Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care. Existing law authorizes the Director of the Department of Managed Health Care to authorize a pilot program in southern California under which approved providers may undertake risk-bearing arrangements with a voluntary employees' beneficiary association with enrollment of more than 100,000 lives, as specified, beginning no earlier than January 1, 2022, to December 31, 2027, inclusive, if certain criteria are met. Existing law requires the association and each participating health care provider to report to the department information regarding cost savings and clinical patient outcomes compared to a fee-for-service payment model. Existing law requires the department to report those findings to the Legislature after the termination of the pilot program and before January 1, 2027. Existing law repeals these provisions on January 1, 2030.
This bill would extend that repeal date to January 1, 2031. The bill would extend the end date of the pilot program to December 31, 2030, but would authorize the department to terminate the pilot program for specified reasons and would require the department to terminate the pilot program prior to the pilot program's end date based on any significant negative findings in any report, including if the department identifies any serious deficiencies that could cause enrollee harm. The bill would, instead of requiring the department to report findings to the Legislature after the termination of the pilot program, require the department to submit an interim report of the findings described above and policy recommendations regarding the continuation of the pilot program to the Legislature before January 1, 2029.