Individual legislator voting records for this vote are not currently available. Includes all politicians who were in office at any point during the 2015-2016 Legislature.

AB 533 - An Act to Add Sections 1371.30, 1371.31, and 1371.9 to the Health and Safety Code, and to Add Sections 10112.8, 10112.81, and 10112.82 to the Insurance Code, Relating to Health Care Coverage.

Health care coverage: out-of-network coverage. 2015-2016 Legislature. View bill details
Author(s):
Summary:
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. A willful violation of the act is a crime. Existing law requires a health care service plan to reimburse providers for emergency services and care provided to its enrollees, until the care results in stabilization of… More
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. A willful violation of the act is a crime. Existing law requires a health care service plan to reimburse providers for emergency services and care provided to its enrollees, until the care results in stabilization of the enrollee. Existing law prohibits a health care service plan from requiring a provider to obtain authorization prior to the provision of emergency services and care necessary to stabilize the enrollee’s emergency medical care, as specified.

Existing law also provides for the regulation of health insurers by the Insurance Commissioner. Existing law requires a health insurance policy issued, amended, or renewed on or after January 1, 2014, that provides or covers benefits with respect to services in an emergency department of a hospital to cover emergency services without the need for prior authorization, regardless of whether the provider is a participating provider, and subject to the same cost sharing required if the services were provided by a participating provider, as specified.

This bill would require a health care service plan contract or health insurance policy issued, amended, or renewed on or after July 1, 2016, to provide that if an enrollee or insured receives covered services from a contracting health facility, as defined, at which, or as a result of which, the enrollee or insured receives covered services provided by a noncontracting individual health professional, as defined, the enrollee or insured would be required to pay the noncontracting individual health professional only the same cost sharing required if the services were provided by a contracting individual health professional. The bill would prohibit an enrollee or insured from owing the noncontracting individual health professional at the contracting health facility more than the in-network cost-sharing amount if the noncontracting individual health professional receives reimbursement for services provided to the enrollee or insured at a contracting health facility from the health care service plan or health insurer. However, the bill would make an exception from this prohibition if the enrollee or insured provides written consent that satisfies specified criteria. The bill would require a noncontracting individual health professional who collects more than the in-network cost-sharing amount from the enrollee or insured to refund any overpayment to the enrollee or insured, as specified, and would provide that interest on any amount overpaid by, and not refunded to, the enrollee or insured shall accrue at 15% per annum, as specified.

Existing law requires a contract between a health care service plan and a provider, or a contract between an insurer and a provider, to contain provisions requiring a fast, fair, and cost-effective dispute resolution mechanism under which providers may submit disputes to the plan or insurer. Existing law requires that dispute resolution mechanism also be made accessible to a noncontracting provider for the purpose of resolving billing and claims disputes.

This bill would require the department and the commissioner to each establish an independent dispute resolution process that would allow a noncontracting individual health professional who rendered services at a contracting health facility, or a plan or insurer, to appeal a claim payment dispute, as specified. The bill would authorize the department and the commissioner to contract with one or more independent dispute resolution organizations to conduct the independent dispute resolution process, as specified. The bill would provide that the decision of the organization would be binding on the parties. The bill would require a plan or insurer to base reimbursement for covered services on the amount the individual health professional would have been reimbursed by Medicare for the same or similar services in the general geographic area in which the services were rendered. The bill would require a noncontracting individual health professional who disputes that claim reimbursement to utilize the independent dispute resolution process. The bill would provide that these provisions do not apply to emergency services and care, as defined.

Because a willful violation of the bill’s provisions relative to a health care service plan 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. Hide
 
Status:
The bill was voted on by the Assembly on September 12, 2015. 
Assembly Vote: On Passage

DID NOT PASS on September 12, 2015.

voted YES: 38 voted NO: 10
31 voted present/not voting

An Act to Add Sections 1371.30, 1371.31, and 1371.9 to the Health and Safety Code, and to Add Sections 10112.8, 10112.81, and 10112.82 to the Insurance Code, Relating to Health Care Coverage.

AB 533 — 2015-2016 Legislature

Summary
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. A willful violation of the act is a crime. Existing law requires a health care service plan to reimburse providers for emergency services and care provided to its enrollees, until the care results in stabilization of the enrollee. Existing law prohibits a health care service plan from requiring a provider to obtain authorization prior to the provision of emergency services and care necessary to stabilize the enrollee’s emergency medical care, as specified.

Existing law also provides for the regulation of health insurers by the Insurance Commissioner. Existing law requires a health insurance policy issued, amended, or renewed on or after January 1, 2014, that provides or covers benefits with respect to services in an emergency department of a hospital to cover emergency services without the need for prior authorization, regardless of whether the provider is a participating provider, and subject to the same cost sharing required if the services were provided by a participating provider, as… More
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. A willful violation of the act is a crime. Existing law requires a health care service plan to reimburse providers for emergency services and care provided to its enrollees, until the care results in stabilization of the enrollee. Existing law prohibits a health care service plan from requiring a provider to obtain authorization prior to the provision of emergency services and care necessary to stabilize the enrollee’s emergency medical care, as specified.

Existing law also provides for the regulation of health insurers by the Insurance Commissioner. Existing law requires a health insurance policy issued, amended, or renewed on or after January 1, 2014, that provides or covers benefits with respect to services in an emergency department of a hospital to cover emergency services without the need for prior authorization, regardless of whether the provider is a participating provider, and subject to the same cost sharing required if the services were provided by a participating provider, as specified.

This bill would require a health care service plan contract or health insurance policy issued, amended, or renewed on or after July 1, 2016, to provide that if an enrollee or insured receives covered services from a contracting health facility, as defined, at which, or as a result of which, the enrollee or insured receives covered services provided by a noncontracting individual health professional, as defined, the enrollee or insured would be required to pay the noncontracting individual health professional only the same cost sharing required if the services were provided by a contracting individual health professional. The bill would prohibit an enrollee or insured from owing the noncontracting individual health professional at the contracting health facility more than the in-network cost-sharing amount if the noncontracting individual health professional receives reimbursement for services provided to the enrollee or insured at a contracting health facility from the health care service plan or health insurer. However, the bill would make an exception from this prohibition if the enrollee or insured provides written consent that satisfies specified criteria. The bill would require a noncontracting individual health professional who collects more than the in-network cost-sharing amount from the enrollee or insured to refund any overpayment to the enrollee or insured, as specified, and would provide that interest on any amount overpaid by, and not refunded to, the enrollee or insured shall accrue at 15% per annum, as specified.

Existing law requires a contract between a health care service plan and a provider, or a contract between an insurer and a provider, to contain provisions requiring a fast, fair, and cost-effective dispute resolution mechanism under which providers may submit disputes to the plan or insurer. Existing law requires that dispute resolution mechanism also be made accessible to a noncontracting provider for the purpose of resolving billing and claims disputes.

This bill would require the department and the commissioner to each establish an independent dispute resolution process that would allow a noncontracting individual health professional who rendered services at a contracting health facility, or a plan or insurer, to appeal a claim payment dispute, as specified. The bill would authorize the department and the commissioner to contract with one or more independent dispute resolution organizations to conduct the independent dispute resolution process, as specified. The bill would provide that the decision of the organization would be binding on the parties. The bill would require a plan or insurer to base reimbursement for covered services on the amount the individual health professional would have been reimbursed by Medicare for the same or similar services in the general geographic area in which the services were rendered. The bill would require a noncontracting individual health professional who disputes that claim reimbursement to utilize the independent dispute resolution process. The bill would provide that these provisions do not apply to emergency services and care, as defined.

Because a willful violation of the bill’s provisions relative to a health care service plan 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. Hide
Learn More
At LegInfo.ca.gov
Title
An Act to Add Sections 1371.30, 1371.31, and 1371.9 to the Health and Safety Code, and to Add Sections 10112.8, 10112.81, and 10112.82 to the Insurance Code, Relating to Health Care Coverage.
Author(s)
Rob Bonta
Co-Authors
    Subjects
    • Health care coverage: out-of-network coverage
    Major Actions
    Introduced2/23/2015
    Referred to Committee
    Passed Assembly Committee on Health4/21/2015
    Passed Assembly Committee on Appropriations5/28/2015
    Passed Assembly6/02/2015
    Passed Senate Committee on Health7/15/2015
    Passed Senate Committee on Appropriations8/24/2015
    Passed Senate Committee on Appropriations8/27/2015
    Passed Senate Committee on Health9/09/2015
    Passed Senate9/10/2015
    Failed passage in Assembly9/12/2015
    Bill History
    Chamber/CommitteeMotionDateResult
    select this voteAssembly Committee on HealthDo pass as amended and be re-referred to the Committee on [Appropriations]4/21/2015This motion PASSED the Assembly Committee on Health
    17 voted YES 0 voted NO 0 voted present/not voting
    select this voteAssembly Committee on AppropriationsDo pass.5/28/2015This motion PASSED the Assembly Committee on Appropriations
    17 voted YES 0 voted NO 0 voted present/not voting
    select this voteAssemblyAB 533 BONTA Assembly Third Reading6/02/2015This bill PASSED the Assembly
    74 voted YES 1 voted NO 5 voted present/not voting
    select this voteSenate Committee on HealthDo pass as amended, but first amend, and re-refer to the Committee on [Appropriations]7/15/2015This motion PASSED the Senate Committee on Health
    6 voted YES 2 voted NO 0 voted present/not voting
    select this voteSenate Committee on AppropriationsPlaced on suspense file8/24/2015This motion PASSED the Senate Committee on Appropriations
    7 voted YES 0 voted NO 0 voted present/not voting
    select this voteSenate Committee on AppropriationsDo pass8/27/2015This motion PASSED the Senate Committee on Appropriations
    5 voted YES 2 voted NO 0 voted present/not voting
    select this voteSenate Committee on HealthThat the measure be returned to Senate Floor for consideration. Ordered to third reading.9/09/2015This motion PASSED the Senate Committee on Health
    7 voted YES 1 voted NO 1 voted present/not voting
    select this voteSenateAssembly 3rd Reading AB533 Bonta By Hernandez9/10/2015This bill PASSED the Senate
    25 voted YES 10 voted NO 5 voted present/not voting
    currently selectedAssemblyAB 533 BONTA Concurrence in Senate Amendments9/12/2015This bill DID NOT PASS the Assembly
    38 voted YES 10 voted NO 31 voted present/not voting
    ActionDateDescription
    Introduced2/23/2015
    2/23/2015Read first time. To print.
    2/24/2015From printer. May be heard in committee March 26.
    3/05/2015Referred to Com. on HEALTH.
    4/14/2015In committee: Set, first hearing. Hearing canceled at the request of author.
    4/15/2015From committee chair, with author's amendments: Amend, and re-refer to Com. on HEALTH. Read second time and amended.
    4/16/2015Re-referred to Com. on HEALTH.
    select this voteVote4/21/2015Do pass as amended and be re-referred to the Committee on [Appropriations]
    4/22/2015From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 17. Noes 0.) (April 21).
    4/23/2015Read second time and amended.
    4/27/2015Re-referred to Com. on APPR.
    5/06/2015In committee: Set, first hearing. Referred to APPR. suspense file.
    select this voteVote5/28/2015Do pass.
    5/28/2015From committee: Do pass. (Ayes 17. Noes 0.) (May 28). Read second time. Ordered to third reading.
    6/02/2015Read third time. Passed. Ordered to the Senate. (Ayes 74. Noes 1. Page 1770.)
    6/02/2015In Senate. Read first time. To Com. on RLS. for assignment.
    select this voteAssembly Vote on Passage6/02/2015AB 533 BONTA Assembly Third Reading
    6/11/2015Referred to Com. on HEALTH.
    6/25/2015In committee: Set, first hearing. Hearing canceled at the request of author.
    7/07/2015From committee chair, with author's amendments: Amend, and re-refer to committee. Read second time, amended, and re-referred to Com. on HEALTH.
    select this voteVote7/15/2015Do pass as amended, but first amend, and re-refer to the Committee on [Appropriations]
    8/17/2015From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 6. Noes 2.) (July 15).
    8/18/2015Read second time and amended. Re-referred to Com. on APPR.
    select this voteVote8/24/2015Placed on suspense file
    8/24/2015In committee: Referred to APPR. suspense file.
    select this voteVote8/27/2015Do pass
    8/27/2015From committee: Do pass. (Ayes 5. Noes 2.) (August 27).
    8/31/2015Read second time. Ordered to third reading.
    9/04/2015Read third time and amended. Ordered to second reading.
    9/08/2015Read second time. Ordered to third reading. Re-referred to Com. on RLS. pursuant to Senate Rule 29.10(b). From committee: Be re-referred to Com. on HEALTH pursuant to Senate Rule 29.10(b). (Ayes 5. Noes 0.) Re-referred to Com. on HEALTH.
    select this voteVote9/09/2015That the measure be returned to Senate Floor for consideration. Ordered to third reading.
    9/09/2015From committee: Return to Senate floor for consideration. (Ayes 7. Noes 1.) (September 9).
    9/10/2015Read third time. Passed. Ordered to the Assembly. (Ayes 25. Noes 10. Page 2706.).
    9/10/2015In Assembly. Concurrence in Senate amendments pending.
    select this voteSenate Vote on Passage9/10/2015Assembly 3rd Reading AB533 Bonta By Hernandez
    currently selectedAssembly Vote on Passage9/12/2015AB 533 BONTA Concurrence in Senate Amendments
    9/12/2015Assembly refused to concur in Senate amendments. (Ayes 38. Noes 10. Page 3214.) Motion to reconsider made by Assembly Member Bonta.
    8/31/2016Reconsideration granted. (Page 6544.) Ordered to inactive file at the request of Assembly Member Bonta.

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    Organizations that took a position on
    An Act to Add Sections 1371.30, 1371.31, and 1371.9 to the Health and Safety Code, and to Add Sections 10112.8, 10112.81, and 10112.82 to the Insurance Code, Relating to Health Care Coverage.: AB 533 BONTA Concurrence in Senate Amendments

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    Contributions data source: FollowTheMoney.org

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    Legislator Filters
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    NamePartyDistrict$ From Interest Groups
    That Support
    $ From Interest Groups
    That Oppose
    Vote
    Katcho AchadjianRCA-35$0$0
    Luis AlejoDCA-30$0$0
    Travis AllenRCA-72$0$0
    Toni G. AtkinsDCA-78$0$0
    Catharine B. BakerRCA-16$0$0
    Frank BigelowRCA-5$0$0
    Richard BloomDCA-50$0$0
    Susan BonillaDCA-14$0$0
    Rob BontaDCA-18$0$0
    William P. BroughRCA-73$0$0
    Cheryl BrownDCA-47$0$0
    Autumn R. BurkeDCA-62$0$0
    Ian C. CalderonDCA-57$0$0
    Nora CamposDCA-27$0$0
    Ling Ling ChangRCA-55$0$0
    Ed ChauDCA-49$0$0
    Rocky J. ChavezRCA-76$0$0
    David ChiuDCA-17$0$0
    Kansen ChuDCA-25$0$0
    Ken CooleyDCA-8$0$0
    Jim CooperDCA-9$0$0
    Matthew DababnehDCA-45$0$0
    Brian DahleRCA-1$0$0
    Tom DalyDCA-69$0$0
    Bill DoddDCA-4$0$0
    Susan Talamantes EggmanDCA-13$0$0
    Jim FrazierDCA-11$0$0
    Beth GainesRCA-6$0$0
    James GallagherRCA-3$0$0
    Cristina GarciaDCA-58$0$0
    Eduardo GarciaDCA-56$0$0
    Mike GattoDCA-43$0$0
    Mike A. GipsonDCA-64$0$0
    Jimmy GomezDCA-51$0$0
    Lorena S. GonzalezDCA-80$0$0
    Rich GordonDCA-24$0$0
    Adam C. GrayDCA-21$0$0
    Shannon GroveRCA-34$0$0
    David HadleyRCA-66$0$0
    Matthew HarperRCA-74$0$0
    Roger HernandezDCA-48$0$0
    Chris R. HoldenDCA-41$0$0
    Jacqui IrwinDCA-44$0$0
    Brian JonesRCA-71$0$0
    Reginald B. Jones-Sawyer, Sr.DCA-59$0$0
    Young O. KimRCA-65$0$0
    Tom LackeyRCA-36$0$0
    Marc LevineDCA-10$0$0
    Eric LinderRCA-60$0$0
    Patty LopezDCA-39$0$0
    Evan LowDCA-28$0$0
    Brian MaienscheinRCA-77$0$0
    Devon J. MathisRCA-26$0$0
    Chad MayesRCA-42$0$0
    Kevin McCartyDCA-7$0$0
    Jose MedinaDCA-61$0$0
    Melissa A. MelendezRCA-67$0$0
    Kevin MullinDCA-22$0$0
    Adrin NazarianDCA-46$0$0
    Patrick O'DonnellDCA-70$0$0
    Jay ObernolteRCA-33$0$0
    Kristin OlsenRCA-12$0$0
    Jim PattersonRCA-23$0$0
    Henry PereaDCA-31$0$0
    Bill QuirkDCA-20$0$0
    Anthony RendonDCA-63$0$0
    Sebastian Ridley-ThomasDCA-54$0$0
    Freddie RodriguezDCA-52$0$0
    Rudy SalasDCA-32$0$0
    Miguel SantiagoDCA-53$0$0
    Marc SteinorthRCA-40$0$0
    Mark StoneDCA-29$0$0
    Tony ThurmondDCA-15$0$0
    Philip Y. TingDCA-19$0$0
    Don WagnerRCA-68$0$0
    Marie WaldronRCA-75$0$0
    Shirley N. WeberDCA-79$0$0
    Scott WilkRCA-38$0$0
    Das WilliamsDCA-37$0$0
    Jim WoodDCA-2$0$0

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