Health care coverage: contracted rates: disclosure to consumers.

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 that act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan or a health insurer to submit to the Department of Managed Health Care or the Department of Insurance, as applicable, specified rate information, including information regarding the contracted rate between a health care service plan or health insurer and a provider of health care services. Existing law deems that contracted rate confidential information that is exempt from disclosure under the California Public Records Act and prohibits the Department of Managed Health Care or the Department of Insurance, as applicable, from making that information public. This bill would require, notwithstanding the provisions described above deeming contracted rate information confidential and exempt from public disclosure, a health care service plan or a health insurer to disclose, upon request, to a consumer, as defined, information regarding the contracted rate for a procedure or a full course of treatment between the plan or insurer and a provider or supplier, as defined. Because a willful violation of the bill's requirements relative to health care service plans would be a crime, this 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.