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AB-2895 Primary Care Spending Transparency Act.(2017-2018)

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Date Published: 04/11/2018 09:00 PM
AB2895:v97#DOCUMENT

Amended  IN  Assembly  April 11, 2018
Amended  IN  Assembly  March 08, 2018

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Assembly Bill No. 2895


Introduced by Assembly Members Arambula and Bonta

February 16, 2018


An act to add Section 12803.1 to, and to add and repeal Section 12803.15 of, the Government Sections 1347 and 1385.035 to the Health and Safety Code, to add Sections 10110.8 and 10181.35 to the Insurance Code, and to add Section 14307 to the Welfare and Institutions Code, relating to health care coverage.


LEGISLATIVE COUNSEL'S DIGEST


AB 2895, as amended, Arambula. Primary Care Spending Transparency Act.
Existing law establishes the California Health and Human Services Agency, which consists of various departments, including the Department of Managed Health Care. Existing law, the Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene), 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 provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.
Existing law requires a health care service plan or health insurer to annually report specified information to the Department of Managed Health Care or the Department of Insurance, including, among other things, the number of persons that receive health care coverage under specified health care service plans or health insurance policies. Existing law requires the departments to publicly report that information, including posting it on their Internet Web sites.
This bill, the Primary Care Spending Transparency Act, would require an insurer or a health care service plan or health insurer that offers a health benefit policy reports rate information, as specified, to annually report its total primary care expenditures and other specified information to the California Health and Human Services Agency, and the percentage of expenses the health care service plan or health insurer allocated to primary care, among other things. The bill would require the agency Department of Managed Health Care and the Department of Insurance to annually compile and post a report with that information on its their Internet Web site, sites, beginning July 1, 2020. The bill would direct the agency, in coordination with the Department of Managed Health Care and the Department of Insurance, to adopt rules prescribing the primary care services for which costs are reported. January 1, 2020, and would require the departments to include their reports as discussion items at specified public meetings. The bill would also require a managed health care plan to annually report specified information to the State Department of Health Care Services, which would be required to annually compile and post a report with that information on its Internet Web site, beginning January 1, 2020. The bill would require the agency Department of Managed Health Care and the Department of Insurance to convene the Primary Care Payment Reform Collaborative no later than January 1, 2020, to propose revisions to the types of primary care data collected from health care service plans and insurance carriers, health insurers, as well as to advise and assist in developing specified best practices. The bill would prescribe the membership of the Primary Care Payment Reform Collaborative.

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.

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

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


SECTION 1.

 The Legislature finds and declares the following:
(a) Collaboration among insurers, health care service plans, purchasers, and providers of health care to coordinate service delivery systems and develop innovative payment methods in support of primary integrated and coordinated health care delivery is in the best interest of the public.
(b) It is the intent of the Legislature in enacting this act to provide for collaboration among public payers, private health insurance carriers companies and health care service plans, third-party purchasers, primary care clinicians, and others as necessary to identify consistent appropriate payment methods to support primary care.
(c) It is not the intent of the Legislature in enacting this act to authorize a person or entity to engage in or conspire to engage in an activity that would constitute a per se violation of state or federal antitrust laws, including, but not limited to, an agreement among competing health care service plans or health insurance carriers companies as to the price or specific level of payment for a health care service.
(d) Groups, including, but not limited to, health insurance companies, health care service plans, health care centers, hospitals, health service organizations, employers, health care clinicians, health care facilities, state and local governmental entities, and consumers, may meet to facilitate the development, implementation, and operation of the Primary Care Payment Reform Collaborative in accordance with this act.

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.
(b) The department and the Department of Insurance shall appoint representatives from each of the following groups to participate in the Primary Care Payment Reform Collaborative:
(1) Primary care clinicians.
(2) Health care consumers.
(3) Experts in primary care contracting and payment.
(4) Independent practice associations.
(5) Third-party administrators.
(6) Employers that offer self-insured health benefit plans.
(7) The department.
(8) The Department of Insurance.
(9) Health care service plans and health insurers.
(10) Mental and behavioral health professionals.
(11) A statewide organization representing community clinics.
(12) A statewide organization representing hospitals and health systems.
(13) A statewide professional association for family physicians.
(14) A statewide professional association for physicians.
(15) A statewide professional association for primary care clinicians.
(16) The federal Centers for Medicare and Medicaid Services.
(17) The California Health Benefit Exchange, also known as Covered California.
(c) For purposes of this section:
(1) “Primary care services” means health care services delivered by clinicians specializing in family medicine, general internal medicine, or general pediatrics.
(2) “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.

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:
(1) For medical benefits, a separation of primary care and specialty services.
(2) The percentage of expenses the health care service plan allocated to primary care, compared to the health care service plan’s overall expenditures.
(3) The methods the health care service plan used to financially support the delivery of primary care services.
(b) (1) The department shall compile the information reported pursuant to subdivision (a) into a public report that demonstrates health care service plans’ spending on primary care services. The data in the report shall be aggregated and shall not reveal information specific to an individual health care service plan.
(2) On or before January 1, 2020, and by January 1 every year thereafter, the department shall publish the report on its Internet Web site.
(3) After the report is published, the department shall include the report as part of a discussion item at the public meeting required pursuant to subdivision (b) of Section 1385.045.

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.
(b) The department and the Department of Managed Health Care shall appoint representatives from each of the following groups to participate in the Primary Care Payment Reform Collaborative:
(1) Primary care clinicians.
(2) Health care consumers.
(3) Experts in primary care contracting and payment.
(4) Independent practice associations.
(5) Third-party administrators.
(6) Employers that offer self-insured health benefit plans.
(7) The department.
(8) The Department of Managed Health Care.
(9) Health care service plans and health insurers.
(10) Mental and behavioral health professionals.
(11) A statewide organization representing community clinics.
(12) A statewide organization representing hospitals and health systems.
(13) A statewide professional association for family physicians.
(14) A statewide professional association for physicians.
(15) A statewide professional association for primary care clinicians.
(16) The federal Centers for Medicare and Medicaid Services.
(17) The California Health Benefit Exchange, also known as Covered California.
(c) For purposes of this section:
(1) “Primary care services” means health care services delivered by clinicians specializing in family medicine, general internal medicine, or general pediatrics.
(2) “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.

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:
(1) For medical benefits, a separation of primary care and specialty services.
(2) The percentage of expenses the health insurer allocated to primary care, compared to the health insurer’s overall expenditures.
(3) The methods the health insurer used to financially support the delivery of primary care services.
(b) (1) The department shall compile the information reported pursuant to subdivision (a) into a public report that demonstrates health insurers’ spending on primary care services. The data in the report shall be aggregated and shall not reveal information specific to an individual health insurer.
(2) On or before January 1, 2020, and by January 1 every year thereafter, the department shall publish the report on its Internet Web site.
(3) After the report is published, the department shall include the report as part of a discussion item at the public meeting required pursuant to subdivision (b) of Section 10181.45.

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:
(1) For medical benefits, a separation of primary care and specialty services.
(2) The percentage of expenses the managed care plan allocated to primary care, compared to the managed care plan’s overall expenditures.
(3) The methods the managed care plan used to financially support the delivery of primary care services.
(b) (1) The department shall compile the information reported pursuant to subdivision (a) into a public report that demonstrates managed care plans’ spending on primary care services. The data in the report shall be aggregated and shall not reveal information specific to an individual managed care plan.
(2) On or before January 1, 2020, and by January 1 every year thereafter, the department shall publish the report on its Internet Web site.

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.
SEC. 3.Section 12803.1 is added to the Government Code, to read:
12803.1.

(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.

SEC. 4.Section 12803.15 is added to the Government Code, to read:
12803.15.

(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.