Existing law provides for the licensure and regulation of health care service plans by the Department of Corporations, and provides that a willful violation of these provisions is subject to criminal sanction. Existing law requires every health care service plan that will affect the choice of physician, hospital, or other health care providers to clearly inform prospective enrollees of this restriction of choice, as prescribed. This bill would require every health care service plan, medical group, independent practice association, or participating health care provider that uses or receives financial bonuses or any other incentives to provide a written summary to any person who requests it that includes a general description of the bonus or incentive arrangements used in its compensation agreements and how bonus or incentive arrangements may relate to a provider's use of referral services. By imposing this requirement on health care service plans, this bill would change the definition of a crime, thereby imposing 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. Nothing in this section shall be construed to require disclosure of trade secrets or commercial or financial information that is privileged or confidential, such as payment rates, as determined by the commissioner, pursuant to state law. A description regarding whether, and in what manner, the bonuses and any other incentives are related to a provider's use of referral services. It is not the intent of this section to require that the names of individual health care providers be enumerated to prospective enrollees. Notwithstanding Section 17580 of the Government Code, unless otherwise specified, the provisions of this act shall become operative on the same date that the act takes effect pursuant to the California Constitution.