AB 685 – CaliforniaStatus: Inactive / Dead
Year Introduced: 2021
Health care service plans: reimbursement.
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, and makes a willful violation of the act a crime. Existing law requires a health care service plan to reimburse complete claims, or portions thereof, no later than 30 working days after receipt of the claim, or 45 working days if a health care service plan is a health maintenance organization. Existing law establishes the process and for a health care service plan to contest or deny a claim for reimbursement. Existing law requires a health care service plan to pay the provider, as specified, for failure to reimburse uncontested claims within the respective time frames.
This bill would require a health care service plan to reimburse each complete claim, or portion thereof, no later than 15 working days after receipt of the complete claim. The bill would also make necessary conforming changes to this provision. Because a willful violation of the bill’s requirements relative to health care service plans would be a crime, the bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
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