Bill Text: CA AB2198 | 2023-2024 | Regular Session | Amended

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Bill Title: Health information.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Engrossed) 2024-08-20 - Read second time. Ordered to third reading. [AB2198 Detail]

Download: California-2023-AB2198-Amended.html

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Amended  IN  Senate  August 19, 2024

Amended  IN  Senate  June 17, 2024

Amended  IN  Senate  June 03, 2024

Amended  IN  Assembly  April 29, 2024

CALIFORNIA LEGISLATURE— 2023–2024 REGULAR SESSION

Assembly Bill

No. 2198

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Introduced by Assembly Member Flora

February 07, 2024

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An act to amend Section 1374.196 of, and to add Section 1374.1965 to, of the Health and Safety Code, and to amend Section 10133.12 of, and to add Section 10133.125 to, of the Insurance Code, relating to health care.

LEGISLATIVE COUNSEL'S DIGEST

AB 2198, as amended, Flora. Health information.

Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care. Care and makes a willful violation of the act’s requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires health care service plans and health insurers insurers, commencing January 1, 2024, to establish and maintain specified application programming interfaces (API), including patient access API, for the benefit of enrollees, insureds, and contracted providers. Existing law authorizes the departments to require health care service plans or health insurers, as applicable, to establish and maintain provider access API and prior authorization support API if and when final federal rules are published .

This bill would, except for Medi-Cal dental managed care contracts, exclude a specialized plan or insurer that issues, sells, renews, or offers a contract or policy covering dental or vision services from the above-described API requirements, and would instead require a specialized plan or insurer that issues, sells, renews, or offers a contract or policy covering dental or vision services and meets specified enrollment requirements to comply with the above-described API requirements beginning January 1, 2027, or when the final federal rules for impacted payers are implemented, whichever is later.

This bill would instead require the departments, commencing January 1, 2027, or when final federal rules are implemented, whichever occurs later, to require health care service plans and health insurers to establish and maintain patient access API, provider access API, payer-to-payer API, and prior authorization API. The bill, until January 1, 2027, would authorize the departments to issue guidance relating to these provisions not subject to the Administrative Procedure Act, as specified. Because a violation of these requirements by a health care service plan would be a crime, this bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Digest Key

Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NOYES  

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Bill Text

The people of the State of California do enact as follows:

SECTION 1.

 Section 1374.196 of the Health and Safety Code is amended to read:

1374.196.

 (a) Commencing January 1, 2024, to facilitate patient and provider access to health information, a health care service plan shall 2027, or when final federal rules are implemented, whichever occurs later, the department shall require a health care service plan to establish and maintain the following application programming interfaces (API) for the benefit of enrollees and contracted providers, as applicable:

(1)Patient access API, as described in Section 422.119(a)-(e) of Title 42 of the Code of Federal Regulations.

(2)Provider directory API, as described in Section 422.120 of Title 42 of the Code of Federal Regulations.

(3)Payer-to-payer exchange API, as described in Section 422.119(f) of Title 42 of the Code of Federal Regulations.

(b)In addition to the API described in subdivision (a), the department may require a health care service plan to establish and maintain the following API if and when final rules are published by the federal government:

(1)Provider access API.

(2)Prior authorization support API.

(1) Patient access API.

(2) Provider access API.

(3) Payer-to-payer API.

(4) Prior authorization API.

(c)

(b) API described in subdivision (b) (a) shall be in accordance with standards published in a final rule issued by the federal Centers for Medicare and Medicaid Services and published in the Federal Register, and shall align with federal effective dates, including enforcement delays and suspensions, issued by the federal Centers for Medicare and Medicaid Services.

(c) (1) Until January 1, 2027, the director may issue guidance to health care service plans regarding compliance with this section and that guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).

(2) In developing the guidance under this subdivision, the department shall seek input from the State Department of Health Care Services.

(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 1367.27.

(e)Except for Medi-Cal dental managed care contracts authorized under Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code, a specialized health care service plan that issues, sells, renews, or offers a contract covering dental or vision services is excluded from the requirements of this section.

SEC. 2.Section 1374.1965 is added to the Health and Safety Code, to read:

1374.1965.

(a)Commencing January 1, 2027, or when the final federal rules for impacted payers are implemented, whichever is later, a specialized health care service plan, not subject to Section 1374.196, that issues, sells, renews, or offers a contract covering dental or vision services shall establish and maintain the following application programming interfaces (API) for the benefit of enrollees and contracted providers, as applicable:

(1)Patient access API, as described in Section 422.119(a)-(e) of Title 42 of the Code of Federal Regulations.

(2)Provider directory API, as described in Section 422.120 of Title 42 of the Code of Federal Regulations.

(3)Payer-to-payer exchange API, as described in Section 422.119(f) of Title 42 of the Code of Federal Regulations.

(b)In addition to the API described in subdivision (a), the department may require a dental or vision plan to establish and maintain the following API if and when final rules are published by the federal government:

(1)Provider access API.

(2)Prior authorization support API.

(c)API described in subdivision (b) shall be in accordance with standards published in a final rule issued by the federal Centers for Medicare and Medicaid Services and published in the Federal Register, and shall align with federal effective dates, including enforcement delays and suspensions, issued by the federal Centers for Medicare and Medicaid Services.

(d)This section does not limit existing requirements under this chapter, including, but not limited to, Section 1367.27.

SEC. 3.SEC. 2.

 Section 10133.12 of the Insurance Code is amended to read:

10133.12.

 (a) Commencing January 1, 2024, to facilitate patient and provider access to health information, a health insurer shall 2027, or when final federal rules are implemented, whichever occurs later, the department shall require a health insurer to establish and maintain the following application programming interfaces (API) for the benefit of all insureds and contracted providers, as applicable:

(1)Patient access API, as described in Section 422.119(a)-(e) of Title 42 of the Code of Federal Regulations.

(2)Provider directory API, as described in Section 422.120 of the Code of Federal Regulations.

(3)Payer-to-payer exchange API, as described in Section 422.119(f) of the Code of Federal Regulations.

(b)In addition to the API described in subdivision (a), the department may require a health insurer to establish and maintain the following API if and when final rules are published by the federal government:

(1)Provider access API.

(2)Prior authorization support API.

(1) Patient access API.

(2) Provider access API.

(3) Payer-to-payer API.

(4) Prior authorization API.

(c)

(b) API described in subdivision (b) (a) shall be in accordance with standards published in a final rule issued by the federal Centers for Medicare and Medicaid Services and published in the Federal Register, and shall align with federal effective dates, including enforcement delays and suspensions, issued by the federal Centers for Medicare and Medicaid Services.

(c) Until January 1, 2027, the commissioner may issue guidance to health insurers regarding compliance with this section and that guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).

(d) This section does not limit existing requirements under this chapter, including, but not limited to, Section 10133.15.

(e)Except for Medi-Cal dental managed care contracts authorized under Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code, a specialized health insurer that issues, sells, renews, or offers a policy covering dental or vision services is excluded from the requirements of this section.

SEC. 4.Section 10133.125 is added to the Insurance Code, to read:

10133.125.

(a)Commencing January 1, 2027, or when the final federal rules for impacted payers are implemented, whichever is later, a specialized health insurer, not subject to Section 10133.12, that issues, sells, renews, or offers a policy covering dental or vision services shall establish and maintain the following application programming interfaces (API) for the benefit of insureds and contracted providers, as applicable:

(1)Patient access API, as described in Section 422.119(a)-(e) of Title 42 of the Code of Federal Regulations.

(2)Provider directory API, as described in Section 422.120 of Title 42 of the Code of Federal Regulations.

(3)Payer-to-payer exchange API, as described in Section 422.119(f) of Title 42 of the Code of Federal Regulations.

(b)In addition to the API described in subdivision (a), the department may require a dental or vision insurer to establish and maintain the following API if and when final rules are published by the federal government:

(1)Provider access API.

(2)Prior authorization support API.

(c)API described in subdivision (b) shall be in accordance with standards published in a final rule issued by the federal Centers for Medicare and Medicaid Services and published in the Federal Register, and shall align with federal effective dates, including enforcement delays and suspensions, issued by the federal Centers for Medicare and Medicaid Services.

(d)This section does not limit existing requirements under this chapter, including, but not limited to, Section 10133.15.

SEC. 3.

 No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.