Health care coverage: health facilities: cost and quality information.

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. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law prohibits a contract between a plan or insurer and a health care provider from containing certain terms. This bill would prohibit a contract by or on behalf of a plan or insurer and a health care facility, as defined, to provide inpatient hospital services or ambulatory care services to subscribers and enrollees of the plan or policyholders and insureds of the insurer from containing a provision that restricts the ability of the plan or insurer to furnish information to subscribers or enrollees of the plan or policyholders or insureds of the insurer concerning the cost range of procedures at the facility or the quality of services performed by the facility, provided that, among other requirements, the cost information is limited to certain elective, uncomplicated procedures, the plan or insurer also discloses the location of its facility cost ranges and quality measurements and makes specified disclosures regarding those measurements and the cost information provided, and the plan or insurer provides affected facilities an opportunity to review the information prior to furnishing it to subscribers, enrollees, policyholders, or insureds, as specified. The bill would make a contractual provision inconsistent with the bill's requirements void and unenforceable.