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Home > Complaint Data Reports > Legislative Mandates

Legislative Mandates

The Office of the Patient Advocate (OPA) has its authority under California Health and Human Safety Code §136000, as mandated by SB 857 (Chapter 31, Statutes of 2014). Here is an excerpt pertinent to OPA's complaint data reports.

(b) (1) The duties of the office shall include, but not be limited to, all of the following:

(B) Produce a baseline review and annual report to be made publically available on the office’s Internet Web site by July 1, 2015, and annually thereafter, of health care consumer or patient assistance help centers, call centers, ombudsperson, or other assistance centers operated by the Department of Managed Health Care, the Department of Health Care Services, the Department of Insurance, and the Exchange, that includes, at a minimum, all of the following:
(i) The types of calls received and the number of calls.
(ii) The call center’s role with regard to each type of call, question, complaint, or grievance.
(iii) The call center’s protocol for responding to requests for assistance from health care consumers, including any performance standards.
(iv) The protocol for referring or transferring calls outside the jurisdiction of the call center.
(v) The call center’s methodology of tracking calls, complaints, grievances, or inquiries.

(C) (i) Collect, track, and analyze data on problems and complaints by, and questions from, consumers about health care coverage for the purpose of providing public information about problems faced and information needed by consumers in obtaining coverage and care. The data collected shall include demographic data, source of coverage, regulator, type of problem or issue or comparable types of problems or issues, and resolution of complaints, including timeliness of resolution. Notwithstanding Section 10231.5 of the Government Code, the office shall submit a report by July 1, 2015, and annually thereafter to the Legislature. The report shall be submitted in compliance with Section 9795 of the Government Code. The format may be modified annually as needed based upon comments from the Legislature and stakeholders.
(ii) For the purpose of publically reporting information as required in subparagraph (B) and this subparagraph about the problems faced by consumers in obtaining care and coverage, the office shall analyze data on consumer complaints and grievances resolved by the agencies listed in subdivision (c), including demographic data, source of coverage, insurer or plan, resolution of complaints, and other information intended to improve health care and coverage for consumers.

(E) Develop model protocols, in consultation with consumer assistance call centers and stakeholders, that may be used by call centers for responding to and referring calls that are outside the jurisdiction of the call center, program, or regulator.
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