Primary Care Spending Transparency Act.

Existing law establishes the California Health and Human Services Agency, which consists of various departments, including the Department of Managed Health Care. Existing law, the Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene) , 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. Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law requires a health care service plan or health insurer to annually report specified information to the Department of Managed Health Care or the Department of Insurance, including, among other things, the number of persons that receive health care coverage under specified health care service plans or health insurance policies. Existing law requires the departments to publicly report that information, including posting it on their Internet Web sites. This bill, the Primary Care Spending Transparency Act, would require a health care service plan or health insurer that reports rate information, as specified, to annually report the percentage of expenses the health care service plan or health insurer allocated to primary care, among other things. The bill would require the Department of Managed Health Care and the Department of Insurance to annually compile and post a report with that information on their Internet Web sites, beginning January 1, 2020, and would require the departments to include their reports as discussion items at specified public meetings. The bill would also require a managed health care plan to annually report specified information to the State Department of Health Care Services, which would be required to annually compile and post a report with that information on its Internet Web site, beginning January 1, 2020. The bill would require the Department of Managed Health Care and the Department of Insurance to convene the Primary Care Payment Reform Collaborative no later than January 1, 2020, to propose revisions to the types of primary care data collected from health care service plans and health insurers, as well as to advise and assist in developing specified best practices. The bill would prescribe the membership of the Primary Care Payment Reform Collaborative. 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.