SECTIONS 14200-14206 - California Statutes

WELFARE AND INSTITUTIONS CODE

SECTION 14200-14206

14200. This chapter shall be known and may be cited as the
Waxman-Duffy Prepaid Health Plan Act.

14200.1. The purpose of this chapter is to afford persons eligible
to receive benefits under Chapter 7 (commencing with Section 14000)
of this part the opportunity to enroll as regular subscribers in
prepaid health plans, without reference to marital status or any
characteristic listed or defined in Section 11135 of the Government
Code.

14201. The intent of the Legislature is to provide, to the extent
feasible, through the provisions of this chapter and the necessarily
related provisions of Chapter 7 (commencing with Section 14000) of
this part, recipients of public assistance and medically indigent
aged and other persons with the opportunity to enroll in prepaid
health plans. It is further intended that this legislation is to
benefit the people of the State of California by:
(a) Encouraging the development of more efficient delivery of
health care to Medi-Cal recipients.
(b) Reducing the inflationary costs of health care.
(c) Improving the quality of medical services rendered to those
eligible enrollees as defined in this chapter and Chapter 7
(commencing with Section 14000) of this part.
(d) Reducing administrative costs of operating the Medi-Cal Act by
allowing prepaid health plans to assume substantial costs of
administration and utilization controls that are now assumed by the
State Department of Health Services.

14203. (a) For purposes of administering this chapter and Chapter 7
(commencing with Section 14000) of this part, the department is
hereby designated as the single or appropriate state agency with full
power to administer and adopt regulations in order to secure full
compliance with applicable provisions of state and federal laws.
(b) The department may adopt regulations implementing this chapter
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. Initial regulations to implement this chapter may be
adopted as emergency regulations. The adoption of these initial
emergency regulations shall be considered by the Office of
Administrative Law as necessary for the immediate preservation of the
public peace, health, and safety, or general welfare. Initial
emergency regulations adopted pursuant to this section shall remain
in effect for no more than 180 days.
(c) This section shall become operative on January 1, 1995.

14204. (a) Pursuant to the provisions of this chapter, the
department may contract with one or more prepaid health plans in
order to provide the benefits authorized under this chapter and
Chapter 7 (commencing with Section 14000) of this part. The
department may contract with one or more children's hospitals on an
exclusive basis for a specified population in a specified geographic
area. Contracts entered into pursuant to this chapter may be awarded
on a bid or nonbid basis.
(b) In order to achieve maximum cost savings the Legislature
hereby determines that expedited contract process for contracts under
this chapter is necessary. Therefore, contracts under this chapter
shall be exempt from Chapter 2 (commencing with Section 10290) of
Part 2 of Division 2 of the Public Contract Code.

14205. Except where the context otherwise requires, or where
specific exceptions are authorized, all provisions of Chapter 7
(commencing with Section 14000) of this part shall be applicable to
the provisions of this chapter and the violation of the provisions of
this chapter or any rule or regulation adopted pursuant thereto
shall be deemed to be a violation of Chapter 7.

14206. (a) No prepaid health plan or pilot program shall be deemed
to transact insurance or to be subject to any provision of the
Insurance Code by virtue of negotiating, executing, or performing a
prepaid health plan or pilot program contract under this chapter, or
by virtue of compliance with the provisions of such a prepaid health
plan or pilot program contract, including, but not limited to,
creation, segregation, or maintenance of security to protect or
safeguard the performance of such a prepaid health plan or pilot
program contract. The director may require such security in respect
to any such contract including, but not limited to, securities,
surety bonds, or evidences of governmental debt, of the kinds, in the
manner, and to the extent provided by the prepaid health plan or
pilot program contract.
(b) Prepaid health plans or pilot programs to which the state is a
party under the provisions of this chapter, and contracts and
arrangements embodying such plans or programs shall not be subject to
the provisions of law prescribing the forms of hospital or medical
service or insurance contracts or requiring approval thereof or of
the form thereof, by any state officer or agency except the director
or the department.
This exemption applies, but is not limited to: (1) Chapter 4
(commencing with Section 10270) of Part 2 of Division 2 of the
Insurance Code, (2) Section 11069 of the Insurance Code, and (3)
Section 11513 of the Insurance Code. However, the exemption provided
for in this section shall not exempt any insurer subject to taxation
under Part 7 (commencing with Section 12001) of Division 2 of the
Revenue and Taxation Code from the tax imposed under such part on
gross premiums derived from contracts under this chapter.