Health and Safety Code — Part 37 | HSC — United States — California law | Esheria

Health and Safety Code

Part 37 of 87 · provisions 7,201–7,400

This section says the act is to be known as the Health and Safety Code.

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About this statute

The Legislature states findings supporting a unified, single-payer-style health care financing system for all Californians. The State Department of Health Services is renamed the State Department of Health Care Services, and its retained functions continue with the renamed department. The Director of Health Care Services is appointed by the Governor with Senate confirmation, the director receives a salary set by law, and the Governor may appoint up to two chief deputies on the director’s recommendation. The director has the powers of a department head under the cited Government Code chapter. The Department of Health Services has a Division of Rural Health, and that division must administer specified chapters and sections.

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Provisions of Health and Safety Code

Showing 200 of 17,333

  1. 1391.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 8. Other Enforcement Procedures [1390 - 1394.3] ( Article 8 added by Stats. 1975, Ch. 941. )

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    The director may order certain plans and related persons to stop violating this chapter, and hearing requests can stay part of the order in some cases.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 8. Other Enforcement Procedures [1390 - 1394.3] ( Article 8 added by Stats. 1975, Ch. 941. ) ## 1391. (a) (1) The director may issue an order directing a plan, solicitor firm, or any representative thereof, a solicitor, or any other person to cease and desist from engaging in any act or practice in violation of the provisions of this chapter, any rule adopted pursuant to this chapter, or any order issued by the director pursuant to this chapter. (2) If the plan, solicitor firm, or any representative thereof, or solicitor, or any other person fails to file a written request for a hearing within 30 days from the date of service of the order, the order shall be deemed a final order of the director and shall not be subject to review by any court or agency, notwithstanding subdivision (b) of Section 1397. (b) If a timely request for a hearing is made by a licensed plan, the request shall automatically stay the effect of the order only to the extent that the order requires the cessation of operation of the plan or prohibits acceptance of new members by the plan or both. However, no automatic stay shall be issued if any examination or inspection of the plan performed by the director discloses, or reports or documents submitted to the director by the plan on their face show, that the plan is in violation of any fiscal requirement of this chapter or in violation of any requirement of Section 1384 or 1385. In the event of an automatic stay, only that portion of the order requiring cessation of operation or prohibiting enrollment shall be stayed and all other portions of the order shall remain effective. If a hearing is held, and a finding is made that the health or safety of the members and potential members of the plan might be adversely affected by its continued operation, the stay shall be terminated. This finding shall be made, if at all, not later than 30 days after the date of the hearing. (c) If a timely request for a hearing is made by an unlicensed plan, the director may stay the effect of the order to the extent that the order requires the cessation of operation of the plan or prohibits acceptance of new members by the plan, for that period and subject to those conditions that the director may require, upon a determination by the director that the action would be in the public interest. (Amended by Stats. 1999, Ch. 525, Sec. 138. Effective January 1, 2000. Operative July 1, 2000, or sooner, by Sec. 214 of Ch. 525.)
  2. 1391.5.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 8. Other Enforcement Procedures [1390 - 1394.3] ( Article 8 added by Stats. 1975, Ch. 941. )

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    The director may order an unsafe or injurious act or practice to stop, but the order becomes final only after notice and hearing rules are followed.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 8. Other Enforcement Procedures [1390 - 1394.3] ( Article 8 added by Stats. 1975, Ch. 941. ) ## 1391.5. (a) If, after examination or investigation, the director has reasonable grounds to believe that irreparable loss and injury to the plan’s enrollee or enrollees occurred or may occur as a result of any act or practice unless the director acts immediately, the director may, by written order, addressed to that person, order the discontinuance of the unsafe or injurious act or practice. The order shall become effective immediately, but shall not become final except in accordance with this section. (b) No order issued pursuant to this section shall become final except after notice to the affected person of the director’s intention to make the order final and of the reasons for the finding. The director shall also notify that person that upon receiving a request for hearing by the plan, the matter shall be set for hearing to commence with 15 business days after receipt of the request, unless that person consents to have the hearing commence at a later date. (c) If no hearing is requested within 15 days after the mailing or service of the required notice, and none is ordered by the director, the order shall become final on the 15th day without a hearing and shall not be subject to review by any court or agency notwithstanding subdivision (b) of Section 1397. (d) If a hearing is requested or ordered, it shall be held in accordance with the provisions of the Administrative Procedure Act (Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government Code), and the director shall have all of the powers granted under that act. (e) If, upon conclusion of the hearing, it appears to the director that the affected person has conducted business in an unsafe or injurious manner, the director shall make the order of discontinuance final. (f) For purposes of this section, “person” includes any plan, solicitor firm, or any representative thereof, a solicitor, or any other person defined in subdivision (j) of Section 1345. (Amended by Stats. 2000, Ch. 857, Sec. 44. Effective January 1, 2001.)
  3. 13910.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 8. Alternative Revenues [13910 - 13919] ( Chapter 8 added by Stats. 1987, Ch. 1013, Sec. 11. )

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    If the district board finds available revenue is not enough, it may raise revenues under this chapter or other law.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 8. Alternative Revenues [13910 - 13919] ( Chapter 8 added by Stats. 1987, Ch. 1013, Sec. 11. ) ## 13910. Whenever the district board determines that the amount of revenue available to the district or any of its zones is inadequate to meet the costs of providing services pursuant to Section 13862, the board may raise revenues pursuant to this chapter or any other provision of law. (Repealed and added by Stats. 1987, Ch. 1013, Sec. 11.)
  4. 13911.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 8. Alternative Revenues [13910 - 13919] ( Chapter 8 added by Stats. 1987, Ch. 1013, Sec. 11. )

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    A district may levy a special tax under the cited Government Code article.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 8. Alternative Revenues [13910 - 13919] ( Chapter 8 added by Stats. 1987, Ch. 1013, Sec. 11. ) ## 13911. A district may levy a special tax pursuant to Article 3.5 (commencing with Section 50075) of Chapter 1 of Part 1 of Division 1 of Title 5 of the Government Code. (Repealed and added by Stats. 1987, Ch. 1013, Sec. 11.)
  5. 13912.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 8. Alternative Revenues [13910 - 13919] ( Chapter 8 added by Stats. 1987, Ch. 1013, Sec. 11. )

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    A district may levy a special tax under the Mello-Roos Community Facilities Act of 1982.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 8. Alternative Revenues [13910 - 13919] ( Chapter 8 added by Stats. 1987, Ch. 1013, Sec. 11. ) ## 13912. A district may levy a special tax pursuant to the Mello-Roos Community Facilities Act of 1982, Chapter 2.5 (commencing with Section 53311) of Part 1 of Division 2 of Title 5 of the Government Code. (Repealed and added by Stats. 1987, Ch. 1013, Sec. 11.)
  6. 13913.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 8. Alternative Revenues [13910 - 13919] ( Chapter 8 added by Stats. 1987, Ch. 1013, Sec. 11. )

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    A district may levy a special tax, but it cannot charge new construction a higher tax rate or measure than other real property.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 8. Alternative Revenues [13910 - 13919] ( Chapter 8 added by Stats. 1987, Ch. 1013, Sec. 11. ) ## 13913. A district may levy a special tax pursuant to Article 16 (commencing with Section 53970) of Chapter 4 of Part 1 of Division 2 of Title 5 of the Government Code. However, the tax shall not require a higher rate of payment or other measure of tax on the part of new construction than on the part of other real property. (Repealed and added by Stats. 1987, Ch. 1013, Sec. 11.)
  7. 13914.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 8. Alternative Revenues [13910 - 13919] ( Chapter 8 added by Stats. 1987, Ch. 1013, Sec. 11. )

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    A district may levy an assessment for fire suppression services if it does so under the referenced Government Code article.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 8. Alternative Revenues [13910 - 13919] ( Chapter 8 added by Stats. 1987, Ch. 1013, Sec. 11. ) ## 13914. A district may levy an assessment for fire suppression services pursuant to Article 3.6 (commencing with Section 50078) of Chapter 1 of Part 1 of Division 1 of Title 5 of the Government Code. (Repealed and added by Stats. 1987, Ch. 1013, Sec. 11.)
  8. 13915.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 8. Alternative Revenues [13910 - 13919] ( Chapter 8 added by Stats. 1987, Ch. 1013, Sec. 11. )

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    A district may levy assessments to pay for capital improvements under specified Streets and Highways Code acts.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 8. Alternative Revenues [13910 - 13919] ( Chapter 8 added by Stats. 1987, Ch. 1013, Sec. 11. ) ## 13915. A district may levy assessments to finance capital improvements pursuant to the Improvement Act of 1911, Division 7 (commencing with Section 5000), the Improvement Bond Act of 1915, Division 10 (commencing with Section 8500), and the Municipal Improvement Act of 1913, Division 12 (commencing with Section 10000) of the Streets and Highways Code. (Repealed and added by Stats. 1987, Ch. 1013, Sec. 11.)
  9. 13916.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 8. Alternative Revenues [13910 - 13919] ( Chapter 8 added by Stats. 1987, Ch. 1013, Sec. 11. )

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    A district board may charge service or enforcement fees, but only up to cost and not for certain new construction or development costs. It must adopt a fee ordinance, give notice before new or increased fees, provide public cost data before the meeting, and hear objections.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 8. Alternative Revenues [13910 - 13919] ( Chapter 8 added by Stats. 1987, Ch. 1013, Sec. 11. ) ## 13916. (a) A district board may charge a fee to cover the cost of any service which the district provides or the cost of enforcing any regulation for which the fee is charged. No fee shall exceed the costs reasonably borne by the district in providing the service or enforcing the regulation for which the fee is charged. A district board shall not charge a fee on new construction or development for the construction of public improvements or facilities or the acquisition of equipment. (b) The district board shall adopt an ordinance establishing a schedule of fees. Before either approving an increase in an existing fee or initially imposing a new fee, the district board shall publish notice of its intention to establish a schedule of fees pursuant to Section 6066 of the Government Code. The notice shall state the time and place of the meeting, including a general explanation of the matter to be considered, and a statement that the data required by subdivision (d) is available. (c) The district board shall mail the notice of the meeting at least 14 days before the meeting to any interested party who has filed a written request with the district board for mailed notice of the meeting on new or increased fees. Any written request for mailed notice is valid for one year from the date on which it is filed unless a renewal request is filed. Renewal requests for mailed notice shall be filed on or before April 1 of each year. The district board may establish a reasonable annual charge for sending these notices based on the estimated cost of providing that service. (d) At least 10 days before the meeting, the district board shall make available to the public, data indicating the amount of cost, or estimated cost, required to provide the service or the cost of enforcing any regulation for which the fee is charged and the revenue sources anticipated to provide the service or the cost of enforcing any regulation, including general fund revenues. (e) Any costs incurred by a district in conducting the meeting required by this section may be recovered from fees charged for the service or the cost of enforcing any regulation which were the subject of the meeting. (f) At the meeting, the district board shall hear and consider any objections or protests to the proposed schedule of fees. (Repealed and added by Stats. 1987, Ch. 1013, Sec. 11.)
  10. 13917.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 8. Alternative Revenues [13910 - 13919] ( Chapter 8 added by Stats. 1987, Ch. 1013, Sec. 11. )

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    A district board may charge residents or taxpayers a lower authorized fee than it charges nonresidents or nontaxpayers.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 8. Alternative Revenues [13910 - 13919] ( Chapter 8 added by Stats. 1987, Ch. 1013, Sec. 11. ) ## 13917. A district board may charge residents or taxpayers of the district a fee authorized pursuant to Section 13916 which is less than the fee which it charges to nonresidents or nontaxpayers of the district. (Amended by Stats. 1988, Ch. 465, Sec. 9. Effective August 22, 1988.)
  11. 13918.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 8. Alternative Revenues [13910 - 13919] ( Chapter 8 added by Stats. 1987, Ch. 1013, Sec. 11. )

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    A district board may charge a fee to other public agencies if the fee is authorized under Section 13916, even though Section 6103 of the Government Code would otherwise apply.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 8. Alternative Revenues [13910 - 13919] ( Chapter 8 added by Stats. 1987, Ch. 1013, Sec. 11. ) ## 13918. Notwithstanding Section 6103 of the Government Code, a district board may charge a fee authorized pursuant to Section 13916 to other public agencies. (Repealed and added by Stats. 1987, Ch. 1013, Sec. 11.)
  12. 13919.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 8. Alternative Revenues [13910 - 13919] ( Chapter 8 added by Stats. 1987, Ch. 1013, Sec. 11. )

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    A district board may waive a fee if it finds payment would not be in the public interest, but it must first adopt a resolution setting waiver policies and procedures.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 8. Alternative Revenues [13910 - 13919] ( Chapter 8 added by Stats. 1987, Ch. 1013, Sec. 11. ) ## 13919. A district board may waive payment of a fee authorized pursuant to Section 13916 when it determines that payment would not be in the public interest. Before waiving payment of any fee, a district board shall adopt a resolution which specifies the policies and procedures governing waivers. (Repealed and added by Stats. 1987, Ch. 1013, Sec. 11.)
  13. 1392.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 8. Other Enforcement Procedures [1390 - 1394.3] ( Article 8 added by Stats. 1975, Ch. 941. )

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    The director may seek court action to stop violations of this chapter and related rules or orders, and may ask the Attorney General to do so. The court may also award additional relief, and court-appointed fiduciaries may exercise the defendant’s powers with court approval. Lawsuits against those officials for doing those duties are barred.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 8. Other Enforcement Procedures [1390 - 1394.3] ( Article 8 added by Stats. 1975, Ch. 941. ) ## 1392. (a) (1) Whenever it appears to the director that any person has engaged, or is about to engage, in any act or practice constituting a violation of any provision of this chapter, any rule adopted pursuant to this chapter, or any order issued pursuant to this chapter, the director may bring an action in superior court, or the director may request the Attorney General to bring an action to enjoin these acts or practices or to enforce compliance with this chapter, any rule or regulation adopted by the director pursuant to this chapter, or any order issued by the director pursuant to this chapter, or to obtain any other equitable relief. (2) If the director determines that it is in the public interest, the director may include in any action authorized by paragraph (1) a claim for any ancillary or equitable relief and the court shall have jurisdiction to award this additional relief. (3) Upon a proper showing, a permanent or preliminary injunction, restraining order, writ of mandate, or other relief shall be granted, and a receiver, monitor, conservator, or other designated fiduciary or officer of the court may be appointed for the defendant or the defendant’s assets. (b) A receiver, monitor, conservator, or other designated fiduciary, or officer of the court appointed by the superior court pursuant to this section may, with the approval of the court, exercise any or all of the powers of the defendant’s officers, directors, partners, or trustees, or any other person who exercises similar powers and performs similar duties, including the filing of a petition for bankruptcy. No action at law or in equity may be maintained by any party against the director, or a receiver, monitor, conservator, or other designated fiduciary or officer of the court by reason of their exercising these powers or performing these duties pursuant to the order of, or with the approval of, the superior court. (Amended by Stats. 1999, Ch. 525, Sec. 140. Effective January 1, 2000. Operative July 1, 2000, or sooner, by Sec. 214 of Ch. 525.)
  14. 1392.5.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 8. Other Enforcement Procedures [1390 - 1394.3] ( Article 8 added by Stats. 1975, Ch. 941. )

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    This section sets rules for court-supervised receiverships in certain Department of Managed Health Care enforcement actions and limits interference with the receiver.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 8. Other Enforcement Procedures [1390 - 1394.3] ( Article 8 added by Stats. 1975, Ch. 941. ) ## 1392.5. (a) This section applies to every action brought in the name of the people of the State of California by the Director of the Department of Managed Health Care before, on, or after the effective date of this section, when enforcing provisions of those laws administered by the Director of the Department of Managed Health Care which authorize the Director of the Department of Managed Health Care to seek a permanent or preliminary injunction, restraining order, or writ of mandate, or the appointment of a receiver, monitor, conservator, or other designated fiduciary or officer of the court. Upon a proper showing, a permanent or preliminary injunction, restraining order, or writ of mandate shall be granted and a receiver, monitor, conservator, or other designated fiduciary or officer of the court may be appointed for the defendant or the defendant’s assets, or any other ancillary relief may be granted as appropriate. The court may order that the expenses and fees of the receiver, monitor, conservator, or other designated fiduciary or officer of the court, be paid from the property held by the receiver, monitor, conservator, or other court-designated fiduciary or officer, but neither the state, the Health and Human Services Agency, nor the Department of Managed Health Care shall be liable for any of those expenses and fees, unless expressly provided for by written contract. (b) The receiver, monitor, conservator, or other designated fiduciary or officer of the court may do any of the following subject to the direction of the court: (1) Sue for, collect, receive, and take into possession all the real and personal property derived by any unlawful means, including property with which that property or the proceeds thereof has been commingled if that property or the proceeds thereof cannot be identified in kind because of the commingling. (2) Take possession of all books, records, and documents relating to any unlawfully obtained property and the proceeds thereof. In addition, they shall have the same right as a defendant to request, obtain, inspect, copy, and obtain copies of books, records, and documents maintained by third parties that relate to unlawfully obtained property and the proceeds thereof. (3) Transfer, encumber, manage, control, and hold all property subject to the receivership, including the proceeds thereof, in the manner directed or ratified by the court. (4) Avoid a transfer of any interest in any unlawfully obtained property including the proceeds thereof to any person who committed, aided or abetted, or participated in the commission of unlawful acts or who had knowledge that the property had been unlawfully obtained. (5) Avoid a transfer of any interest in any unlawfully obtained property including the proceeds thereof made with the intent to hinder or delay the recovery of that property or any interest in it by the receiver or any person from whom the property was unlawfully obtained. (6) Avoid a transfer of any interest in any unlawfully obtained property including the proceeds thereof that was made within one year before the date of the entry of the receivership order if less than a reasonably equivalent value was given in exchange for the transfer, except that a bona fide transferee for value and without notice that the property had been unlawfully obtained may retain the interest transferred until the value given in exchange for the transfer is returned to the transferee. (7) Avoid a transfer of any interest in any unlawfully obtained property including the proceeds thereof made within 90 days before the date of the entry of the receivership order to a transferee from whom the defendant unlawfully obtained some property if (A) the receiver establishes that the avoidance of the transfer will promote a fair pro rata distribution of restitution among all people from whom defendants unlawfully obtained property and (B) the transferee cannot establish that the specific property transferred was the same property that had been unlawfully obtained from the transferee. (8) Exercise any power authorized by statute or ordered by the court. (c) A person with actual or constructive notice of the receivership shall not interfere with the discharge of the receiver’s duties. (d) A person shall not file any action or enforce or create any lien, or cause to be issued, served, or levied any summons, subpoena, attachment, or writ of execution against the receiver or any property subject to the receivership without first obtaining prior court approval upon motion with notice to the receiver and the Director of the Department of Managed Health Care. Any legal procedure described in this subdivision commenced without prior court approval is void except as to a bona fide purchaser or encumbrancer for value and without notice of the receivership. A person without notice of the receivership shall not incur any liability for commencing or maintaining any legal procedure described by this subdivision. (e) The court shall have jurisdiction of all questions arising in the receivership proceedings and may make any orders and judgments as may be required, including orders after noticed motion by the receiver to avoid transfers as provided in paragraphs (4), (5), (6), and (7) of subdivision (b). (f) This section is cumulative to all other provisions of law. (g) If any provision of this section or the application thereof to any person or circumstances is held invalid, that invalidity shall not affect other provisions or applications of this section that can be given effect without the invalid provision or application, and to this end the provisions of this section are severable. (h) The recordation of a copy of the receivership order imparts constructive notice of the receivership in connection with any matter involving real property located in the county in which the receivership order is recorded. (Added by renumbering Government Code Section 13975.2 by Stats. 2021, Ch. 124, Sec. 31. (AB 938) Effective January 1, 2022.)
  15. 13925.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 9. General Obligation Bonds [13925 - 13938] ( Chapter 9 added by Stats. 1987, Ch. 1013, Sec. 11. )

    Verify source ↗

    If a district board decides it is necessary to incur general obligation bonded indebtedness for certain property, capital, or refinancing purposes, it must adopt a resolution and call an election on the bond proposition.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 9. General Obligation Bonds [13925 - 13938] ( Chapter 9 added by Stats. 1987, Ch. 1013, Sec. 11. ) ## 13925. Whenever a district board determines that it is necessary to incur a general obligation bonded indebtedness for the acquisition or construction of any real property or other capital expense or for funding or refunding of any outstanding indebtedness, the district board shall adopt a resolution making determinations and calling an election on a proposition to incur indebtedness and to issue general obligation bonds. (Repealed and added by Stats. 1987, Ch. 1013, Sec. 11.)
  16. 13926.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 9. General Obligation Bonds [13925 - 13938] ( Chapter 9 added by Stats. 1987, Ch. 1013, Sec. 11. )

    Verify source ↗

    The resolution must state the debt purpose, amount, bond term, interest rate, voter measure, election date, and any other required election-law matters.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 9. General Obligation Bonds [13925 - 13938] ( Chapter 9 added by Stats. 1987, Ch. 1013, Sec. 11. ) ## 13926. The resolution shall state: (a) The purpose for which the proposed debt is to be incurred, which may include expenses for the authorization, issuance, and sale of bonds. (b) The amount of debt to be incurred. (c) The maximum term of the bonds, not to exceed 30 years. (d) The maximum rate of interest to be paid, not to exceed the maximum rate permitted pursuant to Article 7 (commencing with Section 53530) of Chapter 3 of Part 1 of Division 2 of Title 5 of the Government Code. (e) The measure to be submitted to the voters. (f) The date the election will be held. (g) Any other matters that are required pursuant to the Uniform District Election Law, Part 4 (commencing with Section 10500) of Division 10 of the Elections Code. (Amended by Stats. 1994, Ch. 923, Sec. 139. Effective January 1, 1995.)
  17. 13927.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 9. General Obligation Bonds [13925 - 13938] ( Chapter 9 added by Stats. 1987, Ch. 1013, Sec. 11. )

    Verify source ↗

    The election must be conducted under the Uniform District Election Law in the Elections Code.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 9. General Obligation Bonds [13925 - 13938] ( Chapter 9 added by Stats. 1987, Ch. 1013, Sec. 11. ) ## 13927. The election shall be conducted pursuant to the Uniform District Election Law, Part 4 (commencing with Section 10500) of Division 10 of the Elections Code. (Amended by Stats. 1994, Ch. 923, Sec. 140. Effective January 1, 1995.)
  18. 13928.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 9. General Obligation Bonds [13925 - 13938] ( Chapter 9 added by Stats. 1987, Ch. 1013, Sec. 11. )

    Verify source ↗

    If two-thirds of voters support the proposition, the district board may adopt resolutions to issue bonds.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 9. General Obligation Bonds [13925 - 13938] ( Chapter 9 added by Stats. 1987, Ch. 1013, Sec. 11. ) ## 13928. If two-thirds of voters voting upon the proposition favor incurring the indebtedness and issuing the bonds, the district board may adopt resolutions to issue bonds for all or any part of the amount of the indebtedness. (Repealed and added by Stats. 1987, Ch. 1013, Sec. 11.)
  19. 13929.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 9. General Obligation Bonds [13925 - 13938] ( Chapter 9 added by Stats. 1987, Ch. 1013, Sec. 11. )

    Verify source ↗

    The district board may issue bonds in any amount, series, and terms, so long as the bonds do not exceed voter-approved limits.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 9. General Obligation Bonds [13925 - 13938] ( Chapter 9 added by Stats. 1987, Ch. 1013, Sec. 11. ) ## 13929. The district board may provide for the issuance of bonds in any amounts, in any series, and on any terms, provided that they do not exceed the limits approved by the voters. (Repealed and added by Stats. 1987, Ch. 1013, Sec. 11.)
  20. 1393.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 8. Other Enforcement Procedures [1390 - 1394.3] ( Article 8 added by Stats. 1975, Ch. 941. )

    Verify source ↗

    This section lets the court or the director take control of a health care service plan’s property and business under specified conditions, and it sets deadlines, powers, and penalties tied to that process.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 8. Other Enforcement Procedures [1390 - 1394.3] ( Article 8 added by Stats. 1975, Ch. 941. ) ## 1393. (a) The superior court of the county in which is located the principal office of the plan in this state shall, upon the filing by the director of a verified application showing any of the conditions enumerated in Section 1386 to exist, issue its order vesting title to all of the assets of the plan, wherever situated, in the director or the director’s successor in office, in his or her official capacity as such, and direct the director to take possession of all of its books, records, property, real and personal, and assets, and to conduct, as conservator, the business or portion of the business of the person as may seem appropriate to the director, and enjoining the person and its officers, directors, agents, servants, and employees from the transaction of its business or disposition of its property until the further order of the court. (b) Whenever it appears to the director that irreparable loss and injury to the property and business of the plan or to the plan’s enrollees has occurred or may occur unless the director acts immediately, the director, without notice and before applying to the court for any order, may take possession of the property, business, books, records, and accounts of the plan, and of the offices and premises occupied by it for the transaction of its business, and retain possession until returned to the plan or until further order of the director or subject to an order of the court. Any person having possession of and refusing to deliver any of the books, records, or assets of a plan against which a seizure order has been issued by the director, shall be guilty of a misdemeanor and punishable by a fine not exceeding ten thousand dollars ($10,000) or imprisonment not exceeding one year, or both the fine and imprisonment. Whenever the director has taken possession of any plan pursuant to this subdivision, the owners, officers, and directors of the plan may apply to the superior court in the county in which the principal office of the plan is located, within 10 days after the taking, to enjoin further proceedings. The court, after citing the director to show cause why further proceedings should not be enjoined, and after a hearing and a determination of the facts upon the merits, may do any of the following: (1) Dismiss the application after confirming the director’s authority to take possession of all of the plan’s books, records, property, real and personal, and assets, and to conduct, as conservator, the business or portion of the business as the director may deem appropriate, and enjoining the owners, officers, and directors, and their agents and employees, from the transaction of plan business or disposition of plan property until the further order of the court. (2) Enjoin the director from further proceedings and direct the director to surrender the property and business to the plan. (3) Make any further order as may be just. (c) If any facts occur that would entitle the director to take possession of the property, business, and assets of the plan, the director may appoint a conservator over the plan and require any bond of the conservator as the director deems proper. The conservator, under the direction of the director, shall take possession of the property, business, and assets of the plan pending further disposition of its business. The conservator shall retain possession until the property, business, and assets of the plan are returned to the plan, or until further order of the director, except that the conservator shall be able to pay necessary costs of the ongoing operation without formal order of the director. Whenever the director has taken possession of any plan pursuant to subdivision (b), the director shall, within 10 days after the taking, apply to the superior court in the county in which the principal office of the plan is located for an order confirming the director’s appointment of the conservator. The order may be given after a hearing upon notice that the court prescribes. (d) (1) Subject to the other provisions of this section, a conservator, while in possession of the property, business, and assets of a plan, has the same powers and rights, and is subject to the same duties and obligations, as the director under the same circumstances, and during this time, the rights of a plan and of all persons with respect to the plan are the same as if the director had taken possession of the property, business, and assets of the plan, for the purpose of carrying out the conservatorship. (2) Subject to the other provisions of this section, a conservator, while in possession of the property, business, and assets of a plan, shall have all of the rights, powers, and privileges of the plan, and its officers and directors, for the purpose of carrying out the conservatorship. All expenses of any conservatorship shall be paid from the assets of the plan, and shall be a lien on the plan which shall be prior to any other lien. (3) No action at law or in equity may be maintained by any party against the director or a conservator by reason of their exercising or performing the privileges, powers, rights, duties, and obligations pursuant to the order, or with the approval, of the superior court. (e) Upon appointing a conservator, the director shall cause to be made and completed, at the earliest possible date, an examination of the affairs of the plan as shall be necessary to inform the director as to the plan’s financial condition. (f) If the director becomes satisfied that it may be done safely and in the public interest, the director may terminate the conservatorship and permit the plan for which the conservator was appointed to resume its business under the direction of its board of directors, subject to any terms, conditions, restrictions, and limitations the director prescribes. (Amended by Stats. 1999, Ch. 525, Sec. 141. Effective January 1, 2000. Operative July 1, 2000, or sooner, by Sec. 214 of Ch. 525.)
  21. 1393.5.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 8. Other Enforcement Procedures [1390 - 1394.3] ( Article 8 added by Stats. 1975, Ch. 941. )

    Verify source ↗

    People who violate Section 1349, and certain managers or officers linked to that violation, can be liable for civil penalties.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 8. Other Enforcement Procedures [1390 - 1394.3] ( Article 8 added by Stats. 1975, Ch. 941. ) ## 1393.5. (a) A person who violates Section 1349, or any person who directly or indirectly participates in the direction of the management or policies of the person in violation of Section 1349, including, but not limited to, any officer, director, partner, or other person occupying a principal management or supervisory position, shall be liable for civil penalties as follows: (1) A sum of not more than five thousand dollars ($5,000). (2) A sum not exceeding one thousand dollars ($1,000) for each subscriber under an individual or group plan contract that was entered into or renewed while the person was in violation of Section 1349. (b) The penalty specified in paragraph (2) of subdivision (a) shall be imposed only if one or more of the following occurs: (1) The solicitation of the entry into or renewal of such contract, or of any subscription or enrollment thereunder, included the use by the plan or a representative of the plan of any advertising, evidence of coverage, or disclosure form which was untrue, misleading, or deceptive. (2) The contract is not in compliance with this chapter, or the rules adopted pursuant to this chapter. (3) The plan does not have a financially sound operation and adequate provision against the risk of insolvency. (4) The plan has operated in violation of the provisions of subdivision (a), (b), (c), (d), or (e) of Section 1367. (5) The plan has not complied with the provisions of Section 1379. (c) The civil penalty may be assessed and recovered only in a civil action. The cause of action may be brought in the name of the people of the State of California by the Attorney General or the director, as determined by the director. (d) Commencing January 1, 2028, and every five years thereafter, the penalty amounts specified in this section shall be adjusted based on the average rate of change in premium rates for the individual and small group markets, and weighted by enrollment, since the previous adjustment. (Amended by Stats. 2022, Ch. 985, Sec. 8. (SB 858) Effective January 1, 2023.)
  22. 1393.6.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 8. Other Enforcement Procedures [1390 - 1394.3] ( Article 8 added by Stats. 1975, Ch. 941. )

    Verify source ↗

    The director may impose administrative penalties, after notice and a hearing, for willful violations covered by this section.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 8. Other Enforcement Procedures [1390 - 1394.3] ( Article 8 added by Stats. 1975, Ch. 941. ) ## 1393.6. For violations of Article 3.1 (commencing with Section 1357), Article 3.15 (commencing with Section 1357.50), Article 3.16 (commencing with Section 1357.500), and Article 3.17 (commencing with Section 1357.600), the director may, after appropriate notice and opportunity for hearing, by order levy administrative penalties as follows: (a) Any person, solicitor, or solicitor firm, other than a health care service plan, who willfully violates any provision of this chapter, or who willfully violates any rule or order adopted or issued pursuant to this chapter, is liable for administrative penalties of not less than five hundred dollars ($500) for each first violation, and of not less than two thousand dollars ($2,000) and not more than five thousand dollars ($5,000) for each subsequent violation. (b) Any health care service plan that willfully violates any provision of this chapter, or that willfully violates any rule or order adopted or issued pursuant to this chapter, is liable for administrative penalties of not less than five thousand dollars ($5,000) for each first violation, and of not less than ten thousand dollars ($10,000) nor more than twenty thousand dollars ($20,000) for each second violation, and of not less than thirty thousand dollars ($30,000) and not more than two hundred thousand dollars ($200,000) for each subsequent violation. (c) The administrative penalties shall be paid to the Managed Care Administrative Fines and Penalties Fund and shall be used for the purposes specified in Section 1341.45. (d) The administrative penalties available to the director pursuant to this section are not exclusive, and may be sought and employed in any combination with civil, criminal, and other administrative remedies deemed advisable by the director to enforce the provisions of this chapter. (e) Commencing January 1, 2028, and every five years thereafter, the penalty amounts specified in this section shall be adjusted based on the average rate of change in premium rates for the individual and small group markets, and weighted by enrollment, since the previous adjustment. (Amended by Stats. 2022, Ch. 985, Sec. 9. (SB 858) Effective January 1, 2023.)
  23. 13930.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 9. General Obligation Bonds [13925 - 13938] ( Chapter 9 added by Stats. 1987, Ch. 1013, Sec. 11. )

    Verify source ↗

    The district board must adopt a resolution for the bonds and coupons, state when principal is due, and may defer the first principal payment for up to five years.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 9. General Obligation Bonds [13925 - 13938] ( Chapter 9 added by Stats. 1987, Ch. 1013, Sec. 11. ) ## 13930. The district board shall adopt a resolution prescribing the form and denomination of the bonds and any coupons. The resolution shall specify the dates on which all or any part of the principal shall become due and payable. The payment of the first installment or principal may be deferred for a maximum period not to exceed five years from the date on which the district board issues the first bonds or first bonds in each series. (Repealed and added by Stats. 1987, Ch. 1013, Sec. 11.)
  24. 13931.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 9. General Obligation Bonds [13925 - 13938] ( Chapter 9 added by Stats. 1987, Ch. 1013, Sec. 11. )

    Verify source ↗

    The district board may authorize bonds to be called and redeemed before maturity, on the terms it sets. A bond cannot be called or redeemed before maturity unless it says so in a recital or printed statement.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 9. General Obligation Bonds [13925 - 13938] ( Chapter 9 added by Stats. 1987, Ch. 1013, Sec. 11. ) ## 13931. The district board may provide for the call and redemption of bonds before their maturity at times and prices and upon any other terms as it specifies. A bond shall not be subject to call or redemption before maturity unless it contains a recital to that effect or unless a statement to that effect is printed on it. (Repealed and added by Stats. 1987, Ch. 1013, Sec. 11.)
  25. 13932.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 9. General Obligation Bonds [13925 - 13938] ( Chapter 9 added by Stats. 1987, Ch. 1013, Sec. 11. )

    Verify source ↗

    The bonds’ principal and interest must be paid in lawful U.S. money at the district treasurer’s office or another place chosen by the bondholder.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 9. General Obligation Bonds [13925 - 13938] ( Chapter 9 added by Stats. 1987, Ch. 1013, Sec. 11. ) ## 13932. The principal and interest of the bonds shall be payable in lawful money of the United States at the office of the district treasurer or any other place, at the option of the bondholder. (Repealed and added by Stats. 1987, Ch. 1013, Sec. 11.)
  26. 13933.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 9. General Obligation Bonds [13925 - 13938] ( Chapter 9 added by Stats. 1987, Ch. 1013, Sec. 11. )

    Verify source ↗

    District bonds must be dated, numbered consecutively, and signed by the district board president and treasurer; coupons must be signed by the treasurer.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 9. General Obligation Bonds [13925 - 13938] ( Chapter 9 added by Stats. 1987, Ch. 1013, Sec. 11. ) ## 13933. (a) The bonds shall be dated, numbered consecutively, and be signed by the president of the district board and the district treasurer. The district treasurer shall sign any coupons. Any signatures or countersignatures may be mechanically reproduced by any means, except that one of the signatures shall be signed by hand. (b) If the president of the district board or the district treasurer whose signature appears on a bond or coupon ceases to hold that office before the delivery of the bonds or the coupons to the purchaser, the signature is nevertheless valid and sufficient for any purpose as if the president or treasurer had remained in office until the delivery of the bonds or coupons. (Repealed and added by Stats. 1987, Ch. 1013, Sec. 11.)
  27. 13934.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 9. General Obligation Bonds [13925 - 13938] ( Chapter 9 added by Stats. 1987, Ch. 1013, Sec. 11. )

    Verify source ↗

    The district board must give public notice and invite sealed bids before selling the bonds or coupons, and must award the sale to the highest responsible bidder.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 9. General Obligation Bonds [13925 - 13938] ( Chapter 9 added by Stats. 1987, Ch. 1013, Sec. 11. ) ## 13934. (a) Before selling the bonds or coupons, the district board shall give notice inviting sealed bids. At a minimum, the district board shall publish notice at least once in a newspaper of general circulation in the district at least 10 days before the deadline for receiving the bids. (b) The district board shall award the sale of the bonds to the highest responsible bidder. (c) If the district board does not receive any bids or if it determines that the bids received are not satisfactory as to price or responsibility of the bidders, it may reject all bids, if any, and either readvertise or sell the bonds at private sale. (Repealed and added by Stats. 1987, Ch. 1013, Sec. 11.)
  28. 13935.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 9. General Obligation Bonds [13925 - 13938] ( Chapter 9 added by Stats. 1987, Ch. 1013, Sec. 11. )

    Verify source ↗

    Bond sale money must be deposited and then allocated to specified district funds and purposes.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 9. General Obligation Bonds [13925 - 13938] ( Chapter 9 added by Stats. 1987, Ch. 1013, Sec. 11. ) ## 13935. (a) All premiums and accrued interest received from the sale of the bonds shall be deposited with the district treasurer in a special bond service fund to be used for the payment of the principal of and interest on the bonds, and the remainder of the proceeds of the bonds shall be placed to the credit of the proper improvement fund and applied exclusively to the purpose and object recited in the proposition approved by the voters. (b) When the purpose and object have been accomplished, any moneys remaining in the improvement fund shall be transferred to the special bond service fund. When the purpose and object have been accomplished and all principal and interest on the bonds have been paid, any balance of money then remaining shall be transferred to the general fund of the district. (Repealed and added by Stats. 1987, Ch. 1013, Sec. 11.)
  29. 13936.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 9. General Obligation Bonds [13925 - 13938] ( Chapter 9 added by Stats. 1987, Ch. 1013, Sec. 11. )

    Verify source ↗

    District-issued general obligation bonds have the same force, value, and use as city-issued bonds, and the bonds and their interest are exempt from California taxation.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 9. General Obligation Bonds [13925 - 13938] ( Chapter 9 added by Stats. 1987, Ch. 1013, Sec. 11. ) ## 13936. Any general obligation bonds issued by a district have the same force, value, and use as bonds issued by a city and the bonds and the interest on the bonds are exempt from all taxation within the State of California. (Repealed and added by Stats. 1987, Ch. 1013, Sec. 11.)
  30. 13937.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 9. General Obligation Bonds [13925 - 13938] ( Chapter 9 added by Stats. 1987, Ch. 1013, Sec. 11. )

    Verify source ↗

    A district must not incur bonded indebtedness above 10% of the assessed value of all taxable property within the district.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 9. General Obligation Bonds [13925 - 13938] ( Chapter 9 added by Stats. 1987, Ch. 1013, Sec. 11. ) ## 13937. A district shall not incur a bonded indebtedness in excess of 10 percent of the assessed value of all taxable property within the district. (Repealed and added by Stats. 1987, Ch. 1013, Sec. 11.)
  31. 13938.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 9. General Obligation Bonds [13925 - 13938] ( Chapter 9 added by Stats. 1987, Ch. 1013, Sec. 11. )

    Verify source ↗

    After a district incurs general obligation debt, the district board must keep directing the county tax collector to levy a tax until the debt is paid or enough money is in the special bond service fund.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 9. General Obligation Bonds [13925 - 13938] ( Chapter 9 added by Stats. 1987, Ch. 1013, Sec. 11. ) ## 13938. (a) After incurring a general obligation indebtedness, and annually thereafter until the indebtedness is paid or until there is a sum in the district treasury in a special bond service fund set apart for that purpose sufficient to meet all payments of principal and interest on that indebtedness as it becomes due, the district board shall adopt a resolution directing the county tax collector to levy a tax on behalf of the district. (b) The tax shall be in addition to all other taxes levied by and for the district and shall be collected in the same manner and at the same time as county taxes. A county may recover its costs as provided by Section 29142 of the Government Code. (c) The rate of the tax shall be fixed to result in proceeds which are sufficient to pay any principal and interest which will become due before the next proceeds of a tax to be levied will be available. (Amended by Stats. 2001, Ch. 176, Sec. 41. Effective January 1, 2002.)
  32. 1394.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 8. Other Enforcement Procedures [1390 - 1394.3] ( Article 8 added by Stats. 1975, Ch. 941. )

    Verify source ↗

    The director may use civil, criminal, and administrative remedies in any combination the director thinks advisable to enforce this chapter.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 8. Other Enforcement Procedures [1390 - 1394.3] ( Article 8 added by Stats. 1975, Ch. 941. ) ## 1394. The civil, criminal, and administrative remedies available to the director pursuant to this article are not exclusive, and may be sought and employed in any combination deemed advisable by the director to enforce the provisions of this chapter. (Amended by Stats. 1999, Ch. 525, Sec. 144. Effective January 1, 2000. Operative July 1, 2000, or sooner, by Sec. 214 of Ch. 525.)
  33. 1394.1.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 8. Other Enforcement Procedures [1390 - 1394.3] ( Article 8 added by Stats. 1975, Ch. 941. )

    Verify source ↗

    The director may file a verified complaint to dissolve a health care service plan involuntarily, and it must be filed in the proper superior court.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 8. Other Enforcement Procedures [1390 - 1394.3] ( Article 8 added by Stats. 1975, Ch. 941. ) ## 1394.1. Notwithstanding any other provision of law, the director may file a verified complaint for involuntary dissolution of a health care service plan on any one or more of the grounds specified in subdivision (b) of Section 1386. The complaint shall be filed in the superior court of the county where the principal executive office of the health care service plan is located or, if the principal executive office of the health care service plan is not located in this state, or the health care service plan has no such office, the County of Sacramento. (Amended by Stats. 1999, Ch. 525, Sec. 145. Effective January 1, 2000. Operative July 1, 2000, or sooner, by Sec. 214 of Ch. 525.)
  34. 1394.2.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 8. Other Enforcement Procedures [1390 - 1394.3] ( Article 8 added by Stats. 1975, Ch. 941. )

    Verify source ↗

    In a health care service plan dissolution or other insolvency proceeding, this section sets the order that certain expenses and claims must be paid, and it allows the superior court to relieve subscribers and enrollees from liability or pause payment proceedings in some cases.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 8. Other Enforcement Procedures [1390 - 1394.3] ( Article 8 added by Stats. 1975, Ch. 941. ) ## 1394.2. Notwithstanding any other provision of law, in any involuntary dissolution of a health care service plan as provided for in Section 1394.1, or other insolvency proceeding involving a health care service plan, the following expenses and claims have priority in the following order: (a) First, administrative expenses allowed by the superior court and any fees and charges assessed against the estate of the dissolved health care service plan in conjunction with the dissolution of the estate. (b) Second, taxes due the State of California. (c) Third, claims having preference by the laws of the United States and by the laws of this state. (d) Fourth, claims of health care service plan subscribers and enrollees for reimbursement for services rendered by noncontracting providers. Upon proper showing, the superior court may make an order relieving subscribers and enrollees from liability or stay any proceeding to secure payment for any services rendered by a noncontracting provider upon payment, in whole or in part, of the claim or claims of those noncontracting providers. (e) Fifth, claims of health care service plan group contract holders for reimbursement for services rendered by noncontracting providers to subscribers and enrollees under the group contract. (f) Sixth, any and all claims, including all officers’ and directors’ claims for indemnity, arising against the estate of the dissolved health care service plan. (Added by Stats. 1985, Ch. 908, Sec. 6.)
  35. 1394.3.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 8. Other Enforcement Procedures [1390 - 1394.3] ( Article 8 added by Stats. 1975, Ch. 941. )

    Verify source ↗

    A health care service plan’s involuntary dissolution must follow the specified Corporations Code chapter, unless Sections 1394.1 or 1394.2 apply.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 8. Other Enforcement Procedures [1390 - 1394.3] ( Article 8 added by Stats. 1975, Ch. 941. ) ## 1394.3. Except as provided for in Section 1394.1, and 1394.2, the involuntary dissolution of a health care service plan shall be in accordance with either of the following: (a) Chapter 18 (commencing with Section 1800) of Division 1 of Title 1 of the Corporations Code, if the plan is incorporated under the General Corporation Law. (b) Chapter 15 (commencing with Section 8510) of Part 3 of Division 2 of Title 1 of the Corporations Code if the plan is incorporated under the Nonprofit Corporation Law. (Amended by Stats. 1999, Ch. 525, Sec. 146. Effective January 1, 2000. Operative July 1, 2000, or sooner, by Sec. 214 of Ch. 525.)
  36. 1394.5.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 8.5. Service of Process [1394.5 - 1394.8] ( Article 8.5 added by Stats. 1989, Ch. 845, Sec. 4. )

    Verify source ↗

    This section lets process be served through the director’s office for certain covered conduct, but the service is not effective unless notice and a copy of the process are promptly sent and any required affidavit is filed.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 8.5. Service of Process [1394.5 - 1394.8] ( Article 8.5 added by Stats. 1989, Ch. 845, Sec. 4. ) ## 1394.5. When any person, including any nonresident of this state, engages in conduct prohibited or made actionable by this chapter or any rule, regulation, or order adopted hereunder, whether or not the person has filed a power of attorney under subdivision (j) of Section 1351, and personal jurisdiction over the person cannot otherwise be obtained in this state, that conduct shall be considered equivalent to the appointment of the director or the director’s successor in office to be the attorney in fact to receive any lawful process in any noncriminal suit, action, or proceeding against the person or the person’s successor, executor, or administrator which arises out of that conduct and which is brought under this chapter or any rule, regulation, or order adopted hereunder, with the same force and validity as if personally served. Service may be made by leaving a copy of the process in the office of the director, but it is not effective unless the plaintiff or petitioner, who may be the director in a suit, action, or proceeding instituted by him or her, forthwith sends notice of the service and a copy of the process by registered or certified mail to the defendant or respondent at his or her last known address or takes other steps which are reasonably calculated to give actual notice, and in a court action, an affidavit of compliance with this section is filed in the case on or before the return day of the process, if any, or within such further time as the court allows. In the case of administrative orders issued by the director, the affidavit of compliance need not be filed with the administrative tribunal unless the respondent requests a hearing. (Amended by Stats. 1999, Ch. 525, Sec. 147. Effective January 1, 2000. Operative July 1, 2000, or sooner, by Sec. 214 of Ch. 525.)
  37. 1394.7.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 8.5. Service of Process [1394.5 - 1394.8] ( Article 8.5 added by Stats. 1989, Ch. 845, Sec. 4. )

    Verify source ↗

    When a health care service plan becomes insolvent, the director can require other plans to take over enrollment or contracts, and providers must keep serving affected enrollees for a limited transition period.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 8.5. Service of Process [1394.5 - 1394.8] ( Article 8.5 added by Stats. 1989, Ch. 845, Sec. 4. ) ## 1394.7. (a) As used in this section the following definitions shall apply: (1) “Health care service plan” means any plan as defined in Section 1345, but this section does not apply to specialized health care service contracts. (2) “Carrier” means a health care service plan, an insurer issuing group disability coverage which covers hospital, medical, or surgical expenses, a nonprofit hospital service plan, or any other entity responsible for either the payment of benefits or the provision of hospital, medical, and surgical benefits under a group contract. (3) “Insolvency” means that the director has determined that the health care service plan is not financially able to provide health care services to its enrollees and (A) the director has taken an action pursuant to Section 1386, 1391, or 1399, or (B) an order requested by the director or the Attorney General has been issued by the superior court under Section 1392, 1393, or 1394.1. (b) In the event of the insolvency of a health care service plan and upon order of the director, any health care service plan which the director determines to have sufficient health care delivery resources and sufficient financial and administrative capacity and that participated in the enrollment process with the insolvent health care service plan at the last regular open enrollment period of a group shall offer enrollees of the group in the insolvent health care service plan a 30-day enrollment period commencing upon the date specified by the director. Each health care service plan shall offer enrollees of the group in the insolvent health care service plan the same coverages and rates that it offered to enrollees of the group at the last regular open enrollment period of the group. Coverage shall be effective upon receipt by the successor plan of an application for enrollment by or on behalf of a subscriber or enrollee of the insolvent plan. The director shall send a notice of the insolvency of a health care service plan to the Insurance Commissioner. (c) If no other carrier had been offered to groups enrolled in the insolvent health care service plan, or if the director determines that the other carriers do not include a sufficient number of health care service plans that have adequate health care delivery resources or the financial or administrative capacity to assure that health care services will be available and accessible to all of the group enrollees of the insolvent health care service plan, then the director shall allocate equitably the insolvent health care service plan’s group contracts for the groups, except for Medi-Cal contracts made pursuant to Section 14200 of the Welfare and Institutions Code, among all health care service plans which operate within at least a portion of the service area of the insolvent health care service plan, taking into consideration the health care delivery resources and the financial and administrative capacity of each health care service plan. The director shall also have the authority to allocate equitably enrollees, except Medi-Cal enrollees, if he or she has been unable to successfully place them through the open enrollment procedure in subdivision (b). The director shall make every reasonable effort to allocate enrollees within 30 days of the insolvency of the plan, but not later than 45 days after insolvency. Each health care service plan to which a group or groups are so allocated shall offer the group or groups the health care service plan’s coverage which is most similar to each group’s coverage with the insolvent health care service plan, as determined by the director, at rates determined in accordance with the successor health care service plan’s existing rating methodology. Coverage shall be effective upon the date specified by the director. Further, except to the extent benefits for any condition would have been reduced or excluded under the insolvent health care service plan’s contract or policy, no provision in a successor health care service plan’s contract of coverage that would operate to reduce or exclude benefits on the basis that the condition giving rise to benefits preexisted on the effective date of the enrollee’s assignment to the succeeding health care service plan shall be applied with respect to those enrollees validly covered under the insolvent health care service plan’s contract or policy on the date of the assignment. The State Department of Health Services shall have the authority to allocate Medi-Cal enrollees to other carriers with valid Medi-Cal contracts, which operate within the same service area of an insolvent Medi-Cal contractor and that have sufficient capacity to absorb the Medi-Cal enrollees allocated to them. (d) The director shall also allocate equitably the insolvent health care service plan’s nongroup enrollees among all health care service plans which operate within at least a portion of the service area of the insolvent health care service plan, taking into consideration the health care delivery resources or the financial and administrative capacity of each health care service plan. Each health care service plan to which nongroup enrollees are allocated shall offer the nongroup enrollees the health care service plan’s most similar coverage for individual or conversion coverage, as determined by the director, taking into consideration his or her type of coverage in the insolvent health care service plan, at rates determined in accordance with the successor health care service plan’s existing rating methodology. Coverage shall be effective upon the date specified by the director. Further, except to the extent benefits for any condition would have been reduced or excluded under the insolvent health care service plan’s contract or policy, no provision in a successor health care service plan’s contract of coverage that would operate to reduce or exclude benefits on the basis that the condition giving rise to benefits preexisted on the effective date of the enrollee’s assignment to the succeeding health care service plan shall be applied with respect to those enrollees validly covered under the insolvent health care service plan’s contract or policy on the date of the assignment. Successor health care service plans which do not offer direct nongroup enrollment may aggregate all allocated nongroup enrollees into one group for rating and coverage purposes. (e) Contracting providers shall continue to provide services to enrollees of an insolvent plan until the effective date of an enrollee’s coverage in a successor plan selected pursuant to either open enrollment or the allocation process but in no event for the period exceeding that required by their contract or 45 days in the case of allocation, whichever is greater; or for a period exceeding that required by their contract or 30 days in the case of open enrollment, whichever is greater. (f) The failure to comply with an order under this section shall constitute a violation of this section. (Amended by Stats. 1999, Ch. 525, Sec. 148. Effective January 1, 2000. Operative July 1, 2000, or sooner, by Sec. 214 of Ch. 525.)
  38. 1394.8.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 8.5. Service of Process [1394.5 - 1394.8] ( Article 8.5 added by Stats. 1989, Ch. 845, Sec. 4. )

    Verify source ↗

    If a specialized health care service plan becomes insolvent, the director must arrange open enrollment or equitable allocation to successor plans, and providers must keep serving enrollees until coverage transfers.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 8.5. Service of Process [1394.5 - 1394.8] ( Article 8.5 added by Stats. 1989, Ch. 845, Sec. 4. ) ## 1394.8. (a) As used in this section: (1) “Carrier” means a specialized health care service plan, and any of the following entities which offer coverage comparable to the coverages offered by a specialized health care service plan: an insurer issuing group disability coverage; a nonprofit hospital service plan; or any other entity responsible for either the payment of benefits for or the provisions of services under a group contract. (2) “Insolvency” means that the director has determined that the specialized health care service plan is not financially able to provide specialized health care services to its enrollees and (A) the director has taken an action pursuant to Section 1386, 1391, 1399, or (B) an order requested by the director or the Attorney General has been issued by the superior court under Sections 1392, 1393, or 1394.1. (3) “Specialized health care service plan” means any plan authorized to issue only specialized health care service plan contracts as defined in Section 1345. (b) In the event of the insolvency of a specialized health care service plan and upon order of the director, any specialized health care service plan which the director determines to have sufficient health care delivery resources and sufficient financial and administrative capacity and that participated in the enrollment process with the insolvent specialized health care service plan at the last regular open enrollment period of a group for the same type of specialized health care services shall offer enrollees of the group in the insolvent specialized health care service plan a 30-day enrollment period commencing upon the date specified by the director. Each specialized health care service plan shall offer enrollees of the group in the insolvent specialized health care service plan the same specialized coverage and rates that it offered to the enrollees of the group at its last regular open enrollment period. Coverage shall be effective upon receipt by the successor plan of an application for enrollment by or on behalf of a subscriber or enrollee of the insolvent plan. The director shall send a notice of the insolvency of a specialized health care service plan to the Insurance Commissioner. (c) If no other carrier for the same type of specialized health care services had been offered to some groups enrolled in the insolvent specialized health care service plan, or if the director determines that the other carriers do not include a sufficient number of specified health care service plans which have adequate health care delivery resources or the financial and administrative capacity to assure that the specialized health care services will be available and accessible to all of the group enrollees of the insolvent specialized health care service plan, then the director shall allocate equitably the insolvent specialized health care service plan’s group contracts for the groups among all specialized health care service plans which offer the same type of specialized health care services as the insolvent plan and which operate within at least a portion of the service area of the insolvent specialized health care service plan, taking into consideration the health care delivery resources and the financial and administrative capacity of each specialized health care service plan. The director shall also have the authority to allocate equitable enrollees if he or she has been unable to successfully place them through the open enrollment procedure in subdivision (b). The director shall make every reasonable effort to allocate enrollees within 30 days of the insolvency of the plan, but not later than 45 days after insolvency. Each specialized health care service plan to which a group or groups is so allocated shall offer such group or groups the specialized health care service plan’s coverage which is most similar to each group’s coverage with the insolvent specialized health care service plan as determined by the director, at rates determined in accordance with the successor specialized health care service plan’s existing rating methodology. Coverage shall be effective on a date specified by the director. Further, except to the extent benefits for any condition would have been reduced or excluded under the insolvent specialized health care service plan’s contract or policy, no provision in a successor specialized health care service plan’s contract of coverage which would operate to reduce or exclude benefits on the basis that the condition giving rise to benefits preexisted on the effective date of the enrollee’s assignment to the succeeding plan shall be applied with respect to those enrollees validly covered under the insolvent specialized health care service plan’s contract or policy on the date of the assignment. (d) The director shall also allocate equitably the insolvent specialized health care service plan’s nongroup enrollees among all specialized health care services which offer the same type of specialized health care services as the insolvent plan and which operate within at least a portion of the insolvent specialized health care service plan’s service area, taking into consideration the health care delivery resources and the financial and administrative capacity of each specialized health care service plan. Each specialized health care service plan to which nongroup enrollees are allocated shall offer the nongroup enrollees the health care service plan’s most similar coverage for individual or conversion coverage, as determined by the director, taking into consideration his or her type of coverage in the insolvent specialized health care service plan at rates determined in accordance with the successor specialized health care service plan’s existing rating methodology. Coverage shall be effective on the date specified by the director. Further, except to the extent benefits for any condition would have been reduced or excluded under the insolvent specialized health care service plan’s contract or policy, no provision in a successor specialized health care service plan’s contract of coverage which would operate to reduce or exclude benefits on the basis that the condition giving rise to benefits preexisted on the effective date of the enrollee’s assignment to the succeeding plan shall be applied with respect to those enrollees validly covered under the insolvent specialized health care service plan’s contract or policy on the date of the assignment. Successor specialized health care service plans which do not offer direct nongroup enrollment may aggregate all allocated nongroup enrollees into one group for rating and coverage purposes. (e) Contracting providers shall continue to provide services to enrollees of an insolvent plan until the effective date of an enrollee’s coverage in a successor plan selected pursuant to either open enrollment or the allocation process but in no event for the period exceeding that required by their contract or 45 days in the case of allocation, whichever is greater; or for a period exceeding that required by their contract or 30 days in the case of open enrollment, whichever is greater. (f) Failure to comply with an order pursuant to this section shall constitute a violation of this section. (Amended by Stats. 1999, Ch. 525, Sec. 149. Effective January 1, 2000. Operative July 1, 2000, or sooner, by Sec. 214 of Ch. 525.)
  39. 1395.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 9. Miscellaneous [1395 - 1399.5] ( Article 9 added by Stats. 1975, Ch. 941. )

    Verify source ↗

    Health care service plans may advertise and use professionals, but their advertising must be exact, nonmisleading, and supported by verifiable data.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 9. Miscellaneous [1395 - 1399.5] ( Article 9 added by Stats. 1975, Ch. 941. ) ## 1395. (a) Notwithstanding Article 6 (commencing with Section 650) of Chapter 1 of Division 2 of the Business and Professions Code, any health care service plan or specialized health care service plan may, except as limited by this subdivision, solicit or advertise with regard to the cost of subscription or enrollment, facilities and services rendered, provided, however, Article 5 (commencing with Section 600) of Chapter 1 of Division 2 of the Business and Professions Code remains in effect. Any price advertisement shall be exact, without the use of such phrases as “as low as,” “and up,” “lowest prices” or words or phrases of similar import. Any advertisement that refers to services, or costs for the services, and that uses words of comparison must be based on verifiable data substantiating the comparison. Any health care service plan or specialized health care service plan so advertising shall be prepared to provide information sufficient to establish the accuracy of the comparison. Price advertising shall not be fraudulent, deceitful, or misleading, nor contain any offers of discounts, premiums, gifts, or bait of similar nature. In connection with price advertising, the price for each product or service shall be clearly identifiable. The price advertised for products shall include charges for any related professional services, including dispensing and fitting services, unless the advertisement specifically and clearly indicates otherwise. (b) Plans licensed under this chapter shall not be deemed to be engaged in the practice of a profession, and may employ, or contract with, any professional licensed pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code to deliver professional services. Employment by or a contract with a plan as a provider of professional services shall not constitute a ground for disciplinary action against a health professional licensed pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code by a licensing agency regulating a particular health care profession. (c) A health care service plan licensed under this chapter may directly own, and may directly operate through its professional employees or contracted licensed professionals, offices and subsidiary corporations, including pharmacies that satisfy the requirements of subdivision (d) of Section 4080.5 of the Business and Professions Code, as are necessary to provide health care services to the plan’s subscribers and enrollees. (d) A professional licensed pursuant to the provisions of Division 2 (commencing with Section 500) of the Business and Professions Code who is employed by, or under contract to, a plan may not own or control offices or branch offices beyond those expressly permitted by the provisions of the Business and Professions Code. (e) Nothing in this chapter shall be construed to repeal, abolish, or diminish the effect of Section 129450 of the Health and Safety Code. (f) Except as specifically provided in this chapter, nothing in this chapter shall be construed to limit the effect of the laws governing professional corporations, as they appear in applicable provisions of the Business and Professions Code, upon specialized health care service plans. (g) No representative of a participating health, dental, or vision plan or its subcontractor representative shall in any manner use false or misleading claims to misrepresent itself, the plan, the subcontractor, or the Healthy Families or Medi-Cal program while engaging in application assistance activities that are subject to this section. Notwithstanding any other provision of this chapter, any representative of the health, dental, or vision care plan or of the health, dental, or vision care plan’s subcontractor who violates any of the provisions of Section 12693.325 of the Insurance Code shall only be subject to a fine of five hundred dollars ($500) for each of those violations. (h) A health care service plan shall comply with Section 12693.325 of the Insurance Code and Section 14409 of the Welfare and Institutions Code. In addition to any other disciplinary powers provided by this chapter, if a health care service plan violates any of the provisions of Section 12693.325 of the Insurance Code, the department may prohibit the health care service plan from providing application assistance and contacting applicants pursuant to Section 12693.325 of the Insurance Code. (Amended by Stats. 2001, Ch. 171, Sec. 2. Effective August 10, 2001.)
  40. 1395.5.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 9. Miscellaneous [1395 - 1399.5] ( Article 9 added by Stats. 1975, Ch. 941. )

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    Health care service plan contracts generally may not stop or limit a provider from advertising, subject to listed exceptions.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 9. Miscellaneous [1395 - 1399.5] ( Article 9 added by Stats. 1975, Ch. 941. ) ## 1395.5. (a) Except as provided in subdivisions (b) and (c), no contract that is issued, amended, renewed, or delivered on or after January 1, 1999, between a health care service plan, including a specialized health care service plan, and a provider shall contain provisions that prohibit, restrict, or limit the health care provider from advertising. (b) Nothing in this section shall be construed to prohibit plans from establishing reasonable guidelines in connection with the activities regulated pursuant to this chapter, including those to prevent advertising that is, in whole or in part, untrue, misleading, deceptive, or otherwise inconsistent with this chapter or the rules and regulations promulgated thereunder. For advertisements mentioning a provider’s participation in a plan, nothing in this section shall be construed to prohibit plans from requiring each advertisement to contain a disclaimer to the effect that the provider’s services may be covered for some, but not all, plan contracts, or that plan contracts may cover some, but not all, provider services. (c) Nothing in this section is intended to prohibit provisions or agreements intended to protect service marks, trademarks, trade secrets, or other confidential information or property. If a health care provider participates on a provider panel or network as a result of a direct contractual arrangement with a health care service plan that, in turn, has entered into a direct contractual arrangement with another person or entity, pursuant to which enrollees, subscribers, insureds, and other beneficiaries of that other person or entity may receive covered services from the health care provider, then nothing in this section is intended to prohibit reasonable provisions or agreements in the direct contractual arrangement between the health care provider and the health care service plan that protect the name or trade name of the other person or entity or require that the health care provider obtain the consent of the health care service plan prior to the use of the name or trade name of the other person or entity in any advertising by the health care provider. (d) Nothing in this section shall be construed to impair or impede the authority of the director to regulate advertising, disclosure, or solicitation pursuant to this chapter. (Amended by Stats. 1999, Ch. 525, Sec. 150. Effective January 1, 2000. Operative July 1, 2000, or sooner, by Sec. 214 of Ch. 525.)
  41. 1395.6.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 9. Miscellaneous [1395 - 1399.5] ( Article 9 added by Stats. 1975, Ch. 941. )

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    This section requires contracting agents and certain payors to disclose how contracted provider lists and contracted rates may be used, and it requires payors to prove entitlement to contracted rates on request.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 9. Miscellaneous [1395 - 1399.5] ( Article 9 added by Stats. 1975, Ch. 941. ) ## 1395.6. (a) In order to prevent the improper selling, leasing, or transferring of a health care provider’s contract, it is the intent of the Legislature that every arrangement that results in a payor paying a health care provider a reduced rate for health care services based on the health care provider’s participation in a network or panel shall be disclosed to the provider in advance and that the payor shall actively encourage beneficiaries to use the network, unless the health care provider agrees to provide discounts without that active encouragement. (b) Beginning July 1, 2000, every contracting agent that sells, leases, assigns, transfers, or conveys its list of contracted health care providers and their contracted reimbursement rates to a payor, as defined in subparagraph (A) of paragraph (3) of subdivision (d), or another contracting agent shall, upon entering or renewing a provider contract, do all of the following: (1) Disclose to the provider whether the list of contracted providers may be sold, leased, transferred, or conveyed to other payors or other contracting agents, and specify whether those payors or contracting agents include workers’ compensation insurers or automobile insurers. (2) Disclose what specific practices, if any, payors utilize to actively encourage a payor’s beneficiaries to use the list of contracted providers when obtaining medical care that entitles a payor to claim a contracted rate. For purposes of this paragraph, a payor is deemed to have actively encouraged its beneficiaries to use the list of contracted providers if one of the following occurs: (A) The payor’s contract with subscribers or insureds offers beneficiaries direct financial incentives to use the list of contracted providers when obtaining medical care. “Financial incentives” means reduced copayments, reduced deductibles, premium discounts directly attributable to the use of a provider panel, or financial penalties directly attributable to the nonuse of a provider panel. (B) The payor provides information to its beneficiaries, who are parties to the contract, or, in the case of workers’ compensation insurance, the employer, advising them of the existence of the list of contracted providers through the use of a variety of advertising or marketing approaches that supply the names, addresses, and telephone numbers of contracted providers to beneficiaries in advance of their selection of a health care provider, which approaches may include, but are not limited to, the use of provider directories, or the use of toll-free telephone numbers or Internet web site addresses supplied directly to every beneficiary. However, internet web site addresses alone shall not be deemed to satisfy the requirements of this subparagraph. Nothing in this subparagraph shall prevent contracting agents or payors from providing only listings of providers located within a reasonable geographic range of a beneficiary. (3) Disclose whether payors to which the list of contracted providers may be sold, leased, transferred, or conveyed may be permitted to pay a provider’s contracted rate without actively encouraging the payors’ beneficiaries to use the list of contracted providers when obtaining medical care. Nothing in this subdivision shall be construed to require a payor to actively encourage the payor’s beneficiaries to use the list of contracted providers when obtaining medical care in the case of an emergency. (4) Disclose, upon the initial signing of a contract, and within 30 calendar days of receipt of a written request from a provider or provider panel, a payor summary of all payors currently eligible to claim a provider’s contracted rate due to the provider’s and payor’s respective written agreement with any contracting agent. (5) Allow providers, upon the initial signing, renewal, or amendment of a provider contract, to decline to be included in any list of contracted providers that is sold, leased, transferred, or conveyed to payors that do not actively encourage the payors’ beneficiaries to use the list of contracted providers when obtaining medical care as described in paragraph (2). Each provider’s election under this paragraph shall be binding on the contracting agent with which the provider has the contract and any contracting agent that buys, leases, or otherwise obtains the list of contracted providers. A provider shall not be excluded from any list of contracted providers that is sold, leased, transferred, or conveyed to payors that actively encourage the payors’ beneficiaries to use the list of contracted providers when obtaining medical care, based upon the provider’s refusal to be included on any list of contracted providers that is sold, leased, transferred, or conveyed to payors that do not actively encourage the payors’ beneficiaries to use the list of contracted providers when obtaining medical care. (6) Nothing in this subdivision shall be construed to impose requirements or regulations upon payors, as defined in subparagraph (A) of paragraph (3) of subdivision (d). (c) Beginning July 1, 2000, a payor, as defined in subparagraph (B) of paragraph (3) of subdivision (d), shall do all of the following: (1) Provide an explanation of benefits or explanation of review that identifies the name of the network that has a written agreement signed by the provider whereby the payor is entitled, directly or indirectly, to pay a preferred rate for the services rendered. (2) Demonstrate that it is entitled to pay a contracted rate within 30 business days of receipt of a written request from a provider who has received a claim payment from the payor. The failure of a payor to make the demonstration within 30 business days shall render the payor responsible for the amount that the payor would have been required to pay pursuant to the applicable health care service plan contract, including a specialized health care service plan contract, covering the beneficiary, which amount shall be due and payable within 10 business days of receipt of written notice from the provider, and shall bar the payor from taking any future discounts from that provider without the provider’s express written consent until the payor can demonstrate to the provider that it is entitled to pay a contracted rate as provided in this paragraph. A payor shall be deemed to have demonstrated that it is entitled to pay a contracted rate if it complies with either of the following: (A) Discloses the name of the network that has a written agreement with the provider whereby the provider agrees to accept discounted rates, and describes the specific practices the payor utilizes to comply with paragraph (2) of subdivision (b). (B) Identifies the provider’s written agreement with a contracting agent whereby the provider agrees to be included on lists of contracted providers sold, leased, transferred, or conveyed to payors that do not actively encourage beneficiaries to use the list of contracted providers pursuant to paragraph (5) of subdivision (b). (d) For the purposes of this section, the following terms have the following meanings: (1) “Beneficiary” means: (A) For workers’ compensation insurance, an employee seeking health care services for a work-related injury. (B) For automobile insurance, those persons covered under the medical payments portion of the insurance contract. (C) For group or individual health services covered through a health care service plan contract, including a specialized health care service plan contract, or a policy of disability insurance that covers hospital, medical, or surgical benefits, a subscriber, an enrollee, a policyholder, or an insured. (2) “Contracting agent” means a health care service plan, including a specialized health care service plan, while engaged, for monetary or other consideration, in the act of selling, leasing, transferring, assigning, or conveying, a provider or provider panel to payors to provide health care services to beneficiaries. (3) (A) For the purposes of subdivision (b), “payor” means a health care service plan, including a specialized health care service plan, an insurer licensed under the Insurance Code to provide disability insurance that covers hospital, medical, or surgical benefits, automobile insurance, workers’ compensation insurance, or a self-insured employer that is responsible to pay for health care services provided to beneficiaries. (B) For the purposes of subdivision (c), “payor” means only a health care service plan, including a specialized health care service plan that has purchased, leased, or otherwise obtained the use of a provider or provider panel to provide health care services to beneficiaries pursuant to a contract that authorizes payment at discounted rates. (4) “Payor summary” means a written summary that includes the payor’s name and the type of plan, including, but not limited to, a group health plan, an automobile insurance plan, and a workers’ compensation insurance plan. (5) “Provider” means any of the following: (A) Any person licensed or certified pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code. (B) Any person licensed pursuant to the Chiropractic Initiative Act or the Osteopathic Initiative Act. (C) Any person licensed pursuant to Chapter 2.5 (commencing with Section 1440) of Division 2. (D) A clinic, health dispensary, or health facility licensed pursuant to Division 2 (commencing with Section 1200). (E) Any entity exempt from licensure pursuant to Section 1206. (e) This section shall become operative on July 1, 2000. (Amended by Stats. 2000, Ch. 1069, Sec. 2. Effective January 1, 2001.)
  42. 1395.7.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 9. Miscellaneous [1395 - 1399.5] ( Article 9 added by Stats. 1975, Ch. 941. )

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    Staff-model dental health care service plans with certain credit or payment arrangements must have policies that ensure compliance and timely refunds.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 9. Miscellaneous [1395 - 1399.5] ( Article 9 added by Stats. 1975, Ch. 941. ) ## 1395.7. (a) A staff-model dental health care service plan that arranges for or establishes credit extended by a third party shall establish and comply with policies and procedures that ensure that its dentists, employees, and agents, and employees or agents of its dentists, comply with Section 654.3 of the Business and Professions Code. (b) A staff-model dental health care service plan that arranges for or establishes credit extended by a third party shall establish and comply with policies and procedures that ensure that, within 15 business days of an enrollee’s request, the plan refunds to a lender any payment received through that credit for treatment that has not been rendered or costs that have not been incurred. (c) A staff-model dental health care service plan that directly extends credit or establishes a payment plan shall, at a minimum, establish and comply with policies and procedures that ensure that, within 15 business days of an enrollee’s request, the plan refunds to the enrollee any payment received through that credit or payment plan for treatment that has not been rendered or costs that have not been incurred. (d) For purposes of this section, the following definitions shall apply: (1) “Staff-model dental health care service plan” means a specialized health care service plan that contracts to provide coverage for dental care services and that retains dentists as employees to care for its enrollees. (2) “Enrollee” includes, but is not limited to, an enrollee’s parent or other legal representative. (Added by Stats. 2009, Ch. 418, Sec. 2. (AB 171) Effective January 1, 2010.)
  43. 13950.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 10. Service Zones [13950 - 13956] ( Chapter 10 added by Stats. 1987, Ch. 1013, Sec. 11. )

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    A district board may create service zones, and if it starts the process it must adopt a resolution and give public notice in the specified ways.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 10. Service Zones [13950 - 13956] ( Chapter 10 added by Stats. 1987, Ch. 1013, Sec. 11. ) ## 13950. (a) Whenever a district board determines that it is in the public interest to provide different services, to provide different levels of service, or to raise additional revenues within specific areas of the district, it may form one or more service zones pursuant to this chapter. (b) The district board shall initiate proceedings for the formation of a new zone by adopting a resolution which shall do all of the following: (1) State that the proposal is made pursuant to this chapter. (2) Set forth a description of the boundaries of the territory to be included in the zone. (3) State the different services, different levels of service, or additional revenues which the zone will provide. (4) Set forth the methods by which those services or levels of service will be financed. (5) State the reasons for forming the zone. (6) Propose a name or number for the zone. (7) Fix the date, time, and place for the public hearing on the formation of the zone. (c) The district board shall publish notice of the hearing, including the information required by subdivision (b), pursuant to Section 6061 of the Government Code in one or more newspapers of general circulation in the district. The district board shall mail the notice to all owners of property within the proposed zone. The district board shall post the notice in at least three public places within the territory of the proposed zone. (d) At the hearing, the district board shall hear and consider any protests to the formation of the zone. At the conclusion of the hearing, the district board may adopt a resolution ordering the formation of the zone. (Repealed and added by Stats. 1987, Ch. 1013, Sec. 11.)
  44. 13951.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 10. Service Zones [13950 - 13956] ( Chapter 10 added by Stats. 1987, Ch. 1013, Sec. 11. )

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    A district board may change a service zone’s boundaries or dissolve the zone if it follows Section 13950 procedures.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 10. Service Zones [13950 - 13956] ( Chapter 10 added by Stats. 1987, Ch. 1013, Sec. 11. ) ## 13951. A district board may change the boundaries of a service zone or dissolve a zone by following the procedures in Section 13950. (Repealed and added by Stats. 1987, Ch. 1013, Sec. 11.)
  45. 13952.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 10. Service Zones [13950 - 13956] ( Chapter 10 added by Stats. 1987, Ch. 1013, Sec. 11. )

    Verify source ↗

    A local agency formation commission has no power or duty to review and approve or disapprove proposals to create, change the boundaries of, or dissolve a service zone.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 10. Service Zones [13950 - 13956] ( Chapter 10 added by Stats. 1987, Ch. 1013, Sec. 11. ) ## 13952. A local agency formation commission shall have no power or duty to review and approve or disapprove a proposal to create a service zone, a proposal to change the boundaries of a zone, or a proposal to dissolve a zone. (Repealed and added by Stats. 1987, Ch. 1013, Sec. 11.)
  46. 13953.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 10. Service Zones [13950 - 13956] ( Chapter 10 added by Stats. 1987, Ch. 1013, Sec. 11. )

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    A service zone may provide any service within its boundaries if the district board determines it may do so.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 10. Service Zones [13950 - 13956] ( Chapter 10 added by Stats. 1987, Ch. 1013, Sec. 11. ) ## 13953. As determined by the district board, a service zone may provide any service at any level within its boundaries which the district may provide. (Repealed and added by Stats. 1987, Ch. 1013, Sec. 11.)
  47. 13954.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 10. Service Zones [13950 - 13956] ( Chapter 10 added by Stats. 1987, Ch. 1013, Sec. 11. )

    Verify source ↗

    A service zone may exercise the district’s fiscal powers within its boundaries, if the district board determines this and the chapter’s requirements are met.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 10. Service Zones [13950 - 13956] ( Chapter 10 added by Stats. 1987, Ch. 1013, Sec. 11. ) ## 13954. As determined by the district board and pursuant to the requirements of this part, a service zone may exercise any fiscal powers within its boundaries that the district may exercise. (Repealed and added by Stats. 1987, Ch. 1013, Sec. 11.)
  48. 13955.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 10. Service Zones [13950 - 13956] ( Chapter 10 added by Stats. 1987, Ch. 1013, Sec. 11. )

    Verify source ↗

    Taxes, special taxes, assessments, or fees meant only to support services within a zone must be levied, assessed, and collected only inside that zone.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 10. Service Zones [13950 - 13956] ( Chapter 10 added by Stats. 1987, Ch. 1013, Sec. 11. ) ## 13955. Any taxes, special taxes, assessments, or fees which are intended solely for the support of services within a zone shall be levied, assessed, and collected only within the boundaries of the zone. (Added by Stats. 1987, Ch. 1013, Sec. 11.)
  49. 13956.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 10. Service Zones [13950 - 13956] ( Chapter 10 added by Stats. 1987, Ch. 1013, Sec. 11. )

    Verify source ↗

    The district board may appoint one or more advisory groups to help operate a service zone.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 10. Service Zones [13950 - 13956] ( Chapter 10 added by Stats. 1987, Ch. 1013, Sec. 11. ) ## 13956. To assist it in the operation of a service zone, the district board may appoint one or more advisory groups composed of persons who reside in or own property in the zone. (Added by Stats. 1987, Ch. 1013, Sec. 11.)
  50. 1396.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 9. Miscellaneous [1395 - 1399.5] ( Article 9 added by Stats. 1975, Ch. 941. )

    Verify source ↗

    It is unlawful to willfully make a false material statement, or willfully omit a required material fact, in covered filings submitted to the director.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 9. Miscellaneous [1395 - 1399.5] ( Article 9 added by Stats. 1975, Ch. 941. ) ## 1396. It is unlawful for any person willfully to make any untrue statement of material fact in any application, notice, amendment, report, or other submission filed with the director under this chapter or the regulations adopted thereunder, or willfully to omit to state in any application, notice, or report any material fact which is required to be stated therein. (Amended by Stats. 1999, Ch. 525, Sec. 151. Effective January 1, 2000. Operative July 1, 2000, or sooner, by Sec. 214 of Ch. 525.)
  51. 1396.5.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 9. Miscellaneous [1395 - 1399.5] ( Article 9 added by Stats. 1975, Ch. 941. )

    Verify source ↗

    Certain nonprofit hospital corporations may enjoy specified privileges under the act if they meet the stated historical and regulatory conditions.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 9. Miscellaneous [1395 - 1399.5] ( Article 9 added by Stats. 1975, Ch. 941. ) ## 1396.5. A nonprofit hospital corporation which substantially indemnified subscribers and enrollees and was operating in 1965 under Chapter 11A (commencing with Section 11490) of Part 2 of Division 2 of the Insurance Code and which is regulated under the Knox-Keene Health Care Service Plan Act shall enjoy the privileges under the act which would have been available to it had it been registered under the Knox-Mills Health Plan Act and applied for a license under the Knox-Keene Health Care Service Plan Act in 1976. (Added by Stats. 1990, Ch. 1043, Sec. 10.)
  52. 13960.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 11. Employee Relations [13960 - 13970] ( Chapter 11 added by Stats. 1987, Ch. 1013, Sec. 11. )

    Verify source ↗

    This section says two labor-relations laws apply to all fire protection districts.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 11. Employee Relations [13960 - 13970] ( Chapter 11 added by Stats. 1987, Ch. 1013, Sec. 11. ) ## 13960. (a) The Meyers-Milias-Brown Act, Chapter 10 (commencing with Section 3500) of Division 4 of Title 1 of the Government Code applies to all fire protection districts. (b) Chapter 4 (commencing with Section 1960) of Part 7 of Division 2 of the Labor Code applies to all fire protection districts. (Added by Stats. 1987, Ch. 1013, Sec. 11.)
  53. 13961.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 11. Employee Relations [13960 - 13970] ( Chapter 11 added by Stats. 1987, Ch. 1013, Sec. 11. )

    Verify source ↗

    A district board may adopt an ordinance to establish an employee relations system.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 11. Employee Relations [13960 - 13970] ( Chapter 11 added by Stats. 1987, Ch. 1013, Sec. 11. ) ## 13961. (a) A district board may adopt an ordinance establishing an employee relations system. (b) “Employee relations system” as used in this chapter means a civil service system or a merit system. (Added by Stats. 1987, Ch. 1013, Sec. 11.)
  54. 13962.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 11. Employee Relations [13960 - 13970] ( Chapter 11 added by Stats. 1987, Ch. 1013, Sec. 11. )

    Verify source ↗

    If enough district voters petition for an employee relations system, the district board must act, and employee circulation of the petition is allowed off duty.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 11. Employee Relations [13960 - 13970] ( Chapter 11 added by Stats. 1987, Ch. 1013, Sec. 11. ) ## 13962. (a) Upon receipt of a petition proposing an employee relations system for employees of the district, signed by at least 10 percent of the registered voters of the district, the district board shall either adopt an ordinance providing for the employee relations system, or adopt an ordinance subject to the approval of the voters of the district. (b) District employees may circulate the petitions described in subdivision (a) at any time when they are not on duty. (c) If the question is submitted to the voters at a general district election, the notice required by Section 12112 of the Elections Code shall contain a statement of the question to appear on the ballot. If the question is submitted to the voters at a special election, the notice of election and ballot shall contain a statement of the question. (d) The question placed before the voters shall call for a “Yes” or “No” vote and shall be in substantially the following form: “Shall the ordinance of the Board of Directors of the ______ (name of the district), adopting an employee relations system for the employees of the district, be approved?” (e) If a majority of the voters voting on the question approve of the question, the ordinance shall go into effect. (Amended by Stats. 2006, Ch. 588, Sec. 15. Effective January 1, 2007.)
  55. 13963.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 11. Employee Relations [13960 - 13970] ( Chapter 11 added by Stats. 1987, Ch. 1013, Sec. 11. )

    Verify source ↗

    If multiple districts share one board, that board may set common employee relations rules, use shared examinations and eligibility lists, create a seniority list, and set a time limit on that list; workers laid off for lack of work get reemployment preference.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 11. Employee Relations [13960 - 13970] ( Chapter 11 added by Stats. 1987, Ch. 1013, Sec. 11. ) ## 13963. When more than one district is governed by the same board of directors, the district board may do all of the following: (a) Adopt the same set of employee relations rules, regulations, and procedures for any or all districts. (b) Authorize one examination for any or all districts for each classification of employment, establish one eligibility list, permit qualified candidates to transfer from one district to another, and allow requested changes in assignment. (c) Adopt one seniority list to be used in the layoff of all employees of any or all districts. Persons laid off due to lack of work shall be eligible for reemployment and shall be reemployed in preference to the employment of new applicants. The district board may set a time limit on the use of this seniority list. (Added by Stats. 1987, Ch. 1013, Sec. 11.)
  56. 13964.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 11. Employee Relations [13960 - 13970] ( Chapter 11 added by Stats. 1987, Ch. 1013, Sec. 11. )

    Verify source ↗

    A county board of supervisors that has made itself the district board may change certain employee statuses between county fire warden department, district, and county status, subject to charter and employee-relations rules.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 11. Employee Relations [13960 - 13970] ( Chapter 11 added by Stats. 1987, Ch. 1013, Sec. 11. ) ## 13964. If a county board of supervisors has appointed itself as the district board, it may change to district status any employee of a county fire warden department and the status of any district employee may be changed to that of a county employee, subject to charter provisions relating to employee relations, and the rules, regulations, and procedures of the employee relations system of the employer county. (Added by Stats. 1987, Ch. 1013, Sec. 11.)
  57. 13965.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 11. Employee Relations [13960 - 13970] ( Chapter 11 added by Stats. 1987, Ch. 1013, Sec. 11. )

    Verify source ↗

    The district’s employee-relations commission or similar body may, in some cases, certify a person as eligible for a district position without an examination.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 11. Employee Relations [13960 - 13970] ( Chapter 11 added by Stats. 1987, Ch. 1013, Sec. 11. ) ## 13965. If the civil service commission or body performing employee relations functions for a district finds that a person has been employed by a city or another district which has, or any portion of which has, been annexed to, included within, or contracts with, the district for all fire protection, rescue, or emergency medical services, in a position classification the duties of which and qualifications for which are substantially the same as those of any position classification in the district, at the request of the district board, the civil service commission or other body may certify, without examination, that person as eligible to hold that district position classification or any lower position classification for which the person is qualified and which would not result in a lower level of salary than was received by the person immediately before the annexation, inclusion, or contract. If a person is employed by the district after certification without examination by the civil service commission or other body because of his or her employment in a position classification of similar duties by a city or district, all time employed in that city or district shall be considered as time employed by the district, to determine seniority rights and salary rates. (Added by Stats. 1987, Ch. 1013, Sec. 11.)
  58. 13966.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 11. Employee Relations [13960 - 13970] ( Chapter 11 added by Stats. 1987, Ch. 1013, Sec. 11. )

    Verify source ↗

    A district board in the specified Santa Clara County district may call an election on whether to use binding arbitration for impasses in employer-employee relations.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 11. Employee Relations [13960 - 13970] ( Chapter 11 added by Stats. 1987, Ch. 1013, Sec. 11. ) ## 13966. (a) In the case of a district where the Board of Supervisors of the County of Santa Clara has appointed itself as the district board of a district, the district board may call an election to be held in the district for the purpose of submitting to the voters of the district the question of whether the district board may provide for a system of binding arbitration for the resolution of impasses in employer-employee relations. (b) Where the district has created service zones, the election specified in subdivision (a) shall be held only in those zones in which the district provides direct fire protection and not in those zones in which fire protection is provided by contract with other agencies. (Added by Stats. 1987, Ch. 1013, Sec. 11.)
  59. 13967.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 11. Employee Relations [13960 - 13970] ( Chapter 11 added by Stats. 1987, Ch. 1013, Sec. 11. )

    Verify source ↗

    A district board may require district employees to be bonded, and the district must pay the bond cost.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 11. Employee Relations [13960 - 13970] ( Chapter 11 added by Stats. 1987, Ch. 1013, Sec. 11. ) ## 13967. A district board may require any employee of the district to be bonded. The district shall pay the cost of the bonds. (Added by Stats. 1987, Ch. 1013, Sec. 11.)
  60. 13968.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 11. Employee Relations [13960 - 13970] ( Chapter 11 added by Stats. 1987, Ch. 1013, Sec. 11. )

    Verify source ↗

    A district board may provide programs that benefit its employees or the district board’s members, subject to the cited Government Code chapter.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 11. Employee Relations [13960 - 13970] ( Chapter 11 added by Stats. 1987, Ch. 1013, Sec. 11. ) ## 13968. A district board may provide for any programs for the benefits of its employees or members of the district board, pursuant to Chapter 2 (commencing with Section 53200) of Part 1 of Division 2 of Title 5 of the Government Code. (Added by Stats. 1987, Ch. 1013, Sec. 11.)
  61. 13969.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 11. Employee Relations [13960 - 13970] ( Chapter 11 added by Stats. 1987, Ch. 1013, Sec. 11. )

    Verify source ↗

    A district board must train certain district employees in first aid and CPR, but not employees whose duties are mainly clerical or administrative. The board may also offer other training programs.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 11. Employee Relations [13960 - 13970] ( Chapter 11 added by Stats. 1987, Ch. 1013, Sec. 11. ) ## 13969. A district board shall train all employees of the district who are expected to provide services pursuant to Section 13862, except those whose duties are primarily clerical or administrative, to administer first aid and cardiopulmonary resuscitation, as required pursuant to Section 1797.182. A district board may provide any other training programs for its employees. (Added by Stats. 1987, Ch. 1013, Sec. 11.)
  62. 1397.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 9. Miscellaneous [1395 - 1399.5] ( Article 9 added by Stats. 1975, Ch. 941. )

    Verify source ↗

    Hearings before or by the director must follow the Administrative Procedure Act, and the director has the powers given by that Act.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 9. Miscellaneous [1395 - 1399.5] ( Article 9 added by Stats. 1975, Ch. 941. ) ## 1397. (a) Whenever reference is made in this chapter to a hearing before or by the director, the hearing shall be held in accordance with the Administrative Procedure Act (Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government Code), and the director shall have all of the powers granted under that act. (b) Every final order, decision, license, or other official act of the director under this chapter is subject to judicial review in accordance with the law. (Amended by Stats. 1999, Ch. 525, Sec. 152. Effective January 1, 2000. Operative July 1, 2000, or sooner, by Sec. 214 of Ch. 525.)
  63. 1397.5.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 9. Miscellaneous [1395 - 1399.5] ( Article 9 added by Stats. 1975, Ch. 941. )

    Verify source ↗

    The director must file an annual public summary of grievances against health care service plans and include a statutory disclaimer.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 9. Miscellaneous [1395 - 1399.5] ( Article 9 added by Stats. 1975, Ch. 941. ) ## 1397.5. (a) The director shall make and file annually with the Department of Managed Health Care as a public record, an aggregate summary of grievances against plans filed with the director by enrollees or subscribers. This summary shall include at least all of the following information: (1) The total number of grievances filed. (2) The types of grievances. (b) The summary set forth in subdivision (a) shall include the following disclaimer: “THIS INFORMATION IS PROVIDED FOR STATISTICAL PURPOSES ONLY. THE DIRECTOR OF THE DEPARTMENT OF MANAGED CARE HAS NEITHER INVESTIGATED NOR DETERMINED WHETHER THE GRIEVANCES COMPILED WITHIN THIS SUMMARY ARE REASONABLE OR VALID.” (c) Nothing in this section shall require or authorize the disclosure of grievances filed with or received by the director and made confidential pursuant to any other provision of law including, but not limited to, the California Public Records Act (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code) and the Information Practices Act of 1977 (Chapter 1 (commencing with Section 1798) of Title 1.8 of Part 4 of Division 3 of the Civil Code). Nothing in this section shall affect any other provision of law including, but not limited to, the California Public Records Act and the Information Practices Act of 1977. (Amended by Stats. 2021, Ch. 615, Sec. 229. (AB 474) Effective January 1, 2022. Operative January 1, 2023, pursuant to Sec. 463 of Stats. 2021, Ch. 615.)
  64. 1397.6.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 9. Miscellaneous [1395 - 1399.5] ( Article 9 added by Stats. 1975, Ch. 941. )

    Verify source ↗

    The director may hire necessary medical consultants for the health care program, and those contracts must be on a noncompetitive bid basis and are exempt from a specified Public Contract Code chapter.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 9. Miscellaneous [1395 - 1399.5] ( Article 9 added by Stats. 1975, Ch. 941. ) ## 1397.6. The director may contract with necessary medical consultants to assist with the health care program. These contracts shall be on a noncompetitive bid basis and shall be exempt from Chapter 2 (commencing with Section 10290) of Part 2 of Division 2 of the Public Contract Code. (Amended by Stats. 1999, Ch. 525, Sec. 154. Effective January 1, 2000. Operative July 1, 2000, or sooner, by Sec. 214 of Ch. 525.)
  65. 13970.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 11. Employee Relations [13960 - 13970] ( Chapter 11 added by Stats. 1987, Ch. 1013, Sec. 11. )

    Verify source ↗

    A fire protection district is treated as a fire district for granting leaves of absence instead of temporary disability payments under the cited Labor Code article.

    ## Health and Safety Code - HSC ## DIVISION 12. FIRES AND FIRE PROTECTION [13000 - 14959] ( Division 12 enacted by Stats. 1939, Ch. 60. ) ## PART 2.7. FIRE PROTECTION DISTRICT LAW OF 1987 [13800 - 13970] ( Heading of Part 2.7 renumbered from Part 3 (as added by Stats. 1987, Ch. 1013) by Stats. 1989, Ch. 1360, Sec. 91. ) ## CHAPTER 11. Employee Relations [13960 - 13970] ( Chapter 11 added by Stats. 1987, Ch. 1013, Sec. 11. ) ## 13970. A fire protection district shall be considered a “fire district” to grant leaves of absence in lieu of temporary disability payments pursuant to Article 7 (commencing with Section 4850) of Chapter 2 of Part 2 of Division 4 of the Labor Code. (Added by Stats. 1987, Ch. 1013, Sec. 11.)
  66. 1398.5.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 9. Miscellaneous [1395 - 1399.5] ( Article 9 added by Stats. 1975, Ch. 941. )

    Verify source ↗

    References to the repealed Knox-Mills Health Plan Act must be read as references to the Knox-Keene Health Care Service Plan Act of 1975.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 9. Miscellaneous [1395 - 1399.5] ( Article 9 added by Stats. 1975, Ch. 941. ) ## 1398.5. All references to the Knox-Mills Health Plan Act (Article 2.5 (commencing with Section 12530) of Chapter 6 of Part 2 of Division 3 of the Government Code), which was repealed by Chapter 941 of the Statutes of 1975, shall be deemed to be references to the Knox-Keene Health Care Service Plan Act of 1975. (Added by Stats. 1976, Ch. 490.)
  67. 1399.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 9. Miscellaneous [1395 - 1399.5] ( Article 9 added by Stats. 1975, Ch. 941. )

    Verify source ↗

    A health plan license surrender usually takes effect 30 days after the surrender application is received, but the director can act sooner or set different conditions if a revocation or suspension proceeding is pending or started. The director may also summarily revoke or suspend a plan’s license for specified noncompliance or if the plan is no longer operating or cannot be found.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 9. Miscellaneous [1395 - 1399.5] ( Article 9 added by Stats. 1975, Ch. 941. ) ## 1399. (a) Surrender of a license as a health plan becomes effective 30 days after receipt of an application to surrender the license or within a shorter period of time as the director may determine, unless a revocation or suspension proceeding is pending when the application is filed or a proceeding to revoke or suspend or to impose conditions upon the surrender is instituted within 30 days after the application is filed. If this proceeding is pending or instituted, surrender becomes effective at the time and upon the conditions as the director by order determines. (b) If the director finds that any plan is no longer in existence, or has ceased to do business or has failed to initiate business activity as a licensee within six months after licensure, or cannot be located after reasonable search, the director may by order summarily revoke the license of the plan. (c) The director may summarily suspend or revoke the license of a plan upon (1) failure to pay any fee required by this chapter within 15 days after notice by the director that the fee is due and unpaid, (2) failure to file any amendment or report required under this chapter within 15 days after notice by the director that the report is due, (3) failure to maintain any bond or insurance pursuant to Section 1376, (4) failure to maintain a deposit, insurance, or guaranty arrangement pursuant to Section 1377, or (5) failure to maintain a deposit pursuant to Section 1300.76.1 of Title 28 of the California Code of Regulations. (Amended by Stats. 2009, Ch. 298, Sec. 9. (AB 1540) Effective January 1, 2010.)
  68. 1399.1.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 9. Miscellaneous [1395 - 1399.5] ( Article 9 added by Stats. 1975, Ch. 941. )

    Verify source ↗

    Past orders and actions under Section 1350(c) stay effective, and the prior Knox-Mills Health Plan Act still governs certain pending or later-started proceedings tied to facts before September 30, 1977.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 9. Miscellaneous [1395 - 1399.5] ( Article 9 added by Stats. 1975, Ch. 941. ) ## 1399.1. (a) All orders and other actions taken by the Commissioner of Corporations pursuant to the authority contained in subdivision (c) of Section 1350 on or before September 30, 1977, and all administrative or judicial decisions or orders relating to the same and all conditions imposed upon the same remain in effect against a plan holding a transitional license. (b) The Knox-Mills Health Plan Act as in effect prior to its repeal continues to govern all suits, actions, prosecutions or proceedings which are pending or which may be initiated under subdivision (c) of Section 1350 on the basis of facts or circumstances occurring on or before September 30, 1977. (Amended by Stats. 1999, Ch. 525, Sec. 157. Effective January 1, 2000. Operative July 1, 2000, or sooner, by Sec. 214 of Ch. 525.)
  69. 1399.3.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 9. Miscellaneous [1395 - 1399.5] ( Article 9 added by Stats. 1975, Ch. 941. )

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    A health care service plan must give a solicitor written or electronic notice at least 45 days before a material contract change takes effect, unless the change is mutually agreed or required by state or federal law.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 9. Miscellaneous [1395 - 1399.5] ( Article 9 added by Stats. 1975, Ch. 941. ) ## 1399.3. (a) A material change made by a health care service plan, as defined in subdivision (f) of Section 1345, to the terms and conditions of a contract between the health care service plan and a solicitor shall not become effective until the health care service plan has delivered to the solicitor, at least 45 days prior to the effective date of the change, written or electronic notice indicating the change or changes to the contract. For purposes of this section, a “material change” is a change made to a provision of the contract affecting any of the following: (1) Commissions, bonuses, and incentives paid to the solicitor. (2) Right of survivorship. (3) Indemnification of the solicitor by the health care service plan. (4) Errors and omissions coverage requirements for the solicitor. (b) Subdivision (a) shall not apply under either of the following circumstances: (1) The change to the contract is mutually agreed upon by the health care service plan and the solicitor. (2) The change to the contract is required by state or federal law. (Added by Stats. 2015, Ch. 482, Sec. 1. (AB 1163) Effective January 1, 2016.)
  70. 1399.5.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 9. Miscellaneous [1395 - 1399.5] ( Article 9 added by Stats. 1975, Ch. 941. )

    Verify source ↗

    The Legislature states that this chapter applies to private or public entities and political subdivisions that provide, administer, or arrange health care services for a prepaid or periodic charge, unless exempt under Section 1343.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 9. Miscellaneous [1395 - 1399.5] ( Article 9 added by Stats. 1975, Ch. 941. ) ## 1399.5. It is the intent of the Legislature that the provisions of this chapter shall be applicable to any private or public entity or political subdivision which, in return for a prepaid or periodic charge paid by or on behalf of a subscriber or enrollee, provides, administers or otherwise arranges for the provision of health care services, as defined in this chapter, unless such entity is exempted from the provisions of this chapter by, or pursuant to, Section 1343. (Amended by Stats. 1980, Ch. 628.)
  71. 1399.55.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 9.5. Claims Reviewers [1399.55 - 1399.57] ( Article 9.5 added by Stats. 1992, Ch. 544, Sec. 1. )

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    Health care service plans must explain why they rejected a claim if the provider or patient asks.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 9.5. Claims Reviewers [1399.55 - 1399.57] ( Article 9.5 added by Stats. 1992, Ch. 544, Sec. 1. ) ## 1399.55. Health care service plans shall, upon rejecting a claim from a health care provider or a patient, and upon their demand, disclose the specific rationale used in determining why the claim was rejected. Nothing in this section is intended to expand or restrict the ability of a health care provider or a patient from having health care coverage approved in advance of services. (Added by Stats. 1992, Ch. 544, Sec. 1. Effective January 1, 1993.)
  72. 1399.56.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 9.5. Claims Reviewers [1399.55 - 1399.57] ( Article 9.5 added by Stats. 1992, Ch. 544, Sec. 1. )

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    A person hired by a health care service plan to review claims cannot be paid based on claim reductions or on the number or cost of denied claims.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 9.5. Claims Reviewers [1399.55 - 1399.57] ( Article 9.5 added by Stats. 1992, Ch. 544, Sec. 1. ) ## 1399.56. Compensation of a person retained by a health care service plan to review claims for health care services shall not be based on either of the following: (a) A percentage of the amount by which a claim is reduced for payment. (b) The number of claims or the cost of services for which the person has denied authorization or payment. (Amended by Stats. 1995, Ch. 787, Sec. 2. Effective January 1, 1996.)
  73. 1399.57.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 9.5. Claims Reviewers [1399.55 - 1399.57] ( Article 9.5 added by Stats. 1992, Ch. 544, Sec. 1. )

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    This article does not apply to services or benefits provided under Medi-Cal.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 9.5. Claims Reviewers [1399.55 - 1399.57] ( Article 9.5 added by Stats. 1992, Ch. 544, Sec. 1. ) ## 1399.57. This article does not apply to services or benefits provided pursuant to Medi-Cal, including services or benefits provided under Chapters 7 (commencing with Section 14000) and 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code. (Added by Stats. 1992, Ch. 544, Sec. 1. Effective January 1, 1993.)
  74. 1399.60.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 10. Discontinuance and Replacement of Group Health Care Service Plan Contracts [1399.60 - 1399.64] ( Article 10 added by Stats. 1977, Ch. 64. )

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    This article applies to all group health care service contracts issued in this state under this chapter.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 10. Discontinuance and Replacement of Group Health Care Service Plan Contracts [1399.60 - 1399.64] ( Article 10 added by Stats. 1977, Ch. 64. ) ## 1399.60. The provisions of this article shall apply to all group health care service contracts issued in this state pursuant to this chapter. (Added by Stats. 1977, Ch. 64.)
  75. 1399.61.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 10. Discontinuance and Replacement of Group Health Care Service Plan Contracts [1399.60 - 1399.64] ( Article 10 added by Stats. 1977, Ch. 64. )

    Verify source ↗

    This section defines key terms used in the article on discontinuance and replacement of group health care service plan contracts.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 10. Discontinuance and Replacement of Group Health Care Service Plan Contracts [1399.60 - 1399.64] ( Article 10 added by Stats. 1977, Ch. 64. ) ## 1399.61. In this article, unless the context otherwise requires: (a) “Carrier” shall mean the health care service plan or other entity responsible for the payment of benefits or provision of services under a group contract. (b) “Dependent” shall have the meaning set forth in a contract. (c) “Discontinuance” shall mean the termination of the contract between the entire employer unit under a contract and the health care service plan, and does not refer to the termination of any agreement between any individual member under a contract and the health care service plan. (d) “Employee” shall mean all agents, employees, and members of unions or associations to whom benefits are provided under a contract. (e) “Extension of benefits” shall mean the continuation of coverage under a particular benefit provided under a contract following discontinuance with respect to an employee or dependent who is totally disabled on the date of discontinuance. (f) “Contract” shall mean any group health care service plan or contract subject to the provisions of this article. (g) “Contractholder” shall mean the entity to which a contract is issued. (h) “Dues” shall mean the consideration payable to the carrier. (i) “Replacement coverage” shall mean the benefits provided by a succeeding carrier. (j) “Totally disabled” shall have the meaning set forth in a contract. (Amended by Stats. 1983, Ch. 126, Sec. 1.)
  76. 1399.62.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 10. Discontinuance and Replacement of Group Health Care Service Plan Contracts [1399.60 - 1399.64] ( Article 10 added by Stats. 1977, Ch. 64. )

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    Health care service plan contracts with disability coverage must include a reasonable extension of benefits after discontinuance for certain totally disabled employees or dependents.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 10. Discontinuance and Replacement of Group Health Care Service Plan Contracts [1399.60 - 1399.64] ( Article 10 added by Stats. 1977, Ch. 64. ) ## 1399.62. (a) Every contract containing hospital, medical, or surgical expense benefits or service benefits shall contain a reasonable extension of such benefits upon discontinuance of the contract with respect to employees or dependents who become totally disabled while enrolled under the contract on or after the date this article becomes applicable to such contract and who continue to be totally disabled at the date of discontinuance of the contract. (b) Every contract providing hospital, medical or surgical expense benefits or service benefits shall be deemed to include a reasonable extension of such benefits upon discontinuance of the contract if it provides benefits for covered services directly relating to the condition causing total disability existing at the time dues payments cease for the employee or dependent and incurred during a period of not less than 12 months thereafter, which period shall not be interrupted by discontinuance of the contract. That extension of benefits may be terminated at such time as the employee or dependent is no longer totally disabled or at such time as a succeeding carrier may elect to provide replacement coverage to that employee or dependent without limitation as to the disabling condition. (c) The services provided during any extension of benefits may be subject to all limitations or restrictions contained in the contract. (Amended by Stats. 1983, Ch. 888, Sec. 1.)
  77. 1399.63.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 10. Discontinuance and Replacement of Group Health Care Service Plan Contracts [1399.60 - 1399.64] ( Article 10 added by Stats. 1977, Ch. 64. )

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    A replacement health plan carrier must keep covered employees and dependents insured, subject to the section’s limits.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 10. Discontinuance and Replacement of Group Health Care Service Plan Contracts [1399.60 - 1399.64] ( Article 10 added by Stats. 1977, Ch. 64. ) ## 1399.63. (a) Any carrier providing replacement coverage with respect to hospital, medical or surgical expense or service benefits within a period of 60 days from the date of discontinuance of a prior contract or policy providing such hospital, medical or surgical expense or service benefits shall immediately cover all employees and dependents who were validly covered under the previous contract or policy at the date of discontinuance, including all former employees entitled to continuation coverage under Section 1373.621, who are within the definitions of eligibility under the succeeding carrier’s contract and who would otherwise be eligible for coverage under the succeeding carrier’s contract, regardless of any provisions of the contract relating to active full-time employment or hospital confinement or pregnancy. However, with respect to employees or dependents who are totally disabled on the date of discontinuance of the prior carrier’s contract or policy and entitled to an extension of benefits pursuant to subdivision (b) of Section 1399.62, or pursuant to subdivision (d) of Section 10128.2 of the Insurance Code, the succeeding carrier is not required to provide benefits for services or expenses directly related to any conditions which caused the total disability. (b) Except as otherwise provided in subdivision (a), until an employee or dependent entitled to coverage under a succeeding carrier’s contract pursuant to subdivision (a) of this section qualifies for full benefits by meeting all effective date requirements of the succeeding carrier’s contract, the level of benefits shall not be lower than the benefits provided under the prior carrier’s contract or policy reduced by the amount of benefits paid by the prior carrier. Such employee or dependent shall continue to be covered by the succeeding carrier until the earlier of the following dates: (1) The date coverage would terminate for an employee or dependent in accordance with the provisions of the succeeding carrier’s contract, or (2) In the case of an employee or dependent who was totally disabled on the date of discontinuance of the prior carrier’s contract or policy and entitled to an extension of benefits pursuant to subdivision (d) of Section 10128.2 of the Insurance Code or subdivision (b) of Section 1399. 62, the date the period of extension of benefits terminates or, if the prior carrier’s contract or policy is not subject to this article, the date to which benefits would have been extended had the prior carrier’s contract or policy been subject to this article. (c) Except as otherwise provided in this section, and except to the extent that benefits for the condition would have been reduced or excluded under the prior carrier’s contract or policy, no provision in a succeeding carrier’s contract of replacement coverage which would operate to reduce or exclude benefits on the basis that the condition giving rise to benefits preexisted the effective date of the succeeding carrier’s contract shall be applied with respect to those employees, former employees entitled to continuation coverage under Section 1373.621, and dependents validly covered under the prior carrier’s contract or policy on the date of discontinuance. (d) In a situation where a determination of the prior carrier’s benefit is required by the succeeding carrier, at the succeeding carrier’s request, the prior carrier shall furnish a statement of benefits available or pertinent information, sufficient to permit verification of the benefit determination by the succeeding carrier. (e) For purposes of subdivision (a), a succeeding carrier’s coverage shall not exclude any dependent child who was covered by the previous carrier solely because the plan member does not provide the primary support for that dependent child. (f) Except to the extent that benefits for the condition would have been reduced or excluded under the prior carrier’s contract or policy, no provision in the succeeding carrier’s contract, where an employee changes carriers due to a change in employment or other circumstances, that would operate to reduce or exclude benefits for the following congenital craniofacial anomalies: cleft lip and palate (as defined in ICD-9-CM Diagnosis Code 749, International Classification of Diseases, 9th Revision, Clinical Modification, Volume 1, Second Edition, September, 1980), acrocephalosyndactyly (as defined in ICD-9-CM Diagnosis Code 755.55, cranio only), and other congenital musculoskeletal anomalies (as defined in ICD-9-CM Diagnosis Code 756.0), on the basis that the condition giving rise to benefits preexisted the effective date of the succeeding carrier’s contract, shall be applied to those employees, former employees entitled to continuation coverage under Section 1373.621, and dependents validly covered under the prior carrier’s contract or policy on the date the prior contract or policy terminated when payment or services had been commenced by the previous carrier. That succeeding coverage shall otherwise be subject to all other provisions of the contract between the insured and the succeeding carrier. Nothing in this subdivision shall be construed to limit or otherwise affect any obligation of a succeeding carrier to provide benefits for a condition not specified in this subdivision, where expressly or impliedly required by other provisions of this chapter; this subdivision is not intended to affect the construction of the language of any other provision of this chapter. (Amended by Stats. 1995, Ch. 489, Sec. 2. Effective January 1, 1996.)
  78. 1399.64.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 10. Discontinuance and Replacement of Group Health Care Service Plan Contracts [1399.60 - 1399.64] ( Article 10 added by Stats. 1977, Ch. 64. )

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    This section says the article applies to certain group health care service plan contracts after January 1, 1977, and some policies affected by later amendments are treated as complying with the article and those amendments.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 10. Discontinuance and Replacement of Group Health Care Service Plan Contracts [1399.60 - 1399.64] ( Article 10 added by Stats. 1977, Ch. 64. ) ## 1399.64. This article shall apply to all contracts issued, delivered, amended, or renewed in this state after January 1, 1977. A policy subject to the provisions of this article which is issued, delivered, amended as to benefits, or renewed in this state on or after the effective date of amendments to this article made at the 1977–1978 Regular Session of the Legislature shall be construed to be in compliance with the provisions of this article and such amendments to this article. (Added by Stats. 1977, Ch. 64.)
  79. 1399.65.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 10.2. Mergers and Acquisitions of Health Care Service Plans [1399.65 - 1399.66] ( Article 10.2 added by Stats. 2018, Ch. 292, Sec. 1. )

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    A health care service plan must notify the director and get prior approval before certain mergers, acquisitions, or control transactions can be completed.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 10.2. Mergers and Acquisitions of Health Care Service Plans [1399.65 - 1399.66] ( Article 10.2 added by Stats. 2018, Ch. 292, Sec. 1. ) ## 1399.65. (a) (1) A health care service plan that intends to merge or consolidate with, or enter into an agreement resulting in its purchase, acquisition, or control by, any entity, including another health care service plan or a health insurer licensed under the Insurance Code, shall give notice to, and secure prior approval from, the director. (2) The transactions or agreements described in paragraph (1) may not be completed until the director approves the transaction or agreement. (3) A health care service plan described in paragraph (1) shall meet all of the requirements of this chapter. The health care service plan shall file all the information necessary for the director to make the determination to approve, conditionally approve, or disapprove the transaction or agreement described in paragraph (1), including, but not limited to, a complete description of the proposed transaction or agreement, any modified exhibits for plan licensure pursuant to Section 1351, any approvals by federal or other state agencies required for the transaction or agreement, and any supporting documentation required by the director. (4) The director may conditionally approve the transaction or agreement, contingent upon the health care service plan’s agreement to fulfill one or more conditions to benefit subscribers and enrollees of the health care service plan, provide for a stable health care delivery system, and impose other conditions specific to the transaction or agreement in furtherance of this chapter. The director shall engage stakeholders in determining the measures for improvement. For a major transaction or agreement, the director shall obtain an independent analysis of the impact of the transaction or agreement on subscribers and enrollees, the stability of the health care delivery system, and other relevant provisions of this chapter. For any other transaction or agreement, the director may obtain an independent analysis consistent with this paragraph. (5) If an entity involved in the transaction or agreement is a nonprofit corporation described in Section 5046 of the Corporations Code, the health care service plan shall file all the information required by Article 11 (commencing with Section 1399.70). (b) In addition to any grounds for disapproval as a result of information provided by a health care service plan pursuant to paragraph (3) of subdivision (a), the director may disapprove the transaction or agreement if the director finds the transaction or agreement would substantially lessen competition in health care service plan products or create a monopoly in this state, including, but not limited to, health coverage products for a specific line of business. In making this finding, the director may obtain an opinion from a consultant or consultants with the expertise to assess the competitive impact of the transaction or agreement. (c) Prior to approving, conditionally approving, or disapproving a major transaction or agreement, the department shall hold a public meeting on the proposed transaction or agreement. For any other transaction or agreement, the department may hold a public meeting on the proposed transaction or agreement. The public meeting shall be conducted pursuant to the Bagley-Keene Open Meeting Act (Article 9 (commencing with Section 11120) of Chapter 1 of Part 1 of Division 3 of Title 2 of the Government Code). The meeting shall permit the parties to the proposed transaction and members of the public to provide written and verbal comments regarding the proposed transaction. If a substantive change in the proposed transaction or agreement is submitted to the director after the initial public meeting, the director may conduct an additional public meeting to hear comments from interested parties with respect to that change. The director shall consider the testimony and comments received at the public meeting in making the determination to approve, conditionally approve, or disapprove the transaction or agreement. (d) If the director determines a material amount of assets of a health care service plan is subject to purchase, acquisition, or control, the director shall prepare a statement describing the proposed transaction or agreement subject to subdivision (a) and make it available to the public. The statement shall be made available before the public meeting. (e) This section does not limit the authority of the director to enforce any other provision of this chapter. (f) For purposes of this section, “entity” means a health care service plan, an individual, a corporation, a limited liability company, a partnership, an association, a joint stock company, a business trust, an unincorporated organization, any similar entity, or any combination thereof acting in concert. (g) (1) For purposes of this section, “major transaction or agreement” means a transaction or agreement that meets any of the following criteria: (A) Affects a significant number of enrollees. (B) Involves a material amount of assets. (C) Adversely affects either the subscribers or enrollees or the stability of the health care delivery system because of the entity’s market position, including, but not limited to, the entity’s market exit from a market segment or the entity’s dominance of a market segment. (2) The director shall, upon request, make available to the public his or her determination of whether a transaction or agreement meets the criteria set forth in this subdivision. (Added by Stats. 2018, Ch. 292, Sec. 1. (AB 595) Effective January 1, 2019.)
  80. 1399.66.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 10.2. Mergers and Acquisitions of Health Care Service Plans [1399.65 - 1399.66] ( Article 10.2 added by Stats. 2018, Ch. 292, Sec. 1. )

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    A health care service plan filing a specified material modification must pay the same fees and reimburse the director’s reasonable costs for related review activities.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 10.2. Mergers and Acquisitions of Health Care Service Plans [1399.65 - 1399.66] ( Article 10.2 added by Stats. 2018, Ch. 292, Sec. 1. ) ## 1399.66. (a) Notwithstanding subdivision (d) of Section 1352, a health care service plan that files a material modification that is a transaction or agreement described in subdivision (a) of Section 1399.65 shall be subject to the same fees required by subdivision (a) of Section 1356. (b) (1) In addition to paying the fees described in subdivision (a), the health care service plan shall reimburse the director for the reasonable costs of all of the following: (A) The independent analysis described in paragraph (4) of subdivision (a) of Section 1399.65. (B) The opinion described in subdivision (b) of Section 1399.65. (C) The public meeting described in subdivision (c) of Section 1399.65. (D) The statement described in subdivision (d) of Section 1399.65. (2) The reimbursement required by this subdivision shall be irrespective of the director’s approval, conditional approval, or disapproval of the transaction or agreement described in subdivision (a) of Section 1399.65. (3) If a transaction described in subdivision (a) of Section 1399.65 involves two health care service plans, the director shall determine whether the reimbursement requirements of this subdivision apply to one or both of the plans. (Amended by Stats. 2019, Ch. 497, Sec. 152. (AB 991) Effective January 1, 2020.)
  81. 1399.70.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11. Nonprofit Plans [1399.70 - 1399.76] ( Article 11 added by Stats. 1995, Ch. 792, Sec. 1. )

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    A nonprofit health care service plan seeking to restructure or convert its activities must file specified corporate documents and a nonprofit-activities report with the director, and must update that report if the director asks for more information.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11. Nonprofit Plans [1399.70 - 1399.76] ( Article 11 added by Stats. 1995, Ch. 792, Sec. 1. ) ## 1399.70. (a) In addition to the information required by subdivision (a) of Section 1399.73, a nonprofit health care service plan submitting an application to the director to restructure or convert its activities pursuant to this article shall submit to the director a copy of all of its original and amended articles of incorporation and bylaws, as well as a report summarizing the activities undertaken by the plan to meet its nonprofit obligations as directed by the director. (b) The report required by this section shall include a summary of the following: (1) The nature of public benefit or charitable activities undertaken by the plan. (2) The expenditures incurred by the plan on these public benefit or charitable activities. (3) The plan’s procedure for avoiding conflicts of interest involving public benefit or charitable activities and a summary of any conflicts that have occurred and the manner in which they were resolved. (c) The report required by this section shall also include a written plan that specifies on a projected basis the information required by subdivision (b) for the immediately following fiscal year. (d) When requested by the director, the plan shall promptly supplement the report to include any additional information as the director deems necessary to ascertain whether the plan’s assets are appropriately being used by the plan to meet its nonprofit obligations. (e) For purposes of this article, a “nonprofit health care service plan” includes a plan formed under or subject to Part 2 (commencing with Section 5110) or Part 3 (commencing with Section 7110) of Division 2 of the Corporations Code. (Amended by Stats. 1999, Ch. 525, Sec. 158. Effective January 1, 2000. Operative July 1, 2000, or sooner, by Sec. 214 of Ch. 525.)
  82. 1399.71.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11. Nonprofit Plans [1399.70 - 1399.76] ( Article 11 added by Stats. 1995, Ch. 792, Sec. 1. )

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    Nonprofit health care service plans must get director approval before restructuring, and plans seeking restructuring approval must submit a public benefit program for department approval.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11. Nonprofit Plans [1399.70 - 1399.76] ( Article 11 added by Stats. 1995, Ch. 792, Sec. 1. ) ## 1399.71. (a) Any nonprofit health care service plan that intends to restructure its activities as defined in subdivision (d) shall, prior to restructuring, secure approval from the director. (b) Every nonprofit health care service plan that applies to the department to restructure its activities shall submit for approval by the department a public benefit program that identifies activities to be undertaken by the nonprofit health care service plan following restructuring to continue to meet its nonprofit public benefit obligations. The program shall include all information required pursuant to subdivisions (b) and (c) of Section 1399.70. (c) The director shall apply the requirements of Section 1399.72 to the public benefit program submitted for approval as part of a restructuring proposal submitted pursuant to subdivision (b) of this section. The set-aside requirement in paragraph (1) of subdivision (c) of Section 1399.72 shall apply only to the fair value of the portion of the nonprofit health care service plan involved in the restructuring, as determined by the director. (d) (1) For the purposes of this section, a “restructuring” or “restructure” by a nonprofit health care service plan means the sale, lease, conveyance, exchange, transfer, or other similar disposition of a substantial amount of a nonprofit health care service plan’s assets, as determined by the director, to a business or entity carried on for profit. Nothing in this section shall be construed to prohibit the director from consolidating actions taken by a plan for the purpose of treating the consolidated actions as a restructuring or restructure of the plan. (2) For the purposes of this section, a “restructuring” or “restructure” by a nonprofit health care service plan shall not include any sales or purchases undertaken in the normal and ordinary course of plan business. The director may request information from the plan to verify that transactions qualify as occurring in the normal and ordinary course of plan business, and are not subject to the requirements of subdivision (e). (e) Notwithstanding that a transaction or consolidated transactions involve a substantial amount of a nonprofit health care service plan’s assets and are not in the normal and ordinary course of plan business, a “restructuring” or “restructure” by a nonprofit health care service plan shall not include any of the following transactions: (1) Investments in a wholly owned subsidiary of the nonprofit health care service plan in which all of the following occur: (A) Any profit from the investment will not inure to the benefit of any individual. (B) The investment is fundamentally consistent with and advances the public benefit, charitable, or mutual benefit purpose of the plan. (C) The investment does not adversely impact the plan’s ability to fulfill its public benefit, charitable, or mutual benefit purposes. (D) No officer or director of the plan has any financial interest constituting a conflict of interest in the investments. (E) The investment results in the provision of services, goods, or insurance to or for the benefit of the plan or its members, enrollees, or groups. (2) Sales or purchases of plan assets, including interests in wholly owned subsidiaries and in joint ventures, partnerships, and other investments in for-profit entities, in which all of the following occur: (A) Any profit from the sale will not inure to the benefit of any individual. (B) The sale or purchase is fundamentally consistent with and advances the public benefit, charitable, or mutual benefit purposes of the plan. (C) The plan receives all proceeds from the sale. (D) No officer or director of the plan has any financial interest constituting a conflict of interest in the sale or purchase. (E) The transaction is conducted at arm’s length and for fair market value. (F) The sale or purchase does not adversely impact the plan’s ability to fulfill its public benefit, charitable, or mutual benefit purposes. (3) Investments in or joint ventures and partnerships with a for-profit entity in which all of the following occur: (A) Any profit will not inure to the benefit of any individual. (B) The mission or purpose of the investment, joint venture, or partnership is fundamentally consistent with the public benefit, charitable, or mutual benefit purposes of the plan. (C) No officer or director of the plan has any financial interest constituting a conflict of interest in the investment, joint venture, or partnership. (D) The transaction is conducted at arm’s length and for fair market value. (E) The investment, joint venture, or partnership furthers the plan’s ability to fulfill its public benefit, charitable, or mutual benefit purposes. (F) The investment, joint venture, or partnership results in the provision of services, goods, or insurance to or for the benefit of the plan or its members, enrollees, or groups. The sharing of profits or earnings upon a reasonable and equitable basis reflecting the contribution of other participants to the investment, joint venture, or partnership or the success thereof shall not constitute private inurement. (f) All transactions subject to the exemptions listed in subdivision (e) may not be executed by the plan without the written prior approval of the director. In the application for material modification seeking approval, the plan shall demonstrate that the proposed transaction meets all of the relevant conditions for exemption required by subdivision (e). (g) Prior to issuing a decision to approve an application for a material modification involving a transaction that is exempt pursuant to subdivision (e), the director shall issue a public notice of the filing of the application and may seek public review and comment on the director’s determination that the transaction is exempt under subdivision (e). (h) The director may approve or deny the material modification request, or approve the request with conditions necessary to satisfy the requirements of this section, taking into consideration any public comments submitted to the director. (Amended by Stats. 1999, Ch. 525, Sec. 159. Effective January 1, 2000. Operative July 1, 2000, or sooner, by Sec. 214 of Ch. 525.)
  83. 1399.72.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11. Nonprofit Plans [1399.70 - 1399.76] ( Article 11 added by Stats. 1995, Ch. 792, Sec. 1. )

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    A health care service plan must get the director’s approval before converting from nonprofit to for-profit status, and it may not file related Secretary of State forms until approved or authorized by the director.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11. Nonprofit Plans [1399.70 - 1399.76] ( Article 11 added by Stats. 1995, Ch. 792, Sec. 1. ) ## 1399.72. (a) Any health care service plan that intends to convert from nonprofit to for-profit status, as defined in subdivision (b), shall, prior to the conversion, secure approval from the director. (b) For the purposes of this section, a “conversion” or “convert” by a nonprofit health care service plan means the transformation of the plan from nonprofit to for-profit status, as determined by the director. (c) Prior to approving a conversion, the director shall find that the conversion proposal meets all of the following charitable trust requirements: (1) The fair market value of the nonprofit plan is set aside for appropriate charitable purposes. In determining fair market value, the director shall consider, but not be bound by, any market-based information available concerning the plan. (2) The set-aside shall be dedicated and transferred to one or more existing or new tax-exempt charitable organizations operating pursuant to Section 501(c)(3) (26 U.S.C. Sec. 501(c)(3)) of the federal Internal Revenue Code. The director shall consider requiring that a portion of the set-aside include equity ownership in the plan. Further, the director may authorize the use of a federal Internal Revenue Code Section 501(c)(4) organization (26 U.S.C. Sec. 501(c)(4)) if, in the director’s view, it is necessary to ensure effective management and monetization of equity ownership in the plan and if the plan agrees that the Section 501(c)(4) organization will be limited exclusively to these functions, that funds generated by the monetization shall be transferred to the Section 501(c)(3) organization except to the extent necessary to fund the level of activity of the Section 501(c)(4) organization as may be necessary to preserve the organization’s tax status, that no funds or other resources controlled by the Section 501(c)(4) organization shall be expended for campaign contributions, lobbying, or other political activities, and that the Section 501(c)(4) organization shall comply with reporting requirements that are applicable to Section 501(c)(3) organizations, and that the 501(c)(4) organization shall be subject to any other requirements imposed upon 501(c)(3) organizations that the director determines to be appropriate. (3) Each 501(c)(3) or 501(c)(4) organization receiving a set-aside, its directors and officers, and its assets including any plan stock, shall be independent of any influence or control by the health care service plan and its directors, officers, subsidiaries, or affiliates. (4) The charitable mission and grant-making functions of the charitable organization receiving any set-aside shall be dedicated to serving the health care needs of the people of California. (5) Every 501(c)(3) or 501(c)(4) organization that receives a set-aside under this section shall have in place procedures and policies to prohibit conflicts of interest, including those associated with grant-making activities that may benefit the plan, including the directors, officers, subsidiaries, or affiliates of the plan. (6) Every 501(c)(3) or 501(c)(4) organization that receives a set-aside under this section shall demonstrate that its directors and officers have sufficient experience and judgment to administer grant-making and other charitable activities to serve the state’s health care needs. (7) Every 501(c)(3) or 501(c)(4) organization that receives a set-aside under this section shall provide the director and the Attorney General with an annual report that includes a detailed description of its grant-making and other charitable activities related to its use of the set-aside received from the health care service plan. The annual report shall be made available by the director and the Attorney General for public inspection, notwithstanding the California Public Records Act (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code). Each organization shall submit the annual report for its immediately preceding fiscal year within 120 days after the close of that fiscal year. When requested by the director or the Attorney General, the organization shall promptly supplement the report to include any additional information that the director or the Attorney General deems necessary to ascertain compliance with this article. (8) The plan has satisfied the requirements of this chapter, and a disciplinary action pursuant to Section 1386 is not warranted against the plan. (d) The plan shall not file any forms or documents required by the Secretary of State in connection with any conversion or restructuring until the plan has received an order of the director approving the conversion or restructuring, or unless authorized to do so by the director. (Amended by Stats. 2021, Ch. 615, Sec. 230. (AB 474) Effective January 1, 2022. Operative January 1, 2023, pursuant to Sec. 463 of Stats. 2021, Ch. 615.)
  84. 1399.73.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11. Nonprofit Plans [1399.70 - 1399.76] ( Article 11 added by Stats. 1995, Ch. 792, Sec. 1. )

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    For conversion or restructuring applications, the director may require information, must charge the health care service plan a filing fee based on actual processing cost, may hire experts or consultants, and the applicant must promptly pay contract costs when requested.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11. Nonprofit Plans [1399.70 - 1399.76] ( Article 11 added by Stats. 1995, Ch. 792, Sec. 1. ) ## 1399.73. (a) An application for a conversion or restructuring shall contain the information the director may require, by rule or order. (b) The director shall charge a health care service plan an application filing fee. The fee for filing an application shall be the actual cost of processing the application, including the overhead costs. The filing fee shall include the costs of undertaking the activities described in subdivisions (c), (d), and (e) of Section 1399.74. (c) The director may contract with experts or consultants to assist the director in reviewing the application. Contract costs shall not exceed an amount that is reasonable and necessary to review the application. Any contract entered into under this subdivision shall be on a noncompetitive bid basis and shall be exempt from Chapter 2 (commencing with Section 10290) of Part 2 of Division 2 of the Public Contract Code. The applicant shall promptly pay the director, upon request, for all contract costs. (Amended by Stats. 1999, Ch. 525, Sec. 161. Effective January 1, 2000. Operative July 1, 2000, or sooner, by Sec. 214 of Ch. 525.)
  85. 1399.74.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11. Nonprofit Plans [1399.70 - 1399.76] ( Article 11 added by Stats. 1995, Ch. 792, Sec. 1. )

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    The director must issue emergency regulations for nonprofit health care service plan restructurings or conversions, give public notice and access to records, hold public comment and hearing steps, and may reject noncompliant applications.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11. Nonprofit Plans [1399.70 - 1399.76] ( Article 11 added by Stats. 1995, Ch. 792, Sec. 1. ) ## 1399.74. (a) By July 1, 1996, the director shall adopt regulations, on an emergency basis, that specify the application procedures and requirements for the restructuring or conversion of nonprofit health care service plans. This subdivision shall not be construed to limit or otherwise restrict the director’s authority to adopt regulations under Section 1344, including, but not limited to, any additional regulations to implement this article. (b) Upon receiving an application to restructure or convert, the director shall publish a notice in one or more newspapers of general circulation in the plan’s service area describing the name of the applicant, the nature of the application, and the date of receipt of the application. The notice shall indicate that the director will be soliciting public comments and will hold a public hearing on the application. The director shall require the plan to publish a written notice concerning the application pursuant to conditions imposed by rule or order. (c) Any applications, reports, plans, or other documents under this article shall be public records, subject to the California Public Records Act (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code) and regulations adopted by the director thereunder. The director shall provide the public with prompt and reasonable access to public records relating to the restructuring and conversion of health care service plans. Access to public records covered by this section shall be made available no later than one month prior to any solicitation for public comments or public hearing scheduled pursuant to this article. (d) Prior to approving any conversion or restructuring, the director shall solicit public comments in written form and shall hold at least one public hearing concerning the plan’s proposal to comply with the set-aside and other conditions required under this article. (e) The director may disapprove any application to restructure or convert if the application does not meet the requirements of this chapter or of the Nonprofit Corporation Law (Div. 2 (commencing with Sec. 5000), Title 1, Corp. C.), including any requirements imposed by rule or order of the director. (Amended by Stats. 2021, Ch. 615, Sec. 231. (AB 474) Effective January 1, 2022. Operative January 1, 2023, pursuant to Sec. 463 of Stats. 2021, Ch. 615.)
  86. 1399.75.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11. Nonprofit Plans [1399.70 - 1399.76] ( Article 11 added by Stats. 1995, Ch. 792, Sec. 1. )

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    Some nonprofit mutual benefit health care service plans must get director approval before converting or restructuring, and the director must first find they have met their noncharitable obligations.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11. Nonprofit Plans [1399.70 - 1399.76] ( Article 11 added by Stats. 1995, Ch. 792, Sec. 1. ) ## 1399.75. (a) This article shall apply to the restructuring or conversion of nonprofit mutual benefit health care service plans to the extent these plans have held or currently hold assets subject to a charitable trust obligation, as determined by the director. (b) Nonprofit mutual benefit health care service plans that do not have, or have only a partial, charitable trust obligation, and that intend to convert or restructure their activities shall, prior to the conversion or restructuring, secure approval from the director. (c) Prior to approving a mutual benefit health care service plan restructuring or conversion under subdivision (b), the director shall find that the plan has complied with its noncharitable obligations including, but not limited to, any obligations set forth in its articles of incorporation regarding the dedication and distribution of assets. (d) The director, in carrying out the department’s responsibilities under subdivision (c), may apply, to the extent appropriate in each case as determined by the director, the beneficiary protections authorized in this act, including, but not limited to, protections concerning the fair market value of assets, the avoidance of conflicts of interest, and the avoidance of undue influence or control, with respect to a mutual benefit plan’s proposed disposition of assets. (e) Nothing in this section shall be construed to limit the director’s, Attorney General’s, or a court’s authority under existing law to impose charitable trust obligations upon any or all of the assets of a mutual benefit corporation or otherwise treat a mutual benefit corporation in the same manner as a public benefit corporation. (Amended by Stats. 1999, Ch. 525, Sec. 163. Effective January 1, 2000. Operative July 1, 2000, or sooner, by Sec. 214 of Ch. 525.)
  87. 1399.76.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11. Nonprofit Plans [1399.70 - 1399.76] ( Article 11 added by Stats. 1995, Ch. 792, Sec. 1. )

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    This article does not apply to certain nonprofit health care service plan restructures or conversions submitted to the department as a material modification before May 16, 1995.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11. Nonprofit Plans [1399.70 - 1399.76] ( Article 11 added by Stats. 1995, Ch. 792, Sec. 1. ) ## 1399.76. This article shall not apply to a nonprofit health care service plan restructure or conversion that has been submitted as a material modification to the department for review and approval prior to May 16, 1995. (Added by Stats. 1995, Ch. 792, Sec. 1. Effective January 1, 1996.)
  88. 1399.801.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.5. Individual Access to Contracts for Health Care Services [1399.801 - 1399.818] ( Heading of Article 11.5 renumbered from Article 10.5 by Stats. 2001, Ch. 159, Sec. 126. )

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    This section defines key terms used in the article, including creditable coverage, dependent, federally eligible defined individual, in force business, new business, and preexisting condition provision.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.5. Individual Access to Contracts for Health Care Services [1399.801 - 1399.818] ( Heading of Article 11.5 renumbered from Article 10.5 by Stats. 2001, Ch. 159, Sec. 126. ) ## 1399.801. As used in this article: (a) “Creditable coverage” means: (1) Any individual or group policy, contract, or program that is written or administered by a disability insurer, health care service plan, fraternal benefits society, self-insured employer plan, or any other entity, in this state or elsewhere, and that arranges or provides medical, hospital, and surgical coverage not designed to supplement other plans. The term includes continuation or conversion coverage but does not include accident only, credit, disability income, Medicare supplement, long-term care, dental, vision, coverage issued as a supplement to liability insurance, insurance arising out of a workers’ compensation or similar law, automobile medical payment insurance, or insurance under which benefits are payable with or without regard to fault and that is statutorily required to be contained in any liability insurance policy or equivalent self-insurance. (2) The federal Medicare program pursuant to Title XVIII of the Social Security Act. (3) The medicaid program pursuant to Title XIX of the Social Security Act. (4) Any other publicly sponsored program, provided in this state or elsewhere, of medical, hospital, and surgical care. (5) 10 U.S.C.A. Chapter 55 (commencing with Section 1071) (CHAMPUS). (6) A medical care program of the Indian Health Service or of a tribal organization. (7) A state health benefits risk pool. (8) A health plan offered under 5 U.S.C.A. Chapter 89 (commencing with Section 8901) (FEHBP). (9) A public health plan as defined in federal regulations authorized by Section 2701(c)(1)( l) of the Public Health Service Act, as amended by Public Law 104-191, the Health Insurance Portability and Accountability Act of 1996. (10) A health benefit plan under 22 U.S.C.A. 2504(e) of the Peace Corps Act. (b) “Dependent” means the spouse or child of an eligible individual or other individual applying for coverage, subject to applicable terms of the health care plan contract covering the eligible person. (c) “Federally eligible defined individual” means an individual who as of the date on which the individual seeks coverage under this part, (1) has 18 or more months of creditable coverage, and whose most recent prior creditable coverage was under a group health plan, a federal governmental plan maintained for federal employees, or a governmental plan or church plan as defined in the federal Employee Retirement Income Security Act of 1974 (29 U.S.C. Sec. 1002), (2) is not eligible for coverage under a group health plan, Medicare, or Medi-Cal, and has no other health insurance coverage, (3) was not terminated from his or her most recent creditable coverage due to nonpayment of premiums or fraud, and (4) if offered continuation coverage under COBRA or Cal-COBRA, had elected and exhausted this coverage. (d) “In force business” means an existing health benefit plan contract issued by the plan to a federally eligible defined individual. (e) “New business” means a health care service plan contract issued to an eligible individual that is not the plan’s in force business. (f) “Preexisting condition provision” means a contract provision that excludes coverage for charges and expenses incurred during a specified period following the eligible individual’s effective date, as to a condition for which medical advice, diagnosis, and care of treatment was recommended or received during a specified period immediately preceding the effective date of coverage. (Added by Stats. 2000, Ch. 810, Sec. 2. Effective January 1, 2001.)
  89. 1399.802.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.5. Individual Access to Contracts for Health Care Services [1399.801 - 1399.818] ( Heading of Article 11.5 renumbered from Article 10.5 by Stats. 2001, Ch. 159, Sec. 126. )

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    Health care service plans that offer plan contracts to individuals must follow this article, and employer group plans cannot be sold to sole proprietorships or partnerships without employees.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.5. Individual Access to Contracts for Health Care Services [1399.801 - 1399.818] ( Heading of Article 11.5 renumbered from Article 10.5 by Stats. 2001, Ch. 159, Sec. 126. ) ## 1399.802. (a) Every health care service plan offering plan contracts to individuals shall, in addition to complying with the provisions of this chapter and the rules adopted thereunder, comply with the provisions of this article. (b) For the purposes of determining eligibility for small employer coverage, a sole proprietor and the sole proprietor’s spouse are not employees with respect to a sole proprietorship that consists only of the sole proprietor and the sole proprietor’s spouse. A partner and a partner’s spouse are not employees of a partnership that consists solely of partners and their spouses. Employer group health care service plans shall not be issued, marketed, or sold to a sole proprietorship or partnership without employees directly or indirectly through any arrangement. Only individual health care service plans shall be sold to any entity without employees. (Amended by Stats. 2018, Ch. 700, Sec. 5. (SB 1375) Effective January 1, 2019.)
  90. 1399.803.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.5. Individual Access to Contracts for Health Care Services [1399.801 - 1399.818] ( Heading of Article 11.5 renumbered from Article 10.5 by Stats. 2001, Ch. 159, Sec. 126. )

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    This section says the article does not stop the chapter from applying to certain organizations and persons connected with health care service plans.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.5. Individual Access to Contracts for Health Care Services [1399.801 - 1399.818] ( Heading of Article 11.5 renumbered from Article 10.5 by Stats. 2001, Ch. 159, Sec. 126. ) ## 1399.803. Nothing in this article shall be construed to preclude the application of this chapter to either of the following: (a) an association, trust, or other organization acting as a health care service plan as defined under Section 1345, or (b) an association, trust, multiple employer welfare arrangement, or other organization or person presenting information regarding a health care service plan to persons who may be interested in subscribing or enrolling in the plan. (Added by Stats. 2000, Ch. 810, Sec. 2. Effective January 1, 2001.)
  91. 1399.804.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.5. Individual Access to Contracts for Health Care Services [1399.801 - 1399.818] ( Heading of Article 11.5 renumbered from Article 10.5 by Stats. 2001, Ch. 159, Sec. 126. )

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    Health plans must offer and make available certain contracts to federally eligible defined individuals, and they may not reject applications or steer applicants away for prohibited reasons.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.5. Individual Access to Contracts for Health Care Services [1399.801 - 1399.818] ( Heading of Article 11.5 renumbered from Article 10.5 by Stats. 2001, Ch. 159, Sec. 126. ) ## 1399.804. (a) Commencing January 1, 2001, a plan shall fairly and affirmatively offer, market, and sell the health care service plan contracts described in subdivision (d) of Section 1366.35 that are sold to individuals or to associations that include individuals to all federally eligible defined individuals in each service area in which the plan provides or arranges for the provision of health care services. Each plan shall make available to each federally eligible defined individual the identified health care service plan contracts which the plan offers and sells to individuals or to associations that include individuals. (b) The plan may not reject an application from a federally eligible defined individual for a health care service plan contract under the following circumstances: (1) The federally eligible defined individual as defined by subdivision (c) of Section 1399.801 agrees to make the required premium payments. (2) The federally eligible defined individual, and his or her dependents who are to be covered by the plan contract, work or reside in the service area in which the plan provides or otherwise arranges for the provision of health care services. (c) No plan or solicitor shall, directly or indirectly, encourage or direct federally eligible defined individuals to refrain from filing an application for coverage with a plan because of health status, claims experience, industry, occupation, receipt of health care, genetic information, evidence of insurability, including conditions arising out of acts of domestic violence, disability, or geographic location provided that it is within the plan’s approved service area. (d) No plan shall, directly or indirectly, enter into any contract, agreement, or arrangement with a solicitor that provides for or results in the compensation paid to a solicitor for the sale of a health care service plan contract to be varied because of health status, claims experience, industry, occupation, receipt of health care, genetic information, evidence of insurability, including conditions arising out of acts of domestic violence, disability, or geographic location of the individual. (e) Each plan shall comply with the requirements of Section 1374.3. (Added by Stats. 2000, Ch. 810, Sec. 2. Effective January 1, 2001.)
  92. 1399.805.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.5. Individual Access to Contracts for Health Care Services [1399.801 - 1399.818] ( Heading of Article 11.5 renumbered from Article 10.5 by Stats. 2001, Ch. 159, Sec. 126. )

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    The plan must notify a federally eligible individual of the actual premium within 30 days after a completed application, and it cannot charge premiums above the stated caps.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.5. Individual Access to Contracts for Health Care Services [1399.801 - 1399.818] ( Heading of Article 11.5 renumbered from Article 10.5 by Stats. 2001, Ch. 159, Sec. 126. ) ## 1399.805. (a) (1) After the federally eligible defined individual submits a completed application form for a plan contract, the plan shall, within 30 days, notify the individual of the individual’s actual premium charges for that plan contract, unless the plan has provided notice of the premium charge prior to the application being filed. In no case shall the premium charged for any health care service plan contract identified in subdivision (d) of Section 1366.35 exceed the following amounts: (A) For health care service plan contracts that offer services through a preferred provider arrangement, the average premium paid by a subscriber of the Major Risk Medical Insurance Program who is of the same age and resides in the same geographic area as the federally eligible defined individual. However, for a federally eligible defined individual who is between the ages of 60 and 64 years, inclusive, the premium shall not exceed the average premium paid by a subscriber of the Major Risk Medical Insurance Program who is 59 years of age and resides in the same geographic area as the federally eligible defined individual. (B) For health care service plan contracts identified in subdivision (d) of Section 1366.35 that do not offer services through a preferred provider arrangement, 170 percent of the standard premium charged to an individual who is of the same age and resides in the same geographic area as the federally eligible defined individual. However, for a federally eligible defined individual who is between the ages of 60 and 64 years, inclusive, the premium shall not exceed 170 percent of the standard premium charged to an individual who is 59 years of age and resides in the same geographic area as the federally eligible defined individual. The individual shall have 30 days in which to exercise the right to buy coverage at the quoted premium rates. (2) A plan may adjust the premium based on family size, not to exceed the following amounts: (A) For health care service plans that offer services through a preferred provider arrangement, the average of the Major Risk Medical Insurance Program rate for families of the same size that reside in the same geographic area as the federally eligible defined individual. (B) For health care service plans identified in subdivision (d) of Section 1366.35 that do not offer services through a preferred provider arrangement, 170 percent of the standard premium charged to a family that is of the same size and resides in the same geographic area as the federally eligible defined individual. (3) This subdivision shall become inoperative on January 1, 2014. This subdivision shall become operative on January 1, 2020. (b) (1) After the federally eligible defined individual submits a completed application form for a plan contract, the plan shall, within 30 days, notify the individual of the individual’s actual premium charges for that plan contract, unless the plan has provided notice of the premium charge prior to the application being filed. In no case shall the premium charged for any health care service plan contract identified in subdivision (d) of Section 1366.35 exceed the following amounts: (A) With respect to the rate charged for coverage provided in 2014, the rate charged in 2013 for that coverage multiplied by 1.09. (B) With respect to the rate charged for coverage provided in 2015 and each subsequent year, the rate charged in the prior year multiplied by a factor of one plus the percentage change in the statewide average premium for the second lowest cost silver plan offered on the Exchange. The Exchange shall determine the percentage change in the statewide average premium for the second lowest cost silver plan by subtracting clause (i) from clause (ii) and dividing the result by clause (i). (i) The average of the premiums charged in the year prior to the applicable year for the second lowest cost silver plan in all 19 rating regions, with the premium for each region weighted based on the region’s relative share of the Exchange’s total individual enrollment according to the latest data available to the Exchange. (ii) The average of the premiums to be charged in the applicable year for the second lowest cost silver plan in all 19 rating regions, with the premium for each region weighted based on the region’s relative share of the Exchange’s total individual enrollment according to the latest data available to the Exchange. (C) The Exchange shall determine the percentage change in the statewide average premium no later than 30 days after the Exchange’s rates for individual coverage for the applicable year have been finalized. (2) For purposes of this subdivision, “Exchange” means the California Health Benefit Exchange established pursuant to Section 100500 of the Government Code. (3) This subdivision shall become operative on January 1, 2014. This subdivision shall become inoperative on January 1, 2020. (c) When a federally eligible defined individual submits a premium payment, based on the quoted premium charges, and that payment is delivered or postmarked, whichever occurs earlier, within the first 15 days of the month, coverage shall begin no later than the first day of the following month. When that payment is neither delivered or postmarked until after the 15th day of a month, coverage shall become effective no later than the first day of the second month following delivery or postmark of the payment. (d) During the first 30 days after the effective date of the plan contract, the individual shall have the option of changing coverage to a different plan contract offered by the same health care service plan. If the individual notified the plan of the change within the first 15 days of a month, coverage under the new plan contract shall become effective no later than the first day of the following month. If an enrolled individual notified the plan of the change after the 15th day of a month, coverage under the new plan contract shall become effective no later than the first day of the second month following notification. (e) (1) On and after January 1, 2014, and except as provided in paragraph (2), this section shall apply only to individual grandfathered health plan contracts previously issued pursuant to this section to federally eligible defined individuals. (2) If Section 5000A of the Internal Revenue Code, as added by Section 1501 of PPACA, is repealed or amended to no longer apply to the individual market, as defined in Section 2791 of the federal Public Health Service Act (42 U.S.C. Section 300gg-91), paragraph (1) shall become inoperative on the date of that repeal or amendment and this section shall apply to health care service plan contracts issued, amended, or renewed on or after that date. (3) For purposes of this subdivision, the following definitions apply: (A) “Grandfathered health plan” has the same meaning as that term is defined in Section 1251 of PPACA. (B) “PPACA” means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care Education and Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued pursuant to that law. (Amended by Stats. 2013, Ch. 441, Sec. 9. (AB 1180) Effective October 1, 2013.)
  93. 1399.806.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.5. Individual Access to Contracts for Health Care Services [1399.801 - 1399.818] ( Heading of Article 11.5 renumbered from Article 10.5 by Stats. 2001, Ch. 159, Sec. 126. )

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    A health plan may not exclude or limit coverage for federally eligible defined individuals or their dependents based on health conditions or by type of illness, treatment, medical condition, or accident.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.5. Individual Access to Contracts for Health Care Services [1399.801 - 1399.818] ( Heading of Article 11.5 renumbered from Article 10.5 by Stats. 2001, Ch. 159, Sec. 126. ) ## 1399.806. A plan may not exclude any federally eligible defined individual, or his or her dependents, who would otherwise be entitled to health care services on the basis of an actual or expected health condition of that individual or dependent. No plan contract may limit or exclude coverage for a specific federally eligible defined individual, or his or her dependents, by type of illness, treatment, medical condition, or accident. (Added by Stats. 2000, Ch. 810, Sec. 2. Effective January 1, 2001.)
  94. 1399.809.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.5. Individual Access to Contracts for Health Care Services [1399.801 - 1399.818] ( Heading of Article 11.5 renumbered from Article 10.5 by Stats. 2001, Ch. 159, Sec. 126. )

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    The director may order a health care service plan to stop offering contracts or accepting applications if the director determines the plan lacks enough financial, organizational, and administrative capacity to deliver services to enrollees.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.5. Individual Access to Contracts for Health Care Services [1399.801 - 1399.818] ( Heading of Article 11.5 renumbered from Article 10.5 by Stats. 2001, Ch. 159, Sec. 126. ) ## 1399.809. The director may require a plan to discontinue the offering of contracts or the acceptance of applications from any individual upon a determination by the director that the plan does not have sufficient financial viability, organization, and administrative capacity to assure the delivery of health care services to its enrollees. In determining whether the conditions of this section have been met, the director shall consider, but not be limited to, the plan’s compliance with the requirements of Section 1367, Article 6 (commencing with Section 1375), and the rules adopted thereunder. (Added by Stats. 2000, Ch. 810, Sec. 2. Effective January 1, 2001.)
  95. 1399.810.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.5. Individual Access to Contracts for Health Care Services [1399.801 - 1399.818] ( Heading of Article 11.5 renumbered from Article 10.5 by Stats. 2001, Ch. 159, Sec. 126. )

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    Health care service plan contracts for federally eligible defined individuals are generally renewable at the contractholder’s option, except for listed exceptions.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.5. Individual Access to Contracts for Health Care Services [1399.801 - 1399.818] ( Heading of Article 11.5 renumbered from Article 10.5 by Stats. 2001, Ch. 159, Sec. 126. ) ## 1399.810. All health care service plan contracts offered to a federally eligible defined individual shall be renewable with respect to the individual and dependents at the option of the contractholder except in cases of: (a) Nonpayment of the required premiums. (b) Fraud or misrepresentation by the contractholder. (c) The plan ceases to provide or arrange for the provision of health care services for individual health care service plan contracts in this state, provided, however, that the following conditions are satisfied: (1) Notice of the decision to cease new or existing individual health benefit plans in this state is provided to the director and to the contractholder. (2) Individual health care service plan contracts subject to this chapter shall not be canceled for 180 days after the date of the notice required under paragraph (1) and for that business of a plan that remains in force, any plan that ceases to offer for sale new individual health care service plan contracts shall continue to be governed by this article with respect to business conducted under this article. (3) A plan that ceases to write new individual business in this state after January 1, 2001, shall be prohibited from offering for sale new individual health care service plan contracts in this state for a period of three years from the date of the notice to the director. (d) When the plan withdraws a health care service plan contract from the individual market, provided that the plan makes available to eligible individuals all plan contracts that it makes available to new individual business, and provided that the premium for the new plan contract complies with the renewal increase requirements set forth in Section 1399.811. (e) (1) On and after January 1, 2014, and except as provided in paragraph (2), this section shall apply only to individual grandfathered health plan contracts previously issued pursuant to this section to federally eligible defined individuals. (2) If Section 5000A of the Internal Revenue Code, as added by Section 1501 of PPACA, is repealed or amended to no longer apply to the individual market, as defined in Section 2791 of the federal Public Health Service Act (42 U.S.C. Section 300gg-91), paragraph (1) shall become inoperative on the date of that repeal or amendment and this section shall apply to health care service plan contracts issued, amended, or renewed on or after that date. (3) For purposes of this subdivision, the following definitions apply: (A) “Grandfathered health plan” has the same meaning as that term is defined in Section 1251 of PPACA. (B) “PPACA” means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care Education and Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued pursuant to that law. (Amended by Stats. 2013, Ch. 441, Sec. 10. (AB 1180) Effective October 1, 2013.)
  96. 1399.811.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.5. Individual Access to Contracts for Health Care Services [1399.801 - 1399.818] ( Heading of Article 11.5 renumbered from Article 10.5 by Stats. 2001, Ch. 159, Sec. 126. )

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    Health plan premiums for covered individual contracts are capped, with different limits depending on contract type, age, and whether the plan uses a preferred provider arrangement.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.5. Individual Access to Contracts for Health Care Services [1399.801 - 1399.818] ( Heading of Article 11.5 renumbered from Article 10.5 by Stats. 2001, Ch. 159, Sec. 126. ) ## 1399.811. (a) (1) Premiums for contracts offered, delivered, amended, or renewed by plans on or after January 1, 2001, shall be subject to the following requirements: (A) The premium for new business for a federally eligible defined individual shall not exceed the following amounts: (i) For health care service plan contracts identified in subdivision (d) of Section 1366.35 that offer services through a preferred provider arrangement, the average premium paid by a subscriber of the Major Risk Medical Insurance Program who is of the same age and resides in the same geographic area as the federally eligible defined individual. However, for federally eligible defined individuals who are between the ages of 60 to 64 years, inclusive, the premium shall not exceed the average premium paid by a subscriber of the Major Risk Medical Insurance Program who is 59 years of age and resides in the same geographic area as the federally eligible defined individual. (ii) For health care service plan contracts identified in subdivision (d) of Section 1366.35 that do not offer services through a preferred provider arrangement, 170 percent of the standard premium charged to an individual who is of the same age and resides in the same geographic area as the federally eligible defined individual. However, for federally eligible defined individuals who are between the ages of 60 to 64 years, inclusive, the premium shall not exceed 170 percent of the standard premium charged to an individual who is 59 years of age and resides in the same geographic area as the federally eligible defined individual. (B) The premium for in force business for a federally eligible defined individual shall not exceed the following amounts: (i) For health care service plan contracts identified in subdivision (d) of Section 1366.35 that offer services through a preferred provider arrangement, the average premium paid by a subscriber of the Major Risk Medical Insurance Program who is of the same age and resides in the same geographic area as the federally eligible defined individual. However, for federally eligible defined individuals who are between the ages of 60 and 64 years, inclusive, the premium shall not exceed the average premium paid by a subscriber of the Major Risk Medical Insurance Program who is 59 years of age and resides in the same geographic area as the federally eligible defined individual. (ii) For health care service plan contracts identified in subdivision (d) of Section 1366.35 that do not offer services through a preferred provider arrangement, 170 percent of the standard premium charged to an individual who is of the same age and resides in the same geographic area as the federally eligible defined individual. However, for federally eligible defined individuals who are between the ages of 60 and 64 years, inclusive, the premium shall not exceed 170 percent of the standard premium charged to an individual who is 59 years of age and resides in the same geographic area as the federally eligible defined individual. The premium effective on January 1, 2001, shall apply to in force business at the earlier of either the time of renewal or July 1, 2001. (2) This subdivision shall become inoperative on January 1, 2014. This subdivision shall become operative on January 1, 2020. (b) (1) Premiums for contracts offered, delivered, amended, or renewed by plans on or after January 1, 2014, shall be subject to the following requirements: (A) With respect to the rate charged for coverage provided in 2014, the rate charged in 2013 for that coverage multiplied by 1.09. (B) With respect to the rate charged for coverage provided in 2015 and each subsequent year, the rate charged in the prior year multiplied by a factor of one plus the percentage change in the statewide average premium for the second lowest cost silver plan offered on the Exchange. The Exchange shall determine the percentage change in the statewide average premium for the second lowest cost silver plan by subtracting clause (i) from clause (ii) and dividing the result by clause (i). (i) The average of the premiums charged in the year prior to the applicable year for the second lowest cost silver plan in all 19 rating regions, with the premium for each region weighted based on the region’s relative share of the Exchange’s total individual enrollment according to the latest data available to the Exchange. (ii) The average of the premiums to be charged in the applicable year for the second lowest cost silver plan in all 19 rating regions, with the premium for each region weighted based on the region’s relative share of the Exchange’s total individual enrollment according to the latest data available to the Exchange. (C) The Exchange shall determine the percentage change in the statewide average premium no later than 30 days after the Exchange’s rates for individual coverage for the applicable year have been finalized. (2) For purposes of this subdivision, “Exchange” means the California Health Benefit Exchange established pursuant to Section 100500 of the Government Code. (3) This subdivision shall become operative on January 1, 2014. This subdivision shall become inoperative on January 1, 2020. (c) The premium applied to a federally eligible defined individual may not increase by more than the following amounts: (1) For health care service plan contracts identified in subdivision (d) of Section 1366.35 that offer services through a preferred provider arrangement, the average increase in the premiums charged to a subscriber of the Major Risk Medical Insurance Program who is of the same age and resides in the same geographic area as the federally eligible defined individual. (2) For health care service plan contracts identified in subdivision (d) of Section 1366.35 that do not offer services through a preferred provider arrangement, the increase in premiums charged to a nonfederally eligible defined individual who is of the same age and resides in the same geographic area as the federally eligible defined individual. The premium for an eligible individual may not be modified more frequently than every 12 months. (3) For a contract that a plan has discontinued offering, the premium applied to the first rating period of the new contract that the federally eligible defined individual elects to purchase shall be no greater than the premium applied in the prior rating period to the discontinued contract. (d) (1) On and after January 1, 2014, and except as provided in paragraph (2), this section shall apply only to individual grandfathered health plan contracts previously issued pursuant to this section to federally eligible defined individuals. (2) If Section 5000A of the Internal Revenue Code, as added by Section 1501 of PPACA, is repealed or amended to no longer apply to the individual market, as defined in Section 2791 of the federal Public Health Service Act (42 U.S.C. Section 300gg-91), paragraph (1) shall become inoperative on the date of that repeal or amendment and this section shall apply to health care service plan contracts issued, amended, or renewed on or after that date. (3) For purposes of this subdivision, the following definitions apply: (A) “Grandfathered health plan” has the same meaning as that term is defined in Section 1251 of PPACA. (B) “PPACA” means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care Education and Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued pursuant to that law. (Amended by Stats. 2013, Ch. 441, Sec. 11. (AB 1180) Effective October 1, 2013.)
  97. 1399.812.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.5. Individual Access to Contracts for Health Care Services [1399.801 - 1399.818] ( Heading of Article 11.5 renumbered from Article 10.5 by Stats. 2001, Ch. 159, Sec. 126. )

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    Health care service plans must apply premiums consistently for all federally eligible defined individuals who apply for coverage.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.5. Individual Access to Contracts for Health Care Services [1399.801 - 1399.818] ( Heading of Article 11.5 renumbered from Article 10.5 by Stats. 2001, Ch. 159, Sec. 126. ) ## 1399.812. Plans shall apply premiums consistently with respect to all federally eligible defined individuals who apply for coverage. (Added by Stats. 2000, Ch. 810, Sec. 2. Effective January 1, 2001.)
  98. 1399.813.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.5. Individual Access to Contracts for Health Care Services [1399.801 - 1399.818] ( Heading of Article 11.5 renumbered from Article 10.5 by Stats. 2001, Ch. 159, Sec. 126. )

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    When a plan offers a plan contract for sale to an individual, the plan must make a reasonable disclosure of all individual contracts in its solicitation and sales materials.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.5. Individual Access to Contracts for Health Care Services [1399.801 - 1399.818] ( Heading of Article 11.5 renumbered from Article 10.5 by Stats. 2001, Ch. 159, Sec. 126. ) ## 1399.813. In connection with the offering for sale of any plan contract to an individual, each plan shall make a reasonable disclosure, as part of its solicitation and sales materials, of all individual contracts. (Added by Stats. 2000, Ch. 810, Sec. 2. Effective January 1, 2001.)
  99. 1399.814.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.5. Individual Access to Contracts for Health Care Services [1399.801 - 1399.818] ( Heading of Article 11.5 renumbered from Article 10.5 by Stats. 2001, Ch. 159, Sec. 126. )

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    This section says a health benefit plan is not required to offer an individual contract if it does not already offer contracts to individuals.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.5. Individual Access to Contracts for Health Care Services [1399.801 - 1399.818] ( Heading of Article 11.5 renumbered from Article 10.5 by Stats. 2001, Ch. 159, Sec. 126. ) ## 1399.814. Nothing in this article shall be construed to require a health benefit plan to offer a contract to an individual if the plan does not otherwise offer contracts to individuals. (Added by Stats. 2000, Ch. 810, Sec. 2. Effective January 1, 2001.)
  100. 1399.815.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.5. Individual Access to Contracts for Health Care Services [1399.801 - 1399.818] ( Heading of Article 11.5 renumbered from Article 10.5 by Stats. 2001, Ch. 159, Sec. 126. )

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    A plan must file amendment notices and amendments with the director before certain contract changes, including renewals, initial offerings, and premium changes.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.5. Individual Access to Contracts for Health Care Services [1399.801 - 1399.818] ( Heading of Article 11.5 renumbered from Article 10.5 by Stats. 2001, Ch. 159, Sec. 126. ) ## 1399.815. (a) At least 20 business days prior to renewing or amending a plan contract subject to this article, or at least 20 business days prior to the initial offering of a plan contract subject to this article, a plan shall file a notice of an amendment with the director in accordance with the provisions of Section 1352. The notice of an amendment shall include a statement certifying that the plan is in compliance with subdivision (a) of Section 1399.805 and with Section 1399.811. Any action by the director, as permitted under Section 1352, to disapprove, suspend, or postpone the plan’s use of a plan contract shall be in writing, specifying the reasons the plan contract does not comply with the requirements of this chapter. (b) Prior to making any changes in the premium, the plan shall file an amendment in accordance with the provisions of Section 1352, and shall include a statement certifying the plan is in compliance with subdivision (a) of Section 1399.805 and with Section 1399.811. All other changes to a plan contract previously filed with the director pursuant to subdivision (a) shall be filed as an amendment in accordance with the provisions of Section 1352, unless the change otherwise would require the filing of a material modification. (c) (1) On and after January 1, 2014, and except as provided in paragraph (2), this section shall apply only to individual grandfathered health plan contracts previously issued pursuant to this section to federally eligible defined individuals. (2) If Section 5000A of the Internal Revenue Code, as added by Section 1501 of PPACA, is repealed or amended to no longer apply to the individual market, as defined in Section 2791 of the federal Public Health Service Act (42 U.S.C. Section 300gg-91), paragraph (1) shall become inoperative on the date of that repeal or amendment and this section shall apply to plan contracts issued, amended, or renewed on or after that date. (3) For purposes of this subdivision, the following definitions apply: (A) “Grandfathered health plan” has the same meaning as that term is defined in Section 1251 of PPACA. (B) “PPACA” means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care Education and Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued pursuant to that law. (Amended by Stats. 2013, Ch. 441, Sec. 12. (AB 1180) Effective October 1, 2013.)
  101. 1399.817.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.5. Individual Access to Contracts for Health Care Services [1399.801 - 1399.818] ( Heading of Article 11.5 renumbered from Article 10.5 by Stats. 2001, Ch. 159, Sec. 126. )

    Verify source ↗

    The director may issue regulations to carry out this article, and must enforce those regulations.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.5. Individual Access to Contracts for Health Care Services [1399.801 - 1399.818] ( Heading of Article 11.5 renumbered from Article 10.5 by Stats. 2001, Ch. 159, Sec. 126. ) ## 1399.817. The director may issue regulations that are necessary to carry out the purposes of this article. Any rules and regulations adopted pursuant to this article may be adopted as emergency regulations in accordance with Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code. Until December 31, 2001, the adoption of these regulations shall be deemed an emergency and necessary for the immediate preservation of the public peace, health and safety, or general welfare. The regulations shall be enforced by the director. (Added by Stats. 2000, Ch. 810, Sec. 2. Effective January 1, 2001.)
  102. 1399.818.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.5. Individual Access to Contracts for Health Care Services [1399.801 - 1399.818] ( Heading of Article 11.5 renumbered from Article 10.5 by Stats. 2001, Ch. 159, Sec. 126. )

    Verify source ↗

    This section says the article applies to health care service plan contracts offered, delivered, amended, or renewed on or after January 1, 2001.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.5. Individual Access to Contracts for Health Care Services [1399.801 - 1399.818] ( Heading of Article 11.5 renumbered from Article 10.5 by Stats. 2001, Ch. 159, Sec. 126. ) ## 1399.818. This article shall apply to health care service plan contracts offered, delivered, amended, or renewed on or after January 1, 2001. (Added by Stats. 2000, Ch. 810, Sec. 2. Effective January 1, 2001.)
  103. 1399.825.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.7. Child Access to Health Care Coverage [1399.825 - 1399.836] ( Heading of Article 11.7 amended by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 15. )

    Verify source ↗

    This section defines terms used for child health care coverage rules.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.7. Child Access to Health Care Coverage [1399.825 - 1399.836] ( Heading of Article 11.7 amended by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 15. ) ## 1399.825. As used in this article: (a) “Child” means any individual under 19 years of age. (b) “Individual grandfathered plan coverage” means health care coverage in which an individual was enrolled on March 23, 2010, consistent with Section 1251 of PPACA and any rules or regulations adopted pursuant to that law. (c) “Initial open enrollment period” means the open enrollment period beginning on January 1, 2011, and ending 60 days thereafter. (d) “Late enrollee” means a child without coverage who did not enroll in a health care service plan contract during an open enrollment period because of any of the following: (1) The child lost dependent coverage due to termination or change in employment status of the child or the person through whom the child was covered; cessation of an employer’s contribution toward an employee or dependent’s coverage; death of the person through whom the child was covered as a dependent; legal separation; divorce; loss of coverage under the Healthy Families Program, the Access for Infants and Mothers Program, or the Medi-Cal program; or adoption of the child. (2) The child became a resident of California during a month that was not the child’s birth month. (3) The child is born as a resident of California and did not enroll in the month of birth. (4) The child is mandated to be covered pursuant to a valid state or federal court order. (e) “Open enrollment period” means the annual open enrollment period, subsequent to the initial open enrollment period, applicable to each individual child that is the month of the child’s birth date. (f) “PPACA” means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any subsequent rules or regulations issued pursuant to that law. (g) “Preexisting condition exclusion” means, with respect to coverage, a limitation or exclusion of benefits relating to a condition based on the fact that the condition was present before the date of enrollment of the coverage, whether or not any medical advice, diagnosis, care, or treatment was recommended or received before that date. (h) “Responsible party for a child” means an adult having custody of the child or with responsibility for the financial needs of the child, including the responsibility to provide health care coverage. (i) “Standard risk rate” means the lowest rate that can be offered for a child with the same benefit plan, effective date, age, geographic region, and family status. (Added by Stats. 2010, Ch. 656, Sec. 3. (AB 2244) Effective January 1, 2011. Inoperative, pursuant to Section 1399.836, on January 1, 2014, subject to condition for resuming operation.)
  104. 1399.826.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.7. Child Access to Health Care Coverage [1399.825 - 1399.836] ( Heading of Article 11.7 amended by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 15. )

    Verify source ↗

    Health care service plans in the individual market must offer child coverage during open enrollment and may not reject certain child applications or use specified health-related factors to deny or condition coverage, subject to stated grandfathered-plan and federal-law exceptions.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.7. Child Access to Health Care Coverage [1399.825 - 1399.836] ( Heading of Article 11.7 amended by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 15. ) ## 1399.826. (a) (1) During each open enrollment period, every health care service plan offering plan contracts in the individual market, other than individual grandfathered plan coverage, shall offer to the responsible party for a child coverage for the child that does not exclude or limit coverage due to any preexisting condition of the child. (b) A health care service plan offering coverage in the individual market shall not reject an application for a health care service plan contract from a child or filed on behalf of a child by the responsible party during an open enrollment period or from a late enrollee during a period no longer than 63 days from the qualifying event listed in subdivision (d) of Section 1399.825. (c) Except to the extent permitted by federal law, rules, regulations, or guidance issued by the relevant federal agency, a health care service plan shall not condition the issuance or offering of individual coverage on any of the following factors: (1) Health status. (2) Medical condition, including physical and mental illnesses. (3) Claims experience. (4) Receipt of health care. (5) Medical history. (6) Genetic information. (7) Evidence of insurability, including conditions arising out of acts of domestic violence. (8) Disability. (9) Any other health status-related factor as determined by department. This subdivision shall not apply to a contract providing individual grandfathered plan coverage. (d) When a responsible party for a child submits a premium payment, based on the quoted premium charges, and that payment is delivered or postmarked, whichever occurs earlier, within the first 15 days of the month, coverage under the plan contract shall become effective no later than the first day of the following month. When that payment is neither delivered nor postmarked until after the 15th day of the month, coverage shall become effective no later than the first day of the second month following delivery or postmark of the payment. (e) A health care service plan offering coverage in the individual market shall not reject the request of a responsible party for a child to include that child as a dependent on an existing health care service plan contract that includes dependent coverage during an open enrollment period. (f) Nothing in this article shall be construed to prohibit a health care service plan offering coverage in the individual market from establishing rules for eligibility for coverage and offering coverage pursuant to those rules for children and individuals based on factors otherwise authorized under federal and state law for health plan contracts in addition to those offered on a guaranteed issue basis during an open enrollment period to children or late enrollees pursuant to this article. However, a health care service plan, other than a plan providing individual grandfathered plan coverage, shall not impose a preexisting condition provision on coverage, including dependent coverage, offered to a child. (g) Nothing in this article shall be construed to require a plan to establish a new service area or to offer health coverage on a statewide basis, outside of the plan’s existing service area. (h) Nothing in this article shall be construed to prevent a health care service plan from offering coverage to a family member of an enrollee in grandfathered health plan coverage consistent with Section 1251 of PPACA. (Added by Stats. 2010, Ch. 656, Sec. 3. (AB 2244) Effective January 1, 2011. Inoperative, pursuant to Section 1399.836, on January 1, 2014, subject to condition for resuming operation.)
  105. 1399.827.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.7. Child Access to Health Care Coverage [1399.825 - 1399.836] ( Heading of Article 11.7 amended by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 15. )

    Verify source ↗

    This article does not apply to certain health care service plan contracts.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.7. Child Access to Health Care Coverage [1399.825 - 1399.836] ( Heading of Article 11.7 amended by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 15. ) ## 1399.827. This article shall not apply to health care service plan contracts for coverage of Medicare services pursuant to contracts with the United States government, Medicare supplement contracts, Medi-Cal contracts with the State Department of Health Care Services, plan contracts offered under the Healthy Families Program, long-term care coverage, or specialized health care service plan contracts. (Added by Stats. 2010, Ch. 656, Sec. 3. (AB 2244) Effective January 1, 2011. Inoperative, pursuant to Section 1399.836, on January 1, 2014, subject to condition for resuming operation.)
  106. 1399.828.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.7. Child Access to Health Care Coverage [1399.825 - 1399.836] ( Heading of Article 11.7 amended by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 15. )

    Verify source ↗

    Health care service plans must fairly offer and sell covered contracts to children or their responsible parties in the specified service areas and enrollment periods, and they must not steer applicants away or vary solicitor compensation based on listed child characteristics, subject to a narrow premium-based compensation exception.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.7. Child Access to Health Care Coverage [1399.825 - 1399.836] ( Heading of Article 11.7 amended by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 15. ) ## 1399.828. (a) Upon the effective date of this article, a health care service plan shall fairly and affirmatively offer, market, and sell all of the plan’s health care service plan contracts that are offered and sold to a child or the responsible party for a child in each service area in which the plan provides or arranges for the provision of health care services during any open enrollment period, to late enrollees, and during any other period in which state or federal law, rules, regulations, or guidance expressly provide that a health care service plan shall not condition offer or acceptance of coverage on any preexisting condition. (b) No health care service plan or solicitor shall, directly or indirectly, engage in the following activities: (1) Encourage or direct a child or responsible party for a child to refrain from filing an application for coverage with a plan because of the health status, claims experience, industry, occupation, or geographic location, provided that the location is within the plan’s approved service area, of the child. (2) Encourage or direct a child or responsible party for a child to seek coverage from another plan because of the health status, claims experience, industry, occupation, or geographic location, provided that the location is within the plan’s approved service area, of the child. (c) A health care service plan shall not, directly or indirectly, enter into any contract, agreement, or arrangement with a solicitor that provides for or results in the compensation paid to a solicitor for the sale of a health care service plan contract to be varied because of the health status, claims experience, industry, occupation, or geographic location of the child. This subdivision does not apply to a compensation arrangement that provides compensation to a solicitor on the basis of percentage of premium, provided that the percentage shall not vary because of the health status, claims experience, industry, occupation, or geographic area of the child. (Added by Stats. 2010, Ch. 656, Sec. 3. (AB 2244) Effective January 1, 2011. Inoperative, pursuant to Section 1399.836, on January 1, 2014, subject to condition for resuming operation.)
  107. 1399.829.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.7. Child Access to Health Care Coverage [1399.825 - 1399.836] ( Heading of Article 11.7 amended by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 15. )

    Verify source ↗

    Health care service plans may use certain child characteristics to set rates, but must follow limits on child rating, provide required notices, and cannot require coverage-history documentation.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.7. Child Access to Health Care Coverage [1399.825 - 1399.836] ( Heading of Article 11.7 amended by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 15. ) ## 1399.829. (a) A health care service plan may use the following characteristics of an eligible child for purposes of establishing the rate of the plan contract for that child, where consistent with federal regulations under PPACA: age, geographic region, and family composition, plus the health care service plan contract selected by the child or the responsible party for the child. (b) From the effective date of this article to December 31, 2013, inclusive, rates for a child applying for coverage shall be subject to the following limitations: (1) During any open enrollment period or for late enrollees, the rate for any child due to health status shall not be more than two times the standard risk rate for a child. (2) The rate for a child shall be subject to a 20-percent surcharge above the highest allowable rate on a child applying for coverage who is not a late enrollee and who failed to maintain coverage with any health care service plan or health insurer for the 90-day period prior to the date of the child’s application. The surcharge shall apply for the 12-month period following the effective date of the child’s coverage. (3) If expressly permitted under PPACA and any rules, regulations, or guidance issued pursuant to that act, a health care service plan may rate a child based on health status during any period other than an open enrollment period if the child is not a late enrollee. (4) If expressly permitted under PPACA and any rules, regulations, or guidance issued pursuant to that act, a health care service plan may condition an offer or acceptance of coverage on any preexisting condition or other health status-related factor for a period other than an open enrollment period and for a child who is not a late enrollee. (c) For any individual health care service plan contract issued, sold, or renewed prior to December 31, 2013, the health plan shall provide to a child or responsible party for a child a notice that states the following: “Please consider your options carefully before failing to maintain or renewing coverage for a child for whom you are responsible. If you attempt to obtain new individual coverage for that child, the premium for the same coverage may be higher than the premium you pay now.” (d) A child who applied for coverage between September 23, 2010, and the end of the initial open enrollment period shall be deemed to have maintained coverage during that period. (e) Effective January 1, 2014, except for individual grandfathered health plan coverage, the rate for any child shall be identical to the standard risk rate. (f) Health care service plans shall not require documentation from applicants relating to their coverage history. (g) (1) On and after the operative date of the act adding this subdivision, and until January 1, 2014, a health care service plan shall provide the model notice, as provided in paragraph (3), to all applicants for coverage under this article and to all enrollees, or the responsible party for an enrollee, renewing coverage under this article that contains the following information: (A) Information about the open enrollment period provided under Section 1399.849. (B) An explanation that obtaining coverage during the open enrollment period described in Section 1399.849 will not affect the effective dates of coverage for coverage purchased pursuant to this article unless the applicant cancels that coverage. (C) An explanation that coverage purchased pursuant to this article shall be effective as required under subdivision (d) of Section 1399.826 and that such coverage shall not prevent an applicant from obtaining new coverage during the open enrollment period described in Section 1399.849. (D) Information about the Medi-Cal program, information about the Healthy Families Program if the Healthy Families Program is accepting enrollment, and information about subsidies available through the California Health Benefit Exchange. (2) The notice described in paragraph (1) shall be in plain language and 14-point type. (3) The department shall adopt a uniform model notice to be used by health care service plans in order to comply with this subdivision, and shall consult with the Department of Insurance in adopting that uniform model notice. Use of the model notice shall not require prior approval of the department. The model notice adopted by the department for purposes of this section shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code). (Amended by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 16. (SB 2 1x) Effective September 30, 2013. Inoperative, pursuant to Section 1399.836, on January 1, 2014, subject to condition for resuming operation.)
  108. 1399.832.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.7. Child Access to Health Care Coverage [1399.825 - 1399.836] ( Heading of Article 11.7 amended by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 15. )

    Verify source ↗

    Health care service plans are exempt from offering a contract or accepting applications in specified cases, and the director’s rehabilitation authority is preserved.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.7. Child Access to Health Care Coverage [1399.825 - 1399.836] ( Heading of Article 11.7 amended by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 15. ) ## 1399.832. No health care service plan shall be required to offer a health care service plan contract or accept applications for the contract pursuant to this article in the case of any of the following: (a) To a child, if the child who is to be covered by the plan contract does not work or reside within the plan’s approved service areas. (b) (1) Within a specific service area or portion of a service area, if the plan reasonably anticipates and demonstrates to the satisfaction of the director that it will not have sufficient health care delivery resources to ensure that health care services will be available and accessible to the child because of its obligations to existing enrollees. (2) A health care service plan that cannot offer a health care service plan contract to individuals or children because it is lacking in sufficient health care delivery resources within a service area or a portion of a service area may not offer a contract in the area in which the plan is not offering coverage to individuals to new employer groups until the plan notifies the director that it has the ability to deliver services to individuals, and certifies to the director that from the date of the notice it will enroll all individuals requesting coverage in that area from the plan. (3) Nothing in this article shall be construed to limit the director’s authority to develop and implement a plan of rehabilitation for a health care service plan whose financial viability or organizational and administrative capacity has become impaired. (Added by Stats. 2010, Ch. 656, Sec. 3. (AB 2244) Effective January 1, 2011. Inoperative, pursuant to Section 1399.836, on January 1, 2014, subject to condition for resuming operation.)
  109. 1399.833.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.7. Child Access to Health Care Coverage [1399.825 - 1399.836] ( Heading of Article 11.7 amended by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 15. )

    Verify source ↗

    The director may order a health care service plan to stop offering contracts or accepting applications if the plan lacks enough financial, organizational, or administrative capacity to provide care to enrollees.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.7. Child Access to Health Care Coverage [1399.825 - 1399.836] ( Heading of Article 11.7 amended by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 15. ) ## 1399.833. The director may require a health care service plan to discontinue the offering of contracts or acceptance of applications from any individual or child or responsible party for a child upon a determination by the director that the plan does not have sufficient financial viability or organizational and administrative capacity to ensure the delivery of health care services to its enrollees. In determining whether the conditions of this section have been met, the director shall consider, but not be limited to, the plan’s compliance with the requirements of Section 1367, Article 6 (commencing with Section 1375.1), and the rules adopted under those provisions. (Added by Stats. 2010, Ch. 656, Sec. 3. (AB 2244) Effective January 1, 2011. Inoperative, pursuant to Section 1399.836, on January 1, 2014, subject to condition for resuming operation.)
  110. 1399.834.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.7. Child Access to Health Care Coverage [1399.825 - 1399.836] ( Heading of Article 11.7 amended by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 15. )

    Verify source ↗

    Health care service plan contracts offered to or for a child must meet certain code sections and may be renewed by the enrollee or responsible party, subject to cancellation or nonrenewal rules.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.7. Child Access to Health Care Coverage [1399.825 - 1399.836] ( Heading of Article 11.7 amended by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 15. ) ## 1399.834. (a) All health care service plan contracts offered to a child or on behalf of a child to a responsible party for a child shall conform to the requirements of Sections 1365, 1366.3, and 1373.6, and shall be renewable at the option of the enrollee or responsible party for a child on behalf of the enrollee except as permitted to be canceled, rescinded, or not renewed pursuant to Section 1365. (b) Any plan that ceases to offer for sale new individual health care service plan contracts pursuant to Section 1365 shall continue to be governed by this article with respect to business conducted under this article. (c) Except as authorized under Section 1399.833, a plan that, as of the effective date of this article, does not write new health care service plan contracts for children in this state or that, after the effective date of this article, ceases to write new health care service plan contracts for children in this state shall be prohibited from offering for sale new individual health care service plan contracts in this state for a period of five years from the date of notice to the director. (Amended by Stats. 2011, Ch. 296, Sec. 143. (AB 1023) Effective January 1, 2012. Inoperative, pursuant to Section 1399.836, on January 1, 2014, subject to condition for resuming operation.)
  111. 1399.835.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.7. Child Access to Health Care Coverage [1399.825 - 1399.836] ( Heading of Article 11.7 amended by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 15. )

    Verify source ↗

    The director may issue compliance guidance to health plans by July 1, 2011, and that guidance is not subject to the Administrative Procedure Act.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.7. Child Access to Health Care Coverage [1399.825 - 1399.836] ( Heading of Article 11.7 amended by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 15. ) ## 1399.835. On or before July 1, 2011, the director may issue guidance to health plans regarding compliance with this article and that guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code). The guidance shall only be effective until the director and the Insurance Commissioner adopt joint regulations pursuant to the Administrative Procedure Act. (Amended by Stats. 2011, Ch. 296, Sec. 144. (AB 1023) Effective January 1, 2012. Inoperative, pursuant to Section 1399.836, on January 1, 2014, subject to condition for resuming operation.)
  112. 1399.836.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.7. Child Access to Health Care Coverage [1399.825 - 1399.836] ( Heading of Article 11.7 amended by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 15. )

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    This article becomes inoperative on the stated date, but can become operative again 12 months after a specified federal tax provision is repealed or amended in a way that no longer applies to the individual market.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.7. Child Access to Health Care Coverage [1399.825 - 1399.836] ( Heading of Article 11.7 amended by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 15. ) ## 1399.836. (a) This article shall become inoperative on January 1, 2014, or the 91st calendar day following the adjournment of the 2013–14 First Extraordinary Session, whichever date is later. (b) If Section 5000A of the Internal Revenue Code, as added by Section 1501 of PPACA, is repealed or amended to no longer apply to the individual market, as defined in Section 2791 of the federal Public Health Service Act (42 U.S.C. Sec. 300gg-91), this article shall become operative 12 months after the date of that repeal or amendment. (Amended by Stats. 2015, Ch. 303, Sec. 266. (AB 731) Effective January 1, 2016. Note: This section provides for Article 11.7 (commencing with Section 1399.825) to become inoperative on January 1, 2014, and to resume operation later under certain conditions.)
  113. 1399.845.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.8. Individual Access to Health Care Coverage [1399.845 - 1399.864] ( Article 11.8 added by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 18. )

    Verify source ↗

    This section defines terms used in Article 11.8 for health care coverage.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.8. Individual Access to Health Care Coverage [1399.845 - 1399.864] ( Article 11.8 added by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 18. ) ## 1399.845. For purposes of this article, the following definitions shall apply: (a) “Child” means a child described in Section 22775 of the Government Code and subdivisions (n) to (p), inclusive, of Section 599.500 of Title 2 of the California Code of Regulations. (b) “Dependent” means the spouse or registered domestic partner, child, or parent or stepparent pursuant to Section 1374.1, of an individual, subject to applicable terms of the health benefit plan. (c) “Exchange” means the California Health Benefit Exchange created by Section 100500 of the Government Code. (d) “Family” means the subscriber and their dependent or dependents. (e) “Grandfathered health plan” has the same meaning as defined in Section 1251 of PPACA. (f) “Health benefit plan” means an individual or group health care service plan contract that provides medical, hospital, and surgical benefits. The term does not include a specialized health care service plan contract, a health care service plan contract provided in the Medi-Cal program (Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of the Welfare and Institutions Code), the Healthy Families Program (Part 6.2 (commencing with Section 12693) of Division 2 of the Insurance Code), the Access for Infants and Mothers Program (Part 6.3 (commencing with Section 12695) of Division 2 of the Insurance Code), or the program under Part 6.4 (commencing with Section 12699.50) of Division 2 of the Insurance Code, or Medicare supplement coverage, to the extent consistent with PPACA. (g) “Policy year” means the period from January 1 to December 31, inclusive. (h) “PPACA” means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued pursuant to that law. (i) “Preexisting condition provision” means a contract provision that excludes coverage for charges or expenses incurred during a specified period following the enrollee’s effective date of coverage, as to a condition for which medical advice, diagnosis, care, or treatment was recommended or received during a specified period immediately preceding the effective date of coverage. (j) “Rating period” means the calendar year for which premium rates are in effect pursuant to subdivision (d) of Section 1399.855. (k) “Registered domestic partner” means a person who has established a domestic partnership as described in Section 297 of the Family Code. (Amended by Stats. 2021, Ch. 468, Sec. 2. (AB 570) Effective January 1, 2022.)
  114. 1399.846.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.8. Individual Access to Health Care Coverage [1399.845 - 1399.864] ( Article 11.8 added by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 18. )

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    For small employer coverage, certain sole proprietors, spouses, partners, and spouses of partners are not treated as employees, and employer group health care service plans cannot be issued, marketed, or sold to sole proprietorships or partnerships without employees; only individual plans may be sold to entities without employees.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.8. Individual Access to Health Care Coverage [1399.845 - 1399.864] ( Article 11.8 added by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 18. ) ## 1399.846. For the purposes of determining eligibility for small employer coverage, a sole proprietor and the sole proprietor’s spouse are not employees with respect to a sole proprietorship that consists only of the sole proprietor and the sole proprietor’s spouse. A partner and a partner’s spouse are not employees of a partnership that consists solely of partners and their spouses. Employer group health care service plans shall not be issued, marketed, or sold to a sole proprietorship or partnership without employees directly or indirectly through any arrangement. Only individual health care service plans shall be sold to any entity without employees. (Added by Stats. 2018, Ch. 700, Sec. 6. (SB 1375) Effective January 1, 2019.)
  115. 1399.847.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.8. Individual Access to Health Care Coverage [1399.845 - 1399.864] ( Article 11.8 added by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 18. )

    Verify source ↗

    This section says the article applies only to nongrandfathered individual health benefit plans offered by a health care service plan, except as provided in Sections 1399.858 and 1399.861.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.8. Individual Access to Health Care Coverage [1399.845 - 1399.864] ( Article 11.8 added by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 18. ) ## 1399.847. Except as provided in Sections 1399.858 and 1399.861, the provisions of this article shall only apply with respect to nongrandfathered individual health benefit plans offered by a health care service plan, and shall apply in addition to the other provisions of this chapter and the rules adopted thereunder. (Added by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 18. (SB 2 1x) Effective September 30, 2013.)
  116. 1399.848.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.8. Individual Access to Health Care Coverage [1399.845 - 1399.864] ( Article 11.8 added by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 18. )

    Verify source ↗

    Health plans must offer annual enrollment periods on the stated calendar window, and must set coverage effective dates no later than January 1 or February 1 depending on when plan selection is made.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.8. Individual Access to Health Care Coverage [1399.845 - 1399.864] ( Article 11.8 added by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 18. ) ## 1399.848. (a) Notwithstanding paragraph (1) of subdivision (c) of Section 1399.849, with respect to individual health benefit plans offered outside of the Exchange, a plan shall provide an annual enrollment period for policy years beginning on or after January 1, 2020, from November 1 of the preceding calendar year, to January 31 of the benefit year, inclusive. (b) Notwithstanding paragraphs (2) and (3) of subdivision (c) of Section 1399.849, with respect to individual health benefit plans offered through the Exchange, for policy years beginning on or after January 1, 2023, a plan shall provide an annual enrollment period from November 1 of the preceding calendar year to January 31 of the benefit year, inclusive. (c) Notwithstanding paragraph (3) of subdivision (c) of Section 1399.849, with respect to individual health benefit plans offered outside and through the Exchange, the effective date of coverage shall be as follows: (1) No later than January 1 of the benefit year for plan selection made from November 1 to December 31 of the preceding calendar year, inclusive. (2) No later than February 1 of the benefit year for plan selection made from January 1 to January 31 of the benefit year, inclusive. (Amended by Stats. 2022, Ch. 545, Sec. 3. (SB 1473) Effective September 25, 2022.)
  117. 1399.849.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.8. Individual Access to Health Care Coverage [1399.845 - 1399.864] ( Article 11.8 added by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 18. )

    Verify source ↗

    Health care service plans must offer and enroll individual health benefit plans under specific enrollment rules, and they may not use health status or preexisting-condition rules to block enrollment.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.8. Individual Access to Health Care Coverage [1399.845 - 1399.864] ( Article 11.8 added by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 18. ) ## 1399.849. (a) (1) On and after October 1, 2013, a plan shall fairly and affirmatively offer, market, and sell all of the plan’s health benefit plans that are sold in the individual market for policy years on or after January 1, 2014, to all individuals and dependents in each service area in which the plan provides or arranges for the provision of health care services. A plan shall limit enrollment in individual health benefit plans to open enrollment periods, annual enrollment periods, and special enrollment periods as provided in subdivisions (c) and (d). (2) A plan shall allow the subscriber of an individual health benefit plan to add a dependent to the subscriber’s plan at the option of the subscriber, consistent with the open enrollment, annual enrollment, and special enrollment period requirements in this section. (b) An individual health benefit plan issued, amended, or renewed on or after January 1, 2014, shall not impose any preexisting condition provision upon any individual. (c) (1) With respect to individual health benefit plans offered outside of the Exchange, a plan shall provide an initial open enrollment period from October 1, 2013, to March 31, 2014, inclusive, an annual enrollment period for the policy year beginning on January 1, 2015, from November 15, 2014, to February 15, 2015, inclusive, annual enrollment periods for policy years beginning on or after January 1, 2016, to December 31, 2018, inclusive, from November 1, of the preceding calendar year, to January 31 of the benefit year, inclusive, and annual enrollment periods for policy years beginning on or after January 1, 2019, from October 15, of the preceding calendar year, to January 15 of the benefit year, inclusive. (2) With respect to individual health benefit plans offered through the Exchange, a plan shall provide an annual enrollment period for the policy years beginning on January 1, 2016, to December 31, 2018, inclusive, from November 1, of the preceding calendar year, to January 31 of the benefit year, inclusive, and annual enrollment periods for policy years beginning on or after January 1, 2019, from November 1 to December 15 of the preceding calendar year, inclusive. (3) With respect to individual health benefit plans offered through the Exchange, for policy years beginning on or after January 1, 2019, a plan shall provide a special enrollment period for all individuals selecting an individual health benefit plan through the Exchange from October 15 to October 31 of the preceding calendar year, inclusive, and from December 16, of the preceding calendar year, to January 15 of the benefit year, inclusive. An application for a health benefit plan submitted during these two special enrollment periods shall be treated the same as an application submitted during the annual open enrollment period. The effective date of coverage for plan selections made between October 15 and October 31, inclusive, shall be January 1 of the benefit year, and for plan selections made from December 16 to January 15, inclusive, shall be no later than February 1 of the benefit year. (4) Pursuant to Section 147.104(b)(2) of Title 45 of the Code of Federal Regulations, for individuals enrolled in noncalendar year individual health plan contracts, a plan shall also provide a limited open enrollment period beginning on the date that is 30 calendar days prior to the date the policy year ends in 2014. (d) (1) Subject to paragraph (2), commencing January 1, 2014, a plan shall allow an individual to enroll in or change individual health benefit plans as a result of the following triggering events: (A) The individual or the individual’s dependent loses minimum essential coverage. For purposes of this paragraph, the following definitions shall apply: (i) “Minimum essential coverage” has the same meaning as that term is defined in Section 1345.5 or subsection (f) of Section 5000A of the Internal Revenue Code (26 U.S.C. Sec. 5000A). (ii) “Loss of minimum essential coverage” includes, but is not limited to, loss of that coverage due to the circumstances described in Section 54.9801-6(a)(3)(i) to (iii), inclusive, of Title 26 of the Code of Federal Regulations and the circumstances described in Section 1163 of Title 29 of the United States Code. “Loss of minimum essential coverage” also includes loss of that coverage for a reason that is not due to the fault of the individual. (iii) “Loss of minimum essential coverage” does not include loss of that coverage due to the individual’s failure to pay premiums on a timely basis or situations allowing for a rescission, subject to clause (ii) and Sections 1389.7 and 1389.21. (B) The individual gains a dependent or becomes a dependent. (C) The individual is mandated to be covered as a dependent pursuant to a valid state or federal court order. (D) The individual has been released from incarceration. (E) The individual’s health coverage issuer substantially violated a material provision of the health coverage contract. (F) The individual gains access to new health benefit plans as a result of a permanent move. (G) The individual was receiving services from a contracting provider under another health benefit plan, as defined in Section 1399.845 of this code or Section 10965 of the Insurance Code, for one of the conditions described in subdivision (c) of Section 1373.96 of this code and that provider is no longer participating in the health benefit plan. (H) The individual demonstrates to the Exchange, with respect to health benefit plans offered through the Exchange, or to the department, with respect to health benefit plans offered outside the Exchange, that the individual did not enroll in a health benefit plan during the immediately preceding enrollment period available to the individual because the individual was misinformed that the individual was covered under minimum essential coverage. (I) The individual is a member of the reserve forces of the United States military returning from active duty or a member of the California National Guard returning from active duty service under Title 32 of the United States Code. (J) With respect to individual health benefit plans offered through the Exchange, in addition to the triggering events listed in this paragraph, any other events listed in Section 155.420(d) of Title 45 of the Code of Federal Regulations. (2) With respect to individual health benefit plans offered outside the Exchange, an individual shall have 60 days from the date of a triggering event identified in paragraph (1) to apply for coverage from a health care service plan subject to this section. With respect to individual health benefit plans offered through the Exchange, an individual shall have 60 days from the date of a triggering event identified in paragraph (1) to select a plan offered through the Exchange, unless a longer period is provided in Part 155 (commencing with Section 155.10) of Subchapter B of Subtitle A of Title 45 of the Code of Federal Regulations. (e) With respect to individual health benefit plans offered through the Exchange, the effective date of coverage required pursuant to this section shall be consistent with the dates specified in Section 155.410 or 155.420 of Title 45 of the Code of Federal Regulations, as applicable. A dependent who is a registered domestic partner pursuant to Section 297 of the Family Code shall have the same effective date of coverage as a spouse. (f) With respect to individual health benefit plans offered outside the Exchange, the following provisions shall apply: (1) After an individual submits a completed application form for a plan contract, the health care service plan shall, within 30 days, notify the individual of the individual’s actual premium charges for that plan established in accordance with Section 1399.855. The individual shall have 30 days in which to exercise the right to buy coverage at the quoted premium charges. (2) With respect to an individual health benefit plan for which an individual applies during the initial open enrollment period described in paragraph (1) of subdivision (c), when the subscriber submits a premium payment, based on the quoted premium charges, and that payment is delivered or postmarked, whichever occurs earlier, by December 15, 2013, coverage under the individual health benefit plan shall become effective no later than January 1, 2014. When that payment is delivered or postmarked within the first 15 days of any subsequent month, coverage shall become effective no later than the first day of the following month. When that payment is delivered or postmarked between December 16, 2013, to December 31, 2013, inclusive, or after the 15th day of any subsequent month, coverage shall become effective no later than the first day of the second month following delivery or postmark of the payment. (3) With respect to an individual health benefit plan for which an individual applies during the annual open enrollment period described in paragraph (1) of subdivision (c), when the individual submits a premium payment, based on the quoted premium charges, and that payment is delivered or postmarked, whichever occurs later, by December 15 of the preceding calendar year, coverage shall become effective on January 1 of the benefit year. When that payment is delivered or postmarked within the first 15 days of any subsequent month, coverage shall become effective no later than the first day of the following month. When that payment is delivered or postmarked between December 16 to December 31, inclusive, or after the 15th day of any subsequent month, coverage shall become effective no later than the first day of the second month following delivery or postmark of the payment. (4) With respect to an individual health benefit plan for which an individual applies during a special enrollment period described in subdivision (d), the following provisions shall apply: (A) When the individual submits a premium payment, based on the quoted premium charges, and that payment is delivered or postmarked, whichever occurs earlier, within the first 15 days of the month, coverage under the plan shall become effective no later than the first day of the following month. When the premium payment is neither delivered nor postmarked until after the 15th day of the month, coverage shall become effective no later than the first day of the second month following delivery or postmark of the payment. (B) Notwithstanding subparagraph (A), in the case of a birth, adoption, or placement for adoption, the coverage shall be effective on the date of birth, adoption, or placement for adoption. (C) Notwithstanding subparagraph (A), in the case of marriage or becoming a registered domestic partner or in the case where a qualified individual loses minimum essential coverage, the coverage effective date shall be the first day of the month following the date the plan receives the request for special enrollment. (g) (1) A health care service plan shall not establish rules for eligibility, including continued eligibility, of any individual to enroll under the terms of an individual health benefit plan based on any of the following factors: (A) Health status. (B) Medical condition, including physical and mental illnesses. (C) Claims experience. (D) Receipt of health care. (E) Medical history. (F) Genetic information. (G) Evidence of insurability, including conditions arising out of acts of domestic violence. (H) Disability. (I) Any other health status-related factor as determined by any federal regulations, rules, or guidance issued pursuant to Section 2705 of the federal Public Health Service Act (Public Law 78-410). (2) Notwithstanding Section 1389.1, a health care service plan shall not require an individual applicant or the applicant’s dependent to fill out a health assessment or medical questionnaire prior to enrollment under an individual health benefit plan. A health care service plan shall not acquire or request information that relates to a health status-related factor from the applicant or the applicant’s dependent or any other source prior to enrollment of the individual. (h) (1) A health care service plan shall consider as a single risk pool for rating purposes in the individual market the claims experience of all insureds and all enrollees in all nongrandfathered individual health benefit plans offered by that health care service plan in this state, whether offered as health care service plan contracts or individual health insurance policies, including those insureds and enrollees who enroll in individual coverage through the Exchange and insureds and enrollees who enroll in individual coverage outside of the Exchange. Student health insurance coverage, as that coverage is defined in Section 147.145(a) of Title 45 of the Code of Federal Regulations, shall not be included in a health care service plan’s single risk pool for individual coverage. (2) Each calendar year, a health care service plan shall establish an index rate for the individual market in the state based on the total combined claims costs for providing essential health benefits, as defined pursuant to Section 1302 of PPACA, within the single risk pool required under paragraph (1). The index rate shall be adjusted on a marketwide basis based on the total expected marketwide payments and charges under the risk adjustment program established for the state pursuant to Section 1343 of PPACA and Exchange user fees, as described in subdivision (d) of Section 156.80 of Title 45 of the Code of Federal Regulations. The premium rate for all of the health benefit plans in the individual market within the single risk pool required under paragraph (1) shall use the applicable marketwide adjusted index rate, subject only to the adjustments permitted under paragraph (3). (3) A health care service plan may vary premium rates for a particular health benefit plan from its index rate based only on the following actuarially justified plan-specific factors: (A) The actuarial value and cost-sharing design of the health benefit plan. (B) The health benefit plan’s provider network, delivery system characteristics, and utilization management practices. (C) The benefits provided under the health benefit plan that are in addition to the essential health benefits, as defined pursuant to Section 1302 of PPACA and Section 1367.005. These additional benefits shall be pooled with similar benefits within the single risk pool required under paragraph (1) and the claims experience from those benefits shall be utilized to determine rate variations for plans that offer those benefits in addition to essential health benefits. (D) With respect to catastrophic plans, as described in subsection (e) of Section 1302 of PPACA, the expected impact of the specific eligibility categories for those plans. (E) Administrative costs, excluding user fees required by the Exchange. (i) This section shall only apply with respect to individual health benefit plans for policy years on or after January 1, 2014. (j) This section shall not apply to a grandfathered health plan. (Amended by Stats. 2021, Ch. 764, Sec. 5. (SB 326) Effective January 1, 2022.)
  118. 1399.851.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.8. Individual Access to Health Care Coverage [1399.845 - 1399.864] ( Article 11.8 added by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 18. )

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    A health care service plan or solicitor must not steer people away from individual coverage, use discriminatory marketing or benefit designs, or vary solicitor compensation based on certain personal or geographic factors.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.8. Individual Access to Health Care Coverage [1399.845 - 1399.864] ( Article 11.8 added by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 18. ) ## 1399.851. (a) Commencing October 1, 2013, a health care service plan or solicitor shall not, directly or indirectly, engage in the following activities: (1) Encourage or direct an individual to refrain from filing an application for individual coverage with a plan because of the health status, claims experience, industry, occupation, or geographic location, provided that the location is within the plan’s approved service area, of the individual. (2) Encourage or direct an individual to seek individual coverage from another plan or health insurer or the California Health Benefit Exchange because of the health status, claims experience, industry, occupation, or geographic location, provided that the location is within the plan’s approved service area, of the individual. (3) Employ marketing practices or benefit designs that will have the effect of discouraging the enrollment of individuals with significant health needs or discriminate based on an individual’s race, color, national origin, present or predicted disability, age, sex, gender identity, sexual orientation, expected length of life, degree of medical dependency, quality of life, or other health conditions. (b) Commencing October 1, 2013, a health care service plan shall not, directly or indirectly, enter into any contract, agreement, or arrangement with a solicitor that provides for or results in the compensation paid to a solicitor for the sale of an individual health benefit plan to be varied because of the health status, claims experience, industry, occupation, or geographic location of the individual. This subdivision does not apply to a compensation arrangement that provides compensation to a solicitor on the basis of percentage of premium, provided that the percentage shall not vary because of the health status, claims experience, industry, occupation, or geographic area of the individual. (c) This section shall only apply with respect to individual health benefit plans for policy years on or after January 1, 2014. (Added by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 18. (SB 2 1x) Effective September 30, 2013.)
  119. 1399.853.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.8. Individual Access to Health Care Coverage [1399.845 - 1399.864] ( Article 11.8 added by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 18. )

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    An individual health benefit plan must be renewable at the enrollee’s option, except where cancellation, rescission, or nonrenewal is allowed under the cited provisions.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.8. Individual Access to Health Care Coverage [1399.845 - 1399.864] ( Article 11.8 added by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 18. ) ## 1399.853. (a) An individual health benefit plan shall be renewable at the option of the enrollee except as permitted to be canceled, rescinded, or not renewed pursuant to Section 1365 and Section 155.430(b) of Title 45 of the Code of Federal Regulations. (b) Any plan that ceases to offer for sale new individual health benefit plans pursuant to Section 1365 shall continue to be governed by this article with respect to business conducted under this article. (Added by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 18. (SB 2 1x) Effective September 30, 2013.)
  120. 1399.855.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.8. Individual Access to Health Care Coverage [1399.845 - 1399.864] ( Article 11.8 added by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 18. )

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    A health care service plan may rate individual health benefit plans only using the characteristics listed in this section, and rates may not vary by any other factor.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.8. Individual Access to Health Care Coverage [1399.845 - 1399.864] ( Article 11.8 added by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 18. ) ## 1399.855. (a) With respect to individual health benefit plans for policy years on or after January 1, 2014, a health care service plan may use only the following characteristics of an individual, and any dependent thereof, for purposes of establishing the rate of the individual health benefit plan covering the individual and the eligible dependents thereof, along with the health benefit plan selected by the individual: (1) Age, pursuant to the age bands established by the United States Secretary of Health and Human Services and the age rating curve established by the federal Centers for Medicare and Medicaid Services pursuant to Section 2701(a)(3) of the federal Public Health Service Act (42 U.S.C. Sec. 300gg(a)(3)). Rates based on age shall be determined using the individual’s age as of the date of the health benefit plan contract issuance or renewal, as applicable, and shall not vary by more than three to one for like individuals of different age who are 21 years of age or older as described in federal regulations adopted pursuant to Section 2701(a)(3) of the federal Public Health Service Act (42 U.S.C. Sec. 300gg(a)(3)). (2) (A) Geographic region. The geographic regions for purposes of rating shall be the following: (i) Region 1 shall consist of the Counties of Alpine, Amador, Butte, Calaveras, Colusa, Del Norte, Glenn, Humboldt, Lake, Lassen, Mendocino, Modoc, Nevada, Plumas, Shasta, Sierra, Siskiyou, Sutter, Tehama, Trinity, Tuolumne, and Yuba. (ii) Region 2 shall consist of the Counties of Marin, Napa, Solano, and Sonoma. (iii) Region 3 shall consist of the Counties of El Dorado, Placer, Sacramento, and Yolo. (iv) Region 4 shall consist of the City and County of San Francisco. (v) Region 5 shall consist of the County of Contra Costa. (vi) Region 6 shall consist of the County of Alameda. (vii) Region 7 shall consist of the County of Santa Clara. (viii) Region 8 shall consist of the County of San Mateo. (ix) Region 9 shall consist of the Counties of Monterey, San Benito, and Santa Cruz. (x) Region 10 shall consist of the Counties of Mariposa, Merced, San Joaquin, Stanislaus, and Tulare. (xi) Region 11 shall consist of the Counties of Fresno, Kings, and Madera. (xii) Region 12 shall consist of the Counties of San Luis Obispo, Santa Barbara, and Ventura. (xiii) Region 13 shall consist of the Counties of Imperial, Inyo, and Mono. (xiv) Region 14 shall consist of the County of Kern. (xv) Region 15 shall consist of the ZIP Codes in the County of Los Angeles starting with 906 to 912, inclusive, 915, 917, 918, and 935. (xvi) Region 16 shall consist of the ZIP Codes in the County of Los Angeles other than those identified in clause (xv). (xvii) Region 17 shall consist of the Counties of Riverside and San Bernardino. (xviii) Region 18 shall consist of the County of Orange. (xix) Region 19 shall consist of the County of San Diego. (B) No later than June 1, 2017, the department, in collaboration with the Exchange and the Department of Insurance, shall review the geographic rating regions specified in this paragraph and the impacts of those regions on the health care coverage market in California, and make a report to the appropriate policy committees of the Legislature. (3) Whether the plan covers an individual or family, as described in PPACA. (b) The rate for a health benefit plan subject to this section shall not vary by any factor not described in this section. (c) With respect to family coverage under an individual health benefit plan, the rating variation permitted under paragraph (1) of subdivision (a) shall be applied based on the portion of the premium attributable to each family member covered under the plan. The total premium for family coverage shall be determined by summing the premiums for each individual family member. In determining the total premium for family members, premiums for no more than the three oldest family members who are under 21 years of age shall be taken into account. (d) The rating period for rates subject to this section shall be from January 1 to December 31, inclusive. (e) This section does not apply to an individual health benefit plan that is a grandfathered health plan. (f) The requirement for submitting a report imposed under subparagraph (B) of paragraph (2) of subdivision (a) is inoperative on June 1, 2021, pursuant to Section 10231.5 of the Government Code. (Amended by Stats. 2021, Ch. 764, Sec. 6. (SB 326) Effective January 1, 2022.)
  121. 1399.857.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.8. Individual Access to Health Care Coverage [1399.845 - 1399.864] ( Article 11.8 added by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 18. )

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    A health care service plan is not required to offer or accept applications for certain individual health benefit plans in specified cases, and it may decline coverage if it meets the stated financial and uniform-application conditions.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.8. Individual Access to Health Care Coverage [1399.845 - 1399.864] ( Article 11.8 added by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 18. ) ## 1399.857. (a) A health care service plan shall not be required to offer an individual health benefit plan or accept applications for the plan pursuant to Section 1399.849 in the case of any of the following: (1) To an individual who does not live or reside within the plan’s approved service areas. (2) (A) Within a specific service area or portion of a service area, if the plan reasonably anticipates and demonstrates to the satisfaction of the director both of the following: (i) It will not have sufficient health care delivery resources to ensure that health care services will be available and accessible to the individual because of its obligations to existing enrollees. (ii) It is applying this subparagraph uniformly to all individuals without regard to the claims experience of those individuals or any health status-related factor relating to those individuals. (B) A health care service plan that cannot offer an individual health benefit plan to individuals because it is lacking in sufficient health care delivery resources within a service area or a portion of a service area pursuant to subparagraph (A) shall not offer a health benefit plan in that area to individuals until the later of the following dates: (i) The 181st day after the date coverage is denied pursuant to this paragraph. (ii) The date the plan notifies the director that it has the ability to deliver services to individuals, and certifies to the director that from the date of the notice it will enroll all individuals requesting coverage in that area from the plan. (C) Subparagraph (B) shall not limit the plan’s ability to renew coverage already in force or relieve the plan of the responsibility to renew that coverage as described in Section 1365. (D) Coverage offered within a service area after the period specified in subparagraph (B) shall be subject to this section. (b) (1) A health care service plan may decline to offer an individual health benefit plan to an individual if the plan demonstrates to the satisfaction of the director both of the following: (A) It does not have the financial reserves necessary to underwrite additional coverage. In determining whether this subparagraph has been satisfied, the director shall consider, but not be limited to, the plan’s compliance with the requirements of Section 1367, Article 6 (commencing with Section 1375), and the rules adopted thereunder. (B) It is applying this subdivision uniformly to all individuals without regard to the claims experience of those individuals or any health status-related factor relating to those individuals. (2) A plan that denies coverage to an individual under paragraph (1) shall not offer coverage before the later of the following dates: (A) The 181st day after the date that coverage is denied pursuant to this subdivision. (B) The date the plan demonstrates to the satisfaction of the director that the plan has sufficient financial reserves necessary to underwrite additional coverage. (3) Paragraph (2) shall not limit the plan’s ability to renew coverage already in force or relieve the plan of the responsibility to renew that coverage as described in Section 1365. (4) Coverage offered within a service area after the period specified in paragraph (2) shall be subject to this section. (c) Nothing in this article shall be construed to limit the director’s authority to develop and implement a plan of rehabilitation for a health care service plan whose financial viability or organizational and administrative capacity has become impaired, to the extent permitted by PPACA. (d) This section shall not apply to an individual health benefit plan that is a grandfathered health plan. (Added by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 18. (SB 2 1x) Effective September 30, 2013.)
  122. 1399.858.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.8. Individual Access to Health Care Coverage [1399.845 - 1399.864] ( Article 11.8 added by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 18. )

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    The director may require a health care service plan to stop offering contracts or taking applications from an individual, or a responsible party for an individual, if the director determines the plan lacks sufficient financial, organizational, or administrative capacity.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.8. Individual Access to Health Care Coverage [1399.845 - 1399.864] ( Article 11.8 added by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 18. ) ## 1399.858. The director may require a plan to discontinue the offering of contracts or acceptance of applications from any individual, or responsible party for an individual, upon a determination by the director that the plan does not have sufficient financial viability, or organizational and administrative capacity to ensure the delivery of health care services to its enrollees. In determining whether the conditions of this section have been met, the director shall consider, but not be limited to, the plan’s compliance with the requirements of Section 1367, Article 6 (commencing with Section 1375), and the rules adopted thereunder. (Added by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 18. (SB 2 1x) Effective September 30, 2013.)
  123. 1399.859.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.8. Individual Access to Health Care Coverage [1399.845 - 1399.864] ( Article 11.8 added by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 18. )

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    Health care service plans must tell certain applicants and subscribers about possible lower-cost Exchange coverage and the relevant Exchange enrollment periods.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.8. Individual Access to Health Care Coverage [1399.845 - 1399.864] ( Article 11.8 added by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 18. ) ## 1399.859. (a) A health care service plan that receives an application for an individual health benefit plan outside the Exchange during the initial open enrollment period, an annual enrollment period, or a special enrollment period described in Section 1399.849 shall inform the applicant that he or she may be eligible for lower cost coverage through the Exchange and shall inform the applicant of the applicable enrollment period provided through the Exchange described in Section 1399.849. (b) On or before October 1, 2013, and annually every October 1 thereafter, a health care service plan shall issue a notice to a subscriber enrolled in an individual health benefit plan offered outside the Exchange. The notice shall inform the subscriber that he or she may be eligible for lower cost coverage through the Exchange and shall inform the subscriber of the applicable open enrollment period and special enrollment periods provided through the Exchange described in Section 1399.849. (c) This section shall not apply where the individual health benefit plan described in subdivision (a) or (b) is a grandfathered health plan. (Amended by Stats. 2017, Ch. 468, Sec. 4. (AB 156) Effective January 1, 2018.)
  124. 1399.861.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.8. Individual Access to Health Care Coverage [1399.845 - 1399.864] ( Article 11.8 added by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 18. )

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    Health care service plans must give specified notices to subscribers and include them in renewal and dependent-coverage materials, and they may not market grandfathered individual plans to enroll dependents for later policy years.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.8. Individual Access to Health Care Coverage [1399.845 - 1399.864] ( Article 11.8 added by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 18. ) ## 1399.861. (a) On or before October 1, 2013, and annually every October 1 thereafter, a health care service plan shall issue the following notice to all subscribers enrolled in an individual health benefit plan that is a grandfathered health plan: New improved health insurance options are available in California. You currently have health insurance that is not required to follow many of the new laws. For example, your plan may not provide preventive health services without you having to pay any cost sharing (copayments or coinsurance). Also, your current plan may be allowed to increase your rates based on your health status while new plans and policies cannot. You have the option to remain in your current plan or switch to a new plan. Under the new rules, a health plan cannot deny your application based on any health conditions you may have. For more information about your options, please contact Covered California at ____, your plan representative or insurance agent, or an entity paid by Covered California to assist with health coverage enrollment such as a navigator or an assister. (b) Commencing October 1, 2013, a health care service plan shall include the notice described in subdivision (a) in any renewal material of the individual grandfathered health plan and in any application for dependent coverage under the individual grandfathered health plan. (c) A health care service plan shall not advertise or market an individual health benefit plan that is a grandfathered health plan for purposes of enrolling a dependent of a subscriber into the plan for policy years on or after January 1, 2014. Nothing in this subdivision shall be construed to prohibit an individual enrolled in an individual grandfathered health plan from adding a dependent to that plan to the extent permitted by PPACA. (Amended by Stats. 2014, Ch. 31, Sec. 9. (SB 857) Effective June 20, 2014.)
  125. 1399.862.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.8. Individual Access to Health Care Coverage [1399.845 - 1399.864] ( Article 11.8 added by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 18. )

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    This article applies only to the extent it meets or exceeds PPACA requirements, unless the article itself provides otherwise.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.8. Individual Access to Health Care Coverage [1399.845 - 1399.864] ( Article 11.8 added by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 18. ) ## 1399.862. Except as otherwise provided in this article, this article shall only be implemented to the extent that it meets or exceeds the requirements set forth in PPACA. (Added by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 18. (SB 2 1x) Effective September 30, 2013.)
  126. 1399.863.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.8. Individual Access to Health Care Coverage [1399.845 - 1399.864] ( Article 11.8 added by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 18. )

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    The department may adopt and once readopt emergency regulations for this article, and it must consult the Insurance Commissioner before doing so.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.8. Individual Access to Health Care Coverage [1399.845 - 1399.864] ( Article 11.8 added by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 18. ) ## 1399.863. (a) The department may adopt emergency regulations implementing this article no later than December 31, 2014. The department may readopt any emergency regulation authorized by this section that is the same as or substantially equivalent to an emergency regulation previously adopted under this section. (b) The initial adoption of emergency regulations implementing this article and the one readoption of emergency regulations authorized by this section shall be deemed an emergency and necessary for the immediate preservation of the public peace, health, safety, or general welfare. Initial emergency regulations and the one readoption of emergency regulations authorized by this section shall be exempt from review by the Office of Administrative Law. The initial emergency regulations and the one readoption of emergency regulations authorized by this section shall be submitted to the Office of Administrative Law for filing with the Secretary of State and each shall remain in effect for no more than one year, by which time final regulations may be adopted. The department shall consult with the Insurance Commissioner prior to adopting any regulations pursuant to this section for the specific purpose of ensuring, to the extent practical, that there is consistency of regulations applicable to entities regulated by the department and those regulated by the Insurance Commissioner. (Added by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 18. (SB 2 1x) Effective September 30, 2013.)
  127. 1399.864.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.8. Individual Access to Health Care Coverage [1399.845 - 1399.864] ( Article 11.8 added by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 18. )

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    A health care service plan selling a bridge plan product must make certain license filings, keep a 85% medical loss ratio, report that ratio to the department, and provide specific enrollment periods; it is also exempt from some general offering, marketing, and selling requirements except for eligible individuals.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.8. Individual Access to Health Care Coverage [1399.845 - 1399.864] ( Article 11.8 added by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 18. ) ## 1399.864. (a) For purposes of this article, a bridge plan product shall mean an individual health benefit plan, as defined in subdivision (f) of Section 1399.845, that is offered by a health care service plan licensed under this chapter that contracts with the Exchange pursuant to Title 22 (commencing with Section 100500) of the Government Code. (b) Until December 31, 2014, a health care service plan that contracts with the California Health Benefit Exchange to offer a qualified bridge plan product pursuant to Section 100504 of the Government Code shall do all of the following: (1) As of the effective date of this section, if the health care service plan has not been approved by the director to offer individual health benefit plans pursuant to this chapter, the plan shall file a material modification pursuant to Section 1352 to expand its license to include individual health benefit plans. (2) As of the effective date of this section, if the health care service plan has been approved by the director to offer individual health benefit plans pursuant to this chapter, the plan shall, pursuant to Section 1352, file an amendment to expand its license to include a bridge plan product as an individual health benefit plan. (c) During the time the health care service plan’s material modification or amendment is pending approval by the director, the health care service plan shall be deemed to comply with subdivision (b) of Section 100507 of the Government Code. (d) A health care service plan shall maintain a medical loss ratio of 85 percent for the bridge plan product. A health care service plan shall utilize, to the extent possible, the same methodology for calculating the medical loss ratio for the bridge plan product that is used for calculating the health care service plan medical loss ratio pursuant to Section 1367.003 and shall report its medical loss ratio for the bridge plan product to the department as provided in Section 1367.003. (e) Notwithstanding subdivision (a) of Section 1399.849, a health care service plan selling a bridge plan product shall not be required to fairly and affirmatively offer, market, and sell the health care service plan’s bridge plan product except to individuals eligible for the bridge plan product pursuant to the State Department of Health Care Services and the Medi-Cal managed care plan’s contract entered into pursuant to Section 14005.70 of the Welfare and Institutions Code, provided the health care service plan meets the requirements of subdivision (b) of Section 14005.70 of the Welfare and Institutions Code. (f) Notwithstanding subdivision (c) of Section 1399.849, a health care service plan selling a bridge plan product shall provide an initial open enrollment period of six months, and an annual enrollment period and a special enrollment period consistent with the annual enrollment and special enrollment periods of the Exchange. (g) This section shall become inoperative on the October 1 that is five years after the date that federal approval of the bridge plan option occurs, and, as of the second January 1 thereafter, is repealed, unless a later enacted statute that is enacted before that date deletes or extends the dates on which it becomes inoperative and is repealed. (Added by Stats. 2013, 1st Ex. Sess., Ch. 5, Sec. 10. (SB 3 1x) Effective September 30, 2013. Conditionally inoperative, on date prescribed by its own provisions. Repealed, by its own provisions, on second January 1 after inoperative date.)
  128. 1399.870.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.9. Health Equity and Quality [1399.870 - 1399.874] ( Article 11.9 added by Stats. 2021, Ch. 143, Sec. 14. )

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    The department must convene a Health Equity and Quality Committee, and the committee must give recommendations on standard health equity and quality measures and annual benchmarks.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.9. Health Equity and Quality [1399.870 - 1399.874] ( Article 11.9 added by Stats. 2021, Ch. 143, Sec. 14. ) ## 1399.870. (a) (1) On or before March 1, 2022, the department shall convene a Health Equity and Quality Committee to make recommendations to the department for standard health equity and quality measures, including annual benchmark standards for assessing equity and quality in health care delivery. The department may contract with consultants to assist the committee with the implementation and administration of its duties. (2) The committee shall provide initial recommendations, as well as recommendations on updating and revising standard health equity and quality measures and annual benchmark standards, consistent with this article. These recommendations shall consider the interaction of multiple characteristics in determining where disparate outcomes exist, including, but not limited to, race, ethnicity, gender, sexual orientation, language, age, income, and disability. (3) Meetings of the committee shall be subject to the Bagley-Keene Open Meeting Act (Article 9 (commencing with Section 11120) of Chapter 1 of Part 1 of Division 3 of Title 2 of the Government Code). (4) The department may contract with consultants to assist the committee with the implementation and administration of its duties. (b) In appointing members to the committee, the director shall consider all of the following: (1) The expertise of each committee member so that the committee’s composition reflects a diversity of relevant expertise. (2) The racial, cultural, ethnic, sexual orientation, gender, economic, linguistic, age, disability, and geographical diversity of the state so that the committee’s composition reflects the communities of California. (3) The expertise of representatives from other state agencies that are engaged in the work of setting quality and equity goals or standards for health care entities. (4) The representation of consumer stakeholders that serve diverse populations. (5) Inclusion of experts, researchers, and community members who are engaged in the development of alternative approaches to measuring health equity, consumer experience, and health outcomes. (c) On or before September 30, 2022, the committee shall provide the recommendations described in subdivision (a), which may consider and may include all of the following: (1) Quality measures, including, but not limited to, Healthcare Effectiveness Data and Information Set (HEDIS) measures and the federal Centers for Medicare and Medicaid Services Child and Adult Core Set measures. (2) Surveys or other measures to assess consumer experience and satisfaction, including alternative approaches that take into account cultural competence, health literacy, exposure to discrimination, and social and cultural connectedness, such as connection to community, identity, traditions, and spirituality. (3) Other child and adult quality or outcome measures that the committee determines are appropriate, including establishing new measures for patient-reported outcomes. (4) Effective ways to measure health outcomes in the absence of quality measures, including both of the following: (A) Demographic data or other data related to race, ethnicity, or socioeconomic variables that are currently collected by health care service plans. (B) Other data sources, including the Health Care Payments Data Program established pursuant to Section 127671.1, the health evidence initiative of Covered California for the individual and small group markets, and other statistically valid and reliable sources of data. (5) Approaches to stratifying reporting of results by factors, including, but not limited to, age, sex, geographic region, race, ethnicity, language, sexual orientation, gender identity, and income to the extent health plans or public programs have data on these factors and that the results are statistically valid and reliable. (6) Alternative methods to measure health outcomes that permit sufficient stratification to determine impacts on health equity and quality that are not subject to the methodological limitations of current measurement approaches. (7) Alternative methods to measure physical and behavioral health outcomes, including, but not limited to, measures to assess social and cultural connectedness, such as connection to community, identity, traditions, and spirituality. The department shall consult with the Office of Health Equity in identifying these alternative methods. (8) Measures of social determinants of health, such as housing security, food insecurity, caregiving, and other nonmedical determinants of health. (d) The committee’s recommendations shall include setting annual health equity and quality benchmarks. (e) The department shall consider the committee’s recommendations in establishing the standard measures and annual benchmarks pursuant to Section 1399.871. The department shall enforce the established set of standard health equity and quality measures and applicable annual benchmarks consistent with Section 1399.872. (f) The department shall reconvene the committee following the establishment of the standard measures and annual benchmarks pursuant to Section 1399.871 for the purpose of reviewing or revisiting the standard measures and annual benchmarks after the department has received data from health care service plans pursuant to Section 1399.872. (g) Contracts entered into pursuant to this article are exempt from Part 2 (commencing with Section 10100) of Division 2 of the Public Contract Code, Section 19130 of the Government Code, and Chapter 6 (commencing with Section 14825) of Part 5.5 of Division 3 of Title 2 of the Government Code, and are exempt from the review or approval of any division of the Department of General Services, until January 1, 2024. (Added by Stats. 2021, Ch. 143, Sec. 14. (AB 133) Effective July 27, 2021.)
  129. 1399.871.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.9. Health Equity and Quality [1399.870 - 1399.874] ( Article 11.9 added by Stats. 2021, Ch. 143, Sec. 14. )

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    The department must set health equity and quality measures and annual benchmarks, and health care service plans must follow them and report compliance.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.9. Health Equity and Quality [1399.870 - 1399.874] ( Article 11.9 added by Stats. 2021, Ch. 143, Sec. 14. ) ## 1399.871. (a) (1) The department shall establish standard measures and annual benchmarks for equity and quality in health care delivery. (2) A standard measure or annual benchmark shall not be adopted, updated, or revised in any manner without being discussed during at least one public meeting of the Health Equity and Quality Committee before the meeting in which the committee makes recommendations to the director. (3) Standard measures and annual benchmarks shall sunset at most every five years from the date the department establishes standard measures and annual benchmarks pursuant to paragraph (1). To continue the standard measures and annual benchmarks, the department shall conduct a public assessment, at least one year before the sunset, of whether the measures and benchmarks are improving quality and equity, consistent with this article. (b) In establishing the standard measures and annual benchmarks pursuant to subdivision (a), the department shall consider the recommendations made by the Health Equity and Quality Committee pursuant to Section 1399.870, as well as stakeholder comments on draft standards and benchmarks. (c) After the department establishes the standard measures and benchmarks pursuant to subdivision (a), a health care service plan shall comply with the annual benchmarks and shall demonstrate compliance in reports submitted to the department pursuant to Section 1399.872. (d) (1) On or before January 1, 2026, a health care service plan and its subcontracted health care service plans shall have and maintain National Committee for Quality Assurance (NCQA) accreditation. (2) This subdivision does not apply to a health care service plan that contracts with the State Department of Health Care Services to provide health care services to Medi-Cal beneficiaries. NCQA accreditation for these plans shall be in accordance with Section 14184.203 of the Welfare and Institutions Code. (e) Throughout the development, implementation, and updating of the standard measures and annual benchmarks pursuant to this section, the department shall coordinate with the State Department of Health Care Services, the Office of Statewide Health Planning and Development, the California Health Benefit Exchange, CalPERS, and the State Department of Public Health. (Added by Stats. 2021, Ch. 143, Sec. 14. (AB 133) Effective July 27, 2021.)
  130. 1399.872.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.9. Health Equity and Quality [1399.870 - 1399.874] ( Article 11.9 added by Stats. 2021, Ch. 143, Sec. 14. )

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    Health care service plans must file annual health equity and quality reports, maintain compliance systems, and provide supporting documentation to the department.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.9. Health Equity and Quality [1399.870 - 1399.874] ( Article 11.9 added by Stats. 2021, Ch. 143, Sec. 14. ) ## 1399.872. (a) Upon the department’s establishment or updating of standard measures and annual benchmarks pursuant to Section 1399.871, a health care service plan shall annually submit to the department, at the time and in a manner specified by the department, a report containing health equity and quality data and information. A health care service plan shall implement the policies, procedures, and systems necessary for compliance with this article and shall, in a manner specified by the department, disclose substantiating documentation to the department demonstrating how the health care service plan shall achieve that compliance. (b) The department shall review a health care service plan’s equity and quality report submitted pursuant to this section for compliance with the health equity and quality standard measures and annual benchmarks established pursuant to Section 1399.871. The department may also review and use other credible sources of information and data, including, but not limited to, relevant data provided by other state agencies, to determine a health care service plan’s compliance with the equity and quality standard measures and annual benchmarks. (c) The department shall determine a health care service plan’s compliance with the health equity and quality standard measures and annual benchmarks and issue a report of its findings to the health care service plan, which shall also be made publicly available on the department’s internet website. (d) If a health care service plan does not demonstrate compliance with this article, the department may take the following actions, which may be progressive, as appropriate: (1) Require the health care service plan to implement corrective action to achieve and demonstrate compliance with the health equity and quality standard measures and annual benchmarks. (2) Monitor a health care service plan’s corrective action plan and improvement efforts. (3) Investigate and require supplemental reporting by the health care service plan. (4) Assess an administrative penalty in an amount that is initially commensurate with the failure to meet the requirements of this article, and assess additional penalties, in escalating amounts for repeated or continuing failure to meet the requirements. The director may assess administrative penalties under this paragraph if a health care service plan engages in any of the following conduct: (A) Fails to report complete and accurate data required by this article. (B) Neglects to file a required corrective action plan with the department. (C) Fails to file an acceptable required corrective action plan with the department. (D) Fails to implement or monitor a required corrective action plan. (E) Fails to provide information required by this article to the department. (F) Falsifies information required by this section. (G) Fails to meet the health equity and quality standard measures and annual benchmarks established pursuant to Section 1399.871. (5) Take other disciplinary or other enforcement action, as determined necessary and appropriate by the director. (6) If the department assesses an administrative penalty or takes other disciplinary action, the department shall inform the California Health Benefit Exchange, the Office of Statewide Health Planning and Development, CalPERS, and the State Department of Health Care Services, each of which shall consider appropriate action. (e) (1) For the measurement years 2023 and 2024, the department’s enforcement activities pursuant to subdivision (d) shall address deficiencies in procedural data collection, reporting, corrective action plan implementation, or monitoring requirements pursuant to this article. (2) Commencing with measurement year 2025, and for each following measurement year, the department’s enforcement activities shall address deficiencies in meeting the requirements under paragraph (1), compliance with the standard measures and annual benchmarks, and all other requirements pursuant to this article. (3) For the purpose of this subdivision, “measurement year” means the time period within which a health care service plan shall collect the required information for the report required by this section. (f) Commencing in 2025, and annually thereafter, the department shall publish on its internet website a Health Equity and Quality Compliance Report. (g) The department shall coordinate with the State Department of Health Care Services to support the review of, and any compliance action taken with respect to, Medi-Cal managed care plans consistent with this article, to maintain consistency with the applicable federal and state Medicaid requirements governing those plans. (Added by Stats. 2021, Ch. 143, Sec. 14. (AB 133) Effective July 27, 2021.)
  131. 1399.873.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.9. Health Equity and Quality [1399.870 - 1399.874] ( Article 11.9 added by Stats. 2021, Ch. 143, Sec. 14. )

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    This section says the article applies to certain health care service plans, and they must comply even if they delegate services.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.9. Health Equity and Quality [1399.870 - 1399.874] ( Article 11.9 added by Stats. 2021, Ch. 143, Sec. 14. ) ## 1399.873. (a) Except as provided by any other law, the requirements of this article apply to health care service plans that cover hospital, medical, or surgical expenses, including a health care service plan that contracts with the State Department of Health Care Services to provide health care services to Medi-Cal beneficiaries, and specialized health care service plans that provide behavioral health care. (b) The obligation of a health care service plan to comply with this article is not waived if the health care service plan delegates any services or functions to its medical groups, independent practice associations, or other contracting entities. (Added by Stats. 2021, Ch. 143, Sec. 14. (AB 133) Effective July 27, 2021.)
  132. 1399.874.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.9. Health Equity and Quality [1399.870 - 1399.874] ( Article 11.9 added by Stats. 2021, Ch. 143, Sec. 14. )

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    This section preserves the director’s enforcement authority and lets the department implement, interpret, or make specific the article by guidance materials and similar instructions without regulatory action until January 1, 2027.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.2. Health Care Service Plans [1340 - 1399.874] ( Chapter 2.2 added by Stats. 1975, Ch. 941. ) ## ARTICLE 11.9. Health Equity and Quality [1399.870 - 1399.874] ( Article 11.9 added by Stats. 2021, Ch. 143, Sec. 14. ) ## 1399.874. (a) This article does not restrict the director’s enforcement authority under this chapter. (b) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this article by means of all-plan letters, methodologies, rules, policies, forms, or similar instructions, without taking regulatory action, until January 1, 2027. (Added by Stats. 2021, Ch. 143, Sec. 14. (AB 133) Effective July 27, 2021.)
  133. 1399.900.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.25. Disease Management [1399.900 - 1399.904] ( Heading of Chapter 2.25 renumbered from Chapter 2.5 (as added by Stats. 2000, Ch. 1065) by Stats. 2002, Ch. 664, Sec. 129. )

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    This section defines “disease management organization” and excludes certain entities from that definition.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.25. Disease Management [1399.900 - 1399.904] ( Heading of Chapter 2.25 renumbered from Chapter 2.5 (as added by Stats. 2000, Ch. 1065) by Stats. 2002, Ch. 664, Sec. 129. ) ## 1399.900. (a) For the purposes of this chapter, “disease management organization” means an entity that provides disease management programs and services and that contracts with any of the following: (1) A health care service plan. (2) A contractor of a health care service plan. (3) An employer. (4) A publicly financed health care program. (5) A government agency. (b) A disease management organization shall not include an entity whose primary purpose is to market specific products or services to enrollees of a health care service plan. (c) No medical group, individual licensed pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, or health facility as defined in Section 1250, that provides disease management programs and services incidental to their primary professional practices, shall be considered a disease management organization. (Added by Stats. 2000, Ch. 1065, Sec. 2. Effective January 1, 2001.)
  134. 1399.901.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.25. Disease Management [1399.900 - 1399.904] ( Heading of Chapter 2.25 renumbered from Chapter 2.5 (as added by Stats. 2000, Ch. 1065) by Stats. 2002, Ch. 664, Sec. 129. )

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    This section defines “disease management programs and services” and says they must include certain components.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.25. Disease Management [1399.900 - 1399.904] ( Heading of Chapter 2.25 renumbered from Chapter 2.5 (as added by Stats. 2000, Ch. 1065) by Stats. 2002, Ch. 664, Sec. 129. ) ## 1399.901. For the purposes of this chapter, “disease management programs and services” means services administered to patients in order to improve their overall health and to prevent clinical exacerbations and complications utilizing cost-effective, evidence-based, or consensus-based practice guidelines and patient self-management strategies. Disease management programs and services shall contain all of the following: (a) A population identification process. (b) Evidence-based or consensus-based clinical practice guidelines, risk identification, and matching of interventions with clinical need. (c) Patient self-management and disease education. (d) Process and outcomes measurement, evaluation, management, and reporting. (Added by Stats. 2000, Ch. 1065, Sec. 2. Effective January 1, 2001.)
  135. 1399.902.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.25. Disease Management [1399.900 - 1399.904] ( Heading of Chapter 2.25 renumbered from Chapter 2.5 (as added by Stats. 2000, Ch. 1065) by Stats. 2002, Ch. 664, Sec. 129. )

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    A disease management organization must get physician authorization before it, its employees, or contractors provide certain home health care services or handle prescription medications.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.25. Disease Management [1399.900 - 1399.904] ( Heading of Chapter 2.25 renumbered from Chapter 2.5 (as added by Stats. 2000, Ch. 1065) by Stats. 2002, Ch. 664, Sec. 129. ) ## 1399.902. (a) Every disease management organization shall obtain physician authorization prior to the time that the disease management organization, its employees, or independent contractors do either of the following: (1) Provide home health care services utilized in the treatment of a patient. (2) Dispense, administer, or prescribe a prescription medication. (b) For purposes of this section, a valid prescription written by a treating physician shall constitute authorization to dispense a prescription medication. (c) Home health care followup visits made solely for patient assessment, monitoring, or education are not subject to the physician authorization requirement in subdivision (a). (d) Nothing in this section, in the absence of authorization granted by any other law, shall be construed to authorize the activities described in paragraphs (1) and (2) of subdivision (a). (Added by Stats. 2000, Ch. 1065, Sec. 2. Effective January 1, 2001.)
  136. 1399.903.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.25. Disease Management [1399.900 - 1399.904] ( Heading of Chapter 2.25 renumbered from Chapter 2.5 (as added by Stats. 2000, Ch. 1065) by Stats. 2002, Ch. 664, Sec. 129. )

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    A disease management organization may receive medical information under a referenced Civil Code provision, but it must also follow the other applicable confidentiality rules.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.25. Disease Management [1399.900 - 1399.904] ( Heading of Chapter 2.25 renumbered from Chapter 2.5 (as added by Stats. 2000, Ch. 1065) by Stats. 2002, Ch. 664, Sec. 129. ) ## 1399.903. A disease management organization may receive medical information as provided in paragraph (17) of subdivision (c) of Section 56.10 of the Civil Code. However, a disease management organization shall be subject to the other provisions of the Confidentiality of Medical Information Act (Part 2.6 (commencing with Section 56) of Division 1 of the Civil Code), including, but not limited to, subdivisions (d) and (e) of Section 56.10 of, and Section 56.36 of, the Civil Code. (Added by Stats. 2000, Ch. 1065, Sec. 2. Effective January 1, 2001.)
  137. 1399.904.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.25. Disease Management [1399.900 - 1399.904] ( Heading of Chapter 2.25 renumbered from Chapter 2.5 (as added by Stats. 2000, Ch. 1065) by Stats. 2002, Ch. 664, Sec. 129. )

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    A disease management organization may not use certain medical information to solicit or sell products or services to an enrollee, except when the enrollee elects to receive information and the offer is directly related to the enrollee’s condition.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.25. Disease Management [1399.900 - 1399.904] ( Heading of Chapter 2.25 renumbered from Chapter 2.5 (as added by Stats. 2000, Ch. 1065) by Stats. 2002, Ch. 664, Sec. 129. ) ## 1399.904. A disease management organization shall not use medical information obtained pursuant to Section 1399.903 to solicit or to offer for sale to a health care service plan enrollee any products or services in the provision of disease management services to the enrollee. However, an enrollee may elect to use a disease management organization to obtain information about health care products and services and, pursuant to that election by the enrollee, the disease management organization may offer to the enrollee health care products or services that are directly related to the enrollee’s condition. (Added by Stats. 2000, Ch. 1065, Sec. 2. Effective January 1, 2001.)
  138. 14.

    ## Health and Safety Code - HSC ## GENERAL PROVISIONS ( General Provisions enacted by Stats. 1939, Ch. 60. )

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    This section defines “county” to include a city and county.

    ## Health and Safety Code - HSC ## GENERAL PROVISIONS ( General Provisions enacted by Stats. 1939, Ch. 60. ) ## 14. “County” includes city and county. (Enacted by Stats. 1939, Ch. 60.)
  139. 140.

    ## Health and Safety Code - HSC ## DIVISION 1. ADMINISTRATION OF PUBLIC HEALTH [135 - 1179.102] ( Division 1 enacted by Stats. 1939, Ch. 60. ) ## PART 1. STATE DEPARTMENT OF HEALTH SERVICES [137 - 429.997] ( Heading of Part 1 amended by Stats. 1980, Ch. 676. ) ## CHAPTER 1.3. Women’s Health [137 - 140] ( Chapter 1.3 added by Stats. 1994, Ch. 760, Sec. 2. )

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    This section creates the California Reproductive Justice and Freedom Fund and directs the department to issue grants for medically accurate reproductive and sexual health education, subject to specified timing, eligibility, and spending limits.

    ## Health and Safety Code - HSC ## DIVISION 1. ADMINISTRATION OF PUBLIC HEALTH [135 - 1179.102] ( Division 1 enacted by Stats. 1939, Ch. 60. ) ## PART 1. STATE DEPARTMENT OF HEALTH SERVICES [137 - 429.997] ( Heading of Part 1 amended by Stats. 1980, Ch. 676. ) ## CHAPTER 1.3. Women’s Health [137 - 140] ( Chapter 1.3 added by Stats. 1994, Ch. 760, Sec. 2. ) ## 140. (a) The California Reproductive Justice and Freedom Fund (RJ Fund) is hereby established. The goal of the RJ Fund is to dismantle historic and standing systemic reproductive and sexual health inequities through medically accurate, culturally congruent education and outreach, as well as to create innovative strategies that meaningfully address and function to eliminate root causes of reproductive oppression. (b) Upon appropriation by the Legislature, the State Department of Public Health shall award grants from the RJ Fund to eligible community-based organizations over a three-year period. (1) On or before July 1, 2023, the department shall post the grant application on its internet website and solicit applications. (2) On or before December 31, 2023, the department shall award grants to selected entities based on the eligibility criteria. (c) Notwithstanding paragraphs (1) and (2) of subdivision (b), any civil penalties deposited in the RJ Fund pursuant to Section 1798.99.92 of the Civil Code shall be awarded by the State Department of Public Health in the form of grants, subject to the criteria specified in subdivisions (d) to (h), inclusive. (d) A grant recipient shall use any grant funds awarded pursuant to this section to implement a program or fund an existing program that provides and promotes medically accurate, comprehensive reproductive and sexual health education. (e) A program funded pursuant to this section shall do all of the following: (1) Promote reproductive justice. (2) Provide medically accurate, culturally congruent reproductive and sexual health education that is inclusive of information on abortion rights, care, and services. The education or outreach provided by a program shall include information on how to obtain an abortion or provide abortion referrals, especially upon request. (3) Be targeted at communities that have experienced or continue to experience high reproductive or sexual health inequities or disparities. This includes communities that have experienced reproductive or sexual health inequities or disparities because of historic and systemic oppression, including based on their race and ethnicity, immigration status, sexual orientation, gender expression, foster youth status, or disability. (f) A grant recipient may use a portion of grant funds to pay for costs associated with carrying out grant activities. An assessment of associated costs shall contemplate the community-based organization, the community served, and the nature of services it provides, and may include all of the following: (1) Building staff capacity. (2) Development and dissemination of materials. (3) Travel costs. (g) The department shall not spend more than 5 percent of the funds appropriated for the purposes of this section on administrative costs. (h) For purposes of this section: (1) “Community-based organization” means a public or private not-for-profit organization that provides education, resources, or services and is representative of a disparately impacted community or significant segments of a community or has demonstrated status as a trusted part of the community that it serves. (2) “Culturally congruent education” means education that takes account of the cultural beliefs, values, norms, patterns, way of life, or practices of the target audience to provide appropriate and meaningful education. Culturally congruent education and outreach fits a person’s or community’s lifestyle, values, and systems of meaning. It requires acknowledgment, respect, and adaptation of information to the cultural needs of the communities served. Additionally, it contemplates sociocultural and situational factors into education. (3) “Medically accurate” means factual information, verified or supported by research conducted in compliance with scientific methods, published in peer-reviewed journals, if appropriate, and recognized as accurate and objective by the relevant professional organizations. (4) “Racial equity” means the condition achieved when race can no longer be used to predict life outcomes and when conditions for all groups are improved. Racial equity includes transforming the behaviors, institutions, and systems that harm disparately impacted communities, including by increasing access to power, redistributing and providing additional resources, and eliminating barriers to opportunity, in order to empower Black, Indigenous, and communities of color to thrive and realize their full potential. (5) “Reproductive health” means the state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes. “Reproductive health” implies that a person is able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when, and how often to do so. (6) “Reproductive justice” means the human right to control our sexuality, our gender, our work, and our reproduction, which can only be achieved when all people, particularly women and girls, have the complete economic, social, and political power and resources to make healthy decisions about their bodies, their families, and their communities in all areas of their lives. At the core of “reproductive justice” is the belief that all people have the right to have children, the right to not have children, and the right to parent the children they have with dignity and respect, in safe and sustainable communities. (7) “Sexual health” means the state of physical, emotional, mental, and social well-being in relation to sexuality, and not merely the absence of disease, dysfunction, or infirmity. “Sexual health” requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination, and violence. (Amended by Stats. 2025, Ch. 134, Sec. 6. (AB 45) Effective January 1, 2026.)
  140. 1400.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.3. Referral Agencies [1400 - 1413] ( Chapter 2.3 added by Stats. 1973, Ch. 924. ) ## ARTICLE 1. General Provisions [1400 - 1409.3] ( Article 1 added by Stats. 1973, Ch. 924. )

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    Referral agencies generally cannot operate or take remunerated referrals without the required written license, and certain outside-service referrals by long-term health care facilities are allowed only if listed conditions are met.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.3. Referral Agencies [1400 - 1413] ( Chapter 2.3 added by Stats. 1973, Ch. 924. ) ## ARTICLE 1. General Provisions [1400 - 1409.3] ( Article 1 added by Stats. 1973, Ch. 924. ) ## 1400. (a) It is unlawful for any person, association, or corporation to establish, conduct or maintain a referral agency or to refer any person for remuneration to any extended care, skilled nursing home or intermediate care facility or a distinct part of a facility providing extended care, skilled nursing home care, or intermediate care, without first having obtained a written license therefor as provided in this chapter from the director or from an inspection service approved by the director pursuant to Section 1257. (b) It is unlawful for any person, association, or corporation to establish, conduct, or maintain a referral agency or to refer any person for remuneration to any person or agency outside a long-term health care facility, as defined in Section 1418, for professional services for which the long-term health care facility does not employ a qualified professional person to furnish a specific service, including, but not limited to, laboratory, diagnostic, or therapy services, unless the long-term health care facility complies with current federal and state laws regarding the provision of these services and all of the following conditions are met: (1) The services will be provided in accordance with professional standards applicable to the provision of these services in a long-term health care facility. (2) The long-term health care facility assumes responsibility for timeliness of the services. (3) Services are provided or obtained only when ordered by the attending physician and a notation is made in the resident’s medical chart reflecting that the service has been provided to the resident. (Amended by Stats. 2004, Ch. 661, Sec. 1. Effective January 1, 2005.)
  141. 1401.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.3. Referral Agencies [1400 - 1413] ( Chapter 2.3 added by Stats. 1973, Ch. 924. ) ## ARTICLE 1. General Provisions [1400 - 1409.3] ( Article 1 added by Stats. 1973, Ch. 924. )

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    This section defines “referral agency” for this chapter.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.3. Referral Agencies [1400 - 1413] ( Chapter 2.3 added by Stats. 1973, Ch. 924. ) ## ARTICLE 1. General Provisions [1400 - 1409.3] ( Article 1 added by Stats. 1973, Ch. 924. ) ## 1401. As used in this chapter “referral agency” means a private, profit or nonprofit agency which is engaged in the business of referring persons for remuneration to any extended care, skilled nursing home or intermediate care facility or a distinct part of a facility providing extended care, skilled nursing home care, or intermediate care. (Added by Stats. 1973, Ch. 924.)
  142. 1403.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.3. Referral Agencies [1400 - 1413] ( Chapter 2.3 added by Stats. 1973, Ch. 924. ) ## ARTICLE 1. General Provisions [1400 - 1409.3] ( Article 1 added by Stats. 1973, Ch. 924. )

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    License and renewal applications must include the annual fee, and renewal filings must be made with the director at least 30 days before the license expires.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.3. Referral Agencies [1400 - 1413] ( Chapter 2.3 added by Stats. 1973, Ch. 924. ) ## ARTICLE 1. General Provisions [1400 - 1409.3] ( Article 1 added by Stats. 1973, Ch. 924. ) ## 1403. Each application for a license or renewal of license under this chapter shall be accompanied by an annual Licensing and Certification Program fee set in accordance with Section 1266. Each license shall expire 12 months from its date of issuance and application for renewal accompanied by the fee shall be filed with the director not later than 30 days prior to the date of expiration. (Amended by Stats. 2006, Ch. 74, Sec. 15. Effective July 12, 2006.)
  143. 1404.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.3. Referral Agencies [1400 - 1413] ( Chapter 2.3 added by Stats. 1973, Ch. 924. ) ## ARTICLE 1. General Provisions [1400 - 1409.3] ( Article 1 added by Stats. 1973, Ch. 924. )

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    A licensee under this chapter must not have a direct or indirect financial interest in a medical facility that does business with the licensee.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.3. Referral Agencies [1400 - 1413] ( Chapter 2.3 added by Stats. 1973, Ch. 924. ) ## ARTICLE 1. General Provisions [1400 - 1409.3] ( Article 1 added by Stats. 1973, Ch. 924. ) ## 1404. No licensee under this chapter shall have a direct or indirect financial interest in any medical facility doing business with the licensee. (Added by Stats. 1973, Ch. 924.)
  144. 1404.5.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.3. Referral Agencies [1400 - 1413] ( Chapter 2.3 added by Stats. 1973, Ch. 924. ) ## ARTICLE 1. General Provisions [1400 - 1409.3] ( Article 1 added by Stats. 1973, Ch. 924. )

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    A license application must be submitted to the department when the referral agency changes ownership, name, or location.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.3. Referral Agencies [1400 - 1413] ( Chapter 2.3 added by Stats. 1973, Ch. 924. ) ## ARTICLE 1. General Provisions [1400 - 1409.3] ( Article 1 added by Stats. 1973, Ch. 924. ) ## 1404.5. A license application shall be submitted to the department whenever any of the following circumstances occur: (a) Change of ownership of the referral agency. (b) Change of name of the referral agency. (c) Change of location of the referral agency. (Added by Stats. 1985, Ch. 700, Sec. 10.)
  145. 1405.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.3. Referral Agencies [1400 - 1413] ( Chapter 2.3 added by Stats. 1973, Ch. 924. ) ## ARTICLE 1. General Provisions [1400 - 1409.3] ( Article 1 added by Stats. 1973, Ch. 924. )

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    Applicants for a referral agency license must file an application with the department on department-furnished forms.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.3. Referral Agencies [1400 - 1413] ( Chapter 2.3 added by Stats. 1973, Ch. 924. ) ## ARTICLE 1. General Provisions [1400 - 1409.3] ( Article 1 added by Stats. 1973, Ch. 924. ) ## 1405. Any person, partnership, firm, corporation or association desiring to obtain a license shall file with the department an application on forms furnished by the department. The application shall contain all of the following: (a) Name of applicant, and if an individual, whether the applicant has attained the age of 18 years. (b) Name of referral agency. (c) The location of the referral agency. (d) The business or occupation engaged in by each applicant, and by each partner, officer and director, for at least two years immediately preceding the filing of the application. In addition, each such person shall submit a statement setting forth whether he or she has previously engaged in the operation of a referral agency, whether he or she has been involved in, or the subject of, a refusal or revocation of a referral agency license, and whether he or she has been convicted of a crime other than a minor traffic offense. (e) If the applicant is a corporation, the name and principal business address of each officer and director of the corporation; and for nonpublic corporations, the name and business address of each stockholder owning 10 percent or more of the stock and the name and business address of any corporation member who has responsibility in the operation of the facility. (f) If the applicant is a partnership, the name and principal business address of each partner. (g) Evidence of the right to occupy the premises where the referral agency is to be located. (h) A copy of the partnership agreement of the Articles of Incorporation, if applicable. (i) A copy of the current organization chart. (j) A schedule of fees to be charged and collected by the referral agency, and a statement of the method by which each fee is to be computed or determined. (k) A declaration that the licensee will not have any financial interest in any health facility doing business with the referral agency. ( l) Evidence satisfactory to the department that the applicant demonstrates reputable and responsible character and the capability to comply with this chapter. (Repealed and added by Stats. 1985, Ch. 700, Sec. 12.)
  146. 1406.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.3. Referral Agencies [1400 - 1413] ( Chapter 2.3 added by Stats. 1973, Ch. 924. ) ## ARTICLE 1. General Provisions [1400 - 1409.3] ( Article 1 added by Stats. 1973, Ch. 924. )

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    This chapter does not apply to a local public agency that provides referral services free to recipients of public social services, if it is otherwise authorized by law.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.3. Referral Agencies [1400 - 1413] ( Chapter 2.3 added by Stats. 1973, Ch. 924. ) ## ARTICLE 1. General Provisions [1400 - 1409.3] ( Article 1 added by Stats. 1973, Ch. 924. ) ## 1406. This chapter shall not apply to any local public agency performing referral services without cost to recipients of public social services when otherwise authorized by law. (Added by Stats. 1985, Ch. 700, Sec. 13.)
  147. 1407.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.3. Referral Agencies [1400 - 1413] ( Chapter 2.3 added by Stats. 1973, Ch. 924. ) ## ARTICLE 1. General Provisions [1400 - 1409.3] ( Article 1 added by Stats. 1973, Ch. 924. )

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    A licensee who wants to give up a license for cancellation or temporary suspension must notify the department in writing at least 30 days before the effective date. The department may reinstate a temporarily suspended license within 12 months if it receives an application and proof of compliance with licensing requirements.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.3. Referral Agencies [1400 - 1413] ( Chapter 2.3 added by Stats. 1973, Ch. 924. ) ## ARTICLE 1. General Provisions [1400 - 1409.3] ( Article 1 added by Stats. 1973, Ch. 924. ) ## 1407. (a) Any licensee desiring to voluntarily surrender his or her license for cancellation or temporary suspension shall notify the department in writing as soon as possible and, in all cases, at least 30 days prior to the effective date of cancellation or temporary suspension of the license. (b) Any license placed in temporary suspension pursuant to this section may be reinstated by the department within 12 months of the date of the voluntary suspension on receipt of an application and evidence showing compliance with licensing requirements. (Added by Stats. 1985, Ch. 700, Sec. 14.)
  148. 1408.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.3. Referral Agencies [1400 - 1413] ( Chapter 2.3 added by Stats. 1973, Ch. 924. ) ## ARTICLE 1. General Provisions [1400 - 1409.3] ( Article 1 added by Stats. 1973, Ch. 924. )

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    The department must issue a license if the applicant complies and gets department approval; if the applicant is not compliant, the department must deny the license and notify the applicant in writing.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.3. Referral Agencies [1400 - 1413] ( Chapter 2.3 added by Stats. 1973, Ch. 924. ) ## ARTICLE 1. General Provisions [1400 - 1409.3] ( Article 1 added by Stats. 1973, Ch. 924. ) ## 1408. (a) Upon verification of compliance with this chapter and with the approval of the department, the department shall issue the license to the applicant. (b) If the applicant is not in compliance with this chapter, the department shall deny the applicant a license. Immediately upon the denial of any license, the department shall notify the applicant in writing. Within 20 days of receipt of the department’s notice, the applicant may present his or her written petition for a hearing to the department. The proceedings shall be conducted in accordance with Section 100171. (Amended by Stats. 1997, Ch. 220, Sec. 14. Effective August 4, 1997.)
  149. 1409.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.3. Referral Agencies [1400 - 1413] ( Chapter 2.3 added by Stats. 1973, Ch. 924. ) ## ARTICLE 1. General Provisions [1400 - 1409.3] ( Article 1 added by Stats. 1973, Ch. 924. )

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    Referral agencies on separate, noncontiguous premises must have separate licenses.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.3. Referral Agencies [1400 - 1413] ( Chapter 2.3 added by Stats. 1973, Ch. 924. ) ## ARTICLE 1. General Provisions [1400 - 1409.3] ( Article 1 added by Stats. 1973, Ch. 924. ) ## 1409. Separate licenses shall be required for referral agencies which are maintained on separate, noncontiguous premises. (Added by Stats. 1985, Ch. 700, Sec. 16.)
  150. 1409.1.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.3. Referral Agencies [1400 - 1413] ( Chapter 2.3 added by Stats. 1973, Ch. 924. ) ## ARTICLE 1. General Provisions [1400 - 1409.3] ( Article 1 added by Stats. 1973, Ch. 924. )

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    The license or a true copy must be posted conspicuously in a prominent place visible to the public.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.3. Referral Agencies [1400 - 1413] ( Chapter 2.3 added by Stats. 1973, Ch. 924. ) ## ARTICLE 1. General Provisions [1400 - 1409.3] ( Article 1 added by Stats. 1973, Ch. 924. ) ## 1409.1. The license or true copy thereof shall be conspicuously posted in a prominent location accessible to public view. (Added by Stats. 1985, Ch. 700, Sec. 17.)
  151. 1409.2.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.3. Referral Agencies [1400 - 1413] ( Chapter 2.3 added by Stats. 1973, Ch. 924. ) ## ARTICLE 1. General Provisions [1400 - 1409.3] ( Article 1 added by Stats. 1973, Ch. 924. )

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    Licenses issued under this article cannot be transferred.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.3. Referral Agencies [1400 - 1413] ( Chapter 2.3 added by Stats. 1973, Ch. 924. ) ## ARTICLE 1. General Provisions [1400 - 1409.3] ( Article 1 added by Stats. 1973, Ch. 924. ) ## 1409.2. Licenses issued pursuant to this article are not transferable. (Added by Stats. 1985, Ch. 700, Sec. 18.)
  152. 1409.3.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.3. Referral Agencies [1400 - 1413] ( Chapter 2.3 added by Stats. 1973, Ch. 924. ) ## ARTICLE 1. General Provisions [1400 - 1409.3] ( Article 1 added by Stats. 1973, Ch. 924. )

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    Licensees must notify the department in writing within 10 days when certain ownership or management details change.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.3. Referral Agencies [1400 - 1413] ( Chapter 2.3 added by Stats. 1973, Ch. 924. ) ## ARTICLE 1. General Provisions [1400 - 1409.3] ( Article 1 added by Stats. 1973, Ch. 924. ) ## 1409.3. (a) The licensee shall notify the department within 10 days in writing when a change of stockholder owning 10 percent or more of the nonpublic corporate stock occurs. The writing shall include the name and principal mailing addresses of the new stockholder. (b) When a change of agency manager occurs, the department shall be notified in writing within 10 days by the licensee. The notification shall include the name of the new agency manager. (c) Each licensee shall notify the department within 10 days in writing of any change of the mailing address of the licensee. The writing shall include the new mailing address of the licensee. (d) When a change in the principal officer of a corporate licensee, chairperson, president, or general manager, occurs the department shall be notified within 10 days in writing by the licensee. The writing shall include the name and principal business address of the officer. (Added by Stats. 1985, Ch. 700, Sec. 19.)
  153. 1410.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.3. Referral Agencies [1400 - 1413] ( Chapter 2.3 added by Stats. 1973, Ch. 924. ) ## ARTICLE 2. Penalties [1410 - 1413] ( Article 2 added by Stats. 1973, Ch. 924. )

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    The department may suspend or revoke licenses under this chapter for violations, and must also assess a civil penalty equal to the fees a licensee received from the violation.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.3. Referral Agencies [1400 - 1413] ( Chapter 2.3 added by Stats. 1973, Ch. 924. ) ## ARTICLE 2. Penalties [1410 - 1413] ( Article 2 added by Stats. 1973, Ch. 924. ) ## 1410. The department may suspend or revoke licenses issued under this chapter for violation of any provisions of this chapter or rules and regulations promulgated hereunder. In addition, the department shall assess a civil penalty in the amount of fees received by a licensee as a result of a violation of any provisions of this chapter or rules and regulations promulgated hereunder. Proceedings to suspend or revoke a license shall be conducted pursuant to Section 100171. (Amended by Stats. 1997, Ch. 220, Sec. 15. Effective August 4, 1997.)
  154. 1411.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.3. Referral Agencies [1400 - 1413] ( Chapter 2.3 added by Stats. 1973, Ch. 924. ) ## ARTICLE 2. Penalties [1410 - 1413] ( Article 2 added by Stats. 1973, Ch. 924. )

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    A violation of this chapter or its rules by certain licensed or certificated persons may lead to suspension or revocation of their license.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.3. Referral Agencies [1400 - 1413] ( Chapter 2.3 added by Stats. 1973, Ch. 924. ) ## ARTICLE 2. Penalties [1410 - 1413] ( Article 2 added by Stats. 1973, Ch. 924. ) ## 1411. A violation of the provisions of this chapter or rules and regulations promulgated hereunder by a person licensed pursuant to Division 2 (commencing with Section 500) or a person certificated or licensed pursuant to Chapter 17 (commencing with Section 9000) of Division 3 of, the Business and Professions Code may be grounds for suspension or revocation of the person’s license under such division. (Added by Stats. 1973, Ch. 924.)
  155. 1412.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.3. Referral Agencies [1400 - 1413] ( Chapter 2.3 added by Stats. 1973, Ch. 924. ) ## ARTICLE 2. Penalties [1410 - 1413] ( Article 2 added by Stats. 1973, Ch. 924. )

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    Anyone who refers persons without a license, in violation of Section 1400, is liable for a civil penalty equal to the remuneration illegally received.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.3. Referral Agencies [1400 - 1413] ( Chapter 2.3 added by Stats. 1973, Ch. 924. ) ## ARTICLE 2. Penalties [1410 - 1413] ( Article 2 added by Stats. 1973, Ch. 924. ) ## 1412. Any person, association or corporation referring persons without a license in violation of Section 1400 shall be liable for a civil penalty in the amount of the remuneration illegally recieved, which shall be assessed and recovered in a civil action brought in the name of the people of the State of California by the Attorney General in any court of competent jurisdiction. (Added by Stats. 1973, Ch. 924.)
  156. 1413.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.3. Referral Agencies [1400 - 1413] ( Chapter 2.3 added by Stats. 1973, Ch. 924. ) ## ARTICLE 2. Penalties [1410 - 1413] ( Article 2 added by Stats. 1973, Ch. 924. )

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    Civil penalties collected under this article must be used to administer this chapter.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.3. Referral Agencies [1400 - 1413] ( Chapter 2.3 added by Stats. 1973, Ch. 924. ) ## ARTICLE 2. Penalties [1410 - 1413] ( Article 2 added by Stats. 1973, Ch. 924. ) ## 1413. Civil penalties collected pursuant to this article shall be used to administer the provisions of this chapter. (Added by Stats. 1973, Ch. 924.)
  157. 1416.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 1. General Provisions [1416 - 1416.6] ( Article 1 added by Stats. 2001, Ch. 687, Sec. 5. )

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    This chapter is known as, and may be cited as, the Nursing Home Administrators’ Act.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 1. General Provisions [1416 - 1416.6] ( Article 1 added by Stats. 2001, Ch. 687, Sec. 5. ) ## 1416. This chapter shall be known and may be cited as the Nursing Home Administrators’ Act. (Added by Stats. 2001, Ch. 687, Sec. 5. Effective January 1, 2002.)
  158. 1416.1.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 1. General Provisions [1416 - 1416.6] ( Article 1 added by Stats. 2001, Ch. 687, Sec. 5. )

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    The State Department of Health Services establishes the Nursing Home Administrator Program, and the program licenses and regulates nursing home administrators.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 1. General Provisions [1416 - 1416.6] ( Article 1 added by Stats. 2001, Ch. 687, Sec. 5. ) ## 1416.1. There is hereby established in the State Department of Health Services a Nursing Home Administrator Program (NHAP), which shall license and regulate nursing home administrators. (Added by Stats. 2001, Ch. 687, Sec. 5. Effective January 1, 2002.)
  159. 1416.10.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 2. Administration [1416.10 - 1416.12] ( Article 2 added by Stats. 2001, Ch. 687, Sec. 5. )

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    The program has authority to set, enforce, and administer nursing home administrator licensing standards, issue or revoke licenses, and handle complaints and training-related activities.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 2. Administration [1416.10 - 1416.12] ( Article 2 added by Stats. 2001, Ch. 687, Sec. 5. ) ## 1416.10. In conformity with the requirements of Section 1908(c) of the Social Security Act (42 U.S.C. Sec. 1396g(c)), the program shall have all of the following powers and duties: (a) To develop, impose, and enforce standards that shall be met by individuals in order to receive a license as a nursing home administrator. At a minimum, the standards shall be designed to ensure that nursing home administrators shall be individuals who have not committed acts or crimes constituting grounds for denial of licensure and who are qualified by training or experience in the field of institutional administration to serve as nursing home administrators. (b) To develop and apply procedures, including examinations and investigations, for determining whether an individual meets the standards. (c) To issue licenses to individuals who have been determined to meet the standards, and to revoke or suspend licenses where grounds exist for those actions. (d) To establish and carry out procedures designed to ensure that individuals licensed as nursing home administrators will, during any period that they serve as an administrator, comply with the required standards. (e) To receive, investigate, and take appropriate action with respect to any charge or complaint filed with the program alleging that an individual licensed as a nursing home administrator has failed to comply with the required standards. (f) To conduct studies of the administration of nursing homes within the state, with a view to the improvement of the standards imposed for the licensing of nursing home administrators, and of procedures and methods for the enforcement of standards with respect to administrators of nursing homes who have been licensed under this chapter. (g) To receive and administer all funds and grants as are made available to the program in order to carry out the purposes of this chapter. (h) To encourage qualified educational institutions and other qualified organizations to establish, provide, and conduct training and instruction programs and courses that will enable all otherwise qualified individuals to attain the qualifications necessary to meet the standards set by the program for licensed nursing home administrators, and to enable licensed nursing home administrators to meet the continuing education requirements for the renewal of their licenses. (i) To consult with and seek the recommendations of the appropriate statewide professional societies, associations, institutional organizations, and educational institutions in the development of educational programs. (j) To give due consideration to the recommendations of the National Advisory Council on Nursing Home Administration, in accordance with the provisions of subdivision (f) of Section 1908 of Title XIX of the Social Security Act (42 U.S.C. Sec. 1396g(f)). (Added by Stats. 2001, Ch. 687, Sec. 5. Effective January 1, 2002.)
  160. 1416.12.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 2. Administration [1416.10 - 1416.12] ( Article 2 added by Stats. 2001, Ch. 687, Sec. 5. )

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    The department must notify the program if certain citations are overturned or modified on review, arbitration, or appeal.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 2. Administration [1416.10 - 1416.12] ( Article 2 added by Stats. 2001, Ch. 687, Sec. 5. ) ## 1416.12. The following enforcement actions taken by the department against a facility and the name of the licensed administrator of the facility shall be reported to the program. (a) Temporary suspension orders. (b) Final decertification from the Medi-Cal or Medicare programs based on failure to meet certification requirements. (c) Service of an accusation to revoke a facility’s license. (d) All class “AA” citations and three class “A” citations issued to a facility with the same administrator within a one-calendar year period. The department shall notify the program in the event that citations are overturned or modified in citation review conference, through binding arbitration, or on appeal. (Added by Stats. 2001, Ch. 687, Sec. 5. Effective January 1, 2002.)
  161. 1416.2.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 1. General Provisions [1416 - 1416.6] ( Article 1 added by Stats. 2001, Ch. 687, Sec. 5. )

    Verify source ↗

    This section defines key terms for the nursing home administrator program and limits how the section can be used to extend the program’s jurisdiction or redefine certain facilities.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 1. General Provisions [1416 - 1416.6] ( Article 1 added by Stats. 2001, Ch. 687, Sec. 5. ) ## 1416.2. (a) The following definitions shall apply to this chapter: (1) “Department” means the State Department of Health Services. (2) “NHAP” or “program” means the Nursing Home Administrator Program. (3) “State” means California, unless applied to the different parts of the United States. In this latter case, “state” includes the District of Columbia and the territories. (4) “Nursing home” means any institution, facility, place, building, or agency, or portion thereof, licensed as a skilled nursing facility, intermediate care facility, or intermediate care facility/developmentally disabled, as defined in Chapter 2 (commencing with Section 1250). “Nursing home” also means an intermediate care facility/developmentally disabled habilitative, intermediate care facility/developmentally disabled-nursing, or congregate living health facility, as defined in Chapter 2 (commencing with Section 1250), if a licensed nursing home administrator is charged with the general administration of the facility. (5) “Nursing home administrator” means an individual educated and trained within the field of nursing home administration who carries out the policies of the licensee of a nursing home and is licensed in accordance with this chapter. The nursing home administrator is charged with the general administration of a nursing home, regardless of whether he or she has an ownership interest and whether the administrator’s function or duties are shared with one or more other individuals. (6) “Administrator-in-Training Program” or “AIT Program” means a program that is approved by the NHAP in which qualified persons participate under the coordination, supervision, and teaching of a preceptor, as described in Section 1416.57, who has obtained approval from the NHAP. (b) Nothing in this section shall be construed to allow the program to have jurisdiction over an administrator of an intermediate care facility/developmentally disabled-nursing or an intermediate care facility/developmentally disabled habilitative, if the administrator of the facility is not using licensure under this chapter to qualify as an administrator in accordance with subdivision (d) of Section 1276.5. (c) Nothing in this section shall be construed to define an intermediate care facility/developmentally disabled-nursing or an intermediate care facility/developmentally disabled habilitative as a nursing home for purposes other than the licensure of nursing home administrators under this chapter. (Added by Stats. 2001, Ch. 687, Sec. 5. Effective January 1, 2002.)
  162. 1416.20.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 3. Licensing [1416.20 - 1416.50] ( Article 3 added by Stats. 2001, Ch. 687, Sec. 5. )

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    Applicants for an initial nursing home administrator license must pass the licensing examination, unless another part of the article provides otherwise.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 3. Licensing [1416.20 - 1416.50] ( Article 3 added by Stats. 2001, Ch. 687, Sec. 5. ) ## 1416.20. (a) The nursing home administrator licensing examination shall cover the broad aspects of nursing home administration. (b) Unless otherwise provided in this article, every applicant for an initial license as a nursing home administrator shall pass a nursing home administrator licensing examination, which shall consist of a state and national examination. The state examination shall be held at least four times a year, at a time and place determined by the program. The national examination is computer-based and shall be scheduled by the applicant after the applicant is notified by the program of his or her eligibility to take the examination. (c) If an applicant for licensure under this article, submits an endorsement certificate from another state indicating that he or she scored at least 75 percent on the national examination, the applicant shall be required to take only the California state part of the licensing examination. If the applicant scored less than 75 percent on the national examination, he or she shall take both the state and national examination. (Added by Stats. 2001, Ch. 687, Sec. 5. Effective January 1, 2002.)
  163. 1416.22.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 3. Licensing [1416.20 - 1416.50] ( Article 3 added by Stats. 2001, Ch. 687, Sec. 5. )

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    An applicant must meet age, character, citizenship/residency, and qualification requirements to take the licensing examination, and must submit supporting transcript and work-experience documents.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 3. Licensing [1416.20 - 1416.50] ( Article 3 added by Stats. 2001, Ch. 687, Sec. 5. ) ## 1416.22. (a) To qualify for the licensing examination, an applicant must be at least 18 years of age, be a citizen of the United States or a legal resident, be of reputable and responsible character, demonstrate an ability to comply with this chapter, and comply with at least one of the following requirements: (1) Have a master’s degree in nursing home administration or a related health administration field. The master’s program in which the degree was obtained must have included an internship or residency of at least 480 hours in a skilled nursing facility or intermediate care facility. (2) (A) With regard to applicants who have a current valid license as a nursing home administrator in another state and apply for licensure in this state, meet the minimum education requirements that existed in this state at the time the applicant was originally licensed in the other state. (B) The minimum education requirements that have existed in California are as follows: Prior to 7/1/73 None From 7/1/73 to 6/30/74 30 semester units From 7/1/74 to 6/30/75 45 semester units From 7/1/75 to 6/30/80 60 semester units From 7/1/80 to present Baccalaureate degree (3) A doctorate degree in medicine, a current valid license as a physician and surgeon, and the completion of a program-approved AIT Program of at least 1,000 hours. (4) A baccalaureate degree, and the completion of a program-approved AIT Program of at least 1,000 hours. (5) Ten years of recent full-time work experience, and a current license, as a licensed registered nurse, and the completion of a program-approved AIT Program of at least 1,000 hours. At least the most recent five years of the 10 years of work experience shall be in a supervisory or director of nursing position. (6) Ten years of full-time work experience in any department of a skilled nursing facility, an intermediate care facility, or an intermediate care facility developmentally/disabled with at least 60 semester units (or 90 quarter units) of college or university courses, and the completion of a program-approved AIT Program of at least 1,000 hours. At least the most recent five years of the 10 years of work experience shall be in a position as a department manager. (7) Ten years of full-time hospital administration experience in an acute care hospital with at least 60 semester units (or 90 quarter units) of college or university courses, and the completion of a program-approved AIT Program of at least 1,000 hours. At least the most recent five years of the 10 years of work experience shall be in a supervisory position. (b) An applicant for the licensing examination may obtain from the department a waiver of the education requirements in subdivision (a) if they meet the requirements of Section 1416.23. (c) If the applicant and the preceptor provide compelling evidence that previous work experience of the applicant directly relates to nursing home administrator duties, the program may accept a waiver exception to a portion of the AIT Program that requires 1,000 hours. An applicant seeking a waiver of the educational requirements pursuant to Section 1416.23 shall not be eligible for a waiver under this subdivision. (d) The applicant shall submit an official transcript that evidences the completion of required college and university courses, degrees, or both. An applicant who applies for the licensing examination on the basis of work experience shall submit a declaration signed under penalty of perjury, verifying his or her work experience. This declaration shall be signed by a licensed nursing home administrator, physician and surgeon, chief of staff, director of nurses, or registered nurse who can attest to the applicant’s work experience. (Amended by Stats. 2008, Ch. 397, Sec. 1. Effective January 1, 2009.)
  164. 1416.23.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 3. Licensing [1416.20 - 1416.50] ( Article 3 added by Stats. 2001, Ch. 687, Sec. 5. )

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    Certain applicants may request an educational waiver, but only if they meet specified religious-organization and experience requirements.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 3. Licensing [1416.20 - 1416.50] ( Article 3 added by Stats. 2001, Ch. 687, Sec. 5. ) ## 1416.23. (a) Upon request of an applicant who is a member of a church or religious denomination, recognized by the Internal Revenue Service under Section 501(c)(3) of the Internal Revenue Code, that owns and operates a faith-based skilled nursing facility in California, and whose teachings historically prohibit the acquisition of the formal education that would otherwise be required to qualify for the AIT Program and the licensing examination, that applicant may seek an educational waiver. That applicant shall be required to possess at least an accredited high school diploma or proof of successfully passing a General Educational Development (GED) test of the American Council on Education or the California High School Proficiency Examination, as well as 10 years of full-time work experience in business, health, or rehabilitation fields, with at least five of the 10 years of work experience in business, health, or rehabilitation management or administration. (b) The department may review the applicant’s church’s or religious denomination’s Internal Revenue Code 501(c)(3) application, including attachments, the Internal Revenue Service’s Letter of Determination of tax-exempt status to the church or religious denomination, and the church’s or religious denomination’s bylaws, constitution, or member orientation information to confirm an applicant’s eligibility for the educational waiver. The applicant’s church or religious denomination shall provide the foregoing information to the department for its review and processing of the educational waiver application. The department shall accept notarized copies of these documents. (c) If the educational requirements are waived, the applicant successfully completes the program-approved 1,000 hour AIT Program, and is successful in passing the national and state licensing examinations, the applicant may only serve as a nursing home administrator in a facility that is owned and operated by the applicant’s church or religious denomination. (Added by Stats. 2008, Ch. 397, Sec. 2. Effective January 1, 2009.)
  165. 1416.24.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 3. Licensing [1416.20 - 1416.50] ( Article 3 added by Stats. 2001, Ch. 687, Sec. 5. )

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    Applicants for a nursing home administrator license must file a complete application with the required fee, required examination and licensure materials, fingerprints evidence, and the security agreement terms; the program may extend the one-year application period for good cause.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 3. Licensing [1416.20 - 1416.50] ( Article 3 added by Stats. 2001, Ch. 687, Sec. 5. ) ## 1416.24. (a) An application for a nursing home administrator license shall be submitted to the program on a form provided by the program, with the appropriate nonrefundable fee for any required examination, the application, and licensure. The application shall contain information the program deems necessary to determine the applicant’s qualifications and a statement whether the individual has been convicted of any crime other than a minor traffic violation. Each applicant shall meet the current requirements for any required examination and licensure. Applicants for licensure shall submit evidence of electronic transmission of fingerprints or fingerprint cards to the program. (b) A completed application package, together with the examination application, and licensure fees must be received by the program at least 30 days prior to the examination date. (c) (1) The withdrawal of an application for a license after it has been filed with the department shall not, unless the department consents in writing to the withdrawal, deprive the department of its authority to institute or continue a proceeding against the applicant for the denial of the license upon any ground provided by law or to enter an order denying the license upon that ground. (2) The suspension, expiration, or forfeiture by operation of law of a license issued by the department, the suspension, forfeiture, or cancellation by order of the department or a court of law of a license, or the surrender without the written consent of the department of a license, shall not deprive the department of its authority to institute or continue a disciplinary proceeding against the licensee upon any ground provided by law or to enter an order suspending or revoking the license or otherwise taking disciplinary action against the licensee on any grounds. (d) An application that is submitted to the program is valid for only one year after the date of receipt. An applicant who fails to meet all requirements for licensure, including successfully passing the national and state examinations during that one-year period, shall be required to submit another application and appropriate application and examination fees to the program before attempting further examinations. (e) The program may extend the one-year period described in subdivision (d) upon a showing of good cause. For purposes of this subdivision, good causes shall include, but shall not be limited to, delays in the processing of the application, or delays in applying for and taking the examination caused by illness, accident, or other extenuating circumstances. (f) An applicant shall submit documentation and evidence to the program of his or her eligibility for licensure. (g) At the time of the examination, the applicant shall read and sign the Examination Security Agreement and comply with its terms. (Added by Stats. 2001, Ch. 687, Sec. 5. Effective January 1, 2002.)
  166. 1416.26.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 3. Licensing [1416.20 - 1416.50] ( Article 3 added by Stats. 2001, Ch. 687, Sec. 5. )

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    Applicants for a nursing home administrator license must submit fingerprint information electronically for a criminal record search and provide proof of transmission; the Department of Justice must notify the department of the search response.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 3. Licensing [1416.20 - 1416.50] ( Article 3 added by Stats. 2001, Ch. 687, Sec. 5. ) ## 1416.26. (a) As part of the application process for a nursing home administrator license, an applicant shall electronically submit fingerprint images and related information, for a criminal offender record information search, to the Department of Justice and the Federal Bureau of Investigation, through the Department of Justice. The applicant shall provide proof of electronic transmission of his or her fingerprint images and related information to the Department of Justice and the Federal Bureau of Investigation. Upon receipt of the fingerprint images and related information, the Department of Justice shall notify the department with a state or federal level criminal offender record information search response. If no state or federal level criminal record information has been recorded, the Department of Justice shall provide the department with a statement of that fact. (b) This criminal record clearance shall be completed prior to issuing a license. Applicants shall be responsible for any costs associated with the criminal record clearance. The fee to cover the processing costs of the Department of Justice, not including the costs associated with capturing or transmitting the fingerprint images and related information, shall not exceed thirty-two dollars ($32) for a state level criminal offender record information search, and shall not exceed twenty-four dollars ($24) for a federal level criminal offender record information search. (Amended by Stats. 2006, Ch. 902, Sec. 3. Effective January 1, 2007.)
  167. 1416.28.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 3. Licensing [1416.20 - 1416.50] ( Article 3 added by Stats. 2001, Ch. 687, Sec. 5. )

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    The program must collect an applicant’s or licensee’s federal employer identification number or Social Security number when a nursing home administrator license is applied for, issued, or renewed, and it must restrict disclosure and use of that information.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 3. Licensing [1416.20 - 1416.50] ( Article 3 added by Stats. 2001, Ch. 687, Sec. 5. ) ## 1416.28. (a) Notwithstanding any other law, the program shall at the time of application, issuance, or renewal of a nursing home administrator license require that the applicant or licensee provide the federal employer identification number or social security number of the applicant or licensee. (b) Any applicant or licensee failing to provide a federal identification number or social security number shall be reported by the program to the Franchise Tax Board and, if failing to provide after notification pursuant to paragraph (1) of subdivision (b) of Section 19528 of the Revenue and Taxation Code, shall be subject to the penalty provided in paragraph (2) of subdivision (b) of Section 19528 of the Revenue and Taxation Code. (c) In addition to the penalty specified in subdivision (b), the program may not process any application, original license, or renewal of a license unless the applicant or licensee provides a federal employer identification number or social security number where requested on the application. (d) The program shall, upon request of the Franchise Tax Board, furnish to the Franchise Tax Board the following information with respect to every licensee: (1) Name. (2) Address or addresses of record. (3) Federal employer identification number or social security number. (4) Type of license. (5) Effective date of license or renewal. (6) Expiration date of license. (7) Whether license is active or inactive, if known. (8) Whether license is new or a renewal. (e) The reports required under this section shall be filed on magnetic media or in other machine-readable form, according to standards furnished by the Franchise Tax Board. (f) The program shall provide to the Franchise Tax Board the information required by this section at a time that the Franchise Tax Board may require. (g) Notwithstanding Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code, the social security number and federal employer identification number furnished pursuant to this section shall not be deemed to be a public record and shall not be open to the public for inspection. (h) Any deputy, agent, clerk, officer, or employee of the program described in this chapter, any former officer or employee, or other individual who in the course of employment or duty has or has had access to the information required to be furnished under this chapter, may not disclose or make known in any manner that information, except as provided in this section to the Franchise Tax Board or as provided in subdivision (j). (i) It is the intent of the Legislature in enacting this section to utilize the social security account number or federal employer identification number for the purpose of establishing the identification of persons affected by state tax laws and for purposes of compliance with Section 17520 of the Family Code and, to that end, the information furnished pursuant to this section shall be used exclusively for those purposes. (j) If the program utilizes a national examination to issue a license, and if a reciprocity agreement or comity exists between California and the state requesting release of the social security number, any deputy, agent, clerk, officer, or employee of the program described in this chapter may release a social security number to an examination or licensing entity, only for the purpose of verification of licensure or examination status. (Amended by Stats. 2021, Ch. 615, Sec. 232. (AB 474) Effective January 1, 2022. Operative January 1, 2023, pursuant to Sec. 463 of Stats. 2021, Ch. 615.)
  168. 1416.30.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 3. Licensing [1416.20 - 1416.50] ( Article 3 added by Stats. 2001, Ch. 687, Sec. 5. )

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    Before issuing or renewing a nursing home administrator license, the program must require compliance with any support judgment or order.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 3. Licensing [1416.20 - 1416.50] ( Article 3 added by Stats. 2001, Ch. 687, Sec. 5. ) ## 1416.30. (a) The program shall require compliance with any judgment or order for support prior to issuance or renewal of a license. (b) Each applicant for the issuance or renewal of a nursing home administrator license, who is not in compliance with a judgment or order for support shall be subject to Section 11350.6 of the Welfare and Institutions Code. (c) “Compliance with a judgment or order of support” has the same meaning as specified in paragraph (4) of subdivision (a) of Section 11350.6 of the Welfare and Institutions Code. (Added by Stats. 2001, Ch. 687, Sec. 5. Effective January 1, 2002.)
  169. 1416.32.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 3. Licensing [1416.20 - 1416.50] ( Article 3 added by Stats. 2001, Ch. 687, Sec. 5. )

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    Applicants must sign and follow an examination security agreement before admission to the licensing exam. The program may discipline applicants or licensees for listed exam-security violations, and violating the section is a misdemeanor with possible damages liability.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 3. Licensing [1416.20 - 1416.50] ( Article 3 added by Stats. 2001, Ch. 687, Sec. 5. ) ## 1416.32. (a) Prior to admission to the licensing examination, the applicant shall read and sign an examination security agreement and comply with its terms. (b) The program may deny, suspend, revoke, or otherwise restrict the license of an applicant or a licensee for any of the following acts: (1) Having or attempting to have an impersonator take the examination on one’s behalf. (2) Impersonating or attempting to impersonate another to take the examination on that person’s behalf. (3) Communicating or attempting to communicate about the examination content with another examinee or with any person other than the examination staff. This includes divulging the content of specific written examination items to examination preparation providers. (4) Copying questions or making notes of examination materials or revealing the content of the examination to others who are preparing to take the NHAP examination or who are preparing others to take such examination. (5) Obstructing or attempting to obstruct the administration of the examination in any way. (c) It is a misdemeanor for any person to engage in any conduct that subverts or attempts to subvert any licensing examination or the administration of an examination, including, but not limited to, the following conduct: (1) Conduct that violates the security of the examination materials, removing from the examination room any examination materials without authorization, the unauthorized reproduction by any means of any portion of the actual licensing examination, aiding by any means the unauthorized reproduction of any portion of the actual licensing examination, paying or using professional or paid examination-takers for the purpose of reconstructing any portion of the licensing examination, obtaining examination questions or other examination material, except by specific authorization either before, during, or after an examination, using or purporting to use any examination questions or materials that were improperly removed or taken from any examination for the purpose of instructing or preparing any applicant for examination, or selling, distributing, buying, receiving, or having unauthorized possession of any portion of a future, current, or previously administered licensing examination. (2) Communicating with any other candidate during the administration of a licensing examination, copying answers from another examinee or permitting one’s answers to be copied by another examinee, having in one’s possession during the administration of the licensing examination any books, equipment, notes, written or printed materials, or data of any kind, other than the examination materials distributed, or otherwise authorized to be in one’s possession during the examination, or impersonating any examinee or having an impersonator take the licensing examination on one’s behalf. (d) Nothing in this section shall preclude prosecution under the authority provided for in any other provision of law. (e) In addition to any other penalties, a person found guilty of violating this section, shall be liable for the actual damages sustained by the agency administering the examination not to exceed ten thousand dollars ($10,000) and the costs of litigation. (f) The proceedings under this section shall be governed by Chapter 3 (commencing with Section 525) of Title 7 of Part 2 of the Code of Civil Procedure. (g) The remedy provided for by this section shall be in addition to, and not a limitation on, the authority provided for in any other provision of law. (Added by Stats. 2001, Ch. 687, Sec. 5. Effective January 1, 2002.)
  170. 1416.34.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 3. Licensing [1416.20 - 1416.50] ( Article 3 added by Stats. 2001, Ch. 687, Sec. 5. )

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    This section sets exam, licensing, and reporting rules for nursing home administrator licenses.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 3. Licensing [1416.20 - 1416.50] ( Article 3 added by Stats. 2001, Ch. 687, Sec. 5. ) ## 1416.34. (a) (1) In order to have a passing score on either the national or state examination, an examinee shall earn a score of at least 75 percent. (2) An applicant who fails to pass either the national or state examination shall retake the entire national or state examination. (3) An applicant who fails to pass either the state or national examination after three attempts shall receive additional training as outlined by the program from a program-approved preceptor, prior to participating in another examination. (b) The examination shall be administered and evaluated by either of the following: (1) The department. (2) A contractor or vendor pursuant to a written agreement with the program or department. (c) The results of the examination shall be provided to each applicant in a timely manner, not to exceed 90 days from the date of the examination. (d) The program shall issue a license to an applicant who successfully passes the required examination and has satisfied all other requirements for licensure. (e) A license shall be effective for a period of two years from the date of issuance. (f) The program shall issue a provisional license to candidates who meet the provisional licensure requirements established by this chapter. (g) The program shall replace a lost, damaged, or destroyed license certificate upon receipt of a written request from a licensee and payment of the duplicate license fee. A licensee shall complete a request for a duplicate license on the required program form, and then submit it to the program. (h) A licensee shall inform the program of the licensee’s current home address, mailing address, and if employed by a nursing facility, the name and address of that employer. A licensee shall report a change in any of this information to the program within 30 calendar days. Failure of the licensee to provide timely notice to the program may result in a citation penalty. A licensee shall provide to the program an address to be included in the public files. (i) A licensee shall display his or her license and show to anyone upon request in order to inform patients or the public as to the identity of the regulatory agency that they may contact if they have questions or complaints regarding the licensee. (Added by Stats. 2001, Ch. 687, Sec. 5. Effective January 1, 2002.)
  171. 1416.36.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 3. Licensing [1416.20 - 1416.50] ( Article 3 added by Stats. 2001, Ch. 687, Sec. 5. )

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    This section sets the fees for nursing home administrator licensing and related applications, exams, renewals, and approvals, and requires the department to publish fee adjustment lists and an annual report.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 3. Licensing [1416.20 - 1416.50] ( Article 3 added by Stats. 2001, Ch. 687, Sec. 5. ) ## 1416.36. (a) The fees prescribed by this chapter are as follows: (1) The application fee for reviewing an applicant’s eligibility to take the examination shall be twenty-five dollars ($25). (2) The application fee for persons applying for reciprocity consideration licensure under Section 1416.40 shall be fifty dollars ($50). (3) The application fee for persons applying for the AIT Program shall be one hundred dollars ($100). (4) The examination fees shall be: (A) Two hundred seventy-five dollars ($275) for an automated national examination. (B) Two hundred ten dollars ($210) for an automated state examination or one hundred forty dollars ($140) for a written state examination. (5) The fee for an initial license shall be one hundred ninety dollars ($190). (6) The renewal fee for an active or inactive license shall be one hundred ninety dollars ($190). (7) The delinquency fee shall be fifty dollars ($50). (8) The duplicate license fee shall be twenty-five dollars ($25). (9) The fee for a provisional license shall be two hundred fifty dollars ($250). (10) The fee for endorsement of credentials to the licensing authority of another state shall be twenty-five dollars ($25). (11) The preceptor certification fee shall be fifty dollars ($50) for each three-year period. (12) The biennial fee for approval of a continuing education provider shall be one hundred fifty dollars ($150). (13) The biennial fee for approval of a continuing education course shall be not more than fifteen dollars ($15). (b) (1) If the revenue projected to be collected is less than the projected costs for the budget year, the department may propose that fees be adjusted to an amount sufficient to cover the reasonable regulatory costs to the department. Notwithstanding Section 10231.5 of the Government Code, commencing February 1, 2013, and every February 1 thereafter, the department shall publish a list of proposed adjustments to fees pursuant to this section. The department shall make this list available to the public by submitting it to the appropriate policy and fiscal committees of the Legislature and by posting it on the department’s Internet Web site. (2) The list described in paragraph (1) shall be submitted in compliance with Section 9795 of the Government Code. (c) (1) The department shall, within 30 days of the enactment of the annual Budget Act each year, publish a list of actual numerical fee charges as adjusted pursuant to this section. The final fee list, with an explanation of any adjustment, shall be published by both of the following means: (A) On the department’s Internet Web site. (B) In the initial licensing application package, by including a reference to the link to the department’s Internet Web site address as described in subparagraph (A). (2) (A) This adjustment of fees and the publication of the fee list shall not be subject to the requirements of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code. (d) (1) Notwithstanding Section 10231.5 of the Government Code, by February 1 of each year, the department shall prepare a report containing the following information, and shall make this report available to the public by submitting it to the appropriate policy and fiscal committees of the Legislature and by posting it on the department’s Internet Web site, as required by Section 1266: (A) Estimates of costs to implement activities required by this chapter and estimated fee revenue. (B) Recommended adjustments to fees based on projected workload and costs. (C) An analysis containing the following information for the current fiscal year and each of the previous four fiscal years: (i) The number of persons applying for a nursing home administrator’s license, the number of nursing home administrator licenses approved or denied, and the number of nursing home administrator licenses renewed. (ii) The number of applicants taking the nursing home administrator exam and the number of applicants who pass or fail the exam. (iii) The number of persons applying for, accepted into, and completing the AIT Program. (iv) The number, source, and disposition of complaints made against persons in the AIT Program and licensed nursing home administrators, including the length of time between receipt of the complaint and completion of the investigation. (v) The number and type of final administrative, remedial, or disciplinary actions taken against licensed nursing home administrators. (vi) A listing of the names and nature of violations for individual licensed nursing home administrators, including final administrative, remedial, or disciplinary actions taken. (vii) The number of appeals, informal conferences, or hearings filed by nursing home administrators or held, the length of time between the request being filed and the final determination of the appeal, and the number of administrative, remedial, or disciplinary actions taken. (2) The report required to be submitted pursuant to paragraph (1) shall be submitted in compliance with Section 9795 of the Government Code. (Amended by Stats. 2012, Ch. 672, Sec. 3. (AB 1710) Effective January 1, 2013.)
  172. 1416.38.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 3. Licensing [1416.20 - 1416.50] ( Article 3 added by Stats. 2001, Ch. 687, Sec. 5. )

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    Fees collected under this chapter must be paid into the specified fund within 10 days after the start of each month.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 3. Licensing [1416.20 - 1416.50] ( Article 3 added by Stats. 2001, Ch. 687, Sec. 5. ) ## 1416.38. Within 10 days after the beginning of every month, all fees collected by the program for the month preceding, under this chapter, shall be paid into the State Department of Public Health Licensing and Certification Program Fund established by Section 1266.9, to defray the expenses of the program and in carrying out and enforcing the provisions of this chapter. (Amended by Stats. 2012, Ch. 672, Sec. 4. (AB 1710) Effective January 1, 2013.)
  173. 1416.4.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 1. General Provisions [1416 - 1416.6] ( Article 1 added by Stats. 2001, Ch. 687, Sec. 5. )

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    The program must adopt rules and regulations that are reasonably necessary to carry out this chapter.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 1. General Provisions [1416 - 1416.6] ( Article 1 added by Stats. 2001, Ch. 687, Sec. 5. ) ## 1416.4. The program shall adopt rules and regulations that are reasonably necessary to carry out this chapter. The rules and regulations shall be adopted, amended, and repealed in accordance with Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code. To the extent that the regulations governing the nursing home administrator program that are in effect prior to January 1, 2002, are not in conflict with this chapter, they shall remain in effect until new regulations are implemented for purposes of this chapter. (Added by Stats. 2001, Ch. 687, Sec. 5. Effective January 1, 2002.)
  174. 1416.40.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 3. Licensing [1416.20 - 1416.50] ( Article 3 added by Stats. 2001, Ch. 687, Sec. 5. )

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    This section lets a qualified out-of-state nursing home administrator applicant get a one-year provisional license, but the applicant must apply, certify information, submit documents and fees, meet disclosure and proof requirements, and pass the state examination.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 3. Licensing [1416.20 - 1416.50] ( Article 3 added by Stats. 2001, Ch. 687, Sec. 5. ) ## 1416.40. (a) For purposes of this chapter, “reciprocity applicant” means any applicant who holds a current license as a nursing home administrator in another state has been licensed and in good standing, has passed the national examination, and the applicant is otherwise qualified. (b) An applicant who holds a current valid license as a nursing home administrator in another state may be issued a one-year provisional license as a reciprocity applicant pursuant to this section. The provisional license authorizes the holder to work in this state at a licensed nursing facility during the one-year licensure period. (c) The applicant shall obtain an application form from the program, complete the form accurately, and, under penalty of perjury, certify the experience, education, and criminal record history information supplied in the application. The applicant shall submit the application to the program, along with any supporting documents to substantiate the application and the applicable provisional, examination, and licensure fees. (d) The provisional license may be granted to a reciprocity applicant who complies with all of the following informational requirements: (1) Provides a statement of health consistent with an ability to perform the duties of a nursing home administrator. (2) Discloses the fact of and the circumstances surrounding any of the following: (A) Conviction of any criminal law violation of any country, state, or municipality, except minor traffic violations. The applicant shall submit appropriate criminal record information for purposes of this subparagraph. (B) Any discipline affecting nursing home administrator licensure in any state. (C) Any pending investigations or disciplinary actions concerning, or surrender of, nursing home administrator licensure in any state. The applicant shall submit an endorsement certificate to verify state licensure and substantiate if he or she has no pending investigation, disciplinary action, or surrender under this subparagraph. (3) Submits official transcripts as evidence of completed college or university courses and degrees. (4) Provides satisfactory evidence of current or recent employment experience within the last five years as a licensed nursing home administrator. (5) Submits proof that the applicant is at least 18 years of age. (e) The reciprocity applicant who holds a provisional license as authorized by this section shall be required to pass the state examination. If the provisional licensee, fails to pass the state examination within the one-year provisional licensure period, the provisional license shall expire and no further reciprocity accommodations shall be allowed. The provisional license may not be renewed or extended. At the expiration of the provisional license the applicant may seek licensure in this state through standard procedures. (Added by Stats. 2001, Ch. 687, Sec. 5. Effective January 1, 2002.)
  175. 1416.42.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 3. Licensing [1416.20 - 1416.50] ( Article 3 added by Stats. 2001, Ch. 687, Sec. 5. )

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    Most licenses under this chapter expire 24 months after issuance, with a special exception for provisional licenses. Renewal and reinstatement both require filings with the program, fees, and, for active licenses, proof of continuing education.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 3. Licensing [1416.20 - 1416.50] ( Article 3 added by Stats. 2001, Ch. 687, Sec. 5. ) ## 1416.42. (a) Except for provisional licenses issued pursuant to Section 1416.40, each license issued pursuant to this chapter shall expire 24 months from the date of issuance. (b) To renew an unexpired license the licensee shall, at least 30 days prior to the expiration of the license, submit an application for renewal on a form provided by the program, accompanied by the renewal fee. An applicant may request either an active license or an inactive license. If an applicant requests an active license, he or she shall submit proof of completion of the required hours of program-approved continuing education. (c) A delinquency fee is payable for license renewals not received by the program one day after the license expires. (d) A license which has expired may be reinstated within three years following the date of expiration. The licensee shall apply for reinstatement on a form provided by the program and submit the completed form together with the current fee for license renewal. If the licensee requests an active license, he or she shall furnish proof of completion of the required hours of continuing education. The reinstatement shall be effective on the date that the completed application, including required fees, is submitted and approved. (Added by Stats. 2001, Ch. 687, Sec. 5. Effective January 1, 2002.)
  176. 1416.44.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 3. Licensing [1416.20 - 1416.50] ( Article 3 added by Stats. 2001, Ch. 687, Sec. 5. )

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    Some licensees who let a nursing home administrator license expire while serving in the U.S. armed services during war may reinstate it without examination or penalty if they meet the listed conditions.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 3. Licensing [1416.20 - 1416.50] ( Article 3 added by Stats. 2001, Ch. 687, Sec. 5. ) ## 1416.44. (a) Notwithstanding any other provision of law, a licensee who permitted his or her license to expire while serving in any branch of the armed services of the United States during a period of war, as defined in subdivision (e), may, upon application, reinstate his or her license without examination or penalty if the following conditions are met: (1) His or her license was valid at the time he or she entered the armed services. (2) The application for reinstatement is made while serving in the armed services, not later than one year from the date of discharge from active service or return to inactive military status, or within three years following the license date of expiration whichever is the most recent time period. (3) The application for reinstatement is accompanied by an affidavit showing the date of entrance into the service, whether still in the service or date of discharge, and the renewal fee for the current renewal period in which the application is filed is paid. (4) The application for reinstatement indicates no criminal convictions while absent from the profession. (b) If application for reinstatement is filed more than one year after discharge or return to inactive status, the applicant, in the discretion of the licensing program, may be required to pass an examination and pay additional fees. (c) Unless otherwise specifically provided by law, any licensee who, either part time or full time, practices in this state the nursing home administrator profession shall be required to maintain his or her license in good standing even though he or she is in military service. (d) For the purposes in this section, time spent by a licensee in receiving treatment or hospitalization in any veterans’ facility during which he or she is prevented from practicing his or her profession or vocation shall be excluded in determining the periods specified in paragraph (2) of subdivision (a). (e) As used in this section, “war” means any of the following circumstances: (1) Whenever Congress has declared war and peace has not formally been restored. (2) Whenever the United States is engaged in active military operations against any foreign power, whether or not war has been formally declared. (3) Whenever the United States is assisting the United Nations, in actions involving the use of armed force, to restore international peace and security. (Added by Stats. 2001, Ch. 687, Sec. 5. Effective January 1, 2002.)
  177. 1416.45.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 3. Licensing [1416.20 - 1416.50] ( Article 3 added by Stats. 2001, Ch. 687, Sec. 5. )

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    A licensee may not do licensed work while the license is suspended or revoked, or after it expires.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 3. Licensing [1416.20 - 1416.50] ( Article 3 added by Stats. 2001, Ch. 687, Sec. 5. ) ## 1416.45. A licensee may not engage in licensed activity while his or her license is suspended or revoked, or after it has expired. (Added by Stats. 2001, Ch. 687, Sec. 5. Effective January 1, 2002.)
  178. 1416.46.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 3. Licensing [1416.20 - 1416.50] ( Article 3 added by Stats. 2001, Ch. 687, Sec. 5. )

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    A revoked license cannot be renewed, but the revoked licensee may petition for reinstatement after at least one year, and the program must decide the petition.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 3. Licensing [1416.20 - 1416.50] ( Article 3 added by Stats. 2001, Ch. 687, Sec. 5. ) ## 1416.46. (a) A revoked license may not be renewed. (b) A licensee whose license has been revoked may petition the program for reinstatement after a period of not less than one year has elapsed from the effective date of the decision or from the date of the denial of a similar petition. The petitioner shall be afforded an opportunity to present either oral or written argument before the program. The program shall decide the petition and the decision shall include the reasons therefor, and any terms and conditions that the program reasonably deems appropriate to impose as a condition of reinstatement. (Added by Stats. 2001, Ch. 687, Sec. 5. Effective January 1, 2002.)
  179. 1416.48.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 3. Licensing [1416.20 - 1416.50] ( Article 3 added by Stats. 2001, Ch. 687, Sec. 5. )

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    A licensee who does not plan to do licensed nursing home administrator work may request inactive status for the license.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 3. Licensing [1416.20 - 1416.50] ( Article 3 added by Stats. 2001, Ch. 687, Sec. 5. ) ## 1416.48. A licensee who does not intend to engage in activity requiring nursing home administrator licensure may file a request to place his or her license in inactive status. An inactive license is subject to all requirements for renewal, including payment of fees, but completion of continuing education is not required to renew an inactive license. However, proof of completion of 40 continuing education credits during the last two years shall be submitted together with an application for reinstatement of an active license. (Added by Stats. 2001, Ch. 687, Sec. 5. Effective January 1, 2002.)
  180. 1416.50.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 3. Licensing [1416.20 - 1416.50] ( Article 3 added by Stats. 2001, Ch. 687, Sec. 5. )

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    A nursing home administrator must complete approved continuing education to renew a license, including 40 hours total and at least 10 hours in aging or patient care.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 3. Licensing [1416.20 - 1416.50] ( Article 3 added by Stats. 2001, Ch. 687, Sec. 5. ) ## 1416.50. (a) For purposes of this chapter, “continuing education” means any course of study offered by an educational institution, association, professional society, or organization for the purpose of providing continuing education for nursing home administrators. (b) This section shall govern the continuing education requirements needed by a nursing home administrator to renew his or her nursing home administrator license. (c) In order to renew a license, the applicant shall provide evidence satisfactory to the program that he or she has completed 40 hours of program-approved continuing education courses, of which at least 10 total hours shall be specifically in the area of aging or patient care. (d) The continuing education courses to be approved for credit toward the continuing education requirements may include the following subject areas offered by accredited colleges, universities, community colleges, or a training entity approved by the department. (1) Resident care. (2) Personnel management. (3) Financial management. (4) Environmental management. (5) Regulatory management. (6) Organizational management. (7) Patient care and aging. (e) No continuing education credit shall be allowed for courses failed according to the institution’s grading determination. (f) If the program finds that programs of training and instruction conducted within the state are not sufficient in number or content to enable nursing home administrators to meet requirements established by law and this chapter, the program may approve courses conducted within and without this state as sufficient to meet educational requirements established by law and this chapter. For the purposes of this subdivision, the program shall have the authority to receive funds in a manner consistent with the requirements of the federal government. (Added by Stats. 2001, Ch. 687, Sec. 5. Effective January 1, 2002.)
  181. 1416.55.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 4. Training [1416.55 - 1416.57] ( Article 4 added by Stats. 2001, Ch. 687, Sec. 5. )

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    This section requires the NHAP to develop an Administrator-in-Training Program and sets eligibility and application requirements for applicants.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 4. Training [1416.55 - 1416.57] ( Article 4 added by Stats. 2001, Ch. 687, Sec. 5. ) ## 1416.55. (a) An Administrator-in-Training Program (AIT Program) shall be developed by the NHAP, in consultation with representatives from the long-term care industry and advocacy groups. The AIT Program shall include, but not be limited to, all of the following areas of instruction: (1) Orientation. (2) Administration and business office. (3) State and federal regulations governing long-term care facilities. (4) Residents’ rights and abuse prevention. (5) Staffing requirements and workforce retention. (6) Nursing services. (7) Resident activities. (8) Resident care. (9) Social services. (10) Dietary management. (11) Environmental care, including housekeeping, laundry, and maintenance. (12) Financial management. (13) General management. (14) Government regulations. (15) Legal management. (16) Personnel management and training. (17) Consultants and contracts. (18) Medical records. (19) Public relations and marketing. (b) A person who seeks to satisfy requirements for admission to licensure examinations through participation in an AIT Program shall first receive approval to begin the AIT Program. An applicant shall successfully complete the AIT Program in a program-approved facility under the coordination, supervision, and teaching of a preceptor who has obtained certification from the program and continues to meet the qualifications set forth in the rules and regulations of the program. (c) In order to be eligible for the AIT Program, an applicant shall submit an application package on forms provided by the NHAP, and pay the applicable fees established by this chapter. The applicant shall be at least 18 years of age. (d) In addition to the requirements in subdivision (c), the applicant shall meet one or a combination of the following requirements to be eligible for the AIT Program: (1) A doctorate degree in medicine and a current valid license as a physician and surgeon. (2) A baccalaureate degree. (3) Ten years of full-time work experience and a current valid license as a registered nurse. At least the most recent five years of the 10 years of work experience shall be in a supervisory or director of nursing position. (4) Ten years of full-time work experience in any department of a skilled nursing facility, an intermediate care facility, or an intermediate care facility/developmentally disabled with at least 60 semester units (or 90 quarter units) of college or university courses. At least the most recent five years of the 10 years of work experience shall be in a position as a department manager. (5) Ten years of full-time hospital administration experience in an acute care hospital with at least 60 semester units (or 90 quarter units) of college or university courses. At least the most recent five years of the 10 years of work experience shall be in a supervisory position. (e) An applicant for the AIT Program may obtain from the department a waiver of the education requirements in subdivision (d) if he or she meets the requirements of Section 1416.23. (f) The applicant shall submit an official transcript that evidences the completion of required college or university courses, degrees, or both. An applicant who is a member of a recognized church or religious denomination whose teachings historically prohibit the acquisition of the formal education that would otherwise be required to qualify the applicant for the AIT Program may request a written waiver of the education requirements from the department. (g) An applicant who qualifies for the AIT Program on the basis of work experience shall submit a declaration signed under penalty of perjury verifying his or her work experience. This declaration shall be signed by a licensed nursing home administrator, physician and surgeon, chief of staff, director of nurses, or registered nurse who can attest to the applicant’s work experience. (Amended by Stats. 2008, Ch. 397, Sec. 3. Effective January 1, 2009.)
  182. 1416.57.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 4. Training [1416.55 - 1416.57] ( Article 4 added by Stats. 2001, Ch. 687, Sec. 5. )

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    A person may be approved as a preceptor only if the section’s requirements are met, and the approval lasts two years.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 4. Training [1416.55 - 1416.57] ( Article 4 added by Stats. 2001, Ch. 687, Sec. 5. ) ## 1416.57. (a) An individual may, upon compliance with the requirements of this section, be approved by the program to be a preceptor who is authorized to provide a training program in which the preceptor coordinates, supervises, and teaches persons seeking to meet specified requirements to qualify for the licensing examination under this chapter. The approval obtained under this section shall be effective for a period of two years, after which the preceptor is required to renew his or her preceptor status and attend a preceptor training course provided by the program. (b) In order to qualify to be a preceptor, a person shall meet all of the following conditions: (1) Be a current active California licensed nursing home administrator. (2) Have no pending disciplinary actions. (3) Have served for at least two years as the designated administrator of a California licensed nursing home or for at least four years as the designated assistant administrator of a California licensed nursing home. (4) Have gained experience in all administrative functions of a nursing home. (c) The applicant seeking approval to be a preceptor shall submit an application form provided by the program that requires the applicant’s name, address, birth date, the states and dates of issuance of all professional licenses, including those as a nursing home administrator, and any other information required by the program. (d) At the time of application, for purposes of substantiating that the conditions specified in subdivision (b) have been met, the applicant shall provide satisfactory evidence of his or her education, experience, and knowledge that qualifies him or her to supervise the training of an AIT Program participant and verification that the facilities at which the applicant has had direct management control as an administrator had a continuous operating history, free from major deficiencies, during the period of the applicant’s administration. (e) An applicant shall not be approved as a preceptor until the applicant attends a preceptor’s training seminar provided or approved by the program. (f) (1) For purposes of this section, “AIT” means Administrator-in-Training. (2) The following requirements shall apply to a preceptor approved pursuant to this section: (A) The preceptor shall provide a directly supervised training program that will include a minimum of 20 hours per week and a maximum of 60 hours per week and be available at least by telephone at all other times. There shall be regular personal contact between the preceptor and the AIT during the training program. For purposes of this subparagraph, “a directly supervised training program” means supervision by a preceptor of an AIT during the performance of duties authorized by this section. The preceptor shall be available during the AIT’s performance of those duties. (B) The preceptor shall be the designated administrator of the facility where the training is conducted. (C) The preceptor may not supervise more than two AIT trainees during the same time period. (D) The preceptor shall inform the NHAP of any significant training program changes dealing with his or her specific AIT. (E) The preceptor shall rate the AIT’s training performance and complete an AIT evaluation report at the end of the AIT’s training. (F) The preceptor shall be evaluated by the program based on the examination success and failure history of his or her AIT trainees and the program may revoke or suspend preceptor certificates as appropriate. (Added by Stats. 2001, Ch. 687, Sec. 5. Effective January 1, 2002.)
  183. 1416.6.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 1. General Provisions [1416 - 1416.6] ( Article 1 added by Stats. 2001, Ch. 687, Sec. 5. )

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    A person may not act as a nursing home administrator without an active license, subject to stated acting-administrator exceptions and notice/supervision limits.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 1. General Provisions [1416 - 1416.6] ( Article 1 added by Stats. 2001, Ch. 687, Sec. 5. ) ## 1416.6. (a) It shall be a misdemeanor for any person to act or serve in the capacity of a nursing home administrator, unless he or she is the holder of an active nursing home administrator’s license issued in accordance with this chapter. Persons carrying out functions and duties delegated by a licensed nursing home administrator shall not be acting in violation of this chapter. (b) (1) This chapter shall not apply to any person who serves as an acting administrator as provided in this subdivision when a licensed administrator is not available because of death, illness, or any other reason. (2) A person who is acting as an administrator shall notify the program in writing within five days of acting in this capacity and provide factual information and specific circumstances necessitating the use of an acting administrator. (3) No person shall act as an administrator for more than 10 days unless arrangements have been made for part-time supervision of his or her activities by a nursing home administrator who holds a license or provisional license under this chapter. Supervision shall include at least 8 hours per week of direct onsite supervision by the licensed administrator. The program shall be notified in writing of the nature of this arrangement. No person shall act as an administrator for more than two months without the written approval of the program. The program shall not approve a person to act as an administrator for more than six months. (4) If the acting administrator is an administrator in training, then the supervision required by paragraph (3) may be counted towards the total hours of supervised training required by subdivision (f) of Section 1416.57. (c) Notwithstanding subdivision (b), an individual acting as an administrator for more than 10 days must have management experience in a health facility. (Added by Stats. 2001, Ch. 687, Sec. 5. Effective January 1, 2002.)
  184. 1416.60.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 5. Enforcement [1416.60 - 1416.86] ( Article 5 added by Stats. 2001, Ch. 687, Sec. 5. )

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    Each licensee must notify the program within 30 days after being appointed as a nursing home administrator or after that appointment ends, and the notice must include specified identifying details.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 5. Enforcement [1416.60 - 1416.86] ( Article 5 added by Stats. 2001, Ch. 687, Sec. 5. ) ## 1416.60. Each licensee shall, within 30 days, after each appointment as the designated administrator of a nursing home and after any termination of that appointment, notify the program. Each notification shall include the name of the administrator, the nursing home administrator number assigned, the name and address of the facility or facilities involved, and the date of the appointment or termination. All information provided pursuant to this section shall be public information. (Added by Stats. 2001, Ch. 687, Sec. 5. Effective January 1, 2002.)
  185. 1416.62.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 5. Enforcement [1416.60 - 1416.86] ( Article 5 added by Stats. 2001, Ch. 687, Sec. 5. )

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    The program must keep a current list of certain nursing home administrators and provide it to licensed nursing homes and district offices every six months, and make it available to the public on request.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 5. Enforcement [1416.60 - 1416.86] ( Article 5 added by Stats. 2001, Ch. 687, Sec. 5. ) ## 1416.62. The program shall maintain a current list of nursing home administrators who have been placed on probation or had their licenses suspended or revoked within the last three years. The program shall provide the current list of these administrators to licensed nursing homes and the department district offices every six months. The current list shall also be available to the general public upon request. (Added by Stats. 2001, Ch. 687, Sec. 5. Effective January 1, 2002.)
  186. 1416.64.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 5. Enforcement [1416.60 - 1416.86] ( Article 5 added by Stats. 2001, Ch. 687, Sec. 5. )

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    The program must keep enforcement records, review citation files, notify the administrator before final action, and document reasons if it decides not to act. It may start remedial or disciplinary action when the stated conditions are met.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 5. Enforcement [1416.60 - 1416.86] ( Article 5 added by Stats. 2001, Ch. 687, Sec. 5. ) ## 1416.64. (a) The program shall maintain a record of enforcement actions reported to the program, pursuant to Section 1416.12. The program shall routinely review the citation logs and files of nursing home administrators whose facilities have received citations from the department to determine if remedial or disciplinary action against the administrator is warranted based on the administrator’s involvement or culpability in the citations. Regardless of the facility’s performance record, the program may initiate disciplinary action against an administrator who violates any statute or regulation governing licensed nursing home administrators. (b) Following receipt of reports on temporary suspension orders, service of an accusation for facility license revocations, or final decertification of a facility from participation in the Medi-Cal or Medicare programs, due to failure to meet certification standards, the program shall make a determination as to whether the evidence available warrants remedial or disciplinary action against the administrator or constitutes grounds for denial, suspension, or revocation pursuant to Section 1416.76. (c) If the program determines that action against the administrator is not warranted, the program shall document in the file the reasons and specific circumstances for not taking remedial or disciplinary action against the administrator’s license. (d) The program shall consider all of the following prior to making a determination to initiate disciplinary action: (1) Any information provided to the program by the administrator pursuant to this section. (2) Whether the administrator was in fact the designated administrator of the facility when the violation occurred, or the designated administrator of the facility during the period of time the citation covered. (3) Whether the administrator should have or could have prevented the violation or violations that occurred. (e) Prior to making a final determination to initiate action against an administrator, the program shall notify the administrator that the program is considering action and provide the administrator with an opportunity to show just cause why remedial or disciplinary action should not be initiated. (f) If the program determines that grounds for remedial or disciplinary action exist, the program may initiate either or both of the following actions, as warranted: (1) Remedial action, including, but not limited to, a conference with the administrator, a letter of warning, or both. (2) Disciplinary action, including, but not limited to, citations, fines, formal letters of reprimand, probation, denial, suspension, revocation of the administrator’s license, or any combination of these actions. (Added by Stats. 2001, Ch. 687, Sec. 5. Effective January 1, 2002.)
  187. 1416.66.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 5. Enforcement [1416.60 - 1416.86] ( Article 5 added by Stats. 2001, Ch. 687, Sec. 5. )

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    The program must make a form available, and nursing home administrators may use it to provide information about reported actions. Reports stay in the administrator’s file for five years unless the action is modified or overturned, and any modification must be noted and documented.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 5. Enforcement [1416.60 - 1416.86] ( Article 5 added by Stats. 2001, Ch. 687, Sec. 5. ) ## 1416.66. (a) The program shall develop and make available a form that may be utilized at the nursing home administrator’s option to provide the program with relevant information, documentation, and background on any actions reported to the program pursuant Section 1416.12. (b) Any reports received pursuant to Section 1416.12 shall remain in the administrator’s file for five years, unless the program is notified that the action has been modified or overturned. Any modification of an action shall be noted and documented in the administrator’s file. (Added by Stats. 2001, Ch. 687, Sec. 5. Effective January 1, 2002.)
  188. 1416.68.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 5. Enforcement [1416.60 - 1416.86] ( Article 5 added by Stats. 2001, Ch. 687, Sec. 5. )

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    The nursing home administrator must run the facility’s day-to-day operations and keep it compliant with applicable laws, rules, and regulations.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 5. Enforcement [1416.60 - 1416.86] ( Article 5 added by Stats. 2001, Ch. 687, Sec. 5. ) ## 1416.68. (a) It is the responsibility of the nursing home administrator as the managing officer of the facility to plan, organize, direct, and control the day-to-day functions of a facility and to maintain the facility’s compliance with applicable laws, rules, and regulations. (b) The administrator shall be vested with adequate authority to comply with the laws, rules, and regulations relating to the management of the facility. (c) No licensee shall be cited for any violation caused by any person licensed pursuant to the Medical Practice Act (Chapter 5 (commencing with Section 2000) of Division 2 of the Business and Professions Code) if the person is independent of, and not connected with, the facility and the licensee shows that he or she has exercised reasonable care and diligence in notifying these persons of their duties to the patients in the nursing facility. (d) The delegation of any authority by a licensee shall not diminish the responsibilities of that licensee. (Added by Stats. 2001, Ch. 687, Sec. 5. Effective January 1, 2002.)
  189. 1416.69.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 5. Enforcement [1416.60 - 1416.86] ( Article 5 added by Stats. 2001, Ch. 687, Sec. 5. )

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    A nursing home administrator must notify the department’s district office for licensing and certification within 24 hours after learning of certain listed events, and must confirm by written notice within five calendar days if the notice is given by phone.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 5. Enforcement [1416.60 - 1416.86] ( Article 5 added by Stats. 2001, Ch. 687, Sec. 5. ) ## 1416.69. (a) Within 24 hours after the nursing home administrator acquires actual knowledge or credible information that any of the events specified in subdivision (b) has occurred, the nursing home administrator shall notify the department’s district office for licensing and certification of that knowledge or information. This notification may be in written form if it is provided by telephone facsimile or overnight mail, or by telephone with a written confirmation within five calendar days. The information provided pursuant to this subdivision may not be released to the public by the department unless its release is needed to justify an action taken by the department or it otherwise becomes a matter of public record. A violation of this section may result in a citation. (b) All of the following occurrences shall require notification pursuant to this section as long as the administrator has actual knowledge of the occurrence: (1) The licensee of a facility receives notice that a judgment lien has been levied against the facility or any of the assets of the facility or the licensee. (2) A financial institution refuses to honor a check or other instrument issued by the licensee to its employees for a regular payroll. (3) The supplies, including food items and other perishables, on hand in the facility fall below the minimum specified by any applicable statute or regulation. (4) The financial resources of the licensee fall below the amount needed to operate the facility for a period of at least 45 days based on the current occupancy of the facility. (5) The licensee fails to make timely payment of any premiums required to maintain required insurance policies or bonds in effect, or any tax lien levied by any government agency. (Added by Stats. 2001, Ch. 687, Sec. 5. Effective January 1, 2002.)
  190. 1416.70.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 5. Enforcement [1416.60 - 1416.86] ( Article 5 added by Stats. 2001, Ch. 687, Sec. 5. )

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    The program must run a citation system for licensees, examinees, and participants, and citations can include abatement orders or administrative fines.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 5. Enforcement [1416.60 - 1416.86] ( Article 5 added by Stats. 2001, Ch. 687, Sec. 5. ) ## 1416.70. (a) The program shall establish a system for the issuance of citations to licensees, examinees, or participants of any program activity offered or approved by the program. The citations may contain an order of abatement, an order to pay an administrative fine assessed by the program chief, or both, where the licensee, examinee, or participant is in violation of any state or federal statute or regulation governing licensed nursing home administrators. (b) The system shall contain all of the following provisions: (1) Citations shall be in writing and shall describe with particularity the nature of the violation, including specific reference to the provision of law determined to have been violated. (2) Where appropriate, the citation shall contain an order of abatement fixing reasonable time for abatement of the violation. (3) (A) Administrative fines assessed by the program shall be separate from and shall not preclude the levying of any other fines or any civil or criminal penalty. (B) In no event shall the administrative fine assessed by the program be less than fifty dollars ($50) or exceed two thousand five hundred dollars ($2,500) for each violation. The total assessment shall not exceed ten thousand dollars ($10,000) for each investigation or for counts involving fraudulent billings submitted to insurance companies, Medi-Cal, or Medicare programs. (4) In assessing a fine, the program shall give due consideration to the appropriateness of the amount of the fine with respect to factors such as the gravity of the violation, the good faith effort of the licensee, examinee, or participant, the unprofessional conduct, including, but not limited to, incompetence and negligence in the performance of the duties and responsibilities of an administrator, the extent to which the cited person has mitigated or attempted to mitigate any damage or injury caused by his or her violation, whether the violation was related to patient care, the history of any previous violations, and other matters as may be appropriate. (5) A citation or fine assessment issued pursuant to a citation shall inform the licensee, examinee, or participant that if he or she desires a hearing to contest the finding of a violation, the hearing shall be requested by written notice to the program within 30 days after the date of issuance of the citation or assessment. A licensee may, in lieu of contesting a citation pursuant to this section, transmit to the state department 75 percent of the amount specified in the citation for each violation within 15 business days after the issuance of the citation. (6) Failure of a licensee, examinee, or participant to pay a fine within 30 days of the date of the assessment, unless the citation is being appealed, may result in further disciplinary action being taken by the program. Where a citation is not contested and a fine is not paid, the full amount of the assessed fine, along with any accrued penalty interest, shall be added to the fee for renewal of the license. A license shall not be renewed without payment of the renewal fee, fine, and accrued interest penalty. A citation may be issued without the assessment of an administrative fine. (c) Assessment of administrative fines may be limited to only particular violations of the applicable licensing act. Notwithstanding any other provisions of law, where a fine is paid to satisfy an assessment based on the finding of a violation, payment of the fine shall be represented as satisfactory resolution of the matter for purposes of public disclosures. Administrative fines collected pursuant to this section shall be deposited in the State Department of Public Health Licensing and Certification Program Fund established by Section 1266.9. (Amended by Stats. 2012, Ch. 672, Sec. 5. (AB 1710) Effective January 1, 2013.)
  191. 1416.72.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 5. Enforcement [1416.60 - 1416.86] ( Article 5 added by Stats. 2001, Ch. 687, Sec. 5. )

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    The program may cite licensed nursing home administrators for violations, and a cited licensee can appeal and request an informal conference within set deadlines.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 5. Enforcement [1416.60 - 1416.86] ( Article 5 added by Stats. 2001, Ch. 687, Sec. 5. ) ## 1416.72. (a) The program may issue a citation to any person who holds a license from the program and who violates any statute or regulation governing licensed nursing home administrators. (b) Any licensee served with a citation may contest the citation by appeal to the program within 30 days of service of the citation. Appeals shall be conducted pursuant to Section 100171. (c) In addition to requesting a hearing before an administrative law judge, the licensee may, within 10 days after service of the citation, notify the department in writing of his or her request for an informal conference with the department regarding the violations cited in the citation. At the time of requesting an informal conference, the licensee shall inform the department whether he or she shall be represented at the informal conference by legal counsel. Failure to notify the department of legal representation shall not result in forfeiture of the right to have legal counsel present. Unless the request for an informal hearing is made within the 10-day period, the licensee’s right to an informal hearing is deemed waived. (d) The department shall hold an informal conference with the licensee and, if applicable, his or her legal counsel or authorized representatives. At the conclusion of the informal conference the department may affirm, modify, or dismiss the citation, including any administrative fine levied, or order of abatement issued. (e) The licensee does not waive his or her request for a hearing to contest a citation by requesting an informal conference. If the citation is dismissed after the informal conference, the request for a hearing on the matter of the citation shall be deemed to be withdrawn. If the citation, including any administrative fine levied or order of abatement, is modified or affirmed, the citation shall be upheld and the licensee shall, within 15 working days from the date the citation review conference decision was rendered, notify the director or the director’s designee that he or she wishes to appeal the decision through the procedures set forth in Section 100171. (Added by Stats. 2001, Ch. 687, Sec. 5. Effective January 1, 2002.)
  192. 1416.74.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 5. Enforcement [1416.60 - 1416.86] ( Article 5 added by Stats. 2001, Ch. 687, Sec. 5. )

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    This section sets deadlines for correcting cited violations, allows a written extension request in some cases, and imposes daily civil penalties plus interest on unpaid administrative fines.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 5. Enforcement [1416.60 - 1416.86] ( Article 5 added by Stats. 2001, Ch. 687, Sec. 5. ) ## 1416.74. (a) The time allowed for abatement of violation shall begin the first day after the order of abatement has been served or received. If a licensee who has been issued an order of abatement is unable to complete the correction within the time set forth in the citation because of conditions beyond his or her control after the exercise of reasonable diligence, the licensee may request from the program an extension of time in which to complete the correction. The request shall be in writing and made within the time set for abatement. (b) An order of abatement shall either be personally served upon the licensee or mailed by certified mail, return receipt requested. (c) When an order of abatement is not contested, or if the order is appealed and the licensee does not prevail, failure to abate the violation cited within the time specified in the citation shall constitute a violation and failure to comply with the order of abatement. Where a licensee has failed to correct a violation within the time specified in the citation the department shall assess the licensee a civil penalty in the amount of fifty dollars ($50) for each day that the violation continues beyond the date specified in the citation. If the licensee disputes a determination by the department regarding alleged failure to correct a violation or regarding the reasonableness of the proposed deadline for correction, the licensee may request an informal conference to contest the determination. (d) Any unpaid administrative fine shall begin accruing a 7-percent interest penalty on the unpaid balance due. This interest shall continue to accrue until the administrative fine and interest are paid in full. (Added by Stats. 2001, Ch. 687, Sec. 5. Effective January 1, 2002.)
  193. 1416.75.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 5. Enforcement [1416.60 - 1416.86] ( Article 5 added by Stats. 2001, Ch. 687, Sec. 5. )

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    The program may deny, suspend, or revoke a license for listed grounds such as gross negligence, incompetence, fraud, certain convictions, unlicensed treatment, violations of specified rules, lack of qualifications, or failure to report without just cause.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 5. Enforcement [1416.60 - 1416.86] ( Article 5 added by Stats. 2001, Ch. 687, Sec. 5. ) ## 1416.75. The program may deny, or may suspend or revoke, a license upon any of the following grounds: (a) Gross negligence. (b) Incompetence. (c) The conviction of any crime involving dishonesty or which is substantially related to the qualifications, functions, or duties of a nursing home administrator. A conviction following a plea of nolo contendere is deemed to be a conviction within the meaning of this section. (d) Using fraud or deception in applying for a license or in taking the examination provided for in this chapter. (e) Treating or attempting to treat any physical or mental condition without being currently licensed to do so. (f) Violating Section 650 of the Business and Professions Code, any provision of this chapter, or any rule or regulation of the program adopted pursuant to this chapter. (g) Lack of any qualification requirement for the license. (h) Failure to report under Section 1416.60 to the program, without just cause. (Added by Stats. 2001, Ch. 687, Sec. 5. Effective January 1, 2002.)
  194. 1416.76.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 5. Enforcement [1416.60 - 1416.86] ( Article 5 added by Stats. 2001, Ch. 687, Sec. 5. )

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    The program may deny, suspend, or revoke a nursing home administrator license on specified grounds, but not solely for certain felony or misdemeanor convictions covered by rehabilitation rules.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 5. Enforcement [1416.60 - 1416.86] ( Article 5 added by Stats. 2001, Ch. 687, Sec. 5. ) ## 1416.76. (a) The program may deny a nursing home administrator applicant or licensee, a license, based on one of the following grounds: (1) Conviction of a crime. A conviction within the meaning of this section means a plea or verdict of guilty or a conviction following a plea of nolo contendere. The program may take action following the establishment of a conviction after the time for appeal has elapsed, or the judgment of conviction has been affirmed on appeal, or when an order granting probation is made suspending the imposition of sentence, irrespective of a subsequent order under Section 1203.4 of the Penal Code. (2) Commits any act involving dishonesty, fraud, or deceit with the intent to substantially benefit himself or herself or another, or substantially injure another. (3) Commits any act which, if done by a licentiate, would be grounds for suspension or revocation of license. The program may deny a license pursuant to this subdivision only if the crime or act is substantially related to the qualifications, functions, or duties of a nursing home administrator. (b) Notwithstanding any other provision of this chapter, no person shall be denied a license solely on the basis that he or she has been convicted of a felony if he or she has obtained a certificate of rehabilitation under Section 4852.01 of the Penal Code, or that he or she has been convicted of a misdemeanor and has met all applicable requirements of the criteria of rehabilitation developed by the program pursuant to subdivision (f). (c) The program may deny a nursing home administrator license on the ground that the applicant knowingly made a false statement of fact required to be revealed in the application for the license. (d) The program may suspend or revoke a license on the ground that the applicant or licensee has been convicted of a crime, as defined in paragraph (1) of subdivision (a), if the crime is substantially related to the qualifications, functions, or duties of a nursing home administrator. (e) The program shall develop criteria to use to determine whether a crime or act is substantially related to the qualifications, functions, or duties of a nursing home administrator, and shall use the criteria when considering the denial, suspension, or revocation of a license. (f) The program shall develop criteria to be used by the program to evaluate the rehabilitation of a person when considering the denial, suspension, or revocation of a license under this section. (g) The program shall take into account all competent evidence of rehabilitation furnished by the applicant or licensee pursuant to the evaluation process set forth in subdivision (f). (Added by Stats. 2001, Ch. 687, Sec. 5. Effective January 1, 2002.)
  195. 1416.77.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 5. Enforcement [1416.60 - 1416.86] ( Article 5 added by Stats. 2001, Ch. 687, Sec. 5. )

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    The program may deny, suspend, or revoke a nursing home administrator license or related training participation for listed misconduct or violations.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 5. Enforcement [1416.60 - 1416.86] ( Article 5 added by Stats. 2001, Ch. 687, Sec. 5. ) ## 1416.77. The program may deny, or may suspend or revoke, a nursing home administrator license or participation in specific training program areas under this chapter upon any of the following grounds: (a) Misappropriation of funds or property of the facility, the patients, or of others. (b) Using fraud, deception, or misrepresentation in applying for the AIT Program, the examination for licensure, or any other program functions provided for in this chapter. (c) Procuring a nursing home license by fraud, deception, or misrepresentation. (d) Impersonating any applicant or acting as a proxy for an applicant in an examination. (e) Impersonating any licensed nursing home administrator. (f) Treating or attempting to treat any physical or mental condition without having a valid license to do so. (g) Violating Section 650 of the Business and Professions Code, any provisions of this chapter, or any rule or regulation of the program adopted pursuant to this chapter. (h) Lack of any qualification requirement for a license, participation in the AIT Program or preceptor program. (i) A pattern of failure to report changes under Section 1416.60 to the program without just cause. (j) Failure to comply with this chapter or the laws, rules, and regulations relating to health facilities. (k) The commission of any dishonest, corrupt, or fraudulent act or any act of physical or mental, including sexual, abuse of any person in connection with the administration of, or any patient in, a nursing home. ( l) Violation by the licensee of any of the provisions of this chapter or of the rules and regulations promulgated under this chapter. (m) Aiding, abetting, or conspiring with another person to violate provisions of this chapter or of the rules and regulations promulgated under this chapter. (n) Violation of the examination security agreement. (Added by Stats. 2001, Ch. 687, Sec. 5. Effective January 1, 2002.)
  196. 1416.78.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 5. Enforcement [1416.60 - 1416.86] ( Article 5 added by Stats. 2001, Ch. 687, Sec. 5. )

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    The program may put a nursing home administrator license on probation if the department thinks probation is appropriate. The licensee and program must have an agreement covering probation terms, the probation term cannot exceed two years, and successful completion can restore the license to regular status.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 5. Enforcement [1416.60 - 1416.86] ( Article 5 added by Stats. 2001, Ch. 687, Sec. 5. ) ## 1416.78. (a) The program may place a nursing home administrator license on probation in lieu of formal action to suspend or revoke the license if the department determines that probation is the appropriate action. Upon successful completion of the probation period, the license shall be restored to regular status. (b) The probationary license shall be based upon an agreement entered into between the licensee and the program that specifies terms and conditions of licensure during the probationary period. The terms and conditions shall be related to matters, including, but not limited to, work performance, rehabilitation, training, counseling, progress reports, and treatment programs. (c) The term of the probationary license shall not exceed two years. If the licensee successfully completes the term of probation, as determined by the department, no further action shall be taken upon the allegations that were the basis for the probationary license. If the licensee fails to comply with the terms and conditions of the probationary license agreement, the department may proceed with a formal action to suspend or revoke the license. (Added by Stats. 2001, Ch. 687, Sec. 5. Effective January 1, 2002.)
  197. 1416.80.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 5. Enforcement [1416.60 - 1416.86] ( Article 5 added by Stats. 2001, Ch. 687, Sec. 5. )

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    If licensure is denied on specified grounds, the program must notify the applicant in writing by certified mail, and a hearing petition must be received within 20 business days of that notice.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 5. Enforcement [1416.60 - 1416.86] ( Article 5 added by Stats. 2001, Ch. 687, Sec. 5. ) ## 1416.80. Upon the determination to deny application for licensure for grounds specified in Section 1416.77, the program shall immediately notify the applicant in writing by certified mail. A petition for an administrative hearing must be received by the program within 20 business days of receipt of notification. Upon receipt, the department shall set the matter for administrative hearing, pursuant to procedures specified in Section 100171. (Added by Stats. 2001, Ch. 687, Sec. 5. Effective January 1, 2002.)
  198. 1416.82.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 5. Enforcement [1416.60 - 1416.86] ( Article 5 added by Stats. 2001, Ch. 687, Sec. 5. )

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    This section lets the program and director suspend or revoke a nursing home administrator license in certain cases and sets deadlines for notice, hearings, and final decisions.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 5. Enforcement [1416.60 - 1416.86] ( Article 5 added by Stats. 2001, Ch. 687, Sec. 5. ) ## 1416.82. (a) Proceedings to suspend or revoke licensure for grounds specified in Section 1416.77 shall be conducted in accordance with Section 100171. In the event of conflict between this chapter and Section 100171, Section 100171 shall prevail. (b) (1) The program may temporarily suspend any license prior to any hearing if the action is necessary to protect the public welfare. The program shall notify the licensee of the temporary suspension and the effective date. Upon receipt of a notice of defense by the licensee, the department shall set the matter within 15 days. The administrative hearing conducted in accordance with Section 100171 shall be held as soon as possible but not later than 30 days after receipt of the notice. The temporary suspension shall remain in effect until the hearing is completed and the department has made a final determination on the merits. However, the temporary suspension shall be deemed vacated if the department fails to make a final determination on the merits of the action within 60 days after the original hearing has been completed. If the provisions of this chapter or the rules or regulations promulgated by the director are violated by a licensee, the director may suspend the license for the violation. (2) If the program determines that the temporary suspension shall become an actual suspension, the department shall specify the period of the suspension, not to exceed two years. The program may determine that the suspension shall be stayed, and place the licensee on probation for a period that shall not exceed two years. (c) The program may suspend or revoke a license prior to any hearing when immediate action is necessary in the judgment of the director to protect the public welfare. Proceedings for immediate revocation shall be conducted in accordance with Section 100171. The department shall set the matter for hearing within 15 days and hold the administrative hearing as soon as possible but not later than 30 calendar days from receipt of the request for a hearing. A written hearing decision upholding or setting aside the action shall be sent by certified mail to the licenseholder within 30 calendar days of the hearing. (Added by Stats. 2001, Ch. 687, Sec. 5. Effective January 1, 2002.)
  199. 1416.84.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 5. Enforcement [1416.60 - 1416.86] ( Article 5 added by Stats. 2001, Ch. 687, Sec. 5. )

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    A superior court may issue an injunction or other appropriate order to stop conduct that violates, or is about to violate, this chapter.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 5. Enforcement [1416.60 - 1416.86] ( Article 5 added by Stats. 2001, Ch. 687, Sec. 5. ) ## 1416.84. Whenever any person has engaged, or is about to engage, in any acts or practices that constitute, or will constitute, a violation of this chapter, the superior court in and for the county in which those acts or practices take place, or are about to take place, may issue an injunction or other appropriate order, restraining the conduct, on application of the program, to the Attorney General, or the district attorney. (Added by Stats. 2001, Ch. 687, Sec. 5. Effective January 1, 2002.)
  200. 1416.86.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 5. Enforcement [1416.60 - 1416.86] ( Article 5 added by Stats. 2001, Ch. 687, Sec. 5. )

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    If part of this chapter is invalid, the rest can still apply.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2.35. Nursing Home Administrator Program [1416 - 1416.86] ( Chapter 2.35 added by Stats. 2001, Ch. 687, Sec. 5. ) ## ARTICLE 5. Enforcement [1416.60 - 1416.86] ( Article 5 added by Stats. 2001, Ch. 687, Sec. 5. ) ## 1416.86. If any provision of this chapter, or the application thereof to any person or circumstance, is held invalid, that invalidity shall not affect other provisions or applications of this chapter that can be given effect without the invalid provision or application, and to this end the provisions of this chapter are declared to be severable. (Added by Stats. 2001, Ch. 687, Sec. 5. Effective January 1, 2002.)

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