Bill Text: CA AB1059 | 2011-2012 | Regular Session | Amended
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Emergency medical care.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Passed) 2011-10-02 - Chaptered by Secretary of State - Chapter 403, Statutes of 2011. [AB1059 Detail]
Download: California-2011-AB1059-Amended.html
Bill Title: Emergency medical care.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Passed) 2011-10-02 - Chaptered by Secretary of State - Chapter 403, Statutes of 2011. [AB1059 Detail]
Download: California-2011-AB1059-Amended.html
BILL NUMBER: AB 1059 AMENDED BILL TEXT AMENDED IN ASSEMBLY MAY 27, 2011 INTRODUCED BY Assembly Member Huffman FEBRUARY 18, 2011 An act to add Section1386.51371.371 to the Health and Safety Code, relating to health care service plans. LEGISLATIVE COUNSEL'S DIGEST AB 1059, as amended, Huffman. Health care service plans. Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the regulation of health care service plans by the Department of Managed Health Care. Existing law requires a health care service plan to pay claims for provided health care services within a specified period of time and prohibits a health care service plan from engaging in an unfair payment pattern, as defined. This bill would require the director, upon a final determination that a health care service plan has underpaid or failed to pay a provider, as specified, toassess an administrative penalty and torequire the plan to pay the provider the amount owed plus interest, as specified.The bill would authorize the director to exempt a plan from paying the administrative penalty if the director makes a written finding that paying both the penalty and the provider would jeopardize the financial solvency of the plan.The bill would also specify that a provider shall not be required to resubmit a claim to a plan unless the director makes a determination that an extraordinary circumstance exists and requires the plan to reimburse the provider for the cost of resubmission, as specified. Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. Section1386.51371.371 is added to the Health and Safety Code, to read:1386.5.1371.371. (a) Upon a final determination by the director that a health care service plan has underpaid or failed to pay a provider in violation of Section 1371.37, the director shall, by order, do both of the following:(1) Assess an administrative penalty in an amount not less than the amount owed plus interest.(2)Requirerequire the plan to pay the provider an amount not less than the amount owed plus interest.(b) The director may exempt a plan from paying the administrative penalty assessed in paragraph (1) of subdivision (a) if the director makes a written finding that paying that penalty and making the payment required in paragraph (2) of subdivision (a) would jeopardize the financial solvency of the plan.(c)(b) Except as provided in subdivision(d)(c) , a provider shall not be required to resubmit a claim to a health care service plan in order to receive payment pursuant to this section.(d)(c) If the director makes a determination that an extraordinary circumstance exists, the director may require a provider to resubmit a claim to a health care service plan in order to receive payment pursuant to this section, provided that the director also requires the plan to add to the amount owed to the provider a reasonable amount necessary to reimburse the provider for the cost of resubmission.(e)(d) The remedies provided by this section are not exclusive, and may be sought and employed in any combination with civil, criminal, and other administrative remedies deemed warranted by the director to enforce this chapter.(f)(e) Notwithstanding the date on which the director makes a final determination specified in subdivision (a), the calculation of the amount of the remedy imposed pursuant to subdivision (a) shall be based on the date on which the plan committed the violation specified in that subdivision.(g)(f) Notwithstanding the provisions of subdivision (a), a plan shall not be required to pay a provider more than the amount owed plus interest on a claim, and the department may take into account any other payments that have been made on that same claim.(h)(g) A health care service plan may not delegate a statutory liability under this section.