California Code of Regulations › Title 28 - Managed Health Care › Division 1 - The Department of Managed Health Care › Chapter 2 - Health Care Service Plans › Article 9 - Financial Responsibility › Risk-Bearing Organizations › Section 1300.75.4.4 - Confidentiality

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Financial and
					 other records produced, disclosed or otherwise made available by an
					 organization pursuant to Health and Safety Code section
					 1375.4,
					 and to these Solvency Regulations shall be received and maintained on a
					 confidential basis and protected from public disclosure, unless the Director
					 makes a specific finding that the information can be released in a manner that
					 does not adversely affect the integrity of the contract negotiation process;
					 except that the organization's annual audited financial statement as required
					 by section
					 1300.75.4.2(c)
					 shall be permanently maintained on a confidential basis.
(b) The Director has determined that the
					 disclosure of the following information in the format provided below will not
					 adversely affect the integrity of an organization's contract negotiation
					 process and, therefore, will be made available to the public as follows:
(1) Within 120 days following each reporting
					 period due date, the Department of Managed Health Care (Department) will make
					 the following information available, on its website, for public inspection:
(A) A list of all provider organizations
					 currently identified as risk-bearing organizations;
(B) A list of all risk-bearing organizations
					 that have submitted substantially complete financial survey forms, if required,
					 and whether the risk-bearing organization's submission reflects that the
					 organization has met or not met each of the Grading Criteria, as follows:
1. The designation of "met" to be assigned
					 for each Grading Criteria met by the organization;
2. The designation of "not met" to be
					 assigned for each Grading Criteria not met by the organization;
3. The disclosure of whether the organization
					 has implemented and is compliant with a final CAP designed to remedy any
					 deficiencies reported in the Grading Criteria;
4. The relative working capital of each
					 organization, consistent with section
					 1300.75.4(h),
					 presented as a ratio of current assets divided by current
					 liabilities;
5. The relative
					 tangible net equity (TNE) of each organization, consistent with section
					 1300.75.4(h),
					 presented as a ratio of tangible net assets divided by total
					 liabilities;
6. Claims payment
					 timeliness in a percentage format, consistent with section
					 1300.75.4.(h), reflecting the
					 amount of claims that the organization is paying on a timely basis;
					 and,
7. To the extent feasible,
					 each financial item described in paragraphs 1. through 5. shall be presented
					 for both the current and the four previous reporting periods, following the
					 effective date of these regulations.
(C) A list of all "non-compliant"
					 organizations that fail to substantially comply with the reporting obligations,
					 including the submission of the financial survey reports specified in section
					 1300.75.4.2 of Title 28,
					 California Code of Regulations; and
(D) All information contained in the
					 Statement of Organization of a risk-bearing organization, except responses to
					 sections 1300.75.4.2(d)(8)(A),
					 (d)(14) and financial documentation provided
					 pursuant to section
					 1300.75.4.2
					 (d)(4); and
(E) Comparative, aggregated data on all
					 organizations, and information that enables consumers to assess an
					 organization's relative financial viability in a format that does not identify
					 any individual organizations and consistent with section
					 1300.75.4.4 of Title 28,
					 California Code of Regulations.