Today's Law As Amended

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SB-1255 Health insurance market: financial assistance.(2017-2018)



SECTION 1.

 Section 100504 of the Government Code is amended to read:

100504.
 (a) The board may do the following:
(1) With respect to individual coverage made available in the Exchange, collect premiums and assist in the administration of subsidies.
(2) Enter into contracts.
(3) Sue and be sued.
(4) Receive and accept gifts, grants, or donations of moneys from any an  agency of the United States, any an  agency of the state, and any a  municipality, county, or other political subdivision of the state.
(5) Receive and accept gifts, grants, or donations from individuals, associations, private foundations, and corporations, in compliance with the conflict of interest provisions to be adopted by the board at a public meeting.
(6) (A)  Adopt rules and regulations, as necessary. Until January 1, 2022, any  2017,  necessary rules and regulations, except those implementing Section 1043,  regulations may be adopted as emergency regulations in accordance with the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2). Until January 1, 2019, necessary rules and regulations to implement the eligibility, enrollment, and appeals processes for the individual and small business exchanges, changes to the small business exchange, or an act in effect that amends this title that is operative on or before December 31, 2016,  may be adopted as emergency regulations in accordance with the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2). The adoption of emergency regulations pursuant to this section shall be deemed to be an emergency and necessary for the immediate preservation of the public peace, health and safety, or general welfare. Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2, including subdivisions (e) and (h) of Section 11346.1, any an  emergency regulation adopted pursuant to this section shall be repealed by operation of law unless the adoption, amendment, or repeal of the regulation is promulgated by the board pursuant to Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code  within five years of the initial adoption of the emergency regulation. Any rule or regulation adopted pursuant to this section shall be discussed by the board during at least one properly noticed board meeting prior to the board meeting at which the board adopts the rule or regulation. Notwithstanding subdivision (h) of Section 11346.1, until January 1, 2027, the Office of Administrative Law may approve more than two readoptions of an emergency regulation adopted pursuant to this section. Notwithstanding subdivision (h) of Section 11346.1, until January 1, 2020, the Office of Administrative Law may approve more than two readoptions of an emergency regulation adopted pursuant to this section. The amendments made to this paragraph by the act adding this sentence shall apply to an emergency regulation adopted pursuant to this section before the effective date of the Budget Act of 2015. 
(B) The amendments made to this paragraph by the act that added this subparagraph also shall apply to any regulation adopted pursuant to this section prior to January 1, 2019.
(7) Collaborate with the State Department of Health Care Services and the Managed Risk Medical Insurance Board, to the extent possible, to allow an individual the option to remain enrolled with his or her carrier and provider network in the event the individual experiences a loss of eligibility of premium tax credits and becomes eligible for the Medi-Cal program or the Healthy Families Program, or loses eligibility for the Medi-Cal program or the Healthy Families Program and becomes eligible for premium tax credits through the Exchange.
(8) Share information with relevant state departments, consistent with the confidentiality provisions in Section 1411 of the federal act, necessary for the administration of the Exchange.
(9) Require carriers participating in the Exchange to make available to the Exchange and regularly update an electronic directory of contracting health care providers so that individuals seeking coverage through the Exchange can search by health care provider name to determine which health plans in the Exchange include that health care provider in their network. The board may also require a carrier to provide regularly updated information to the Exchange as to whether a health care provider is accepting new patients for a particular health plan. The Exchange may provide an integrated and uniform consumer directory of health care providers indicating which carriers the providers contract with and whether the providers are currently accepting new patients. The Exchange may also establish methods by which health care providers may transmit relevant information directly to the Exchange, rather than through a carrier.
(10) Make available supplemental coverage for enrollees of the Exchange to the extent permitted by the federal act, provided that no  General Fund money is not  used to pay the cost of that coverage. Any supplemental  Supplemental  coverage offered in the Exchange shall be subject to the charge imposed under subdivision (n) of Section 100503.
(b) The Exchange shall only collect information from individuals or designees of individuals necessary to administer the Exchange and consistent with the federal act.
(c) (1) The board shall have the authority to standardize products to be offered through the Exchange. Any products A product  standardized by the board pursuant to this subdivision shall be discussed by the board during at least one properly noticed board meeting prior to  before  the board meeting at which the board adopts the standardized products to be offered through the Exchange.
(2) The adoption, amendment, or repeal of a regulation by the board to implement this subdivision is exempt from the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2).
(d) The Exchange shall administer financial assistance to help low- and middle-income Californians access affordable health care coverage, with respect to individual coverage made available in the Exchange as follows:
(1) The Exchange shall give priority for financial assistance to an individual whose premium payment is equal to or greater than 8 percent of his or her annual household income. Those individuals shall include an individual whose household income is less than 400 percent of the federal poverty level and who is not eligible for Medi-Cal, or an individual whose annual household income is greater than 400 percent of the federal poverty level.
(2) The Exchange shall also give priority for financial assistance to an individual with an annual income that is equal to or greater than 200 percent of the federal poverty level, but not more than 400 percent of the federal poverty level, who is subject to significant cost-sharing expenses.
(3) The Exchange shall administer financial assistance in a manner that maximizes federally funded subsidies for Californians to the greatest extent possible.
(4) For purposes of this subdivision, “financial assistance” includes, but is not limited to, direct premium assistance through an advanced or refundable credit toward premium payment or assistance with cost sharing.
(5) Notwithstanding Section 100520, the Exchange shall implement this subdivision only to the extent that the Legislature appropriates funding for this purpose.