Cal. HSC § 127771 — California Code / Code hsc / Division 107 / Part 2 / Chapter 11 / Section 127771
Section 127771
Status: in_force

(a) (1) Beginning July 1, 2026, the department shall compile annual publications, to be made publicly available on the department’s internet website, including a quality of care report card that reflects health care service plans, health insurers, preferred provider organizations, and medical groups.

(2) The Department of Managed Health Care, the State Department of Health Care Services, the Department of Insurance, the Exchange, the State Department of Social Services, and any other state health coverage program or state entity shall provide to the department data concerning the quality of care report card in the time, manner, and format requested by the department. The department may also request data related to the cost of care, quality of care, patient experience, socioeconomic status impact on health, access to care, and access to social services programs. The data described in this section may be linked with other department data and used for other department data reports, to the extent allowed by state and federal law.

(3) The department may request data from, and contract with, academic or nonprofit organizations related to quality of health care and patient experience to develop the quality of care report card.

(b) The department shall produce a biennial report in even-numbered calendar years, to be made publicly available on the department’s internet website, of health care consumer or patient assistance help centers, call centers, ombudsperson, or other assistance centers operated by the Department of Managed Health Care, the State Department of Health Care Services, the Department of Insurance, and the Exchange that includes, at a minimum, all of the following:

(1) The types and volume of inquiries received.

(2) The call center’s role with regard to each type of call, question, complaint, or grievance.

(3) The call center’s protocol for responding to requests for assistance from health care consumers, including any performance standards.

(4) The protocol for referring or transferring calls outside the jurisdiction of the call center.

(5) The call center’s methodology of tracking calls, complaints, grievances, or inquiries.

(c) (1) In odd-numbered calendar years, the department shall produce an analysis of the data collected on problems and complaints by, and questions from, consumers about health care coverage for the purpose of providing public information about problems faced and information needed by consumers in obtaining coverage and care. The data collected shall include demographic data, insurer or plan data, appeals, source of coverage, regulator, type of problem or issue, and resolution of complaints, including timeliness of resolution, to the extent that data is readily available. The analysis shall be made public on the department’s internet website. In analyzing the data collected, the department may also identify examples of best practices when responding to consumer inquiries. The analysis may also include identification of practices that could be revised to improve responses to inquiries.

(2) The Department of Managed Health Care, the State Department of Health Care Services, the Department of Insurance, the Exchange, and any other state public health coverage programs shall provide to the department data concerning consumer complaints and issues to meet the reporting requirements in this section in the time, data elements, manner, and format requested by the department.

(3) For the purpose of publicly reporting information as required in paragraph (1) and this paragraph about the challenges in obtaining care and coverage, the department shall analyze data on consumer complaints, appeals, and grievances resolved by the agencies listed in subdivision (b), including demographic data, source of coverage, insurer or plan, resolution of complaints, and other information intended to improve health care and coverage for consumers, to the extent that data is readily available.

(4) The data described in this section may be linked with other department data and used for other department data reports, to the extent allowed by state and federal law.

(d) The department may implement, interpret, or make specific this section by means of a departmental letter or other similar instruction, as necessary, notwithstanding the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).

(e) For purposes of this section:

(1) “Data” means information that is not individually identifiable health information, as defined in Section 160.103 of Title 45 of the Code of Federal Regulations.

(2) “Exchange” means the California Health Benefit Exchange, established pursuant to Title 22 (commencing with Section 100500) of the Government Code.

(3) “Health care” includes services provided by any health care coverage program.

(4) “Health care service plan” has the same meaning as that set forth in subdivision (f) of Section 1345. “Health care service plan” includes specialized health care service plans, including behavioral health plans.

(5) “Health coverage program” includes the Medi-Cal program, tax subsidies and premium credits under the Exchange, and county health care programs.

(6) “Health insurer” means an insurer that offers health insurance, as defined in Section 106 of the Insurance Code.