CA SB1283

Establishes procedures for the Department of Managed Health Care to review grievances when extraordinary circumstances require additional time beyond the standard 30-day review period, including notification requirements and timelines for determining what additional information is needed.

Authorizes the department to impose administrative fines on health care service plans that fail to comply with information requests related to grievance reviews within five calendar days.

Requires health care service plans to submit quarterly reports to the department detailing grievances pending for 30 or more days, including data on resolution timeframes, causes of delays, and breakdowns by Medicare and Medi-Cal enrollees.

Mandates the director include in annual grievance reports data on average resolution timeframes, the number of cases resolved within and beyond 30 days, and analysis of grievances not resolved within 30 days by type and medical condition.

Permits voluntary mediation between subscribers/enrollees and plans prior to submitting grievances to the department, with mediation expenses shared equally by both parties.