California Health Benefit Exchange: appeals.

Existing federal law, the federal Patient Protection and Affordable Care Act (PPACA) , enacts various health care coverage market reforms that take effect January 1, 2014. PPACA also requires each state to, by January 1, 2014, establish an American Health Benefit Exchange that facilitates the purchase of qualified health plans by qualified individuals and qualified small employers, as specified. Existing law establishes the California Health Benefit Exchange (Exchange) to implement the federal law. Existing law also requires the board of the Exchange to establish an appeals process for prospective and current enrollees of the Exchange that complies with all of the requirements of the federal act concerning the role of a state Exchange in facilitating federal appeals of Exchange-related determinations. This bill would require the board of the Exchange to contract with the State Department of Social Services to serve as the Exchange appeals entity designated to hear appeals of eligibility or enrollment determination or redetermination for persons in the individual market or exemption determinations within the Exchange's jurisdiction. The bill would establish an appeals process for eligibility or enrollment determinations and redeterminations for insurance affordability programs, as defined, or exemption determinations within the Exchange's jurisdiction, including an informal resolution process, as specified, establishing procedures and timelines for hearings with the appeals entity, and notice provisions. The bill would also establish a process for continuing eligibility for individuals during the appeals process. The bill would make other related changes, and would specify that certain provisions only be implemented to the extent they do not conflict with federal law.