Curren D Price
- Democratic
Author
Existing law, the Pharmacy Law, provides for the licensure and regulation of pharmacies by the California State Board of Pharmacy. Existing law provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and for the regulation of health insurers by the Department of Insurance. Existing law requires health care service plan contracts and health insurance policies to provide coverage for specified benefits and requires contracts between plans or insurers and providers to contain provisions requiring a fast, fair, and cost-effective dispute resolution mechanism. This bill would impose specified requirements on an audit of pharmacy services provided to beneficiaries of a health benefit plan. Among other things, the bill would prohibit the entity conducting the audit from receiving payment on any basis tied to the amount claimed or recovered from the pharmacy. The bill would require the entity conducting a pharmacy audit to deliver a preliminary audit report to the pharmacy and to give the pharmacy an opportunity to respond to the report. The bill would require the entity to deliver a final audit report to the pharmacy and to establish, in its contract with the pharmacy, a process for appealing the findings of that report, as specified. The bill would allow either party who, following the appeal, is not satisfied with the appeal, to seek relief under the terms of the contract. The bill would provide that if an identified discrepancy for a single audit exceeds $30,000, future payments to the pharmacy in excess of $30,000 may be withheld pending adjudication of an appeal. The bill would prohibit interest accruing for either party during pendency of the audit, as specified. The bill would require that when the entity is using extrapolation, as defined, in calculating penalties or amounts to be recouped from a pharmacy, that the pharmacy be given an opportunity to provide evidence validating certain orders. The bill also would prohibit a pharmacy from being subject to recoupment of funds for a clerical or recordkeeping error, as defined. The bill would enact other related provisions.
Approved by the Governor.
Chaptered by Secretary of State. Chapter 706, Statutes of 2012.
Enrolled and presented to the Governor at 11 a.m.
Read third time. Passed. (Ayes 80. Noes 0. Page 6765.) Ordered to the Senate.
Assembly Rule 63 suspended. (Page 6750.)
Read second time. Ordered to third reading.
Assembly amendments concurred in. (Ayes 35. Noes 0. Page 5099.) Ordered to engrossing and enrolling.
In Senate. Concurrence in Assembly amendments pending.
Read second time and amended. Ordered to second reading.
From committee: Do pass as amended. (Ayes 18. Noes 0.) (August 29).
Joint Rule 62(a) file notice suspended. (Ayes 51. Noes 27. Page 6468.)
Re-referred to Com. on HEALTH pursuant to Assembly Rule 77.2.
In Assembly. Held at Desk.
Action rescinded whereby the bill was read third time, passed, and ordered to the Senate.
Withdrawn from engrossing and enrolling.
Ordered to the Assembly.
Action rescinded whereby the Assembly amendments were concurred in.
Assembly amendments concurred in. (Ayes 37. Noes 0. Page 4677.) Ordered to engrossing and enrolling.
In Senate. Concurrence in Assembly amendments pending.
Read third time. Passed. (Ayes 76. Noes 1. Page 6013.) Ordered to the Senate.
Ordered to third reading.
Read third time and amended. (Ayes 79. Noes 0. Page 5899.)
Read second time. Ordered to third reading.
From committee: Do pass. (Ayes 13. Noes 0.) (July 3).
From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH.
In Assembly. Read first time. Held at Desk.
Read third time. Passed. (Ayes 23. Noes 10. Page 3745.) Ordered to the Assembly.
Read second time. Ordered to third reading.
Ordered to second reading.
Withdrawn from committee.
Read second time and amended. Re-referred to Com. on RLS.
From committee: Do pass as amended and re-refer to Com. on RLS. (Ayes 5. Noes 2. Page 3306.) (April 25).
Set for hearing April 24.
Set, first hearing. Hearing canceled at the request of author.
Set for hearing April 18.
From committee with author's amendments. Read second time and amended. Re-referred to Com. on RLS.
From printer. May be acted upon on or after March 24.
Introduced. Read first time. To Com. on RLS. for assignment. To print.
| Bill Text Versions | Format |
|---|---|
| SB1195 | HTML |
| 02/22/12 - Introduced | |
| 03/26/12 - Amended Senate | |
| 05/01/12 - Amended Senate | |
| 06/26/12 - Amended Assembly | |
| 08/13/12 - Amended Assembly | |
| 08/30/12 - Amended Assembly | |
| 09/10/12 - Enrolled | |
| 09/28/12 - Chaptered |
| Document | Format |
|---|---|
| No related documents. |
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