Today's Law As Amended


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SB-437 Health care coverage: joint senior level working group.(2017-2018)



As Amends the Law Today


SECTION 1.

 Section 1342.4 of the Health and Safety Code is amended to read:

1342.4.
 (a)  The Department of Managed Health Care and the Department of Insurance shall maintain a joint senior level working group to ensure clarity for health care consumers about who enforces their patient rights and consistency in the regulations of these departments.
(b)  The joint working group shall undertake a review and examination of the Health and Safety Code, the Insurance Code, and the Welfare and Institutions Code as they apply to the Department of Managed Health Care and the Department of Insurance to ensure consistency in consumer protection.
(c)  The joint working group shall review and examine all of the following processes in each department:
(1)  Grievance  The grievance  and consumer complaint processes, including, but not limited to, outreach, standard complaints, including coverage and medical necessity complaints, timely access to care, network adequacy,  independent medical review, and information developed for consumer use.
(2)  The processes used to ensure enforcement of the law, including, but not limited to, the medical survey and audit process in the Health and Safety Code and market conduct exams in the Insurance Code.
(3) The state implementation of federal health care reforms, including any changes in federal law, or rules, regulations, or guidance issued under federal law.
(3)  (4)  The processes for regulating the timely payment of claims.
(d)  The joint working group shall report its findings to the Insurance Commissioner and the Director of the Department of Managed Health Care for review and approval. The commissioner and the director shall submit the approved final report under signature to the Legislature by January 1 of every year for five years.

SEC. 2.

 Section 12923.5 of the Insurance Code is amended to read:

12923.5.
 (a) The Department of Managed Health Care and the Department of Insurance shall maintain a joint senior level working group to ensure clarity for health care consumers about who enforces their patient rights and consistency in the regulations of these departments.
(b) The joint working group shall undertake a review and examination of the Health and Safety Code, the Insurance Code, and the Welfare and Institutions Code as they apply to the Department of Managed Health Care and the Department of Insurance to ensure consistency in consumer protection.
(c) The joint working group shall review and examine all of the following processes in each department:
(1) Grievance  The grievance  and consumer complaint processes, including, but not limited to, outreach, standard complaints, including coverage and medical necessity complaints, timely access to care, network adequacy,  independent medical review, and information developed for consumer use.
(2) The processes used to ensure enforcement of the law, including, but not limited to, the medical survey and audit process in the Health and Safety Code and market conduct exams in the Insurance Code.
(3) The state implementation of federal health care reforms, including any changes in federal law, or rules, regulations, or guidance issued under federal law.
(3) (4)  The processes for regulating the timely payment of claims.
(d) The joint working group shall report its findings to the Insurance Commissioner and the Director of the Department of Managed Health Care for review and approval. The commissioner and the director shall submit the approved final report under signature to the Legislature by January 1 of every year for five years.