Section 1356 Of Article 3. Licensing And Fees From California Health And Safety Code >> Division 2. >> Chapter 2.2. >> Article 3.
1356
. (a) Each plan applying for licensure under this chapter shall
reimburse the director for the actual cost of processing the
application, including overhead, up to an amount not to exceed
twenty-five thousand dollars ($25,000). The cost shall be billed not
more frequently than monthly and shall be remitted by the applicant
to the director within 30 days of the date of billing. The director
shall not issue a license to an applicant prior to receiving payment
in full from that applicant for all amounts charged pursuant to this
subdivision.
(b) (1) In addition to other fees and reimbursements required to
be paid under this chapter, each licensed plan shall pay to the
director an amount as estimated by the director for the ensuing
fiscal year, as a reimbursement of its share of all costs and
expenses, including, but not limited to, costs and expenses
associated with routine financial examinations, grievances, and
complaints including maintaining a toll-free telephone number for
consumer grievances and complaints, investigation and enforcement,
medical surveys and reports, and overhead reasonably incurred in the
administration of this chapter and not otherwise recovered by the
director under this chapter or from the Managed Care Fund. The amount
may be paid in two equal installments. The first installment shall
be paid on or before August 1 of each year, and the second
installment shall be paid on or before December 15 of each year.
(2) The amount paid by each plan shall be ten thousand dollars
($10,000) plus an amount up to, but not exceeding, an amount computed
in accordance with paragraph (3).
(3) (A) In addition to the amount specified in paragraph (2), all
plans, except specialized plans, shall pay 65 percent of the total
amount of the department's costs and expenses for the ensuing fiscal
year as estimated by the director. The amount per plan shall be
calculated on a per enrollee basis as specified in paragraph (4).
(B) In addition to the amount specified in paragraph (2), all
specialized plans shall pay 35 percent of the total amount of the
department's costs and expenses for the ensuing fiscal year as
estimated by the director. The amount per plan shall be calculated on
a per enrollee basis as specified in paragraph (4).
(4) The amount paid by each plan shall be for each enrollee
enrolled in its plan in this state as of the preceding March 31, and
shall be fixed by the director by notice to all licensed plans on or
before June 15 of each year. A plan that is unable to report the
number of enrollees enrolled in the plan because it does not collect
that data, shall provide the director with an estimate of the number
of enrollees enrolled in the plan and the method used for determining
the estimate. The director may, upon giving written notice to the
plan, revise the estimate if the director determines that the method
used for determining the estimate was not reasonable.
(5) In determining the amount assessed, the director shall
consider all appropriations from the Managed Care Fund for the
support of this chapter and all reimbursements provided for in this
chapter.
(c) Each licensed plan shall also pay two thousand dollars
($2,000), plus an amount up to, but not exceeding, forty-eight
hundredths of one cent ($0.0048), for each enrollee for the purpose
of reimbursing its share of all costs and expenses, including
overhead, reasonably anticipated to be incurred by the department in
administering Sections 1394.7 and 1394.8 during the current fiscal
year. The amount charged shall be remitted within 30 days of the date
of billing.
(d) In no case shall the reimbursement, payment, or other fee
authorized by this section exceed the cost, including overhead,
reasonably incurred in the administration of this chapter.
(e) For the purpose of calculating the assessment under this
section, an enrollee who is enrolled in one plan and who receives
health care services under arrangements made by another plan or
plans, whether pursuant to a contract, agreement, or otherwise, shall
be considered to be enrolled in each of the plans.
(f) On and after January 1, 2009, no refunds or reductions of the
amounts assessed shall be allowed if any miscalculated assessment is
based on a plan's overestimate of enrollment.