SECTIONS 100500-100521 - California Statutes

GOVERNMENT CODE

SECTION 100500-100521

100500. (a) There is in state government the California Health
Benefit Exchange, an independent public entity not affiliated with an
agency or department, which shall be known as the Exchange. The
Exchange shall be governed by an executive board consisting of five
members who are residents of California. Of the members of the board,
two shall be appointed by the Governor, one shall be appointed by
the Senate Committee on Rules, and one shall be appointed by the
Speaker of the Assembly. The Secretary of California Health and Human
Services or his or her designee shall serve as a voting, ex officio
member of the board.
(b) Members of the board, other than an ex officio member, shall
be appointed for a term of four years, except that the initial
appointment by the Senate Committee on Rules shall be for a term of
five years, and the initial appointment by the Speaker of the
Assembly shall be for a term of two years. Appointments by the
Governor made after January 2, 2011, shall be subject to confirmation
by the Senate. A member of the board may continue to serve until the
appointment and qualification of his or her successor. Vacancies
shall be filled by appointment for the unexpired term. The board
shall elect a chairperson on an annual basis.
(c) (1) Each person appointed to the board shall have demonstrated
and acknowledged expertise in at least two of the following areas:
(A) Individual health care coverage.
(B) Small employer health care coverage.
(C) Health benefits plan administration.
(D) Health care finance.
(E) Administering a public or private health care delivery system.
(F) Purchasing health plan coverage.
(2) Appointing authorities shall consider the expertise of the
other members of the board and attempt to make appointments so that
the board's composition reflects a diversity of expertise.
(d) Each member of the board shall have the responsibility and
duty to meet the requirements of this title, the federal act, and all
applicable state and federal laws and regulations, to serve the
public interest of the individuals and small businesses seeking
health care coverage through the Exchange, and to ensure the
operational well-being and fiscal solvency of the Exchange.
(e) In making appointments to the board, the appointing
authorities shall take into consideration the cultural, ethnic, and
geographical diversity of the state so that the board's composition
reflects the communities of California.
(f) (1) A member of the board or of the staff of the Exchange
shall not be employed by, a consultant to, a member of the board of
directors of, affiliated with, or otherwise a representative of, a
carrier or other insurer, an agent or broker, a health care provider,
or a health care facility or health clinic while serving on the
board or on the staff of the Exchange. A member of the board or of
the staff of the Exchange shall not be a member, a board member, or
an employee of a trade association of carriers, health facilities,
health clinics, or health care providers while serving on the board
or on the staff of the Exchange. A member of the board or of the
staff of the Exchange shall not be a health care provider unless he
or she receives no compensation for rendering services as a health
care provider and does not have an ownership interest in a
professional health care practice.
(2) A board member shall not receive compensation for his or her
service on the board but may receive a per diem and reimbursement for
travel and other necessary expenses, as provided in Section 103 of
the Business and Professions Code, while engaged in the performance
of official duties of the board.
(3) For purposes of this subdivision, "health care provider" means
a person licensed or certified pursuant to Division 2 (commencing
with Section 500) of the Business and Professions Code, or licensed
pursuant to the Osteopathic Act or the Chiropractic Act.
(g) No member of the board shall make, participate in making, or
in any way attempt to use his or her official position to influence
the making of any decision that he or she knows or has reason to know
will have a reasonably foreseeable material financial effect,
distinguishable from its effect on the public generally, on him or
her or a member of his or her immediate family, or on either of the
following:
(1) Any source of income, other than gifts and other than loans by
a commercial lending institution in the regular course of business
on terms available to the public without regard to official status
aggregating two hundred fifty dollars ($250) or more in value
provided to, received by, or promised to the member within 12 months
prior to the time when the decision is made.
(2) Any business entity in which the member is a director,
officer, partner, trustee, employee, or holds any position of
management.
(h) There shall not be any liability in a private capacity on the
part of the board or any member of the board, or any officer or
employee of the board, for or on account of any act performed or
obligation entered into in an official capacity, when done in good
faith, without intent to defraud, and in connection with the
administration, management, or conduct of this title or affairs
related to this title.
(i) The board shall hire an executive director to organize,
administer, and manage the operations of the Exchange. The executive
director shall be exempt from civil service and shall serve at the
pleasure of the board.
(j) The board 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), except that the board may hold closed
sessions when considering matters related to litigation, personnel,
contracting, and rates.
(k) (1) The board shall apply for planning and establishment
grants made available to the Exchange pursuant to Section 1311 of the
federal act. If an executive director has not been hired under
subdivision (i) when the United States Secretary of Health and Human
Services makes the planning and establishment grants available, the
California Health and Human Services Agency shall, upon request of
the board, submit the initial application for planning and
establishment grants to the United States Secretary of Health and
Human Services.
(2) If a majority of the board has not been appointed when the
United States Secretary of Health and Human Services makes the
planning and establishment grants available, the California Health
and Human Services Agency shall submit the initial application for
planning and establishment grants to the United States Secretary of
Health and Human Services. Any subsequent applications shall be made
as described in paragraph (1) once a majority of the members have
been appointed to the board.
(3) The board shall be responsible for using the funds awarded by
the United States Secretary of Health and Human Services for the
planning and establishment of the Exchange, consistent with
subdivision (b) of Section 1311 of the federal act.

100501. For purposes of this title, the following definitions shall
apply:
(a) "Board" means the board described in subdivision (a) of
Section 100500.
(b) "Carrier" means either a private health insurer holding a
valid outstanding certificate of authority from the Insurance
Commissioner or a health care service plan, as defined under
subdivision (f) of Section 1345 of the Health and Safety Code,
licensed by the Department of Managed Health Care.
(c) "Exchange" means the California Health Benefit Exchange
established by Section 100500.
(d) "Federal act" 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 amendments to, or regulations or guidance issued
under, those acts.
(e) "Fund" means the California Health Trust Fund established by
Section 100520.
(f) "Health plan" and "qualified health plan" have the same
meanings as those terms are defined in Section 1301 of the federal
act.
(g) "SHOP Program" means the Small Business Health Options Program
established by subdivision (m) of Section 100502.
(h) "Supplemental coverage" means coverage through a specialized
health care service plan contract, as defined in subdivision (o) of
Section 1345 of the Health and Safety Code, or a specialized health
insurance policy, as defined in Section 106 of the Insurance Code.

100502. The board shall, at a minimum, do all of the following to
implement Section 1311 of the federal act:
(a) Implement procedures for the certification, recertification,
and decertification, consistent with guidelines established by the
United States Secretary of Health and Human Services, of health plans
as qualified health plans. The board shall require health plans
seeking certification as qualified health plans to do all of the
following:
(1) Submit a justification for any premium increase prior to
implementation of the increase. The plans shall prominently post that
information on their Internet Web sites. The board shall take this
information, and the information and the recommendations provided to
the board by the Department of Insurance or the Department of Managed
Health Care under paragraph (1) of subdivision (b) of Section 2794
of the federal Public Health Service Act, into consideration when
determining whether to make the health plan available through the
Exchange. The board shall take into account any excess of premium
growth outside the Exchange as compared to the rate of that growth
inside the Exchange, including information reported by the Department
of Insurance and the Department of Managed Health Care.
(2) (A) Make available to the public and submit to the board, the
United States Secretary of Health and Human Services, and the
Insurance Commissioner or the Department of Managed Health Care, as
applicable, accurate and timely disclosure of the following
information:
(i) Claims payment policies and practices.
(ii) Periodic financial disclosures.
(iii) Data on enrollment.
(iv) Data on disenrollment.
(v) Data on the number of claims that are denied.
(vi) Data on rating practices.
(vii) Information on cost sharing and payments with respect to any
out-of-network coverage.
(viii) Information on enrollee and participant rights under Title
I of the federal act.
(ix) Other information as determined appropriate by the United
States Secretary of Health and Human Services.
(B) The information required under subparagraph (A) shall be
provided in plain language, as defined in subparagraph (B) of
paragraph (3) of subdivision (e) of Section 1311 of the federal act.
(3) Permit individuals to learn, in a timely manner upon the
request of the individual, the amount of cost sharing, including, but
not limited to, deductibles, copayments, and coinsurance, under the
individual's plan or coverage that the individual would be
responsible for paying with respect to the furnishing of a specific
item or service by a participating provider. At a minimum, this
information shall be made available to the individual through an
Internet Web site and through other means for individuals without
access to the Internet.
(b) Provide for the operation of a toll-free telephone hotline to
respond to requests for assistance.
(c) Maintain an Internet Web site through which enrollees and
prospective enrollees of qualified health plans may obtain
standardized comparative information on those plans.
(d) Assign a rating to each qualified health plan offered through
the Exchange in accordance with the criteria developed by the United
States Secretary of Health and Human Services.
(e) Utilize a standardized format for presenting health benefits
plan options in the Exchange, including the use of the uniform
outline of coverage established under Section 2715 of the federal
Public Health Service Act.
(f) Inform individuals of eligibility requirements for the
Medi-Cal program, the Healthy Families Program, or any applicable
state or local public program and, if, through screening of the
application by the Exchange, the Exchange determines that an
individual is eligible for any such program, enroll that individual
in the program.
(g) Establish and make available by electronic means a calculator
to determine the actual cost of coverage after the application of any
premium tax credit under Section 36B of the Internal Revenue Code of
1986 and any cost-sharing reduction under Section 1402 of the
federal act.
(h) Grant a certification attesting that, for purposes of the
individual responsibility penalty under Section 5000A of the Internal
Revenue Code of 1986, an individual is exempt from the individual
requirement or from the penalty imposed by that section because of
either of the following:
(1) There is no affordable qualified health plan available through
the Exchange or the individual's employer covering the individual.
(2) The individual meets the requirements for any other exemption
from the individual responsibility requirement or penalty.
(i) Transfer to the Secretary of the Treasury all of the
following:
(1) A list of the individuals who are issued a certification under
subdivision (h), including the name and taxpayer identification
number of each individual.
(2) The name and taxpayer identification number of each individual
who was an employee of an employer but who was determined to be
eligible for the premium tax credit under Section 36B of the Internal
Revenue Code of 1986 because of either of the following:
(A) The employer did not provide minimum essential coverage.
(B) The employer provided the minimum essential coverage but it
was determined under subparagraph (C) of paragraph (2) of subsection
(c) of Section 36B of the Internal Revenue Code of 1986 to either be
unaffordable to the employee or not provide the required minimum
actuarial value.
(3) The name and taxpayer identification number of each individual
who notifies the Exchange under paragraph (4) of subsection (b) of
Section 1411 of the federal act that they have changed employers and
of each individual who ceases coverage under a qualified health plan
during a plan year and the effective date of that cessation.
(j) Provide to each employer the name of each employee of the
employer described in paragraph (2) of subdivision (i) who ceases
coverage under a qualified health plan during a plan year and the
effective date of that cessation.
(k) Perform duties required of, or delegated to, the Exchange by
the United States Secretary of Health and Human Services or the
Secretary of the Treasury related to determining eligibility for
premium tax credits, reduced cost sharing, or individual
responsibility exemptions.
(l) Establish the navigator program in accordance with subdivision
(i) of Section 1311 of the federal act. Any entity chosen by the
Exchange as a navigator shall do all of the following:
(1) Conduct public education activities to raise awareness of the
availability of qualified health plans.
(2) Distribute fair and impartial information concerning
enrollment in qualified health plans, and the availability of premium
tax credits under Section 36B of the Internal Revenue Code of 1986
and cost-sharing reductions under Section 1402 of the federal act.
(3) Facilitate enrollment in qualified health plans.
(4) Provide referrals to any applicable office of health insurance
consumer assistance or health insurance ombudsman established under
Section 2793 of the federal Public Health Service Act, or any other
appropriate state agency or agencies, for any enrollee with a
grievance, complaint, or question regarding his or her health plan,
coverage, or a determination under that plan or coverage.
(5) Provide information in a manner that is culturally and
linguistically appropriate to the needs of the population being
served by the Exchange.
(m) Establish the Small Business Health Options Program, separate
from the activities of the board related to the individual market, to
assist qualified small employers in facilitating the enrollment of
their employees in qualified health plans offered through the
Exchange in the small employer market in a manner consistent with
paragraph (2) of subdivision (a) of Section 1312 of the federal act.

100503. In addition to meeting the minimum requirements of Section
1311 of the federal act, the board shall do all of the following:
(a) Determine the criteria and process for eligibility,
enrollment, and disenrollment of enrollees and potential enrollees in
the Exchange and coordinate that process with the state and local
government entities administering other health care coverage
programs, including the State Department of Health Care Services, the
Managed Risk Medical Insurance Board, and California counties, in
order to ensure consistent eligibility and enrollment processes and
seamless transitions between coverage.
(b) Develop processes to coordinate with the county entities that
administer eligibility for the Medi-Cal program and the entity that
determines eligibility for the Healthy Families Program, including,
but not limited to, processes for case transfer, referral, and
enrollment in the Exchange of individuals applying for assistance to
those entities, if allowed or required by federal law.
(c) Determine the minimum requirements a carrier must meet to be
considered for participation in the Exchange, and the standards and
criteria for selecting qualified health plans to be offered through
the Exchange that are in the best interests of qualified individuals
and qualified small employers. The board shall consistently and
uniformly apply these requirements, standards, and criteria to all
carriers. In the course of selectively contracting for health care
coverage offered to qualified individuals and qualified small
employers through the Exchange, the board shall seek to contract with
carriers so as to provide health care coverage choices that offer
the optimal combination of choice, value, quality, and service.
(d) Provide, in each region of the state, a choice of qualified
health plans at each of the five levels of coverage contained in
subdivisions (d) and (e) of Section 1302 of the federal act.
(e) Require, as a condition of participation in the Exchange,
carriers to fairly and affirmatively offer, market, and sell in the
Exchange at least one product within each of the five levels of
coverage contained in subdivisions (d) and (e) of Section 1302 of the
federal act. The board may require carriers to offer additional
products within each of those five levels of coverage. This
subdivision shall not apply to a carrier that solely offers
supplemental coverage in the Exchange under paragraph (10) of
subdivision (a) of Section 100504.
(f) (1) Require, as a condition of participation in the Exchange,
carriers that sell any products outside the Exchange to do both of
the following:
(A) Fairly and affirmatively offer, market, and sell all products
made available to individuals in the Exchange to individuals
purchasing coverage outside the Exchange.
(B) Fairly and affirmatively offer, market, and sell all products
made available to small employers in the Exchange to small employers
purchasing coverage outside the Exchange.
(2) For purposes of this subdivision, "product" does not include
contracts entered into pursuant to Part 6.2 (commencing with Section
12693) of Division 2 of the Insurance Code between the Managed Risk
Medical Insurance Board and carriers for enrolled Healthy Families
beneficiaries or contracts entered into pursuant to Chapter 7
(commencing with Section 14000) of, or Chapter 8 (commencing with
Section 14200) of, Part 3 of Division 9 of the Welfare and
Institutions Code between the State Department of Health Care
Services and carriers for enrolled Medi-Cal beneficiaries.
(g) Determine when an enrollee's coverage commences and the extent
and scope of coverage.
(h) Provide for the processing of applications and the enrollment
and disenrollment of enrollees.
(i) Determine and approve cost-sharing provisions for qualified
health plans.
(j) Establish uniform billing and payment policies for qualified
health plans offered in the Exchange to ensure consistent enrollment
and disenrollment activities for individuals enrolled in the
Exchange.
(k) Undertake activities necessary to market and publicize the
availability of health care coverage and federal subsidies through
the Exchange. The board shall also undertake outreach and enrollment
activities that seek to assist enrollees and potential enrollees with
enrolling and reenrolling in the Exchange in the least burdensome
manner, including populations that may experience barriers to
enrollment, such as the disabled and those with limited English
language proficiency.
(l) Select and set performance standards and compensation for
navigators selected under subdivision (l) of Section 100502.
(m) Employ necessary staff.
(1) The board shall hire a chief fiscal officer, a chief
operations officer, a director for the SHOP Exchange, a director of
Health Plan Contracting, a chief technology and information officer,
a general counsel, and other key executive positions, as determined
by the board, who shall be exempt from civil service.
(2) (A) The board shall set the salaries for the exempt positions
described in paragraph (1) and subdivision (i) of Section 100500 in
amounts that are reasonably necessary to attract and retain
individuals of superior qualifications. The salaries shall be
published by the board in the board's annual budget. The board's
annual budget shall be posted on the Internet Web site of the
Exchange. To determine the compensation for these positions, the
board shall cause to be conducted, through the use of independent
outside advisors, salary surveys of both of the following:
(i) Other state and federal health insurance exchanges that are
most comparable to the Exchange.
(ii) Other relevant labor pools.
(B) The salaries established by the board under subparagraph (A)
shall not exceed the highest comparable salary for a position of that
type, as determined by the surveys conducted pursuant to
subparagraph (A).
(C) The Department of Personnel Administration shall review the
methodology used in the surveys conducted pursuant to subparagraph
(A).
(3) The positions described in paragraph (1) and subdivision (i)
of Section 100500 shall not be subject to otherwise applicable
provisions of the Government Code or the Public Contract Code and,
for those purposes, the Exchange shall not be considered a state
agency or public entity.
(n) Assess a charge on the qualified health plans offered by
carriers that is reasonable and necessary to support the development,
operations, and prudent cash management of the Exchange. This charge
shall not affect the requirement under Section 1301 of the federal
act that carriers charge the same premium rate for each qualified
health plan whether offered inside or outside the Exchange.
(o) Authorize expenditures, as necessary, from the California
Health Trust Fund to pay program expenses to administer the Exchange.
(p) Keep an accurate accounting of all activities, receipts, and
expenditures, and annually submit to the United States Secretary of
Health and Human Services a report concerning that accounting.
Commencing January 1, 2016, the board shall conduct an annual audit.
(q) (1) Annually prepare a written report on the implementation
and performance of the Exchange functions during the preceding fiscal
year, including, at a minimum, the manner in which funds were
expended and the progress toward, and the achievement of, the
requirements of this title. This report shall be transmitted to the
Legislature and the Governor and shall be made available to the
public on the Internet Web site of the Exchange. A report made to the
Legislature pursuant to this subdivision shall be submitted pursuant
to Section 9795.
(2) In addition to the report described in paragraph (1), the
board shall be responsive to requests for additional information from
the Legislature, including providing testimony and commenting on
proposed state legislation or policy issues. The Legislature finds
and declares that activities including, but not limited to,
responding to legislative or executive inquiries, tracking and
commenting on legislation and regulatory activities, and preparing
reports on the implementation of this title and the performance of
the Exchange, are necessary state requirements and are distinct from
the promotion of legislative or regulatory modifications referred to
in subdivision (d) of Section 100520.
(r) Maintain enrollment and expenditures to ensure that
expenditures do not exceed the amount of revenue in the fund, and if
sufficient revenue is not available to pay estimated expenditures,
institute appropriate measures to ensure fiscal solvency.
(s) Exercise all powers reasonably necessary to carry out and
comply with the duties, responsibilities, and requirements of this
act and the federal act.
(t) Consult with stakeholders relevant to carrying out the
activities under this title, including, but not limited to, all of
the following:
(1) Health care consumers who are enrolled in health plans.
(2) Individuals and entities with experience in facilitating
enrollment in health plans.
(3) Representatives of small businesses and self-employed
individuals.
(4) The State Medi-Cal Director.
(5) Advocates for enrolling hard-to-reach populations.
(u) Facilitate the purchase of qualified health plans in the
Exchange by qualified individuals and qualified small employers no
later than January 1, 2014.
(v) Report, or contract with an independent entity to report, to
the Legislature by December 1, 2018, on whether to adopt the option
in paragraph (3) of subdivision (c) of Section 1312 of the federal
act to merge the individual and small employer markets. In its
report, the board shall provide information, based on at least two
years of data from the Exchange, on the potential impact on rates
paid by individuals and by small employers in a merged individual and
small employer market, as compared to the rates paid by individuals
and small employers if a separate individual and small employer
market is maintained. A report made pursuant to this subdivision
shall be submitted pursuant to Section 9795.
(w) With respect to the SHOP Program, collect premiums and
administer all other necessary and related tasks, including, but not
limited to, enrollment and plan payment, in order to make the
offering of employee plan choice as simple as possible for qualified
small employers.
(x) Require carriers participating in the Exchange to immediately
notify the Exchange, under the terms and conditions established by
the board when an individual is or will be enrolled in or disenrolled
from any qualified health plan offered by the carrier.
(y) Ensure that the Exchange provides oral interpretation services
in any language for individuals seeking coverage through the
Exchange and makes available a toll-free telephone number for the
hearing and speech impaired. The board shall ensure that written
information made available by the Exchange is presented in a plainly
worded, easily understandable format and made available in prevalent
languages.

100504. (a) The board may do the following:
(1) With respect to individual coverage made available in the
Exchange, collect premiums and assist in the administration of
subsidies.
(2) Enter into contracts.
(3) Sue and be sued.
(4) Receive and accept gifts, grants, or donations of moneys from
any agency of the United States, any agency of the state, any
municipality, county, or other political subdivision of the state.
(5) Receive and accept gifts, grants, or donations from
individuals, associations, private foundations, or corporations, in
compliance with the conflict of interest provisions to be adopted by
the board at a public meeting.
(6) Adopt rules and regulations, as necessary. Until January 1,
2016, any necessary rules and regulations may be adopted as emergency
regulations in accordance with the Administrative Procedure Act
(Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3
of Title 2). The adoption of these regulations shall be deemed to be
an emergency and necessary for the immediate preservation of the
public peace, health and safety, or general welfare.
(7) Collaborate with the State Department of Health Care Services
and the Managed Risk Medical Insurance Board, to the extent possible,
to allow an individual the option to remain enrolled with his or her
carrier and provider network in the event the individual experiences
a loss of eligibility of premium tax credits and becomes eligible
for the Medi-Cal program or the Healthy Families Program, or loses
eligibility for the Medi-Cal program or the Healthy Families Program
and becomes eligible for premium tax credits through the Exchange.
(8) Share information with relevant state departments, consistent
with the confidentiality provisions in Section 1411 of the federal
act, necessary for the administration of the Exchange.
(9) Require carriers participating in the Exchange to make
available to the Exchange and regularly update an electronic
directory of contracting health care providers so that individuals
seeking coverage through the Exchange can search by health care
provider name to determine which health plans in the Exchange include
that health care provider in their network. The board may also
require a carrier to provide regularly updated information to the
Exchange as to whether a health care provider is accepting new
patients for a particular health plan. The Exchange may provide an
integrated and uniform consumer directory of health care providers
indicating which carriers the providers contract with and whether the
providers are currently accepting new patients. The Exchange may
also establish methods by which health care providers may transmit
relevant information directly to the Exchange, rather than through a
carrier.
(10) Make available supplemental coverage for enrollees of the
Exchange to the extent permitted by the federal act, provided that no
General Fund money is used to pay the cost of that coverage. Any
supplemental coverage offered in the Exchange shall be subject to the
charge imposed under subdivision (n) of Section 100503.
(b) The Exchange shall only collect information from individuals
or designees of individuals necessary to administer the Exchange and
consistent with the federal act.
(c) The board shall have the authority to standardize products to
be offered through the Exchange.

100505. The board shall establish and use a competitive process to
select participating carriers and any other contractors under this
title. Any contract entered into pursuant to this title shall be
exempt from Chapter 2 (commencing with Section 10100) of Division 2
of the Public Contract Code, and shall be exempt from the review or
approval of any division of the Department of General Services.

100506. (a) The board shall establish an appeals process for
prospective and current enrollees of the Exchange that complies with
all requirements of the federal act concerning the role of a state
Exchange in facilitating federal appeals of Exchange-related
determinations. In no event shall the scope of those appeals be
construed to be broader than the requirements of the federal act.
Once the federal regulations concerning appeals have been issued in
final form by the United States Secretary of Health and Human
Services, the board may establish additional requirements related to
appeals, provided that the board determines, prior to adoption, that
any additional requirement results in no cost to the General Fund and
no increase in the charge imposed under subdivision (n) of Section
100503.
(b) The board shall not be required to provide an appeal if the
subject of the appeal is within the jurisdiction of the Department of
Managed Health Care pursuant to the Knox-Keene Health Care Service
Plan Act of 1975 (Chapter 2.2 (commencing with Section 1340) of
Division 2 of the Health and Safety Code) and its implementing
regulations, or within the jurisdiction of the Department of
Insurance pursuant to the Insurance Code and its implementing
regulations.

100507. (a) Notwithstanding any other provision of law, the
Exchange shall not be subject to licensure or regulation by the
Department of Insurance or the Department of Managed Health Care.
(b) Carriers that contract with the Exchange shall have a license
or certificate of authority from, and shall be in good standing with,
their respective regulatory agencies.

100508. (a) Records of the Exchange that reveal any of the
following shall be exempt from disclosure under the California Public
Records Act (Chapter 3.5 (commencing with Section 6250) of Division
7 of Title 1:
(1) The deliberative processes, discussions, communications, or
any other portion of the negotiations with entities contracting or
seeking to contract with the Exchange, entities with which the
Exchange is considering a contract, or entities with which the
Exchange is considering or enters into any other arrangement under
which the Exchange provides, receives, or arranges services or
reimbursement.
(2) The impressions, opinions, recommendations, meeting minutes,
research, work product, theories, or strategy of the board or its
staff, or records that provide instructions, advice, or training to
employees.
(b) (1) Except for the portion of a contract that contains the
rates of payment, contracts entered into pursuant to this title shall
be open to inspection one year after their effective dates.
(2) If a contract entered into pursuant to this title is amended,
the amendment shall be open to inspection one year after the
effective date of the amendment.

100520. (a) The California Health Trust Fund is hereby created in
the State Treasury for the purpose of this title. Notwithstanding
Section 13340, all moneys in the fund shall be continuously
appropriated without regard to fiscal year for the purposes of this
title. Any moneys in the fund that are unexpended or unencumbered at
the end of a fiscal year may be carried forward to the next
succeeding fiscal year.
(b) Notwithstanding any other provision of law, moneys deposited
in the fund shall not be loaned to, or borrowed by, any other special
fund or the General Fund, or a county general fund or any other
county fund.
(c) The board of the California Health Benefit Exchange shall
establish and maintain a prudent reserve in the fund.
(d) The board or staff of the Exchange shall not utilize any funds
intended for the administrative and operational expenses of the
Exchange for staff retreats, promotional giveaways, excessive
executive compensation, or promotion of federal or state legislative
or regulatory modifications.
(e) Notwithstanding Section 16305.7, all interest earned on the
moneys that have been deposited into the fund shall be retained in
the fund and used for purposes consistent with the fund.
(f) Effective January 1, 2016, if at the end of any fiscal year,
the fund has unencumbered funds in an amount that equals or is more
than the board approved operating budget of the Exchange for the next
fiscal year, the board shall reduce the charges imposed under
subdivision (n) of Section 100503 during the following fiscal year in
an amount that will reduce any surplus funds of the Exchange to an
amount that is equal to the agency's operating budget for the next
fiscal year.

100521. (a) The board shall ensure that the establishment,
operation, and administrative functions of the Exchange do not exceed
the combination of federal funds, private donations, and other
non-General Fund moneys available for this purpose. No state General
Fund money shall be used for any purpose under this title without a
subsequent appropriation. No liability incurred by the Exchange or
any of its officers or employees may be satisfied using moneys from
the General Fund.
(b) The implementation of the provisions of this title, other than
this section, Section 100500, and paragraphs (4) and (5) of
subdivision (a) of Section 100504, shall be contingent on a
determination by the board that sufficient financial resources exist
or will exist in the fund. The determination shall be based on at
least the following:
(1) Financial projections identifying that sufficient resources
exist or will exist in the fund to implement the Exchange.
(2) A comparison of the projected resources available to support
the Exchange and the projected costs of activities required by this
title
(3) The financial projections demonstrate the sufficiency of
resources for at least the first two years of operation under this
title
(c) The board shall provide notice to the Joint Legislative Budget
Committee and the Director of Finance that sufficient financial
resources exist in the fund to implement this title.
(d) If the board determines that the level of resources in the
fund cannot support the actions and responsibilities described in
subdivision (a), it shall provide the Department of Finance and the
Joint Legislative Budget Committee a detailed report on the changes
to the functions, contracts, or staffing necessary to address the
fiscal deficiency along with any contingency plan should it be
impossible to operate the Exchange without the use of General Fund
moneys.
(e) The board shall assess the impact of the Exchange's operations
and policies on other publicly funded health programs administered
by the state and the impact of publicly funded health programs
administered by the state on the Exchange's operations and policies.
This assessment shall include, at a minimum, an analysis of potential
cost shifts or cost increases in other programs that may be due to
Exchange policies or operations. The assessment shall be completed on
at least an annual basis and submitted to the Secretary of Health
and Human Services and the Director of Finance.