Bill Text: CA SB382 | 2019-2020 | Regular Session | Amended
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Medi-Cal: managed care health plan.
Sponsorship: Bipartisan Bill
Status: (Vetoed) 2020-01-13 - Veto sustained. [SB382 Detail]
Download: California-2019-SB382-Amended.html
Bill Title: Medi-Cal: managed care health plan.
Sponsorship: Bipartisan Bill
Status: (Vetoed) 2020-01-13 - Veto sustained. [SB382 Detail]
Download: California-2019-SB382-Amended.html
|
Amended
IN
Senate
March 26, 2019 |
CALIFORNIA LEGISLATURE—
2019–2020 REGULAR SESSION
| Senate Bill | No. 382 |
| Introduced by |
February 20, 2019 |
An act to amend Section 1368.7 of the Health and Safety Code, and to amend Section 10112.95 of the Insurance Code, relating to healthcare health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
SB 382, as amended, Nielsen.
Healthcare Health care coverage: state of emergency.
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 a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan or health insurer to provide access to medically necessary health care services to its enrollees who have been displaced by a state of emergency. If the Governor declares a state of emergency that displaces or has the immediate potential to displace enrollees, existing law requires a health care service plan to file a specified notification with the department within 48 hours of the declaration.
Existing law enumerates actions that a plan or insurer may be required to take to meet the needs of its enrollees or insureds during the state of emergency.
This bill would make technical, nonsubstantive changes to those provisions.
This bill would require a health care service plan contract or health insurance policy entered into, amended, or renewed on or after January 1, 2020, to provide reimbursement of at least the administrative day rate to enrollees and insureds who remain in acute care hospitals, but no longer meet medically necessary criteria, due to a lack of access to postacute care services during a state of emergency. The bill would specify that a plan or insurer may be
required to identify enrollees or insureds being cared for in acute care hospitals and create individualized postacute care services plans during a state of emergency. 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 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 t6> (a) A health care service plan shall provide an enrollee who has been displaced by a state of emergency, as declared by the Governor pursuant to Section 8625 of the Government Code, access to medically necessary health care services.
(b) Within 48 hours of a declaration by the Governor of a state of emergency that displaces or has the immediate potential to displace enrollees, a health care service plan operating in the county or counties included in the declaration shall file with the department a notification describing whether the plan has experienced or expects to experience any disruption to the operation of the plan, explaining how the plan is communicating with potentially impacted
enrollees, and summarizing the actions the plan has taken or is in the process of taking to ensure that the health care needs of enrollees are met. This may require the plan to take actions, including, but not limited to, the following:
(1) Relax time limits for prior authorization, precertification, or referrals.
(2) Extend filing deadlines for claims.
(3) Suspend prescription refill limitations and allow an impacted enrollee to refill the enrollee’s prescriptions at an out-of-network pharmacy.
(4) Authorize an enrollee to replace medical equipment or supplies.
(5) Allow an enrollee to access
an appropriate out-of-network provider if an in-network provider is unavailable due to the state of emergency or if the enrollee is out of the area due to displacement.
(6) Have a toll-free telephone number that an affected enrollee may call for answers to questions, including questions about the loss of health insurance identification cards, access to prescription refills, or how to access health care.
(7) Identify all enrollees being cared for in acute care hospitals and create individualized plans to meet each enrollee’s postacute care services needs, including, but not limited to, skilled nursing facility placement, home health services, dialysis services, therapy services, behavioral health care, and other needed services to support the
health of the enrollee.
(c) A health care service plan contract entered into, amended, or renewed on or after January 1, 2020, shall provide reimbursement for care provided to enrollees who remain in acute care hospitals, and no longer meet the medical necessity criteria for care in an acute care hospital, due to a lack of access to postacute care services during a state of emergency. Daily reimbursement shall be no lower than the administrative day rate established by the State Department of Health Care Services, unless the plan has otherwise contracted with the acute care hospital for reimbursement during a state of emergency.
(c)
(d) This section does not limit the Governor’s authority under the California Emergency Services Act (Chapter 7 (commencing with Section 8550) of Division 1 of Title 2 of the Government Code), or the director’s authority under this chapter.
SEC. 2.
Section 10112.95 of the Insurance Code is amended to read:10112.95.
(a) A health insurer shall provide an insured who has been displaced by a state of emergency, as declared by the Governor pursuant to Section 8625 of the Government Code, access to medically necessary health care services.(b) Within 48 hours of a declaration by the Governor of a state of emergency that displaces or has the immediate potential to displace insureds, a health insurer operating in the county or counties included in the declaration shall file with the department a notification describing whether the insurer has experienced or expects to experience any disruption to the operation of the insurer, explaining how the insurer is communicating with potentially impacted insureds, and summarizing the actions the insurer has taken or is in the process of
taking to ensure that the health care needs of insureds are met. This may require the insurer to take actions, including, but not limited to, the following:
(1) Relax time limits for prior authorization, precertification, or referrals.
(2) Extend filing deadlines for claims.
(3) Suspend prescription refill limitations and allow an impacted insured to refill his or her the insured’s
prescriptions at an out-of-network pharmacy.
(4) Authorize an insured to replace medical equipment or supplies.
(5) Allow an insured to access an appropriate out-of-network provider if an in-network provider is unavailable due to the state of emergency or if the insured is out of the area due to displacement.
(6) Have a toll-free telephone number that an affected insured may call for answers to questions, including questions about the loss of health insurance identification cards, access to prescription refills, or how to access health care.
(7) Identify all insureds being cared for in acute care hospitals and create individualized plans to meet each
insured’s postacute care services needs, including, but not limited to, skilled nursing facility placement, home health services, dialysis services, therapy services, behavioral health care, and other needed services to support the health of the insured.
(c) A health insurance policy entered into, amended, or renewed on or after January 1, 2020, shall provide reimbursement for care provided to insureds who remain in acute care hospitals, and no longer meet the medical necessity criteria for care in an acute care hospital, due to a lack of access to postacute care services during a state of emergency. Daily reimbursement shall be no lower than the administrative day rate established by the State Department of Health Care Services, unless the plan has otherwise contracted with the acute care hospital for reimbursement during a state of emergency.
(c)
(d) This section shall not be construed to does not limit the Governor’s authority under the California Emergency Services Act (Chapter 7 (commencing with Section 8550) of Division 1 of Title 2 of the Government Code), or the commissioner’s authority under any provision of
this part.
