Health care coverage.

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 provides for the regulation of health insurers by the Department of Insurance. This bill would require health care service plans and health insurers to annually, commencing on the date specified health plans are required to report certain information under the federal Patient Protection and Affordable Care Act, provide specified information regarding their plan contracts or policies to the Department of Managed Health Care or the Department of Insurance, as applicable, including claims payment policies and practices, periodic financial disclosures, and data on enrollment and disenrollment, as specified. The bill would authorize the Director of the Department of Managed Health Care and the Insurance Commissioner to adopt rules and regulations necessary to implement these provisions, as specified. The bill would also require the Department of Managed Health Care and the Department of Insurance to work with stakeholders to determine the form and manner of reporting the data according to these provisions and to avoid redundant reporting, and would authorize these departments to waive specified reporting requirements or modify the timeframe of existing reporting requirements, as specified. Because a willful violation of this reporting requirement by a health care service plan would be a crime, the bill 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.