Parity 

SB 225 (Wiener) – Parity Clean Up Bill

This morning, a new bill (a “gut and amend”; when amendments to a bill remove the current contents in their entirety and replace the contents with different provisions) appeared in print regarding parity. It is a clean up bill to SB 221 (Wiener) that was committed to at the end of last year by the author. Language was negotiated with the Department of Managed Health Care (DMHC), National Union of Healthcare Workers (NUHW), and Health Access.

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 and makes a willful violation of the act a crime. Existing law requires a health care service plan that provides or arranges for the provision of hospital or physician services to comply with specified timely access to care requirements, including ensuring that its network has adequate capacity and availability of licensed health care providers to offer enrollees appointments that meet specified timeframes. Existing law authorizes the department director to take enforcement action against health care plans that fail to comply with these provisions, including assessing administrative penalties.

This bill would require a health care service plan to incorporate timely access to care standards and processes into its quality assurance systems. The bill would authorize the department to develop methodologies to demonstrate appointment wait time compliance and averages, take compliance or disciplinary action, review and adopt standards concerning the availability of health care to ensure enrollees have timely access to care, and make recommendations to the Legislature if it finds that health care service plans and providers have difficulty meeting the standards the department develops. The bill would require the director to consider, as an aggravating factor when assessing administrative penalties, if harm to an enrollee has occurred as a result of plan noncompliance. The bill would clarify that the timely access to care provisions do not alter requirements or standards for Medi-Cal managed care plans, except as specified. 

The DMHC Releases New SB 855 Draft Regulation 

The DMHC has released an additional 855 draft regulation and is seeking feedback by the close of business on June 22nd. In the draft regulations document, you will find track changes from their April to June versions. You may also view a document comparing the changes in each of the subdivisions along with notes on each subdivision/change.

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