Medi-Cal: subcontractors: rates.
Vote required
Majority
Fiscal committee
No
Appropriation
No
Current location
Appropriations
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Progress
Where this bill stands in the legislative process.
- Introduced
- Passed Assembly
- Passed Senate
- To Governor
- Became Law
Overview
This bill aims to ensure that Medi-Cal managed care subcontractors receive rates that are financially sound, as determined by actuarial principles. It requires the Department of Health Care Services to ensure these rates are consistent with federal guidelines and to address potential issues like medical loss ratios or membership declines. Subcontractors will have a process to review rates and seek adjustments if they are not actuarially sound, with a deadline for resolving disputes. The bill also clarifies definitions related to subcontracting and allows the department flexibility in implementing the changes.
Key provisions
- Requires Medi-Cal managed care subcontractors to be paid actuarially sound rates.
- Establishes a process for subcontractors to request a review of rates if certain conditions are met (e.g., high medical loss ratio).
- Directs the Department of Health Care Services to conduct an independent actuarial review of rates.
- Allows the department to order rate revisions if rates are found to be non-actuarially sound.
- Provides a mechanism for subcontractors to file a ‘notice of dispute’ if rates are not adjusted appropriately.
- Sets a 120-day deadline for resolving disputes.
- Authorizes the department to use various methods (e.g., letters, contracts) to implement the new requirements.
- Defines key terms like ‘downstream fully delegated subcontractor’ and ‘downstream partially delegated subcontractor’.
Who is affected
Bill text
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Sponsors
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1 on record
Primary sponsor
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