program only if the waiver or other
federal approval is approved by the federal Centers for Medicare and
Medicaid Services, and, except as provided under the terms and
conditions of the waiver or other federal approval, only to the
extent that federal financial participation is available and funds
are appropriated specifically for this purpose.
SEC. 15. SEC. 14. Part 6.45
(commencing with Section 12699.201) is added to Division 2 of the
Insurance Code, to read:
PART 6.45. THE CALIFORNIA COOPERATIVE HEALTH INSURANCE
PURCHASING PROGRAM
12699.201. For the purposes of this part, the following terms
have the following meanings:
(a) "Benefit plan design" means a specific health coverage product
offered for sale and includes services covered and the levels of
copayments, deductibles, and annual out-of-pocket expenses, and may
include the professional providers who are to provide those services
and the sites where those services are to be provided. A benefit plan
design may also be an integrated system for the financing and
delivery of quality health care services that has significant
incentives for the covered individuals to use the system.
(b) "Board" means the Managed Risk Medical Insurance Board.
(c) "California Cooperative Health Insurance Purchasing Program"
or "Cal-CHIPP" means the purchasing pool established pursuant to this
part and administered by the board. The purchasing pool shall only
be available to employees of, and, if applicable, dependents of
employees of, employers who elect to pay into the California Health
Trust Fund in lieu of making health care expenditures for their
employees and, if applicable, dependents pursuant to Section 2200 of
the Labor Code. Notwithstanding the foregoing, the purchasing
pool shall also be available to eligible employees and, if
applicable, dependents of eligible employees, receiving coverage
through a benchmark plan or policy pursuant to paragraph (2) of
subdivision (b) of Section 1357.24 of the Health and Safety Code or
paragraph (2) of subdivision (b) of Section 10764. These employees
and, if applicable, their dependents shall be limited to
the choice of a benchmark plan or policy under Cal-CHIPP and shall
not have access to other benefit plan options available to Cal-CHIPP
enrollees pursuant to Section 12699.203.
(d) "Participating health plan" means a health insurer holding a
valid outstanding certificate of authority from the Insurance
Commissioner or a health care service plan as defined under
subdivision (f) of Section 1345 of the Health and Safety Code that
contracts with the board to provide coverage in Cal-CHIPP and,
pursuant to its contract with the board, provides, arranges, pays
for, or reimburses the costs of health services for Cal-CHIPP
enrollees.
12699.202. The board shall be responsible for establishing
Cal-CHIPP and administering this part.
12699.203. (a) The board shall develop standards for high-quality
coverage for Cal-CHIPP and negotiate favorable rates and contract
with health plans by leveraging its purchasing power. Cal-CHIPP
enrollees shall be offered a choice of health plans that provide
comprehensive health care coverage, including medical, hospital, and
prescription drug benefits. The board may establish health plan
premiums and administer subsidies to eligible enrollees with incomes
at or below 300 percent of the federal poverty level.
(b) The board shall develop and offer at least three uniform
benefit plan designs to Cal-CHIPP enrollees. The three benefit plan
designs shall include varying benefit levels, deductibles,
coinsurance factors, or copayments, and annual limits on
out-of-pocket expenses. In developing the benefit plan designs, the
board shall do all of the following:
(1) Take into consideration the levels of health care coverage
provided in the state and medical economic factors as may be deemed
appropriate. The board shall include coverage and design elements
that are reflective of and commensurate with health insurance
coverage provided through a representative number of large insured
employers in the state.
(2) Include in all benefit plan designs coverage for primary and
preventive care services and prescription drugs, combined with
enrollee cost-sharing levels that promote prevention and health
maintenance, including appropriate cost sharing for physician office
visits, diagnostic laboratory services, and maintenance medications
to manage chronic diseases, such as asthma, diabetes, and heart
disease.
(3) Consult with the Insurance Commissioner, the Director of the
Department of Managed Health Care, and the Director of the Department
of Health Care Services.
12699.205. The board shall assume lead agency responsibility for
professional review and development of best practice standards in the
care and treatment of patients with high-cost chronic diseases, such
as asthma, diabetes, and heart disease. Upon adoption of the
standards, each state health care program, including, but not limited
to, programs offered under the Public Employees' Medical and
Hospital Care Act, Medi-Cal, Healthy Families, the Major Risk Medical
Insurance Program, and Cal-CHIPP, shall implement those standards.
12699.206. The California Health Trust Fund is hereby created in
the State Treasury. The moneys in the fund shall be continuously
appropriated to the board for the purposes of providing health care
coverage pursuant to this part.
12699.207. The board, subject to federal approval pursuant to
Section 14199.10 of the Welfare and Institutions Code, shall pay the
nonfederal share of cost from the California Health Trust Fund for
employees and dependents eligible under that federal approval.
12699.208. The board shall implement the requirements for a
benchmark plan or policy as required pursuant to Section 1357.24 of
the Health and Safety Code and Section 10764.
SEC. 16. SEC. 15. Section 12711.1 is
added to the Insurance Code, to read:
12711.1. (a) The board shall establish a list of serious health
conditions or diagnoses making an applicant automatically eligible
for the program. In developing the list of conditions, the board
shall consult with the Director of the Department of Managed Health
Care and the commissioner to identify common health plan and insurer
underwriting criteria.
(b) The board shall develop a standardized health questionnaire to
be used by all health plans and insurers that offer and sell
individual coverage. The questionnaire shall be designed to collect
only that information necessary to identify if a person is eligible
for coverage in the program pursuant to subdivision (a). Consistent
with Section 1357.21 of the Health and Safety Code and Section 10761,
health plans and insurers shall not deny coverage for any individual
except for those who qualify for automatic eligibility for the
program as determined by the board pursuant to this section.
SEC. 17. SEC. 16. Part 8.8
(commencing with Section 2200) is added to Division 2 of the Labor
Code, to read:
PART 8.8. EMPLOYER ELECTION
2200. (a) (1) Each employer shall elect to either (A) make health
care expenditures as provided in paragraph (2) for its full-time or
part-time employees, or both, and, if applicable, their dependents,
or (B) pay an equivalent amount in either or both cases, as
applicable, to the California Health Trust Fund, created pursuant to
Section 12699.207 of the Insurance Code, as required by Section 976.7
of the Unemployment Insurance Code.
(2) (A) An employer's cumulative amount of health care
expenditures for the employer's full-time employees working 30 or
more hours per week shall be equivalent to ____
, at a minimum, to 7.5 percent of social
security wages paid by the employer to full-time employees.
(B) An employer's cumulative amount of health care expenditures
for the employer's part-time employees working less than 30 hours per
week shall be equivalent to ____ , at a
minimum, to 7.5 percent of social security wages paid by the
employer to part-time employees.
(b) (1) The amount payable to the California Health Trust Fund by
an employer electing to pay shall be deposited into the fund.
(2) The Employment Development Department, in consultation with
the board, shall ensure that funds are deposited in the California
Health Trust Fund pursuant to this section and are available to
ensure the timely enrollment of eligible employees in the Cal-CHIPP
purchasing pool.
(c) (1) The Employment Development Department shall adopt
regulations that exempt businesses with payrolls of less than one
hundred thousand dollars ($100,000) in a fiscal year, businesses with
fewer than two employees, and new businesses during the first three
years of the establishment of the business, from the requirements of
this part. In adopting these regulations, the department shall deny
the exemption to firms that restructure or reincorporate in order to
avoid the requirements of this part.
(2) The Employment Development Department, in consultation with
the board, shall adopt regulations determining the minimum number of
hours per week a part-time employee must work in order to be subject
to subparagraph (B) of paragraph (2) of subdivision (a) for purposes
of the employer election in this section. The regulations shall
exempt employers of part-time employees not working the required
minimum number of hours from the requirements of this part.
2203. An employee working for an employer that elects, pursuant
to Section 2200, to pay an equivalent amount in lieu of making health
care expenditures shall be required to enroll in the California
Cooperative Health Insurance Purchasing Program pursuant to Part 6.45
(commencing with Section 12699.201) of Division 2 of the Insurance
Code to receive coverage from a participating health plan contracting
with the board through the program. However, an employee is exempt
from this requirement if the employee is able to demonstrate that the
employee is covered by other group health care coverage, such as
group coverage made available by an employer to the employee's spouse
that also covers the employee.
2204. Unless the context requires otherwise, the definitions set
forth in this section shall govern the construction and meaning of
the terms and phrases used in this part:
(a) "Board" means the Managed Risk Medical Insurance Board.
(b) "Employer" means any individual, corporation, association,
partnership, or limited liability company, or any agent thereof,
doing business in this state, deriving income from sources within
this state, or in any manner whatsoever subject to the laws of this
state, the State of California or any political subdivision or agency
thereof, including the Regents of the University of California, any
city organized under a freeholders' charter, or any political body
not a subdivision or agency of the state, any person, officer,
employee, department, or agency thereof, making payment of wages to
employees for services performed within this state, consistent with
regulations adopted pursuant to Section 2200.
(c) "Fund" means the California Health Trust Fund created pursuant
to Section 12699.207 of the Insurance Code.
(d) "Health care expenditures" means any amount paid by
an employer subject to this section to, or on behalf of, its
employees and dependents, if applicable, to provide health care or
health-related services or to reimburse the costs of those services,
including, but not limited to, any of the following:
(1) Contributions to a health savings account as defined by
Section 223 of the Internal Revenue Code.
(2) Reimbursement by the employer to its employees, and their
dependents, if applicable, for incurred health care expenses, where
those recipients have no entitlement to that reimbursement under any
plan, fund, or program maintained by the employer. As used in this
paragraph, "health care expenses" includes, but is not limited to, an
expense for which payment is deductible from personal income under
Section 213(d) of the Internal Revenue Code.
(3) Programs to assist employees to attain and maintain healthy
lifestyles, including, but not limited to, onsite wellness programs,
reimbursement for attending offsite wellness programs, onsite health
fairs and clinics, and financial incentives for participating in
health screenings and other wellness activities.
(4) Disease management programs.
(5) Pharmacy benefit management programs.
(6) Care rendered to employees and their dependents by health care
providers employed by or under contract to employers, such as
employer-sponsored primary care clinics.
(7) Purchasing health care coverage from a health care service
plan or a health insurer.
SEC. 18. SEC. 17. Chapter 11
(commencing with Section 19900) is added to Part 10.2 of Division 2
of the Revenue and Taxation Code, to read:
CHAPTER 11. HEALTH CARE CAFETERIA PLAN
19900. This chapter shall be known and may be cited as the Health
Care Cafeteria Plan.
19901. Unless federal law or the law of this state provides
otherwise, each employer in this state during a taxable year shall
adopt and maintain a cafeteria plan, within the meaning of Section
125 of the Internal Revenue Code, to allow employees to pay for
health insurance premiums, to the extent amounts for such benefits
are excludable from the gross income of the employee under Section
106 of the Internal Revenue Code.
SEC. 19. SEC. 18. Section 131 of the
Unemployment Insurance Code is amended to read:
131. "Contributions" means the money payments to the Unemployment
Fund, Employment Training Fund, California Health Trust Fund, or
Unemployment Compensation Disability Fund that are required by this
division.
SEC. 20. SEC. 19. Section 976.7 is
added to the Unemployment Insurance Code, to read:
976.7. In addition to other contributions required by this
division and consistent with the requirements of Part 8.8 (commencing
with Section 2200) of Division 2 of the Labor Code, an employer
shall pay to the department for deposit into the California Health
Trust Fund the amount required by Section 2200 of the Labor Code.
These contributions shall be collected in the same manner and at the
same time as any contributions required under Sections 976 and 1088.
SEC. 21. SEC. 20. Section 14005.23
of the Welfare and Institutions Code is amended to read:
14005.23. (a) To the extent federal financial participation is
available, the department shall, when determining eligibility for
children under Section 1396a()(1)(D) of Title 42 of the United States
Code, designate a birth date by which all children who have not
attained the age of 19 years will meet the age requirement of Section
1396a()(1)(D) of Title 42 of the United States Code.
(b) Commencing July 1, 2008, to the extent federal financial
participation is available, the department shall apply a less
restrictive income deduction described in Section 1396a(r) of Title
42 of the United States Code when determining eligibility for the
children identified in subdivision (a). The amount of this deduction
shall be the difference between 133 percent and 100 percent of the
federal poverty level applicable to the size of the family.
SEC. 22. SEC. 21. Section 14005.30
of the Welfare and Institutions Code is amended to read:
14005.30. (a) (1) To the extent that federal financial
participation is available, Medi-Cal benefits under this chapter
shall be provided to individuals eligible for services under Section
1396u-1 of Title 42 of the United States Code, including any options
under Section 1396u-1(b)(2)(C) made available to and exercised by the
state.
(2) The department shall exercise its option under Section 1396u-1
(b)(2)(C) of Title 42 of the United States Code to adopt less
restrictive income and resource eligibility standards and
methodologies to the extent necessary to allow all recipients of
benefits under Chapter 2 (commencing with Section 11200) to be
eligible for Medi-Cal under paragraph (1).
(3) To the extent federal financial participation is available,
the department shall exercise its option under Section 1396u-1(b)(2)
(C) of Title 42 of the United States Code authorizing the state to
disregard all changes in income or assets of a beneficiary until the
next annual redetermination under Section 14012. The department shall
implement this paragraph only if, and to the extent that the State
Child Health Insurance Program waiver described in Section 12693.755
of the Insurance Code extending Healthy Families Program eligibility
to parents and certain other adults is approved and implemented.
(b) To the extent that federal financial participation is
available, the department shall exercise its option under Section
1396u-1(b)(2)(C) of Title 42 of the United States Code as necessary
to simplify eligibility for Medi-Cal under subdivision (a) by
exempting all resources for applicants and recipients.
(c) To the extent federal financial participation is available,
the department shall, commencing March 1, 2000, adopt an income
disregard for applicants equal to the difference between the income
standard under the program adopted pursuant to Section 1931(b) of the
federal Social Security Act (42 U.S.C. Sec. 1396u-1) and the amount
equal to 100 percent of the federal poverty level applicable to the
size of the family. A recipient shall be entitled to the same
disregard, but only to the extent it is more beneficial than, and is
substituted for, the earned income disregard available to recipients.
(d) Commencing July 1, 2008, the department shall adopt an income
disregard for applicants equal to the difference between the income
standard under the program adopted pursuant to Section 1931(b) of the
federal Social Security Act (42 U.S.C. Sec. 1396u-1(b)) and the
amount equal to 133 percent of the federal poverty level applicable
to the size of the family. A recipient shall be entitled to the same
disregard, but only to the extent it is more generous than, and is
substituted for, the earned income disregard available to recipients.
Implementation of this subdivision is contingent upon federal
financial participation. Upon implementation of this subdivision, the
income disregard described in subdivision (c) shall no longer apply.
(e) For purposes of calculating income under this section during
any calendar year, increases in social security benefit payments
under Title II of the federal Social Security Act (42 U.S.C. Sec. 401
and following) arising from cost-of-living adjustments shall be
disregarded commencing in the month that these social security
benefit payments are increased by the cost-of-living adjustment
through the month before the month in which a change in the federal
poverty level requires the department to modify the income disregard
pursuant to subdivision (c) and in which new income limits for the
program established by this section are adopted by the department.
(f) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department shall implement, without taking regulatory action,
subdivisions (a) and (b) of this section by means of an all county
letter or similar instruction. Thereafter, the department shall adopt
regulations in accordance with the requirements of Chapter 3.5
(commencing with Section 11340) of Part 1 of Division 3 of Title 2 of
the Government Code. Beginning six months after the effective date
of this section, the department shall provide a status report to the
Legislature on a semiannual basis until regulations have been
adopted.
SEC. 23. SEC. 22. Section 14005.33
is added to the Welfare and Institutions Code, to read:
14005.33. (a) (1) Notwithstanding Section 14005.30, to the extent
that federal financial participation is available, Medi-Cal benefits
under a benchmark plan as permitted under Section 6044 of the
federal Deficit Reduction Act of 2005 (42 U.S.C. Sec. 1396u-7) shall
be provided to individuals eligible for services under Section
1396u-1 of Title 42 of the United States Code, including any options
under Section 1396u-1(b)(2)(C) of Title 42 of the United State Code
made available to and exercised by the state.
(2) The department shall exercise its option under Section 1396u-1
(b)(2)(C) of Title 42 of the United States Code to adopt an income
disregard in an amount that is the difference between the Medi-Cal
income eligibility established under subdivision (d) of Section
14005.30 and 300 percent of the federal poverty level applicable to
the size of the family.
(b) The benchmark benefit plan referenced in subdivision (a) shall
be equivalent to the coverage established under Part 6.2 (commencing
with Section 12693) of Division 2 of the Insurance Code.
(c) To the extent that federal financial participation is
available, the department shall exercise its option under Section
1396u-1(b)(2)(C) of Title 42 of the United States Code as necessary
to simplify eligibility for Medi-Cal under subdivision (a) by
exempting all resources for applicants and recipients.
SEC. 24. SEC. 23. Section 14005.34
is added to the Welfare and Institutions Code, to read:
14005.34. Notwithstanding any other provision of law, all
children under 19 years of age who meet the state residency
requirements of the Medi-Cal program shall be eligible for full scope
benefits under this chapter if they either (a) live in families with
countable household income at or below 133 percent of the federal
poverty level, or (b) meet the income and resource requirements of
Section 14005.7 or 14005.30, including those children for whom
federal financial participation is not available under Title XXI of
the federal Social Security Act (42 U.S.C. Sec. 1396 et seq.), or
under Title XIX of the federal Social Security Act (42 U.S.C. Sec.
1397aa et seq.).
SEC. 25. SEC. 24. Section 14008.85
of the Welfare and Institutions Code is amended to read:
14008.85. (a) To the extent federal financial participation is
available, a parent who is the principal wage earner shall be
considered an unemployed parent for purposes of establishing
eligibility based upon deprivation of a child where any of the
following applies:
(1) The parent works less than 100 hours per month as determined
pursuant to the rules of the Aid to Families with Dependent Children
program as it existed on July 16, 1996, including the rule allowing a
temporary excess of hours due to intermittent work.
(2) The total net nonexempt earned income for the family is not
more than 100 percent of the federal poverty level as most recently
calculated by the federal government. The department may adopt
additional deductions to be taken from a family's income.
(3) The parent is considered unemployed under the terms of an
existing federal waiver of the 100-hour rule for recipients under the
program established by Section 1931(b) of the federal Social
Security Act (42 U.S.C. Sec. 1396u-1).
(4) The parent is eligible for services under Section 1396u-1 of
Title 42 of the United States Code, including any options under
Section 1396u-1(b)(2)(C) made available and exercised by the state.
(b) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department shall implement this section by means of an all county
letter or similar instruction without taking regulatory action.
Thereafter, the department shall adopt regulations in accordance with
the requirements of Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code.
SEC. 26. Section 14124.915 is added to the
Welfare and Institutions Code, to read:
14124.915. (a) A premium assistance benefit shall be established
that maximizes federal financial participation as follows:
(1) An individual eligible for benefits under this program who is
offered health coverage by his or her employer shall enroll in the
employer-offered health coverage on his or her own behalf and on
behalf of his or her dependents, if any.
(2) Individuals and dependents enrolling in employer-offered
health coverage pursuant to this section shall not be responsible for
any premium, deductible, or copayment requirements that are greater
than any premium, deductible, or copayment that the individual or
dependent would be required to pay under this program, if any.
(3) Individuals and dependents enrolling in employer-offered
health coverage pursuant to this section shall be eligible for a
wraparound benefit that covers any gap between the employer-offered
health coverage and the benefits provided by the program.
(b) Notwithstanding subdivision (a), an employer of an individual
who is required to enroll in employer-offered health coverage
pursuant to this section may elect to pay the full premium cost of
this program on behalf of the employee and his or her dependents who
are eligible for the program. An individual whose employer elects to
make this payment shall not be required to enroll in the
employer-offered health coverage, and shall instead enroll in this
program.
(c) The premium assistance benefit under subdivision (a) shall
only apply to individuals and their dependents when the State
Department of Health Care Services determines that it is cost
effective for the state.
SEC. 27. SEC. 25. Article 7
(commencing with Section 14199.10) is added to Chapter 7 of Part 3 of
Division 9 of the Welfare and Institutions Code, to read:
Article 7. Coordination with the California Health Trust Fund
14199.10. The department shall seek any necessary federal
approval to enable the state to receive federal funds for coverage
provided through the California Cooperative Health Insurance
Purchasing Program (Cal-CHIPP) to persons who would be eligible for
Medi-Cal if the state adopted an additional income disregard as
allowed by Section 1931(b) of the Social Security Act (42 U.S.C. Sec.
1396u-1(b)) sufficient to make persons with income up to 300 percent
of the federal poverty level eligible for coverage under that
section. Revenues in the California Health Trust Fund created
pursuant to Section 12699.206 of the Insurance Code shall be used as
state matching funds for receipt of federal funds resulting from the
implementation of this section. All federal funds received pursuant
to that federal approval shall be deposited in the California Health
Trust Fund.
SEC. 28. SEC. 26. (a) Sections 4, 9,
16, 23, and 26 15, and 22 of this act
shall become operative on July 1, 2008.
(b) Sections 15, 17, and 20 14, 16, and 19
of this act shall become operative on January 1, 2009.
SEC. 29. SEC. 27. The Legislature
finds and declares that Section 2 of this act, which amends Section
6254 of the Government Code, imposes a limitation on the public's
right of access to the meetings of public bodies or the writings of
public officials and agencies within the meaning of Section 3 of
Article I of the California Constitution. Pursuant to that
constitutional provision, the Legislature makes the following
findings to demonstrate the interest protected by this limitation and
the need for protecting that interest:
In order to maximize the ability of the Managed Risk Medical
Insurance Board to implement agreements with health plans and to
provide a wide choice of plans at minimal cost under the California
Cooperative Health Insurance Purchasing Program created pursuant to
Part 6.45 (commencing with Section 12699.201) of Division 2 of the
Insurance Code, it is necessary and appropriate to provide limited
confidentiality to certain writings developed in that regard.
SEC. 30. SEC. 28. No reimbursement
is required by this act pursuant to Section 6 of Article XIII B of
the California Constitution for certain costs that may be incurred by
a local agency or school district because, in that regard, 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.
However, if the Commission on State Mandates determines that this
act contains other costs mandated by the state, reimbursement to
local agencies and school districts for those costs shall be made
pursuant to Part 7 (commencing with Section 17500) of Division 4 of
Title 2 of the Government Code.