Health care coverage: quality rating.

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 makes a willful violation of the act's requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires every health care service plan and certain health insurers, on or before July 1, 1999, to file with the respective departments a description of policies and procedures related to economic profiling, as defined, utilized by the plan or insurer and its medical groups and individual practice associations and requires the Director of the Department of Managed Health Care and the Insurance Commissioner to make these filings available to the public upon request with certain exceptions. Existing law requires each plan or health insurer using economic profiling to provide, upon request, a copy of economic profiling information to the profiled individual, group, or association. Existing law also requires each plan or insurer, as a contract condition, to require its contracting medical groups and individual practice associations that maintain economic profiles of individual providers to provide, upon request, a copy to the profiled individual providers. This bill would expand these provisions to apply to quality rating, as defined, utilized by the plan or insurer with respect to a particular physician, provider, medical group, or individual practice association. The bill would also require the department filings to be made immediately upon adoption of the policies and procedures and within 30 days of making any changes to the policies and procedures. The bill would modify the required content of the filings, as specified, and would require a plan or insurer that submitted a filing prior to January 1, 2011, to update the filing by March 31, 2011, to comply with the bill's requirements and to reflect the plan's or insurer's current policies and procedures. Because a willful violation of the bill's requirements with respect to health care service plans would be a crime, it would impose 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.