Bill Text: CA AB2895 | 2017-2018 | Regular Session | Amended
Bill Title: Primary Care Spending Transparency Act.
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Introduced - Dead) 2018-05-25 - In committee: Held under submission. [AB2895 Detail]
Download: California-2017-AB2895-Amended.html
Amended
IN
Assembly
April 11, 2018 |
Amended
IN
Assembly
March 08, 2018 |
Assembly Bill | No. 2895 |
Introduced by Assembly Members Arambula and Bonta |
February 16, 2018 |
LEGISLATIVE COUNSEL'S DIGEST
Beginning July 1, 2020, this bill would require the California Health and Human Services Agency to annually report to the Legislature information regarding plans’ and insurance carriers’ spending in the prior year.
The bill would make this reporting provision inoperative on July 1, 2024, and would repeal it as of January 1, 2025.
Digest Key
Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program:Bill Text
The people of the State of California do enact as follows:
SECTION 1.
The Legislature finds and declares the following:SEC. 2.
This act shall be known and may be cited as the Primary Care Spending Transparency Act.SEC. 3.
Section 1347 is added to the Health and Safety Code, to read:1347.
(a) No later than January 1, 2020, the department and the Department of Insurance shall convene a Primary Care Payment Reform Collaborative to propose revisions to the types of primary care data collected from health care service plans and health insurers, as well as to advise and assist in developing and sharing best practices in technical assistance and methods of payment that direct greater health care resources and investments toward supporting and facilitating health care innovation and care improvement in primary care.SEC. 4.
Section 1385.035 is added to the Health and Safety Code, immediately following Section 1385.03, to read:1385.035.
(a) Beginning October 1, 2019, a health care service plan that reports rate information pursuant to Section 1385.03 or 1385.045 shall report the following information to the department no later than October 1 of each year:SEC. 5.
Section 10110.8 is added to the Insurance Code, to read:10110.8.
(a) No later than January 1, 2020, the department and the Department of Managed Health Care shall convene a Primary Care Payment Reform Collaborative to propose revisions to the types of primary care data collected from health care service plans and health insurers, as well as to advise and assist in developing and sharing best practices in technical assistance and methods of payment that direct greater health care resources and investments toward supporting and facilitating health care innovation and care improvement in primary care.SEC. 6.
Section 10181.35 is added to the Insurance Code, immediately following Section 10181.3, to read:10181.35.
(a) Beginning October 1, 2019, a health insurer that reports rate information pursuant to Section 10181.3 or 10181.45 shall report the following information to the department no later than October 1 of each year:SEC. 7.
Section 14307 is added to the Welfare and Institutions Code, to read:14307.
(a) Beginning October 1, 2019, a managed care plan shall report the following information to the department no later than October 1 of each year:SEC. 8.
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.(a)A carrier shall annually report its total primary care expenditures to the California Health and Human Services Agency and shall include both of the following:
(1)The percentage of expenses the carrier allocated to primary care, compared to the carrier’s overall expenditures.
(2)The methods the carrier used to financially support the delivery of primary care services.
(b)The California Health and Human Services Agency, in coordination with the Department of Managed Health Care and the Department of Insurance, shall adopt rules prescribing the primary care services for which costs are reported pursuant to
subdivision (a).
(c)Beginning July 1, 2020, and no later than July 1 of each year thereafter, the California Health and Human Services Agency shall post a report regarding carriers’ spending in the prior year to its Internet Web site.
(d)(1)No later than January 1, 2020, the California Health and Human Services Agency shall convene a Primary Care Payment Reform Collaborative to propose revisions to the types of primary care data collected from carriers, as well as to advise and assist in developing and sharing best practices in technical assistance and methods of payment that direct greater health care resources and investments toward supporting and facilitating health care innovation and care improvement in primary care.
(2)The California Health and Human Services Agency shall appoint
representatives from each of the following groups to participate in the Primary Care Payment Reform Collaborative:
(A)Primary care clinicians.
(B)Health care consumers.
(C)Experts in primary care contracting and payment.
(D)Independent practice associations.
(E)Third-party administrators.
(F)Employers that offer self-insured health benefit plans.
(G)The Department of Insurance.
(H)The Department of Managed Health Care.
(I)Carriers.
(J)Mental and behavioral health professionals.
(K)A statewide organization representing community clinics.
(L)A statewide organization representing hospitals and health systems.
(M)A statewide professional association for family physicians.
(N)A statewide professional association for physicians.
(O)A statewide professional association for primary care clinicians.
(P)The federal Centers for Medicare and Medicaid Services.
(Q)The California Health Benefit Exchange,
also known as Covered California.
(e)For purposes of this section and Section 12803.15, the following definitions apply:
(1)“Carrier” means an insurer or health care service plan that offers a health benefit policy.
(2)“Primary care” means health care services delivered by clinicians specializing in family medicine, general internal medicine, or general pediatrics.
(3)“Primary care clinician” means a physician or other health professional licensed or certified in California whose clinical practice is in the area of primary care.
(4)“Total primary care expenditures” means a detailed list of all claims-based and non-claims-based payments for physical and mental health primary care
services, excluding prescription drugs, vision care, and dental care, whether the payments are on a fee for service basis, as part of a capitated rate, or another type of payment mechanism, and provided to enrollees or insureds by a primary care clinician in a primary care setting, including payments to support primary care infrastructure.
(a)Beginning July 1, 2020, and no later than July 1 of each year thereafter, the California Health and Human Services Agency shall report to the Legislature regarding carriers’ spending in the prior year using data received pursuant to subdivision (a) of Section 12803.1.
(b)A report submitted pursuant to subdivision (a) shall be submitted in compliance with Section 9795.
(c)This section shall become inoperative on July 1, 2024, and, as of January 1, 2025, is repealed.