JurisdictionCaliforniaCode HSCHealth and Safety Code - HSC
Div. 2.DIVISION 2. LICENSING PROVISIONS
Ch. 2.2.CHAPTER 2.2. Health Care Service Plans
Art. 6.2.ARTICLE 6.2. Review of Rate Increases
This text of California § 1385.07. (1385.07. (Amended by Stats. 2021, Ch. 615, Sec. 228.)) is published on Counsel Stack Legal Research, covering California primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.
(a)Notwithstanding Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code, all information submitted under this article shall be made publicly available by the department except as provided in subdivision (b).
(b)
(1)The contracted rates between a health care service plan and a provider shall be deemed confidential information that shall not be made public by the department and are exempt from disclosure under the California Public Records Act (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code). The contracted rates between a health care service plan and a provider shall not be disclosed by a health care service
plan to a large group purchaser that receives information pursuant to
Section 1385.10.
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(a)
Notwithstanding Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code, all information submitted under this article shall be made publicly available by the department except as provided in subdivision (b).
(b)
(1)
The contracted rates between a health care service plan and a provider shall be deemed confidential information that shall not be made public by the department and are exempt from disclosure under the California Public Records Act (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code). The contracted rates between a health care service plan and a provider shall not be disclosed by a health care service
plan to a large group purchaser that receives information pursuant to
Section 1385.10.
(2)
The contracted rates between a health care service plan, including those submitted to the department pursuant to Section 1385.046, and a large group shall be deemed confidential information that shall not be made public by the department and are exempt from disclosure under the California Public Records Act (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code). Information provided to a large group purchaser pursuant to Section 1385.10 shall be deemed confidential information that shall not be made public by the department and shall be exempt from disclosure under the California Public Records Act (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code).
(c)
All information submitted to
the department under this article shall be submitted electronically in order to facilitate review by the department and the public.
(d)
In addition, the department and the health care service plan shall, at a minimum, make the following information readily available to the public on their internet websites in plain language and in a manner and format specified by the department, except as provided in subdivision (b). For individual and small group health care service plan contracts, the information shall be made public for 120 days prior to the implementation of the rate increase. For large group health care service plan contracts, the information shall be made public for 60 days prior to the implementation of the rate increase. The information shall include:
(1)
Justifications for any unreasonable rate increases, including all information and supporting documentation as to why the rate increase is justified.
(2)
A plan’s overall annual medical trend factor assumptions in each rate filing for all benefits.
(3)
A health care service plan’s actual costs, by aggregate benefit category to include hospital inpatient, hospital outpatient, physician services, prescription drugs and other ancillary services, laboratory, and radiology.
(4)
The amount of the projected trend attributable to the use of services, price inflation, or fees and risk for annual plan contract trends by aggregate benefit category, such as hospital inpatient, hospital outpatient, physician services,
prescription drugs and other ancillary services, laboratory, and radiology.