Today's Law As Amended

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



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 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 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.