Review of Rate Increases

Cal. HSC § 1385.07

California Statutes

(

a) Notwithstanding Division 10 (commencing with

Section 7920.000) of Title of the Government Code, all information submitted under this

article shall be made publicly available by the department except as provided in subdivision (b). (b)

(1) The contracted rates between a health care service plan and a provider shall be deemed confidential information that shall not be made public by the department and are exempt from disclosure under the California Public Records Act (Division 10 (commencing with

Section 7920.000) of Title of the Government Code). The contracted rates between a health care service plan and a provider shall not be disclosed by a health care service plan to a large group purchaser that receives information pursuant to

Section 1385.10.

(2) The contracted rates between a health care service plan, including those submitted to the department pursuant to

Section 1385.046, and a large group shall be deemed confidential information that shall not be made public by the department and are exempt from disclosure under the California Public Records Act (Division 10 (commencing with

Section 7920.000) of Title of the Government Code). Information provided to a large group purchaser pursuant to

Section 1385.10 shall be deemed confidential information that shall not be made public by the department and shall be exempt from disclosure under the California Public Records Act (Division 10 (commencing with

Section 7920.000) of Title of the Government Code). (

c) All information submitted to the department under this

article shall be submitted electronically in order to facilitate review by the department and the public. (

d) In addition, the department and the health care service plan shall, at a minimum, make the following information readily available to the public on their internet websites in plain language and in a manner and format specified by the department, except as provided in subdivision (b). For individual and small group health care service plan contracts, the information shall be made public for days prior to the implementation of the rate increase. For large group health care service plan contracts, the information shall be made public for days prior to the implementation of the rate increase. The information shall include:

(1) Justifications for any unreasonable rate increases, including all information and supporting documentation as to why the rate increase is justified.

(2) A plan’s overall annual medical trend factor assumptions in each rate filing for all benefits.

(3) A health care service plan’s actual costs, by aggregate benefit category to include hospital inpatient, hospital outpatient, physician services, prescription drugs and other ancillary services, laboratory, and radiology.

(4) The amount of the projected trend attributable to the use of services, price inflation, or fees and risk for annual plan contract trends by aggregate benefit category, such as hospital inpatient, hospital outpatient, physician services, prescription drugs and other ancillary services, laboratory, and radiology.

Document details

CollectionCalifornia Statutes
CitationCal. HSC § 1385.07
Date2022-01-01
Typestatute
Languageen
SourceCA_STAT
IdentifierHSC1385.07.2021615228

Review of Rate Increases

Cal. HSC § 1385.07

California Statutes

Review of Rate Increases

Cal. HSC § 1385.07

California Statutes

(

a) Notwithstanding Division 10 (commencing with

Section 7920.000) of Title of the Government Code, all information submitted under this

article shall be made publicly available by the department except as provided in subdivision (b). (b)

(1) The contracted rates between a health care service plan and a provider shall be deemed confidential information that shall not be made public by the department and are exempt from disclosure under the California Public Records Act (Division 10 (commencing with

Section 7920.000) of Title of the Government Code). The contracted rates between a health care service plan and a provider shall not be disclosed by a health care service plan to a large group purchaser that receives information pursuant to

Section 1385.10.

(2) The contracted rates between a health care service plan, including those submitted to the department pursuant to

Section 1385.046, and a large group shall be deemed confidential information that shall not be made public by the department and are exempt from disclosure under the California Public Records Act (Division 10 (commencing with

Section 7920.000) of Title of the Government Code). Information provided to a large group purchaser pursuant to

Section 1385.10 shall be deemed confidential information that shall not be made public by the department and shall be exempt from disclosure under the California Public Records Act (Division 10 (commencing with

Section 7920.000) of Title of the Government Code). (

c) All information submitted to the department under this

article shall be submitted electronically in order to facilitate review by the department and the public. (

d) In addition, the department and the health care service plan shall, at a minimum, make the following information readily available to the public on their internet websites in plain language and in a manner and format specified by the department, except as provided in subdivision (b). For individual and small group health care service plan contracts, the information shall be made public for days prior to the implementation of the rate increase. For large group health care service plan contracts, the information shall be made public for days prior to the implementation of the rate increase. The information shall include:

(1) Justifications for any unreasonable rate increases, including all information and supporting documentation as to why the rate increase is justified.

(2) A plan’s overall annual medical trend factor assumptions in each rate filing for all benefits.

(3) A health care service plan’s actual costs, by aggregate benefit category to include hospital inpatient, hospital outpatient, physician services, prescription drugs and other ancillary services, laboratory, and radiology.

(4) The amount of the projected trend attributable to the use of services, price inflation, or fees and risk for annual plan contract trends by aggregate benefit category, such as hospital inpatient, hospital outpatient, physician services, prescription drugs and other ancillary services, laboratory, and radiology.

Document details

CollectionCalifornia Statutes
CitationCal. HSC § 1385.07
Date2022-01-01
Typestatute
Languageen
SourceCA_STAT
IdentifierHSC1385.07.2021615228