Health care coverage: rate review.
Vote required
Majority
Fiscal committee
No
Appropriation
No
Current location
Enrolled
Take action
Record your position on this measure.
Create an account to record your position, submit testimony, or contact your legislator.
Progress
Where this bill stands in the legislative process.
- Introduced
- Passed Senate
- Passed Assembly
- To Governor
- Became Law
Overview
This bill changes how California health coverage rates are reviewed. Instead of relying on federal definitions of ‘unreasonable rate increase,’ it directs the Department of Managed Health Care and the Insurance Commissioner to determine if rate increases are excessive, unjustified, or unfairly discriminatory. The bill also requires health plans and insurers to demonstrate how cost targets, medical trends, and other factors influence rate development, and to reconcile this information with analysis from the Office of Health Care Affordability. Furthermore, it mandates that regulators consider financial capacity when assessing rate reasonableness and conduct enhanced affordability reviews.
Key provisions
- Defines ‘unreasonable rate increase’ based on state-level determination of excessive, unjustified, or discriminatory increases.
- Requires health plans and insurers to demonstrate the impact of health care cost targets on rate development, including medical trends and administrative costs.
- Mandates reconciliation of rate increases with analysis from the Office of Health Care Affordability.
- Requires regulators to consider financial capacity (surplus condition) when reviewing rate reasonableness.
- Requires enhanced rate reviews to assess affordability for individual and group purchasers.
- Specifies the factors to be included in rate filings when rate growth exceeds cost targets.
- Eliminates the requirement for reimbursement to local agencies or school districts for costs associated with this legislation.
- Requires departments to collaborate with the Office of Health Care Affordability in rate review processes.
Bill text
Read the latest version inline or switch to a previous version.
Text extraction is in progress. View the official source.
Sponsors
Official sponsors from legislative records.
1 on record
Primary sponsor
Arguments
Reasons offered for and against this legislation.
Arguments in favor
No arguments in favor have been submitted.
Submit yoursArguments opposed
No arguments opposed have been submitted.
Submit yours