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An
act to amend Section 6254 of the Government Code, to add Article 3.11
(commencing with Section 1357.20) to Chapter 2.2 of Division 2 of the
Health and Safety Code, to add Section 12693.55 to, and to add Chapter
8.1 (commencing with Section 10760) to Part 2 of Division 2 of, the
Insurance Code, to add Part 8.7 (commencing with Section 2120) to
Division 2 of the Labor Code, to amend Section 131 of, and to add
Section 976.7 to, the Unemployment Insurance Code, and to amend Section
14124.91 of, and to add Sections 14105.981, 14124.915, and 14124.916 to,
the Welfare and Institutions Code, relating to health care coverage, and
making an appropriation therefor.
[Approved
by Governor October 5, 2003. Filed with Secretary of State October 6,
2003.]
LEGISLATIVE
COUNSEL’S DIGEST
SB
2, Burton. Health care coverage.
Existing
law does not provide a system of health care coverage for all California
residents and does not require employers to provide health care coverage
for employees and dependents, other than coverage provided as part of
the workers’ compensation system for work-related employee injuries.
Existing law provides for the creation of various programs to provide
health care services to persons who have limited incomes and meet
various eligibility requirements. These programs include the Healthy
Families Program administered by the Managed Risk Medical Insurance
Board, and the Medi-Cal program administered by the State Department of
Health Services. Existing law provides for the regulation of health care
service plans by the Department of Managed Health Care and health
insurers by the Department of Insurance.
This
bill would create the State Health Purchasing Program, which would be
administered by the Managed Risk Medical Insurance Board. The bill would
require specified health benefits to be provided directly by employers
or through the program. The bill would require the board to arrange
health plan coverage for certain employers, who would be required to pay
a fee for employee health coverage, except that employers who provide
health care coverage directly would receive a credit against the fee.
The bill would require employees and dependents of large employers to be
covered beginning January 1, 2006, while it would require employees of
medium employers to be covered beginning January 1, 2007, subject to
certain conditions. Small employers would be exempt from the requirement
to provide coverage and from the fee. The bill would require the board
to determine the fee to be paid by employers, and would provide that the
associated employee contributions, which employers would be required to
collect from employees, may not exceed 20% of the employer fee. The
fees, including the employee contributions, would be collected by the
Employment Development Department and would be deposited in the newly
created State Health Purchasing Fund. The moneys in the fund would be
continuously appropriated to the board for the purposes of the program.
The bill would authorize the board to coordinate coverage under the
program with coverage available under the Medi-Cal program, the Healthy
Families Program, and other public programs, and would impose various
requirements on the board and the State Department of Health Services in
that regard. The bill would authorize a loan from the General Fund to
the board for startup costs related to the State Health Purchasing
Program, subject to appropriation by the Legislature. The bill would
enact other related provisions.
Existing
law requires health care service plans and health insurers to comply
with various requirements relating to health care coverage for small
employers. A willful violation of provisions governing health care
service plans is a crime.
This
bill would extend the application of these requirements to health care
coverage provided directly by employers under the bill, and would impose
various other requirements. Because a willful violation of these
provisions by health care service plans 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.
This
bill would provide that it shall not become operative unless AB 1528 is
also enacted and becomes operative.
Appropriation:
yes.
The
people of the State of California do enact as follows:
SECTION
1. The Legislature finds and declares all of the following:
(a)
The Legislature finds and declares that working Californians and their
families should have health insurance coverage.
(b)
The Legislature further finds and declares that most working
Californians obtain their health insurance coverage through their
employment.
(c)
The Legislature finds and declares that in 2001, more than 6,000,000
Californians lacked health insurance coverage at some time and 3,600,000
Californians had no health insurance coverage at any time.
(d)
The Legislature finds and declares that more than 80 percent of
Californians without health insurance coverage are working people or
their families. Most of these working Californians without health
insurance coverage work for employers who do not offer health benefits.
(e)
The Legislature finds and declares that employment-based health
insurance coverage provides access for millions of Californians to the
latest advances in medical science, including diagnostic procedures,
surgical interventions, and pharmaceutical therapies.
(f)
The Legislature finds and declares that people who are covered by health
insurance have better health outcomes than those who lack coverage.
Persons without health insurance are more likely to be in poor health,
more likely to have missed needed medications and treatment, and more
likely to have chronic conditions that are not properly managed.
(g)
The Legislature finds and declares that persons without health insurance
are at risk of financial ruin and that medical debt is the second most
common cause of personal bankruptcy in the United States.
(h)
The Legislature further finds and declares that the State of California
provides health insurance to low- and moderate-income working parents
and their children through the Medi-Cal and Healthy Families programs
and pays the cost of coverage for those working people who are not
provided health coverage through employment. The Legislature further
finds and declares that the State of California and local governments
fund county hospitals and clinics, community clinics, and other safety
net providers that provide care to those working people whose employers
fail to provide affordable health coverage to workers and their families
as well as to other uninsured persons.
(i)
The Legislature further finds and declares that controlling health care
costs can be more readily achieved if a greater share of working people
and their families have health benefits so that cost shifting is
minimized.
(j)
The Legislature finds and declares that the social and economic burden
created by the lack of health coverage for some workers and their
dependents creates a burden on other employers, the State of California,
affected workers, and the families of affected workers who suffer ill
health and risk financial ruin.
(k)
It is therefore the intent of the Legislature to assure that working
Californians and their families have health benefits and that employers
pay a user fee to the State of California so that the state may serve as
a purchasing agent to pool those fees to purchase coverage for all
working Californians and their families that is not tied to employment
with an individual employer. However, consistent with this act, if the
employer voluntarily provides proof of health care coverage, that
employer is to be exempted from payment of the fee.
(l)
It is further the intent of the Legislature that workers who work on a
seasonal basis, for multiple employers, or who work multiple jobs for
the same employer should be afforded the opportunity to have health
coverage in the same manner as those who work full-time for a single
employer.
(m)
The Legislature recognizes the vital role played by the health care
safety net and the potential impact this act may have on the resources
available to county hospital systems and clinics, including physicians
or networks of physicians that refer patients to such hospitals and
clinics, as well as community clinics and other safety net providers. It
is the intent of the Legislature to preserve the viability of this
important health care resource.
(n)
Nothing in this act shall be construed to diminish or otherwise change
existing protections in law for persons eligible for public programs
including, but not limited to, Medi-Cal, Healthy Families, California
Children’s Services, Genetically Handicapped Persons Program, county
mental health programs, programs administered by the Department of
Alcohol and Drug Programs, or programs administered by local education
agencies. It is further the intent of the Legislature to preserve
benefits available to the recipients of these programs, including
dental, vision, and mental health benefits.
SEC.
2. Part 8.7 (commencing with Section 2120) is added to Division 2 of the
Labor Code, to read:
PART
8.7. EMPLOYEE HEALTH INSURANCE
CHAPTER
1. TITLE AND PURPOSE
2120.
This part shall be known and may be cited as the Health Insurance Act of
2003.
2120.1.
(a) Large employers, as defined in Section 2122.3, shall comply with the
provisions of this part applicable to large employers commencing on
January 1, 2006.
(b)
Medium employers, as defined in Section 2122.4, shall comply with the
provisions of this part applicable to medium employers commencing on
January 1, 2007, except that those employers with at least 20 employees
but no more than 49 employees are not required to comply with the
provisions of this part unless a tax credit is enacted that is available
to those employers with at least 20 employees but no more than 49
employees. The tax credit shall be 20 percent of net cost to the
employer of the fee owed under Chapter 4 (commencing with Section 2140).
‘‘Net cost’’ means the dollar amount of the employer fee or the
credit consistent with Section 2160.1 reduced by the employee share of
that fee or credit and further reduced by the value of state and federal
tax deductions.
2120.2.
It is the purpose of this part to ensure that working Californians and
their families are provided health care coverage.
2120.3.
This part shall not be construed to diminish any protection already
provided pursuant to collective bargaining agreements or
employer-sponsored plans that are more favorable to the employees than
the health care coverage required by this part.
CHAPTER
2. DEFINITIONS
2122.
Unless the context requires otherwise, the definitions set forth in this
chapter shall govern the construction and meaning of the terms and
phrases used in this part.
2122.1.
‘‘Dependent’’ means the spouse, domestic partner, minor child of
a covered enrollee, or child 18 years of age and over who is dependent
on the enrollee, as specified by the board. ‘‘Dependent’’ does
not include a dependent who is provided coverage by another employer or
who is an eligible enrollee as a consequence of that dependent’s
employment status.
2122.2.
‘‘Enrollee’’ means a person who works at least 100 hours per
month for any individual employer and has worked for that employer for
three months. The term includes sole proprietors or partners of a
partnership, if they are actively engaged at least 100 hours per month
in that business.
2122.3.
‘‘Large employer’’ means a person, as defined in Section 7701(a)
of the Internal Revenue Code, or public or private entity employing for
wages or salary 200 or more persons to work in this state.
2122.4.
‘‘Medium employer’’ means a person, as defined in Section
7701(a) of the Internal Revenue Code, or public or private entity
employing for wages or salary at least 20 but no more than 199 persons
to work in this state.
2122.5.
‘‘Small employer’’ means a person, as defined in Section 7701(a)
of the Internal Revenue Code, or public or private entity employing for
wages or salary at least 2 but no more than 19 persons to work in this
state.
2122.6.
‘‘Employer’’ means an employing unit as defined in Section 135
of the Unemployment Insurance Code, that is either a large employer or
medium employer, as defined in Sections 2122.3 and 2122.4. For purposes
of this part, an employer shall include all of the members of a
controlled group of corporations. A ‘‘controlled group of
corporations’’ means controlled group of corporations as defined in
Section 1563(a) of the Internal Revenue Code, except that ‘‘more
than 50 percent’’ shall be substituted for ‘‘at least 80
percent’’ each place it appears in Section 1563(a)(1) of the
Internal Revenue Code and the determination shall be made without regard
to Sections 1563(a)(4) and 1563(e)(3)(C) of the Internal Revenue Code.
2122.7.
‘‘Principal employer’’ means the employer for whom an enrollee
works the greatest number of hours in any month.
2122.8.
‘‘Wages’’ means wages as defined in subdivision (a) of Section
200 paid directly to an individual by his or her employer.
2122.9.
‘‘Fund’’ means the State Health Purchasing Fund created pursuant
to Section 2210.
2122.10.
‘‘Program’’ means the State Health Purchasing Program, which
includes a purchasing pool providing health care coverage for enrollees,
and, if applicable, their dependents, which will be financed by fees
paid by employers and contributions by enrollees.
2122.11.
‘‘Board’’ means the Managed Risk Medical Insurance Board.
2122.12.
‘‘Fee’’ means the fee as determined in Chapter 4 (commencing
with Section 2140).
CHAPTER
3. STATE HEALTH PURCHASING PROGRAM
2130.
The State Health Purchasing Program is hereby created. The program shall
be managed by the Managed Risk Medical Insurance Board, which shall have
those powers granted to the board with respect to the Healthy Families
Program under Section 12693.21 of the Insurance Code, except that the
emergency regulation authority referenced in subdivision (o) of that
section shall only be in effect for this program from the effective date
of this part until three years after the requirements of this program
are in effect for large and medium employers as provided in Section
2120.1.
2130.1.
Notwithstanding any other provisions of law to the contrary, the board
shall have authority and fiduciary responsibility for the administration
of the program, including sole and exclusive fiduciary responsibility
over the assets of the fund. The board shall also have sole and
exclusive responsibility to administer the program in a manner that will
assure prompt delivery of benefits and related services to the
enrollees, and, if applicable, dependents, including sole and exclusive
responsibility over contract, budget, and personnel matters. Nothing in
this section shall preclude legislative or state auditor oversight over
the program.
2130.2.
The board shall arrange coverage for enrollees, and, if applicable,
dependents eligible under this part by establishing and maintaining a
purchasing pool. The board shall negotiate contracts with those health
care service plans and health insurers that choose to participate for
the benefit package described in this part and shall not self-insure or
partially self-insure the health care benefits under this part.
2130.3.
The health care benefits coverage provided to enrollees, and, if
applicable, dependents, shall be equivalent to the coverage required
under subdivision (a) or (b) of Section 2160.1.
2130.4.
The program shall be funded by employer fees and enrollee contributions
as described in this part. The board shall administer the program in a
manner that assures that the fees and enrollee contributions collected
pursuant to this part are sufficient to fund the program, including
administrative costs.
CHAPTER
4. EMPLOYER FEE
2140.
Except as otherwise provided in this part, every large employer and
every medium employer shall pay a fee as specified in this chapter.
2140.1.
The board shall establish the level of the fee by determining the total
amount necessary to pay for health care for all enrollees, and, if
applicable, their dependents eligible for the program. In setting the
fee the board may include costs associated with the administration of
the fund, including those costs associated with collection of the fee
and its enforcement by the Employment Development Department. The
program implemented pursuant to this part shall be fully supported by
the fees and enrollee contributions collected pursuant to this part. The
fees and enrollee contributions collected pursuant to this part shall
not be used for any purpose other than providing health coverage for
enrollees and, if applicable, their dependents, as well as costs
associated with the administration of the fund and with collection of
the fee and its enforcement by the Employment Development Department.
2140.2.
The board shall provide notice to the Employment Development Department
of the amount of the fee in a time and manner that permits the
Employment Development Department to provide notice to all employers of
the estimated fee for the budget year pursuant to Section 976.7 of the
Unemployment Insurance Code.
2140.3.
The Employment Development Department shall waive the fee of any
employer that is entitled to a credit under the terms of this part. The
Employment Development Department shall specify the manner and means by
which that credit may be claimed by an employer.
2140.4.
Revenue from the fee and from the enrollee contributions specified in
this part shall be deposited into the fund.
2140.5.
The fee paid by employers shall be based on the cost of coverage for all
enrollees, and, if applicable, their dependents. The fee to be paid by
each employer shall be based on the number of potential enrollees, and
if applicable, dependents, using the employer’s own workforce on a
date specified by the board as the basis for the allocation and such
other factors as the board may determine in order to provide coverage
that meets the standards of this part. To assist the board in
determining the fee, each employer shall provide to the board
information as specified by the board regarding potential enrollees,
and, if applicable, dependents. To the extent feasible, the board shall
work with the Employment Development Department to facilitate the
provision of information regarding the number of potential enrollees and
dependents.
2140.6.
A large employer shall pay a fee to the fund for the purpose of
providing health care coverage pursuant to this part. The fee paid by a
large employer shall be based on the number of enrollees and dependents.
2140.7.
A medium employer shall pay a fee to the fund for the purpose of
providing health care coverage pursuant to this part. The fee paid by a
medium employer shall be based on the number of enrollees.
2140.8.
Coverage of an enrollee or, if applicable, dependents shall not be
contingent upon payment of the fee required pursuant to this part by the
employer of that enrollee or, if applicable, dependents. If an employer
fails to pay the required fee, for whatever reason, the employer shall
be responsible to the fund for payment of a penalty of 200 percent of
the amount of any fee that would have otherwise been paid by the
employer including for the period that the enrollee and, if applicable,
dependents should have received coverage but for the employer’s
conduct in violation of this section.
2140.9.
All amounts due and unpaid under this part, including unpaid penalties,
shall bear interest in accordance with Section 1129 of the Unemployment
Insurance Code.
2140.10.
Nothing in this part shall preclude an employer from purchasing
additional benefits or coverage, in addition to paying the fee.
CHAPTER
5. ENROLLEE CONTRIBUTION
2150.
The applicable enrollee contribution, not to exceed 20 percent of the
fee assessed to the employer, shall be collected by the employer and
paid concurrently with the employer fee. The employer may agree to pay
more than 80 percent of the fee, resulting in an enrollee, and, if
applicable, dependent contribution of less than 20 percent. For
enrollees making a contribution for family coverage and whose wages are
less than 200 percent of the federal poverty guidelines for a family of
three, as specified annually by the United States Department of Health
and Human Services, the applicable enrollee contribution shall not
exceed 5 percent of wages. For enrollees making a contribution for
individual coverage and whose wages are less than 200 percent of the
federal poverty guidelines for an individual, the applicable enrollee
contribution shall not exceed 5 percent of wages.
2150.1.
(a) The board shall establish the required enrollee and dependent
deductibles, coinsurance or copayment levels for specific benefits,
including total annual out-of-pocket cost.
(b)
No out-of-pocket costs other than copayments, coinsurance, and
deductibles in accordance with this section shall be charged to
enrollees and dependents for health benefits.
(c)
In determining the required enrollee and dependent deductibles,
coinsurance, and copayments, the board shall consider whether the
proposed copayments, coinsurance, and deductibles deter enrollees and
dependents from receiving appropriate and timely care, including those
enrollees with low or moderate family incomes. The board shall also
consider the impact of out-of-pocket costs on the ability of employers
to pay the fee.
This
section shall apply to coverage provided through the program only and is
not intended to apply coverage that is not provided through the program.
2150.2.
In the event that the employer fails to collect or transmit the enrollee
contribution provided for under this part in a timely manner, the
employer shall become liable for a penalty of 200 percent of the amount
that the employer has failed to collect or transmit, and the employee
shall be relieved of all liability for that failure. In no event shall
the employer’s failure to collect or transmit the required
enrollee’s contribution or to provide enrollment information about an
employee affect the employee’s coverage arranged pursuant to Chapter 3
(commencing with Section 2130), nor may an employer withhold or collect
any amount that is not withheld and transmitted in the manner and at
such times as specified by the Employment Development Department
pursuant to this part. An employee for whom enrollment information is
not otherwise received by the board may demonstrate eligibility for
coverage by any reliable means of demonstrating employment as provided
for in regulation. To the extent feasible, the board shall work with the
Employment Development Department to facilitate the provision of
information regarding the eligibility of enrollees and to provide
information regarding any failure of an employer to collect or transmit
employee contributions as required by this part.
CHAPTER
6. EMPLOYER CREDIT AGAINST THE FEE
2160.
An employer required to pay a fee to the fund may apply to the
Employment Development Department for a credit against the fee by
providing proof of coverage for eligible enrollees and their dependents,
if applicable, consistent with Section 2140.3.
2160.1.
Proof of coverage shall be demonstrated by any of the following:
(a)
Any health care coverage that meets the minimum requirements set forth
in Chapter 2.2 (commencing with Section 1340) of Division 2 of the
Health and Safety Code.
(b)
A group health insurance policy, as defined in subdivision (b) of
Section 106 of the Insurance Code, that covers hospital, surgical, and
medical care expenses, provided the maximum out-of-pocket costs for
insureds do not exceed the maximum out-of-pocket costs for enrollees of
health care service plans providing benefits under a preferred provider
organization policy. For the purposes of this section, a group health
insurance policy shall not include Medicare supplement, vision-only,
dental-only, and Champus-supplement insurance. For purposes of this
section, a group health insurance policy shall not include hospital
indemnity, accident-only, and specified disease insurance that pays
benefits on a fixed benefit, cash-payment-only basis.
(c)
Any Taft-Hartley health and welfare fund or any other lawful collective
bargaining agreement which provides for health and welfare coverage for
collective bargaining unit or other employees thereby covered.
(d)
Any employer sponsored group health plan meeting the requirements of the
federal Employee Retirement Income Security Act of 1974, provided it
meets the benefits required under subdivision (a) or (b) of this
section.
(e)
A multiple employer welfare arrangement established pursuant to Section
742.20 of the Insurance Code, provided that its benefits have not
changed after January 1, 2004, or that it meets the benefits required
under subdivision (a) or (b) of this section.
(f)
Coverage provided under the Public Employees’ Medical and Hospital
Care Act (Part 5 (commencing with Section 22850) of Division 5 of Title
2 of the Government Code, provided it meets the benefits required under
subdivision (a) or (b) of this section or is otherwise collectively
bargained.
(g)
Health coverage provided by the University of California to students of
the University of California who are also employed by the University of
California.
2160.2.
Nothing in this part shall preclude an employer from providing
additional benefits or coverage.
2160.3.
It shall be unlawful for an employer to designate an employee as an
independent contractor or temporary employee, reduce an employee’s
hours of work, or terminate and rehire an employee if a purpose of which
is to avoid the employer’s obligations under this part. An employer
that violates this section shall be responsible to the fund for a
penalty of 200 percent of the amount of any fee that would have
otherwise been paid by the employer including for the period that the
enrollee, and, if applicable, dependents should have received coverage
but for the employer’s conduct in violation of this section. The
rights established under this section shall not reduce any other rights
established under any other provision of law.
2160.4.
An employer shall not request or otherwise seek to obtain information
concerning income or other eligibility requirements for public health
benefit programs regarding an employee, dependent, or other family
member of an employee, other than that information about the
employee’s employment status otherwise known to the employer
consistent with existing state and federal law and regulation. For these
purposes, public health benefit programs include, but are not limited
to, the Medi-Cal program, Healthy Families Program, Major Risk Medical
Insurance Program, and Access for Infants and Mothers program.
2160.5.
The Employment Development Department shall adopt regulations to ensure
that employers abide by the provisions of this chapter. The regulations
may initially be adopted as emergency regulations in accordance with the
Administrative Procedure Act (Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code, but
those emergency regulations shall be in effect only from the effective
date of this part until after the requirements of this program are in
effect for large and medium employers as provided in Section 2120.1.
2160.7.
(a) Any new employer or existing employer that previously was not
subject to this part shall begin complying with all applicable
provisions of this part within one month of the date it became subject
to this part.
(b)
Any existing employer previously subject to this part but no longer
subject to this part shall notify the Employment Development Department
in a manner prescribed by that department within 15 days of this change
before discontinuing to comply with the provisions of this part.
CHAPTER
7. PARTICIPATING HEALTH PLANS
2170.
Notwithstanding any other provision of law, the board shall not be
subject to licensure or regulation by the Department of Insurance or the
Department of Managed Health Care.
2171.
The board shall contract only with insurers that can demonstrate
compliance with Section 10761.2 of the Insurance Code and only with
health care service plans that can demonstrate compliance with the
requirements of Section 1357.23 of the Health and Safety Code.
2173.
(a) The board shall develop and utilize appropriate cost containment
measures to maximize the cost-effectiveness of health care coverage
offered under the program. The board shall consider the findings of the
California Health Care Quality Improvement and Cost Containment
Commission.
(b)
Health care service plans, health insurers, and providers are encouraged
to develop innovative approaches, services, and programs that may have
the potential to deliver health care that is both cost-effective and
responsive to the needs of enrollees.
CHAPTER
8. ENROLLMENT AND COORDINATION WITH PUBLIC PROGRAMS
2190.
(a) Employers shall provide information to the board regarding potential
enrollees, and, if applicable, dependents as prescribed by the board to
assist the board in obtaining information necessary for enrollment. In
no case shall the board require the employer to obtain from the
potential enrollee information about the family income or other
eligibility requirements for Medi-Cal, Healthy Families, or other public
programs other than that information about the enrollee’s employment
status otherwise known to the employer consistent with existing state
and federal law and regulation.
(b)
The board shall obtain enrollment information from potential enrollees
and, if applicable, dependents to be covered by the program. The
enrollee may voluntarily provide information sufficient to determine
whether the enrollee or dependents may be eligible for coverage under
Medi-Cal, Healthy Families, or other public programs if the enrollee
chooses to seek enrollment in those programs. The board shall use a
uniform enrollment form for obtaining that information. The board shall
provide information to enrollees covered by the program regarding the
coverage available under the program and other programs, including Medi-Cal
and Healthy Families, for which enrollees or dependents may be eligible.
2190.1.
(a) An enrollee or dependent who would qualify for Medi-Cal pursuant to
Chapter 7 (commencing with Section 14000) of Part 3 of Division 6 of the
Welfare and Institutions Code and who chooses to provide information
about eligibility for the Medi-Cal program shall be enrolled in the Medi-Cal
program if determined by the State Department of Health Services to be
eligible for that program and shall be charged share-of-cost, copays,
coinsurance, or deductibles in accordance with the requirements of that
program.
(b)
An enrollee or dependent who would qualify for the Healthy Families
Program pursuant to Part 6.2 (commencing with Section 12693) of the
Insurance Code and who chooses to provide information about eligibility
for the Healthy Families Program shall be enrolled in the Healthy
Families Program if determined eligible for that program and shall be
charged share-of-premium, copays, coinsurance, or deductibles in
accordance with the requirements of that program.
2190.2.
(a) The board shall provide to the State Department of Health Services
information concerning the potential or continuing eligibility of
enrollees and dependents in the program for Medi-Cal.
(b)
(1) For those enrollees and dependents of the program who are determined
to be eligible for Medi-Cal, the board shall provide the state share of
financial participation for the cost of Medi-Cal coverage provided
through the program.
(2)
For those enrollees and dependents of the program who are determined to
be eligible for Healthy Families, the board shall provide the state
share of financial participation for the cost of Healthy Families
coverage provided through the program.
(c)
Nothing in this part shall affect the authority of the State Department
of Health Services or the board to verify eligibility as required by
federal law.
(d)
The board shall have authority to make any necessary repayments of
enrollee contributions to persons whose coverage is provided under this
section, and may also delegate to the State Department of Health
Services the authority to repay those contributions.
(e)
The State Department of Health Services shall seek all state plan
amendments and federal approvals as necessary to maximize the amount of
any federal financial participation available.
2190.3.
Nothing in this part shall be construed to diminish or otherwise change
existing protections in law for persons eligible for public programs,
including, but not limited to, California Children’s Services,
Genetically Handicapped Persons Program, county mental health programs,
programs administered by the Department of Alcohol and Drug Programs, or
programs administered by local education agencies.
2190.4.
In implementing this part, the board shall consult with organizations
representing the interests of enrollees, particularly those who may be
covered by public programs as well as family members, providers,
advocacy organizations, and plans providing coverage under public
programs.
CHAPTER
9. ADMINISTRATION
2200.
A contract entered into by the board pursuant to this part shall be
exempt from any provision of law relating to competitive bidding, and
shall be exempt from the review or approval of any division of the
Department of General Services. The board shall not be required to
specify the amounts encumbered for each contract, but may allocate funds
to each contract based on the projected or actual enrollee enrollments
to a total amount not to exceed the amount appropriate for the program
including applicable contributions.
2210.
(a) The State Health Purchasing Fund is hereby created in the State
Treasury and, notwithstanding Section 13340 of the Government Code, is
continuously appropriated to the board for the purposes specified in
this part.
(b)
The board shall authorize the expenditure from the fund of applicable
employer fees and enrollee contributions that are deposited into the
fund. This shall include the authority for the board to transfer funds
to two separate special deposit funds to be established by the board
pursuant to this part, and administered respectively by the State
Department of Health Services and the board, to be used as the state’s
share of financial participation for the respective costs of Medi-Cal or
Healthy Families coverage provided to enrollees, and, if applicable,
dependents, who enroll in Medi-Cal or Healthy Families.
(c)
Notwithstanding Section 2130.4, the board is authorized to obtain a loan
from the General Fund for all necessary and reasonable expenses related
to the establishment and administration of this part prior to the
collection of the employer fee. The proceeds of the loan are subject to
appropriation in the annual Budget Act. The board shall repay principal
and interest, using the rate of interest paid under the Pooled Money
Investment Account, to the General Fund no later than five years after
the first year of implementation of the employer fee.
SEC.
3. Article 3.11 (commencing with Section 1357.20) is added to Chapter
2.2 of Division 2 of the Health and Safety Code, to read:
Article
3.11. Insurance Market Reform
1357.20.
If the provisions of Part 8.7 (commencing with Section 2120) of Division
2 of the Labor Code are held invalid, then the provisions of this
article shall become inoperative.
1357.21.
(a) Notwithstanding any other provision of law, on and after January 1,
2006, except as specified in subdivision (b), all requirements in
Article 3.1 (commencing with Section 1357) applicable to offering,
marketing, and selling health care service plan contracts to small
employers as defined in that article, including, but not limited to, the
obligation to fairly and affirmatively offer, market, and sell all of
the plan’s contracts to all employers, guaranteed renewal of all
health care service plan contracts, use of the risk adjustment factor,
and the restriction of risk categories to age, geographic region, and
family composition as described in that article, shall be applicable to
all health care service plan contracts offered to all small and medium
employers providing coverage to employees pursuant to Part 8.7
(commencing with Section 2120) of Division 2 of the Labor Code, except
as follows:
(1)
For small and medium employers with two to 50 eligible employees, all
requirements in that article shall apply. As used in this article,
‘‘small employer’’ shall have the meaning as defined in Section
2122.5 of the Labor Code and ‘‘medium employer’’ shall have the
meaning as defined in Section 2122.4 of the Labor Code, unless the
context otherwise requires.
(2)
For medium employers with 51 or more eligible employees, all
requirements in that article shall apply, except that the health care
service plan may develop health care coverage benefit plan designs to
fairly and affirmatively market only to medium employer groups of 51 to
199 eligible employees, and apply a risk adjustment factor of no more
than 115 percent and no less than 85 percent of the standard employee
risk rate.
(b)
Health care service plans shall be required to comply with this section
only beginning with the date when coverage begins to be offered through
the State Health Purchasing Program pursuant to Part 8.7 (commencing
with Section 2120 of Division 2 of the Labor Code.
1357.22.
On and after January 1, 2006, a health care service plan contract with
an employer as defined in Section 2122.6 of the Labor Code providing
health coverage to enrollees or subscribers shall meet all of the
following requirements:
(a)
The employer shall be responsible for the cost of health care coverage
except as provided in this section.
(b)
An employer may require a potential enrollee to pay up to 20 percent of
the cost of the coverage, proof of which is provided by the employer in
lieu of paying the fee required by Part 8.7 (commencing with Section
2120) of Division 2 of the Labor Code, unless the wages of the potential
enrollee are less than 200 percent of the federal poverty guidelines, as
specified annually by the United States Department of Health and Human
Services. For enrollees making a contribution for family coverage and
whose wages are less than 200 percent of the federal poverty guidelines
for a family of three, the applicable enrollee contribution shall not
exceed 5 percent of wages. For enrollees making a contribution for
individual coverage and whose wages are less than 200 percent of the
federal poverty guidelines for an individual, the applicable enrollee
contribution shall not exceed 5 percent of wages of the individual.
(c)
If an employer, as defined in Section 2122.6 of the Labor Code, chooses
to purchase more than one means of coverage for potential enrollees and,
if applicable, dependents, the employer may require a higher level of
contribution from potential enrollees as long as one means of coverage
meets the standards of this section.
(d)
An employer, as defined in Section 2122.6 of the Labor Code, may
purchase health care coverage that includes additional out-of-pocket
expenses, such as copayments, coinsurance, or deductibles. In reviewing
subscriber or enrollee share-of-premium, deductibles, copayments, and
other out-of-pocket costs, the department shall consider those permitted
by the board under Part 8.7 (commencing with Section 2120) of Division 2
of the Labor Code.
(e)
Notwithstanding subdivision (b), a medium employer may require an
enrollee to contribute more than 20 percent of the cost of coverage if
both of the following apply:
(1)
The coverage provided by the employer includes coverage for dependents.
(2)
The employer contributes an amount that exceeds 80 percent of the cost
of the coverage for an individual employee.
(f)
The contract includes prescription drug coverage with out-of-pocket
costs for enrollees consistent with subdivision (d).
1357.23.
On and after January 1, 2006, all health care service plans contracting
with employers consistent with Section 1357.22 or with the State Health
Purchasing Program shall make reasonable efforts to contract with county
hospital systems and clinics, including providers or networks of
providers that refer enrollees to such hospitals and clinics, as well as
community clinics and other safety net providers. This section shall not
prohibit a plan from applying appropriate credentialing requirements
consistent with this chapter. This section shall not apply to a
nonprofit health care service plan that provides hospital services to
its enrollees primarily through a nonprofit hospital corporation with
which the health care service plan shares an identical board of
directors.
SEC.
4. Chapter 8.1 (commencing with Section 10760) is added to Part 2 of
Division 2 of the Insurance Code, to read:
CHAPTER
8.1. INSURANCE MARKET REFORM
10760.
If the provisions of Part 8.7 (commencing with Section 2120) of Division
2 of the Labor Code are held invalid, then the provisions of this
chapter shall become inoperative.
10761.
(a) Notwithstanding any other provision of law, on and after January 1,
2006, except as specified in subdivision (b), all requirements in
Chapter 8 (commencing with Section 10700) applicable to offering,
marketing, and selling health benefit plans to small employers as
defined in that chapter, including, but not limited to, the obligation
to fairly and affirmatively offer, market, and sell all of the
insurer’s health benefit plans to all employers, guaranteed renewal of
all health benefit plans, use of the risk adjustment factor, and the
restriction of risk categories to age, geographic region, and family
composition as described in that chapter, shall be applicable to all
health benefit plans offered to all small and medium employers providing
coverage to employees pursuant to Part 8.7 (commencing with Section
2120) of Division 2 of the Labor Code, except as follows:
(1)
For small and medium employers with two to 50 eligible employees, all
requirements in that chapter shall apply. As used in this chapter,
‘‘small employer’’ shall have the meaning as defined in Section
2122.5 of the Labor Code and ‘‘medium employer’’ shall have the
meaning as defined in Section 2122.4 of the Labor Code, unless the
context otherwise requires.
(2)
For medium employers with 51 or more eligible employees, all
requirements in that chapter shall apply, except that the health
insurers may develop health care coverage benefit plan designs to fairly
and affirmatively market only to medium employer groups of 51 to 199
eligible employees, and apply a risk adjustment factor of no more than
115 percent and no less than 85 percent of the standard employee risk
rate.
(b)
Insurers shall be required to comply with this section only beginning
with the date when coverage begins to be offered through the State
Health Purchasing Program pursuant to Part 8.7 (commencing with Section
2120) of Division 2 of the Labor Code.
10762.
On and after January 1, 2006, a health insurer selling a policy to an
employer, as defined in Section 2122.6 of the Labor Code, providing
health coverage to insureds pursuant to Part 8.7 (commencing with
Section 2120) of Division 2 of the Labor Code shall meet all of the
following requirements:
(a)
The employer shall be responsible for the cost of health care coverage
except as provided in this section.
(b)
An employer may require a potential enrollee to pay up to 20 percent of
the cost of the coverage, proof of which is provided by the employer in
lieu of paying the fee required by Part 8.7 (commencing with Section
2120) of Division 2 of the Labor Code, unless the wages of the potential
enrollee are less than 200 percent of the federal poverty guidelines, as
specified annually by the United States Department of Health and Human
Services. For enrollees making a contribution for family coverage and
whose wages are less than 200 percent of the federal poverty guidelines
for a family of three, the applicable enrollee contribution shall not
exceed 5 percent of wages. For enrollees making a contribution for
individual coverage and whose wages are less than 200 percent of the
federal poverty guidelines for an individual, the applicable enrollee
contribution shall not exceed 5 percent of wages of the individual.
(c)
If an employer, as defined in Section 2122.6 of the Labor Code, chooses
to purchase more than one means of coverage for potential enrollees and,
if applicable, dependents, the employer may require a higher level of
contribution from potential enrollees as long as one means of coverage
meets the standards of this section.
(d)
An employer, as defined in Section 2122.6 of the Labor Code, may
purchase health care coverage that includes additional out-of-pocket
expenses, such as copayments, coinsurance, or deductibles. In reviewing
enrollee share-of-premium, deductibles, copayments, and other
out-of-pocket costs, the department shall consider those permitted by
the board under Part 8.7 (commencing with Section 2120) of Division 2 of
the Labor Code.
(e)
Notwithstanding subdivision (b), a medium employer may require an
enrollee to contribute more than 20 percent of the cost of coverage if
both of the following apply:
(1)
The coverage provided by the employer includes coverage for dependents.
(2)
The employer contributes an amount that exceeds 80 percent of the cost
of the coverage for an individual employee.
(f)
The contract includes prescription drug coverage with out-of-pocket
costs for enrollees consistent with subdivision (d).
10763.
On and after January 1, 2006, all insurers that sell insurance policies
to employers consistent with Section 10762 or to the State Health
Purchasing Program shall make reasonable efforts to include as preferred
providers county hospital systems and clinics, including providers or
networks of providers that refer enrollees to those hospitals and
clinics, as well as community clinics and other safety net providers.
This section shall not prohibit a plan from applying appropriate
credentialing requirements consistent with this chapter. This section
shall not apply to a nonprofit health care service plan that provides
hospital services to its enrollees primarily through a nonprofit
hospital corporation with which the plan shares an identical board of
directors.
10764.
(a) On and after January 1, 2006, except as provided in subdivision (b),
health insurers shall not offer or sell the following insurance policies
to employers providing coverage to employees pursuant to Part 8.7
(commencing with Section 2120) of Division 2 of the Labor Code:
(1)
A Medicare supplement, vision-only, dental-only, or Champus-supplement
insurance policy.
(2)
A hospital indemnity, accident-only, or specified disease insurance
policy that pays benefits on a fixed benefit, cash-payment-only basis.
(b)
However, an insurer may sell one or more of the types of policies listed
in paragraph (1) or (2) of subdivision (a) if the employer has purchased
or purchases concurrently health care coverage meeting the standards of
Part 8.7 (commencing with Section 2120) of Division 2 of the Labor Code.
(c)
If an employer, as defined in Section 2022.6 of the Labor Code, chooses
to purchase more than one means of coverage, the employer may require a
higher level of contribution from potential enrollees so long as one
means of coverage meets the standards of this section.
(d)
An employer, as defined in Section 2122.6 of the Labor Code, may
purchase health care coverage that includes additional out-of-pocket
expenses, such as coinsurance or deductibles. In reviewing the
share-of-premium, deductibles, copayments, and other out-of-pocket costs
paid by insureds, the department shall consider those permitted by the
board under Part 8.7 (commencing with Section 2120) of Division 2 of the
Labor Code.
(e)
Notwithstanding subdivision (b), a medium employer, as defined in
Section 2122.4 of the Labor Code, may require an enrollee to contribute
more than 20 percent of the cost of coverage if both of the following
apply:
(1)
The coverage provided by the employer includes coverage for dependents.
(2)
The employer contributes an amount that exceeds 80 percent of the cost
of the coverage for an individual employee.
(f)
The policy includes prescription drug coverage, which shall be subject
to coinsurance, deductibles, and other out-of-pocket costs consistent
with (d).
SEC.
5. Section 12693.55 is added to the Insurance Code, to read:
12693.55.
(a) Prior to implementation of the Health Insurance Act of 2003, the
board shall to the maximum extent permitted by federal law ensure that
persons who are either covered or eligible for Healthy Families will
retain the same amount, duration, and scope of benefits that they
currently receive or are currently eligible to receive, including
dental, vision and mental benefits. The board shall consult with a
stakeholder group that shall include all of the following:
(1)
Consumer advocate groups that represent persons eligible for Healthy
Families.
(2)
Organizations that represent persons with disabilities.
(3)
Representatives of public hospitals, clinics, safety net providers, and
other providers.
(4)
Labor organizations that represent employees whose families include
persons likely to be eligible for Healthy Families.
(5)
Employer organizations.
(b)
The board shall develop a Healthy Families premium assistance program
for eligible individuals as permitted under federal law to reduce state
costs and maximize federal financial participation by providing health
care coverage to eligible individuals through a combination of available
employer-based coverage and a wraparound benefit that covers any gap
between the employer-based coverage and the benefits required by this
part.
(c)
The board shall do all of the following in implementing the premium
assistance program:
(1)
Require eligible individuals with access to employer-based coverage to
enroll themselves or their family or both in the available
employer-based coverage if the board finds that enrollment in that
coverage is cost-effective.
(2)
Promptly reimburse an eligible individual for his or her share of
premium cost under the employer-based coverage, minus any contribution
that an individual would be required to pay pursuant to Section
12693.43.
(d)
If federal approval of a premium assistance program cannot be obtained,
the board in consultation with the stakeholder group shall explore
alternatives that provide that persons who are either covered or
eligible for Healthy Families retain the same amount, duration and scope
of benefits that they currently receive or are currently eligible to
receive, including vision, dental and mental health benefits.
SEC.
6. Section 131 of the Unemployment Insurance Code is amended to read:
131.
‘‘Contributions’’ means the money payments to the Unemployment
Fund, Employment Training Fund, State Health Purchasing Fund, or
Unemployment Compensation Disability Fund which are required by this
division.
SEC.
7. Section 976.7 is added to the Unemployment Insurance Code, to read:
976.7.
(a) In addition to other contributions required by this division and
consistent with the requirements of Chapter 6 (commencing with Section
2160) of Part 8.7 of Division 2 of the Labor Code, an employer shall pay
to the department for deposit into the State Health Purchasing Fund a
fee in the amount set by the Managed Risk Medical Insurance Board for
the State Health Purchasing Program in accordance with Chapter 4
(commencing with Section 2140) of Part 8.7 of Division 2 of the Labor
Code. The fees shall be collected in the same manner and at the same
time as any contributions required under Sections 976 and 1088.
(b)
In notifying employers of the contributions required under this section,
the department shall also provide notice of required employee
contribution amounts consistent with Section 2150 of the Labor Code.
(c)
An employer shall provide information to all newly hired and existing
employees regarding the availability of Medi-Cal coverage for low- and
moderate-income employees, including the availability of Medi-Cal
premium assistance as well as Medi-Cal coverage for persons receiving
coverage through the State Health Purchasing Fund. The Employment
Development Department, in consultation with the State Department of
Health Services and the Managed Risk Medical Insurance Board shall
develop a simple, uniform notice containing that information.
SEC.
8. Section 14105.981 is added to the Welfare and Institutions Code, to
read:
14105.981.
(a) Prior to the implementation of the Health Insurance Act of 2003,
annually for five years after its implementation, and every five years
thereafter, the department shall report to the Legislature and the
Managed Risk Medical Insurance Board regarding utilization patterns for
Medi-Cal pursuant to Chapter 7 (commencing with Section 14000) of Part 3
of Division 6 at county-owned hospitals and clinics, community clinics,
and vital institutional safety net providers eligible for Medi-Cal
payments under Section 14105.98, including determining the number of
Medi-Cal inpatient days and outpatient visits as well as the nature and
cost of care provided to Medi-Cal patients.
(b)
If Medi-Cal fee-for-service utilization or Medi-Cal fee-for-service
payments to county-owned hospitals and clinics, community clinics, and
other vital institutional safety net providers eligible for Medi-Cal
payments under Section 14105.98 have been reduced, then the department
shall review statute, regulations, policies and procedures, payment
arrangements or other mechanisms to determine what changes may be
necessary to protect Medi-Cal funding and maximize federal financial
participation to protect the financial stability of county-owned
hospitals and clinics, community clinics, and other vital institutional
safety net providers. The department shall consult with representatives
of county-owned hospital systems, community clinics, vital institutional
safety net providers eligible for Medi-Cal payments under Section
14105.98, legal services advocates, and recognized collective bargaining
agents for the specified providers.
SEC.
9. Section 14124.91 of the Welfare and Institutions Code is amended to
read:
14124.91.
(a) The State Department of Health Services shall, whenever it is
cost-effective, pay the premium for third-party health coverage for
beneficiaries under this chapter. The State Department of Health
Services shall, when a beneficiary’s third-party health coverage would
lapse due to loss of employment or change in health status, lack of
sufficient income or financial resources, or any other reason, continue
the health coverage by paying the costs of continuation of group
coverage pursuant to federal law or converting from a group to an
individual plan, whenever it is cost-effective. Notwithstanding any
other provision of a contract or of law, the time period for the
department to exercise either of these options shall be 60 days from the
date of lapse of the policy.
(b)
In addition, contingent on federal financial participation, the
department shall implement a Medi-Cal premium assistance program to
reduce state costs and maximize allowable federal financial
participation by paying the premium for employer-based health care
coverage available to persons who are eligible for Medi-Cal, and in
combination with employer-based health care coverage providing a
wraparound benefit that covers any gap between the employer-based health
care coverage and the benefits provided by the Medi-Cal program.
(c)
The department in implementing the premium assistance program shall
promptly reimburse an applicant for Medi-Cal for his or her share of
premium, minus any share of cost required pursuant to this part. Once
enrolled in both the premium assistance program and employer-based
health care coverage repayment to Medi-Cal covered enrollees of any
share of premium shall coincide with the payment by the enrollee of the
premium for the available employer-based health care coverage. Where the
applicant or beneficiary avails himself or herself of the wraparound
benefit, Medi-Cal shall pay for any copayments, deductibles, and other
allowable out-of-pocket medical costs under the employer-based coverage.
(d)
The department shall seek all state plan amendments and federal
approvals as necessary to maximize the amount of any federal financial
participation available.
SEC.
10. Section 14124.915 is added to the Welfare and Institutions Code, to
read:
14124.915.
(a) Six months prior to implementation of Part 8.7 (commencing with
Section 2120) of Division 2 of the Labor Code, the department shall
notify Medi-Cal enrollees of the implementation of the Health Insurance
Act of 2003, the categories of enrollees covered, the requirements of
the program, the availability of Medi-Cal coverage for those persons,
including the availability of a premium assistance program for those
persons eligible for Medi-Cal who are also covered by employer-based
coverage.
(b)
Three months prior to the implementation of each phase of the program
created by the Health Insurance Act of 2003, those persons enrolled in
Medi-Cal shall be offered the opportunity to enroll in a Medi-Cal
premium assistance program.
SEC.
11. Section 14124.916 is added to the Welfare and Institutions Code, to
read:
14124.916.
(a) Prior to the implementation of the Health Insurance Act of 2003, the
department shall convene a stakeholder group that includes, but is not
limited to, the following members:
(1)
The Managed Risk Medical Insurance Board.
(2)
Representatives of county welfare departments.
(3)
Consumer advocacy groups that represent persons enrolled in or eligible
to be enrolled in the Medi-Cal program.
(4)
Organizations that represent persons with disabilities.
(5)
Labor organizations that represent employees and their dependents who
are likely to be eligible for enrollment in Medi-Cal.
(6)
Representatives of public hospitals, clinics, provider groups, and
safety net providers.
(b)
The department in consultation with the stakeholder group shall develop
a plan to accomplish the following objectives:
(1)
Provide that enrollees and, if applicable, dependents who receive
coverage consistent with the Health Insurance Act of 2003 and who are
enrolled in Medi-Cal retain the same amount, duration, and scope of
benefits to which those beneficiaries currently are entitled.
(2)
Provide that enrollees and, if applicable, dependents who receive
coverage consistent with the Health Insurance Act of 2003 and who are
enrolled in Medi-Cal do not incur greater cost-sharing, including
premiums, deductibles, and copays, than currently allowed under federal
Medicaid law.
(3)
Maximize continuity of care for enrollees and, if applicable, dependents
who receive coverage consistent with the Health Insurance Act of 2003
and who are enrolled in Medi-Cal.
(4)
Streamline and simplify eligibility and enrollment requirements for Medi-Cal
beneficiaries who also have other coverage.
(c)
The department shall report to the Legislature every six months and
shall submit its final plan to the Legislature three months prior to
initial implementation of the Health Insurance Act of 2003.
(d)
The department shall seek all state plan amendments and federal
approvals as necessary to maximize the amount of any federal financial
participation available.
SEC.
12. Section 6254 of the Government Code is amended to read:
6254.
Except as provided in Sections 6254.7 and 6254.13, nothing in this
chapter shall be construed to require disclosure of records that are any
of the following:
(a)
Preliminary drafts, notes, or interagency or intra-agency memorandums
that are not retained by the public agency in the ordinary course of
business, provided that the public interest in withholding those records
clearly outweighs the public interest in disclosure.
(b)
Records pertaining to pending litigation to which the public agency is a
party, or to claims made pursuant to Division 3.6 (commencing with
Section 810), until the pending litigation or claim has been finally
adjudicated or otherwise settled.
(c)
Personnel, medical, or similar files, the disclosure of which would
constitute an unwarranted invasion of personal privacy.
(d)
Contained in or related to any of the following:
(1)
Applications filed with any state agency responsible for the regulation
or supervision of the issuance of securities or of financial
institutions, including, but not limited to, banks, savings and loan
associations, industrial loan companies, credit unions, and insurance
companies.
(2)
Examination, operating, or condition reports prepared by, on behalf of,
or for the use of, any state agency referred to in paragraph (1).
(3)
Preliminary drafts, notes, or interagency or intra-agency communications
prepared by, on behalf of, or for the use of, any state agency referred
to in paragraph (1).
(4)
Information received in confidence by any state agency referred to in
paragraph (1).
(e)
Geological and geophysical data, plant production data, and similar
information relating to utility systems development, or market or crop
reports, that are obtained in confidence from any person.
(f)
Records of complaints to, or investigations conducted by, or records of
intelligence information or security procedures of, the office of the
Attorney General and the Department of Justice, and any state or local
police agency, or any investigatory or security files compiled by any
other state or local police agency, or any investigatory or security
files compiled by any other state or local agency for correctional, law
enforcement, or licensing purposes, except that state and local law
enforcement agencies shall disclose the names and addresses of persons
involved in, or witnesses other than confidential informants to, the
incident, the description of any property involved, the date, time, and
location of the incident, all diagrams, statements of the parties
involved in the incident, the statements of all witnesses, other than
confidential informants, to the victims of an incident, or an authorized
representative thereof, an insurance carrier against which a claim has
been or might be made, and any person suffering bodily injury or
property damage or loss, as the result of the incident caused by arson,
burglary, fire, explosion, larceny, robbery, carjacking, vandalism,
vehicle theft, or a crime as defined by subdivision (c) of Section
13960, unless the disclosure would endanger the safety of a witness or
other person involved in the investigation, or unless disclosure would
endanger the successful completion of the investigation or a related
investigation. However, nothing in this division shall require the
disclosure of that portion of those investigative files that reflect the
analysis or conclusions of the investigating officer.
Notwithstanding
any other provision of this subdivision, state and local law enforcement
agencies shall make public the following information, except to the
extent that disclosure of a particular item of information would
endanger the safety of a person involved in an investigation or would
endanger the successful completion of the investigation or a related
investigation:
(1)
The full name and occupation of every individual arrested by the agency,
the individual’s physical description including date of birth, color
of eyes and hair, sex, height and weight, the time and date of arrest,
the time and date of booking, the location of the arrest, the factual
circumstances surrounding the arrest, the amount of bail set, the time
and manner of release or the location where the individual is currently
being held, and all charges the individual is being held upon, including
any outstanding warrants from other jurisdictions and parole or
probation holds.
(2)
Subject to the restrictions imposed by Section 841.5 of the Penal Code,
the time, substance, and location of all complaints or requests for
assistance received by the agency and the time and nature of the
response thereto, including, to the extent the information regarding
crimes alleged or committed or any other incident investigated is
recorded, the time, date, and location of occurrence, the time and date
of the report, the name and age of the victim, the factual circumstances
surrounding the crime or incident, and a general description of any
injuries, property, or weapons involved. The name of a victim of any
crime defined by Section 220, 261, 261.5, 262, 264, 264.1, 273a, 273d,
273.5, 286, 288, 288a, 289, 422.6, 422.7, 422.75, or 646.9 of the Penal
Code may be withheld at the victim’s request, or at the request of the
victim’s parent or guardian if the victim is a minor. When a person is
the victim of more than one crime, information disclosing that the
person is a victim of a crime defined by Section 220, 261, 261.5, 262,
264, 264.1, 273a, 273d, 286, 288, 288a, 289, 422.6, 422.7, 422.75, or
646.9 of the Penal Code may be deleted at the request of the victim, or
the victim’s parent or guardian if the victim is a minor, in making
the report of the crime, or of any crime or incident accompanying the
crime, available to the public in compliance with the requirements of
this paragraph.
(3)
Subject to the restrictions of Section 841.5 of the Penal Code and this
subdivision, the current address of every individual arrested by the
agency and the current address of the victim of a crime, where the
requester declares under penalty of perjury that the request is made for
a scholarly, journalistic, political, or governmental purpose, or that
the request is made for investigation purposes by a licensed private
investigator as described in Chapter 11.3 (commencing with Section 7512)
of Division 3 of the Business and Professions Code, except that the
address of the victim of any crime defined by Section 220, 261, 261.5,
262, 264, 264.1, 273a, 273d, 273.5, 286, 288, 288a, 289, 422.6, 422.7,
422.75, or 646.9 of the Penal Code shall remain confidential. Address
information obtained pursuant to this paragraph shall not be used
directly or indirectly to sell a product or service to any individual or
group of individuals, and the requester shall execute a declaration to
that effect under penalty of perjury.
(g)
Test questions, scoring keys, and other examination data used to
administer a licensing examination, examination for employment, or
academic examination, except as provided for in Chapter 3 (commencing
with Section 99150) of Part 65 of the Education Code.
(h)
The contents of real estate appraisals or engineering or feasibility
estimates and evaluations made for or by the state or local agency
relative to the acquisition of property, or to prospective public supply
and construction contracts, until all of the property has been acquired
or all of the contract agreement obtained. However, the law of eminent
domain shall not be affected by this provision.
(i)
Information required from any taxpayer in connection with the collection
of local taxes that is received in confidence and the disclosure of the
information to other persons would result in unfair competitive
disadvantage to the person supplying the information.
(j)
Library circulation records kept for the purpose of identifying the
borrower of items available in libraries, and library and museum
materials made or acquired and presented solely for reference or
exhibition purposes. The exemption in this subdivision shall not apply
to records of fines imposed on the borrowers.
(k)
Records, the disclosure of which is exempted or prohibited pursuant to
federal or state law, including, but not limited to, provisions of the
Evidence Code relating to privilege.
(l)
Correspondence of and to the Governor or employees of the Governor’s
office or in the custody of or maintained by the Governor’s legal
affairs secretary, provided that public records shall not be transferred
to the custody of the Governor’s Legal Affairs Secretary to evade the
disclosure provisions of this chapter.
(m)
In the custody of or maintained by the Legislative Counsel, except those
records in the public database maintained by the Legislative Counsel
that are described in Section 10248.
(n)
Statements of personal worth or personal financial data required by a
licensing agency and filed by an applicant with the licensing agency to
establish his or her personal qualification for the license,
certificate, or permit applied for.
(o)
Financial data contained in applications for financing under Division 27
(commencing with Section 44500) of the Health and Safety Code, where an
authorized officer of the California Pollution Control Financing
Authority determines that disclosure of the financial data would be
competitively injurious to the applicant and the data is required in
order to obtain guarantees from the United States Small Business
Administration. The California Pollution Control Financing Authority
shall adopt rules for review of individual requests for confidentiality
under this section and for making available to the public those portions
of an application that are subject to disclosure under this chapter.
(p)
Records of state agencies related to activities governed by Chapter 10.3
(commencing with Section 3512), Chapter 10.5 (commencing with Section
3525), and Chapter 12 (commencing with Section 3560) of Division 4 of
Title 1, that reveal a state agency’s deliberative processes,
impressions, evaluations, opinions, recommendations, meeting minutes,
research, work products, theories, or strategy, or that provide
instruction, advice, or training to employees who do not have full
collective bargaining and representation rights under these chapters.
Nothing in this subdivision shall be construed to limit the disclosure
duties of a state agency with respect to any other records relating to
the activities governed by the employee relations acts referred to in
this subdivision.
(q)
Records of state agencies related to activities governed by Article 2.6
(commencing with Section 14081), Article 2.8 (commencing with Section
14087.5), and Article 2.91 (commencing with Section 14089) of Chapter 7
of Part 3 of Division 9 of the Welfare and Institutions Code, that
reveal the special negotiator’s deliberative processes, discussions,
communications, or any other portion of the negotiations with providers
of health care services, impressions, opinions, recommendations, meeting
minutes, research, work product, theories, or strategy, or that provide
instruction, advice, or training to employees.
Except
for the portion of a contract containing the rates of payment, contracts
for inpatient services entered into pursuant to these articles, on or
after April 1, 1984, shall be open to inspection one year after they are
fully executed. In the event that a contract for inpatient services that
is entered into prior to April 1, 1984, is amended on or after April 1,
1984, the amendment, except for any portion containing the rates of
payment, shall be open to inspection one year after it is fully
executed. If the California Medical Assistance Commission enters into
contracts with health care providers for other than inpatient hospital
services, those contracts shall be open to inspection one year after
they are fully executed.
Three
years after a contract or amendment is open to inspection under this
subdivision, the portion of the contract or amendment containing the
rates of payment shall be open to inspection.
Notwithstanding
any other provision of law, the entire contract or amendment shall be
open to inspection by the Joint Legislative Audit Committee. The
committee shall maintain the confidentiality of the contracts and
amendments until the time a contract or amendment is fully open to
inspection by the public.
(r)
Records of Native American graves, cemeteries, and sacred places
maintained by the Native American Heritage Commission. (s) A final
accreditation report of the Joint Commission on Accreditation of
Hospitals that has been transmitted to the State Department of Health
Services pursuant to subdivision (b) of Section 1282 of the Health and
Safety Code.
(t)
Records of a local hospital district, formed pursuant to Division 23
(commencing with Section 32000) of the Health and Safety Code, or the
records of a municipal hospital, formed pursuant to Article 7
(commencing with Section 37600) or Article 8 (commencing with Section
37650) of Chapter 5 of Division 3 of Title 4 of this code, that relate
to any contract with an insurer or nonprofit hospital service plan for
inpatient or outpatient services for alternative rates pursuant to
Section 10133 or 11512 of the Insurance Code. However, the record shall
be open to inspection within one year after the contract is fully
executed.
(u)
(1) Information contained in applications for licenses to carry firearms
issued pursuant to Section 12050 of the Penal Code by the sheriff of a
county or the chief or other head of a municipal police department that
indicates when or where the applicant is vulnerable to attack or that
concerns the applicant’s medical or psychological history or that of
members of his or her family.
(2)
The home address and telephone number of peace officers, judges, court
commissioners, and magistrates that are set forth in applications for
licenses to carry firearms issued pursuant to Section 12050 of the Penal
Code by the sheriff of a county or the chief or other head of a
municipal police department.
(3)
The home address and telephone number of peace officers, judges, court
commissioners, and magistrates that are set forth in licenses to carry
firearms issued pursuant to Section 12050 of the Penal Code by the
sheriff of a county or the chief or other head of a municipal police
department.
(v)
(1) Records of the Major Risk Medical Insurance Program related to
activities governed by Part 6.3 (commencing with Section 12695) and Part
6.5 (commencing with Section 12700) of Division 2 of the Insurance Code,
and that reveal the deliberative processes, discussions, communications,
or any other portion of the negotiations with health plans, or the
impressions, opinions, recommendations, meeting minutes, research, work
product, theories, or strategy of the board or its staff, or records
that provide instructions, advice, or training to employees.
(2)
(A) Except for the portion of a contract that contains the rates of
payment, contracts for health coverage entered into pursuant to Part 6.3
(commencing with Section 12695) or Part 6.5 (commencing with Section
12700) of Division 2 of the Insurance Code, on or after July 1, 1991,
shall be open to inspection one year after they have been fully
executed.
(B)
In the event that a contract for health coverage that is entered into
prior to July 1, 1991, is amended on or after July 1, 1991, the
amendment, except for any portion containing the rates of payment, shall
be open to inspection one year after the amendment has been fully
executed.
(3)
Three years after a contract or amendment is open to inspection pursuant
to this subdivision, the portion of the contract or amendment containing
the rates of payment shall be open to inspection.
(4)
Notwithstanding any other provision of law, the entire contract or
amendments to a contract shall be open to ins | 