Section 1368.05 Of Article 5. Standards From California Health And Safety Code >> Division 2. >> Chapter 2.2. >> Article 5.
1368.05
. (a) (1) By enacting this section, which was originally
enacted by Assembly Bill 922 (Chapter 552 of the Statutes of 2011),
the Legislature recognizes that, because of the enactment of federal
health care reform on March 23, 2010, and the implementation of
various provisions by January 1, 2014, and the ongoing complexities
of health care reform, it is appropriate to transfer the direct
consumer assistance activities that were newly conferred on the
Office of Patient Advocate to the Department of Managed Health Care,
and the Legislature recognizes that these new duties are necessary to
be carried out by the department in partnership with community-based
consumer assistance organizations for the purposes of serving
California's health care consumers.
(2) In addition to maintaining the toll-free telephone number for
the purpose of receiving complaints regarding health care service
plans as required in Section 1368.02, the department and its
contractors shall carry out these new responsibilities, which include
assisting consumers in navigating private and public health care
coverage and assisting consumers in determining the regulator that
regulates the health care coverage of a particular consumer. In order
to further assist in implementing health care reform, the department
and its contractors shall also receive and respond to inquiries,
complaints, and requests for assistance and education concerning
health care coverage available in California.
(b) (1) The department shall annually contract with
community-based organizations in furtherance of providing assistance
to consumers as described in subdivision (a), as authorized by and in
accordance with Section 19130 of the Government Code.
(2) These organizations shall be community-based nonprofit
consumer assistance programs that shall include in their mission the
assistance of, and duty to, health care consumers.
(3) Contracting consumer assistance organizations shall have
experience in assisting consumers in navigating the local health care
system, advising consumers regarding their health care coverage
options, assisting consumers with problems in accessing health care
services, and serving consumers with special needs, including, but
not limited to, consumers with limited-English language proficiency,
consumers requiring culturally competent services, low-income
consumers, consumers with disabilities, consumers with low literacy
rates, and consumers with multiple health conditions, including
behavioral health. The organizations shall also have experience with,
and the capacity for, collecting and reporting data regarding the
consumers they assist, including demographic data, source of
coverage, regulator, type of problem or issue, and resolution of
complaints.