CaliforniaHealth care coverage: rate review.
What it does
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a violation of the act by a health care service plan a misdemeanor. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law defines "unreasonable rate increase," for these purposes, to have the same meaning as in the federal Patient Protection and Affordable Care Act, which is that an unreasonable rate increase exists when the federal Centers for Medicare and Medicaid Services makes a determination that a rate increase is excessive, unjustified, or unfairly discriminatory, among other things.
More detail
This bill would instead define "unreasonable rate increase," for the above-described purposes, to mean a rate increase that the Director of the Department of Managed Health Care or the Insurance Commissioner, as applicable, determines is excessive, unjustified, unfairly discriminatory, or otherwise unreasonable.
Existing law requires a health care service plan or health insurer to submit rates to their regulating entity for review and to demonstrate the impact of any changes in the rate of growth of health care costs resulting from health care cost targets.
This bill would instead require a health care service plan or health insurer to demonstrate the impact of health care cost targets and to demonstrate whether a health care service plan's or health insurer's annual rate growth exceeds or will exceed the cost target for the rating period. The bill would require, if a health care service plan's or health insurer's rate growth is expected to exceed the cost target for a rating period, the health care service plan or health insurer to include specified information in its rate filing, including, among other things, a detailed list of any proactive steps it is taking, or plans to take, for annual rate growth to meet the cost targets. Because a willful violation of these provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program.
Existing law requires the director or the commissioner, as applicable, in determining if a rate is unreasonable or not justified for purposes of the above-described review, to consider the impact on changes in health care costs as a result of the health care cost targets described above.
This bill would delete those provisions and instead require the Department of Managed Health Care and the Department of Insurance to report on if rates, by plan or policy and in aggregate, meet the affordability standard, as defined, for an individual, a couple, and a family of four. The bill would require the report to include the annual change in premiums and cost sharing for the prior 5 years. The bill would, as part of the existing rate submission process, require a health care service plan or health insurer to provide information on premiums, deductibles, cost sharing, and any other factors specified by the department as necessary to complete the reports.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
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Where it stands
- Introduced
- Passed Senate
- Passed Assembly
- To Governor
- Became Law
Looking ahead
No hearings or votes scheduled.
History
- 2026
- Sep 27In Senate. Consideration of Governor's veto pending.Latest
- Sep 27Vetoed by the Governor Gavin Newsom.Major
- Aug 30Enrolled and presented to the Governor at 6 p.m.To Governor
- Aug 25Assembly amendments concurred in. (Ayes 30. Noes 10. Page 5794.) Ordered to engrossing and enrolling.Major
- Vote recorded Unfinished Business SB1037 Weber Pierson Concurrence. Result: pass.Upper
- Aug 24In Senate. Concurrence in Assembly amendments pending.
- Vote recorded SB 1037 Weber Pierson Senate Third Reading By Schiavo. Result: pass.Lower
- Aug 24Read third time. Passed. (Ayes 59. Noes 15. Page 6392.) Ordered to the Senate.Passed Assembly
- Aug 18Ordered to third reading.Minor
- Aug 18Read third time and amended.Major
- Aug 13Read second time. Ordered to third reading.Minor
- Vote recorded Do pass. Result: pass.Lower
- Aug 13From committee: Do pass. (Ayes 11. Noes 2.) (August 13).Minor
- Aug 13Assembly Rule 63 suspended.
- Aug 5August 5 set for first hearing. Placed on suspense file.
- Jul 2Read second time and amended. Re-referred to Com. on APPR.Major
- Jul 1From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 12. Noes 4.) (June 30).Major
- Jun 30
- Vote recorded Do pass as amended and be re-referred to the Committee on [Appropriations]. Result: pass.Lower
- Jun 22From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH.Major
- Jun 4Referred to Com. on HEALTH.Minor
- May 27In Assembly. Read first time. Held at Desk.Minor
- Vote recorded 3rd Reading SB1037 Weber Pierson. Result: pass.Upper
- May 27Read third time. Passed. (Ayes 30. Noes 9. Page 4507.) Ordered to the Assembly.Passed Senate
- May 18Read second time. Ordered to third reading.Minor
- May 14Read second time and amended. Ordered to second reading.Major
- Vote recorded Do pass as amended. Result: pass.Upper
- May 14From committee: Do pass as amended. (Ayes 5. Noes 1. Page 4262.) (May 14).Major
- May 8Set for hearing May 14.
- Apr 27April 27 hearing: Placed on APPR. suspense file.
- Vote recorded Placed on suspense file. Result: pass.Upper
- Apr 17Set for hearing April 27.
- Apr 16From committee: Do pass and re-refer to Com. on APPR. (Ayes 7. Noes 1. Page 3901.) (April 15). Re-referred to Com. on APPR.Minor
- Apr 15
- Vote recorded Do pass, but first be re-referred to the Committee on [Appropriations]. Result: pass.Upper
- Apr 7From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH.Major
- Apr 2Set for hearing April 15.
- Apr 1April 8 set for first hearing canceled at the request of author.
- Mar 23Set for hearing April 8.
- Feb 18Referred to Com. on HEALTH.Minor
- Feb 12From printer. May be acted upon on or after March 14.
- Feb 11Introduced. Read first time. To Com. on RLS. for assignment. To print.Introduced