28 CA ADC § 1300.73.21


      28 CCR s 1300.73.21

      Cal. Admin. Code tit. 28, s 1300.73.21


      CALIFORNIA CODE OF REGULATIONS
      TITLE 28. MANAGED HEALTH CARE
      DIVISION 1. THE DEPARTMENT OF MANAGED HEALTH CARE
      CHAPTER 2. HEALTH CARE SERVICE PLANS
      ARTICLE 8. SELF-POLICING PROCEDURES
      This database is current through 06/09/06, Register 2006, No. 23.

      s 1300.73.21. Arbitration and Settlement Agreements.

      (a) All health care service plans (plans) shall ensure that all 
      arbitration decisions involving the plan and a current or former enrollee 
      shall be provided to the Department as follows:

      (1) Within thirty (30) days of receiving a written arbitration decision, 
      the plan shall provide a copy of the complete arbitration decision to the 
      Department. The complete arbitration decision shall have no part of the 
      decision altered or redacted. The complete arbitration decision shall 
      indicate the prevailing party, the amount and other relevant terms of any 
      award, and the reasons for the decision.

      (2) On a quarterly basis, plans shall provide the Department with redacted 
      copies of all written arbitration decisions. The plan shall be responsible 
      for redacting the written arbitration decisions ensuring that the names of 
      the enrollee, the plan, witnesses, attorneys, providers, plan employees 
      and health facilities have been removed from the decision. The redacted 
      arbitration decisions will be available for public inspection on the 
      Department's web page (www.dmhc.ca.gov).

      (b) Every written arbitration decision, and every written settlement 
      agreement resolving any dispute between a plan and a current or former 
      enrollee shall contain the following language in bold, twelve (12) point 
      type:

      Nothing in this arbitration decision (or settlement agreement) prohibits 
      or restricts the enrollee from discussing or reporting the underlying 
      facts, results, terms and conditions of this decision (or settlement 
      agreement) to the Department of Managed Health Care.

      (c) All health care service contracts containing an arbitration clause; 
      all arbitration agreements and decisions; and all settlement agreements 
      resolving any dispute between a plan and a current or former enrollee, 
      shall contain no language that expressly or impliedly prohibits the 
      enrollee from discussing or reporting the underlying facts, outcome, 
      results or decision with the Department.

      (d) For purposes of this section, a "settlement agreement" shall be 
      broadly construed to include any writing resolving a dispute between a 
      plan and a current or former enrollee wherein the nature of the dispute 
      relates to services, benefits, treatment or other rights and obligations 
      created pursuant to the enrollee and plan's contract for health care 
      coverage, and includes settlements reached in, but not limited to, a 
      mediation, arbitration, or other alternative dispute resolution process, 
      or any civil lawsuit.


      


      Note: Authority Cited: Sections 1344, 1346 and 1373.21, Health and Safety 
      Code. Reference: Sections 1373.19 and 1373.20, Health and Safety Code. 


       HISTORY 
         
      1. New section filed 8-19-2002; operative 9-18-2002 (Register 2002, No. 
      34).
      28 CA ADC s 1300.73.21

      END OF DOCUMENT

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