SECTIONS 12710-12714 - California Statutes

INSURANCE CODE

SECTION 12710-12714

12710. The California Major Risk Medical Insurance Program is
hereby created in the Health and Welfare Agency. The program shall be
managed by the Major Risk Medical Insurance Board. The board shall
consist of seven members, five of whom shall be appointed as follows:
The Governor shall appoint three members, subject to confirmation
by the Senate, and shall designate one of these appointees as chair
of the board. The Senate Committee on Rules shall appoint one member.
The Speaker of the Assembly shall appoint one member. The terms of
appointment shall be four years.
The Secretary of Business, Transportation, and Housing, or his or
her designee, and the Secretary of Health and Welfare, or his or her
designee, shall serve on the board as ex officio, nonvoting members.
The board shall appoint an executive director for the board, who
shall serve at the pleasure of the board. The executive director
shall receive the salary established by the Department of Personnel
Administration for exempt officials. The executive director shall
administer the affairs of the board as directed by the board, and
shall direct the staff of the board. The executive director may
appoint, with the approval of the board, staff necessary to carry out
the provisions of this part.

12710.1. The Major Risk Medical Insurance Board is hereby renamed
the Managed Risk Medical Insurance Board. Any contract or agreement
entered into by the Major Risk Medical Insurance Board shall
constitute contracts or agreements entered into by the Managed Risk
Medical Insurance Board. Any reference in any statute, regulation,
contract, or any other document to the Major Risk Medical Insurance
Board as of the effective date of this act shall be deemed a
reference to the Managed Risk Medical Insurance Board.

12711. The board shall have the authority:
(a) To determine the eligibility of applicants.
(b) To determine the major risk medical coverage to be provided
program subscribers.
(c) To research and assess the needs of persons not adequately
covered by existing private and public health care delivery systems
and promote means of assuring the availability of adequate health
care services.
(d) To approve subscriber contributions, and plan rates, and
establish program contribution amounts.
(e) To provide major risk medical coverage for subscribers or to
contract with a participating health plan or plans to provide or
administer major risk medical coverage for subscribers.
(f) To authorize expenditures from the fund to pay program
expenses which exceed subscriber contributions.
(g) To contract for administration of the program or any portion
thereof with any public agency, including any agency of state
government, or with any private entity.
(h) To issue rules and regulations to carry out the purposes of
this part.
(i) To authorize expenditures from the fund or from other moneys
appropriated in the annual Budget Act for purposes relating to
Section 10127.15 of this code or Section 1373.62 of the Health and
Safety Code.
(j) To exercise all powers reasonably necessary to carry out the
powers and responsibilities expressly granted or imposed upon it
under this part.

12711.5. The board shall include a promotional component in the
administrative costs of the program. This component shall include
reasonable costs of advertising and other appropriate means of
notifying the public of the program. Any state agency requested by
the board shall provide assistance in implementing this promotional
component of the program.

12712. The board shall, pursuant 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), adopt all necessary
rules and regulations to carry out this part, including the
following:
(a) Establishing the scope and content of adequate major medical
coverage.
(b) Determining reasonable minimum standards for participating
health plans.
(c) Determining the time, manner, method, and procedures for
withdrawing program approval from a plan.
(d) Researching and assessing the needs of persons without
adequate health coverage, and promoting means of assuring the
availability of adequate health care services.
(e) Administering the program so as to ensure that the program
subsidy amount does not exceed amounts transferred to the fund
pursuant to Chapter 8 (commencing with Section 12739).
(f) Issuing appropriate rules and regulations for any other
matters it may be authorized or required to provide for by this part.
In adopting these rules and regulations, the board shall be guided
by the needs and welfare of persons unable to secure adequate health
coverage for themselves and their dependents, and prevailing
practices among private health plans.

12713. Plan rates for major risk medical benefits approved for the
program shall not be excessive, inadequate, or unfairly
discriminatory, but shall be adequate to pay anticipated costs of
claims or services and administration.

12714. There is in the program an appropriately qualified
three-member physician advisory panel to be appointed by the board to
provide consultation to the board on the utilization review,
including peer review and quality assurance procedures of any
participating health plan. The composition of the panel shall reflect
the types of delivery systems providing services in this state. This
consultation shall be nonbinding. The term of office of each member
of this panel shall be for three years.