Office of Patient Advocate.

Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the regulation of health care service plans by the Department of Managed Health Care. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law creates within the Department of Managed Health Care an Office of Patient Advocate to assist enrollees with regard to health care coverage, which is headed by a patient advocate recommended to the Governor by the Business, Transportation and Housing Agency. The Office of Patient Advocate is responsible for, among other things, developing educational and informational guides for consumers, compiling an annual publication of a quality of care report card, and rendering advice and assistance to enrollees. The annual budget of the Office of Patient Advocate is separately identified in the annual budget request of the department. The California Health and Human Services Agency consists of, among others, the State Department of Health Care Services, the State Department of Mental Health, the State Department of Public Health, and the State Department of Social Services. This bill would transfer the Department of Managed Health Care and, effective July 1, 2012, the Office of Patient Advocate to the California Health and Human Services Agency. The bill would delete the requirement that the patient advocate be recommended to the Governor by the Business, Transportation and Housing Agency. The bill, effective January 1, 2013, would add additional duties and responsibilities to the existing duties of the Office of Patient Advocate with regard to providing outreach and education about health care coverage to consumers. The bill, effective January 1, 2013, would authorize the office to contract with community organizations, subject to specified requirements, to provide certain services and would also require the office to adopt certain standards and procedures regarding those organizations. The bill, effective January 1, 2013, would require specified state agencies to report to the office regarding consumer complaints submitted to those agencies by individuals with complaints about their health care coverage. The bill would provide that funding for the actual and necessary expenses of the office shall be provided, subject to appropriation by the Legislature, from transfers of moneys from the Managed Care Fund and the Insurance Fund, to be based on the number of covered lives in the state that are covered by plans or insurers, as determined by the Department of Managed Health Care and the Department of Insurance, in proportion to the total number of covered lives in the state. The bill would establish the Office of Patient Advocate Trust Fund for those purposes and would make moneys deposited into that fund available for purposes of administering the program, subject to appropriation by the Legislature. The bill would also authorize the office to apply to the federal government for moneys to fund the office and authorize the office to request from the federal government specified grant moneys.