Section 1385.07 Of Article 6.2. Review Of Rate Increases From California Health And Safety Code >> Division 2. >> Chapter 2.2. >> Article 6.2.
1385.07
. (a) Notwithstanding Chapter 3.5 (commencing with Section
6250) of Division 7 of Title 1 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 (Chapter 3.5 (commencing with
Section 6250) of Division 7 of Title 1 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 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 (Chapter 3.5 (commencing with
Section 6250) of Division 7 of Title 1 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 (Chapter 3.5 (commencing with
Section 6250) of Division 7 of Title 1 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 Web sites, in plain language and in
a manner and format specified by the department, except as provided
in subdivision (b). The information shall be made public for 60 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 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. A health plan that
exclusively contracts with no more than two medical groups in the
state to provide or arrange for professional medical services for the
enrollees of the plan shall instead disclose the amount of its
actual trend experience for the prior contract year by aggregate
benefit category, using benefit categories that are, to the maximum
extent possible, the same or similar to those used by other plans.