CA AB1124

Director of Department of Managed Health Care may authorize up to 2 pilot programs (one in northern California, one in southern California) allowing providers to enter risk-bearing arrangements with voluntary employees' beneficiary associations (enrollment over 100,000) or multiemployer welfare plan trust funds (enrollment over 25,000), operating from January 1, 2022 through December 31, 2025.

Risk-bearing providers must register as risk-based organizations, obtain limited or restricted licenses, maintain financial solvency standards, and comply with quarterly financial reporting requirements during the pilot program period.

Participating voluntary employees' beneficiary associations or trust funds must provide basic health care services, prescription drug benefits, continuity of care, network adequacy standards, language assistance, consumer grievance processes, and member documents; contracts with providers must address financial responsibility, delegated authority, utilization review, and claims processing.

Participating entities must collect and report annually to the department on comparative cost savings versus fee-for-service models, clinical patient outcomes, and enrollee satisfaction; department must submit findings to Legislature by January 1, 2027.

Pilot program participants must reimburse the department up to $500,000 for regulatory costs including report commissioning, application development, and compliance monitoring; provisions sunset and repeal on January 1, 2028.