BILL NUMBER: SB 750 CHAPTERED BILL TEXT CHAPTER 835 FILED WITH SECRETARY OF STATE SEPTEMBER 25, 1998 APPROVED BY GOVERNOR SEPTEMBER 24, 1998 PASSED THE SENATE AUGUST 27, 1998 PASSED THE ASSEMBLY AUGUST 24, 1998 AMENDED IN ASSEMBLY AUGUST 20, 1998 AMENDED IN ASSEMBLY SEPTEMBER 5, 1997 AMENDED IN ASSEMBLY AUGUST 25, 1997 INTRODUCED BY Senator Rosenthal FEBRUARY 26, 1997 An act to amend Section 1367.10 of the Health and Safety Code, relating to health care coverage. LEGISLATIVE COUNSEL'S DIGEST SB 750, Rosenthal. Health care coverage. Existing law provides for the licensure and regulation of health care service plans by the Department of Corporations, and provides that a willful violation of these provisions is subject to criminal sanction. Existing law requires every health care service plan that will affect the choice of physician, hospital, or other health care providers to clearly inform prospective enrollees of this restriction of choice, as prescribed. This bill would require every health care service plan, medical group, independent practice association, or participating health care provider that uses or receives financial bonuses or any other incentives to provide a written summary to any person who requests it that includes a general description of the bonus or incentive arrangements used in its compensation agreements and how bonus or incentive arrangements may relate to a provider's use of referral services. By imposing this requirement on health care service plans, this bill would change the definition of a crime, thereby imposing a state-mandated local program. 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. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. Section 1367.10 of the Health and Safety Code is amended to read: 1367.10. (a) Every health care service plan shall include within its disclosure form and within its evidence of coverage a statement clearly describing how participation in the plan may affect the choice of physician, hospital, or other health care providers, the basic method of reimbursement, including the scope and general methods of payment made to its contracting providers of health care services, and whether financial bonuses or any other incentives are used. The disclosure form and evidence of coverage shall indicate that if an enrollee wishes to know more about these issues, the enrollee may request additional information from the health care service plan, the enrollee's provider, or the provider's medical group or independent practice association regarding the information required pursuant to subdivision (b). (b) If a plan, medical group, independent practice association, or participating health care provider uses or receives financial bonuses or any other incentives, the plan, medical group, independent practice association, or health care provider shall provide a written summary to any person who requests it that includes all of the following: (1) A general description of the bonus and any other incentive arrangements used in its compensation agreements. Nothing in this section shall be construed to require disclosure of trade secrets or commercial or financial information that is privileged or confidential, such as payment rates, as determined by the commissioner, pursuant to state law. (2) A description regarding whether, and in what manner, the bonuses and any other incentives are related to a provider's use of referral services. (c) The statements and written information provided pursuant to subdivisions (a) and (b) shall be communicated in clear and simple language that enables consumers to evaluate and compare health care service plans. (d) The plan shall clearly inform prospective enrollees that participation in that plan will affect the person's choice of provider by placing the following statement in a conspicuous place on all material required to be given to prospective enrollees including promotional and descriptive material, disclosure forms, and certificates and evidences of coverage: PLEASE READ THE FOLLOWING INFORMATION SO YOU WILL KNOW FROM WHOM OR WHAT GROUP OF PROVIDERS HEALTH CARE MAY BE OBTAINED It is not the intent of this section to require that the names of individual health care providers be enumerated to prospective enrollees. If the health care service plan provides a list of providers to patients or contracting providers, the plan shall include within the provider listing a notification that enrollees may contact the plan in order to obtain a list of the facilities with which the health care service plan is contracting for subacute care and/or transitional inpatient care. SEC. 2. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution. Notwithstanding Section 17580 of the Government Code, unless otherwise specified, the provisions of this act shall become operative on the same date that the act takes effect pursuant to the California Constitution.