28 CA ADC § 1300.75.4.4


      28 CCR s 1300.75.4.4

      Cal. Admin. Code tit. 28, s 1300.75.4.4


      CALIFORNIA CODE OF REGULATIONS
      TITLE 28. MANAGED HEALTH CARE
      DIVISION 1. THE DEPARTMENT OF MANAGED HEALTH CARE
      CHAPTER 2. HEALTH CARE SERVICE PLANS
      ARTICLE 9. FINANCIAL RESPONSIBILITY
      RISK-BEARING ORGANIZATIONS
      This database is current through 06/09/06, Register 2006, No. 23.

      s 1300.75.4.4. Confidentiality.

      (a) Financial and other records produced, disclosed or otherwise made 
      available by an organization pursuant to Health and Safety Code section 
      1375.4, and to these Solvency Regulations shall be received and maintained 
      on a confidential basis and protected from public disclosure, unless the 
      Director makes a specific finding that the information can be released in 
      a manner that does not adversely affect the integrity of the contract 
      negotiation process; except that the organization's annual audited 
      financial statement as required by section 1300.75.4.2(c) shall be 
      permanently maintained on a confidential basis.

      (b) The Director has determined that the disclosure of the following 
      information in the format provided below will not adversely affect the 
      integrity of an organization's contract negotiation process and, 
      therefore, will be made available to the public as follows:

      (1) Within 120 days following each reporting period due date, the 
      Department of Managed Health Care (Department) will make the following 
      information available, on its website, for public inspection:

      (A) A list of all provider organizations currently identified as 
      risk-bearing organizations;

      (B) A list of all risk-bearing organizations that have submitted 
      substantially complete financial survey forms, if required, and whether 
      the risk-bearing organization's submission reflects that the organization 
      has met or not met each of the Grading Criteria, as follows:

      1. The designation of "met" to be assigned for each Grading Criteria met 
      by the organization;

      2. The designation of "not met" to be assigned for each Grading Criteria 
      not met by the organization;

      3. The disclosure of whether the organization has implemented and is 
      compliant with a final CAP designed to remedy any deficiencies reported in 
      the Grading Criteria;

      4. The relative working capital of each organization, consistent with 
      section 1300.75.4(h), presented as a ratio of current assets divided by 
      current liabilities;

      5. The relative tangible net equity (TNE) of each organization, consistent 
      with section 1300.75.4(h), presented as a ratio of tangible net assets 
      divided by total liabilities;

      6. Claims payment timeliness in a percentage format, consistent with 
      section 1300.75.4.(h), reflecting the amount of claims that the 
      organization is paying on a timely basis; and,

      7. To the extent feasible, each financial item described in paragraphs 1. 
      through 5. shall be presented for both the current and the four previous 
      reporting periods, following the effective date of these regulations.

      (C) A list of all "non-compliant" organizations that fail to substantially 
      comply with the reporting obligations, including the submission of the 
      financial survey reports specified in section 1300.75.4.2 of Title 28, 
      California Code of Regulations; and

      (D) All information contained in the Statement of Organization of a 
      risk-bearing organization, except responses to sections 
      1300.75.4.2(d)(8)(A), (d)(14) and financial documentation provided 
      pursuant to section 1300.75.4.2 (d)(4); and

      (E) Comparative, aggregated data on all organizations, and information 
      that enables consumers to assess an organization's relative financial 
      viability in a format that does not identify any individual organizations 
      and consistent with section 1300.75.4.4 of Title 28, California Code of 
      Regulations.

      (c) Information received and maintained on a confidential basis pursuant 
      to this section may be disclosed by the Director under the following 
      circumstances:

      (1) To other local, state or federal regulatory or law-enforcement 
      agencies in accordance with the law;

      (2) When necessary or appropriate in any proceeding or investigation 
      conducted by the Department to enforce the provisions of the Knox-Keene 
      Act;

      (3) In the event that an organization publicly questions or challenges the 
      Department's decision to approve or disapprove an organization's proposed 
      CAP submitted in accordance with section 1300.75.4.8 of Title 28 of the 
      California Code of Regulations, the Department may release the relevant 
      portions of the organization's financial information to explain the 
      Department's decision; and,

      (4) Upon a determination by the Director, pursuant to Health and Safety 
      Code section 1375.4(b)(7), that the justification for the confidential 
      treatment no longer exists, provided that the information that is 
      disclosed is at least two (2) years old.


      


      Note: Authority cited: Sections 1344 and 1375.4, Health and Safety Code. 
      Reference: Section 1375.4, Health and Safety Code. 


       HISTORY 
         
      1. New section filed 8-10-2005; operative 9-9-2005 (Register 2005, No. 
32).
      For prior history, see Register 2002, No. 28.
      28 CA ADC s 1300.75.4.4

      END OF DOCUMENT

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