2005 California Health and Safety Code Sections 444.20-444.24 PART 1.86. HEALTH CARE CONSUMER ASSISTANCE PROGRAMS

444.20.  The Legislature finds and declares all of the following:
   (a) The health care delivery system continues to undergo rapid and
dramatic change.  Health care services are provided by a variety of
managed care structures, including health maintenance organizations
(HMOs), preferred provider organizations (PPOs), and an array of
hybrid models that have elements of traditional fee-for-service and
indemnity systems while applying managed care's utilization
management, gatekeeper, and case management techniques.  As a result
of these changes, many consumers are confused about how managed care
works or have problems navigating the health care system.
   (b) The Health Rights Hotline operates in the Sacramento area to
help all health care consumers.  The program's goals are to provide
an independent source of information and help for health care
consumers, to collect needed information regarding health care
consumers' problems, and to advocate for health care system
improvements for all consumers.  The program is independent from, but
works in close collaboration with, health plans, providers,
purchasers, insurance agents and brokers, consumer groups, and
regulators.  The program also works with the local Health Insurance
Counseling and Advocacy Program, which serves Medicare beneficiaries
and those imminent of becoming eligible for Medicare statewide.
   (c) The program educates consumers about their health care rights
and responsibilities.  It also assists consumers with questions about
their health plans and with specific problems through hotline and
in-person services.  In addition, the program collects and analyzes
information, generated both by consumers' use of the program and from
other sources, that can identify the strengths and weaknesses of
particular plans, provider groups, and delivery systems.  The program
has informed health plans, providers, purchasers, consumers,
regulators, and the Legislature about how independent support can be
provided to consumers in managed care.
   (d) Maintaining consumer confidence is a paramount concern in the
operation of the program.  While one vehicle to protect these
communications would be to establish attorney-client relationships
with consumers served, the program is generally not designed as a
"legal" program and it would undercut its collaborative strategy and
problem-solving orientation if assistance were required to be
positioned in a legal context.  Furthermore, it is critical that
consumers using the program are free from any retribution.
   (e) The Health Consumer Alliance, a partnership of independent,
nonprofit legal services agencies, includes seven local health
consumer assistance programs in the Counties of Alameda, Fresno, Los
Angeles, Orange, San Diego, San Francisco, and San Mateo.  These
seven Health Consumer Centers help low-income consumers receive
necessary health care through education, training, and advocacy, and
analysis of systemic health access issues.
   (f) The Health Insurance Counseling and Advocacy Program (HICAP)
provides Medicare beneficiaries and those imminent of becoming
eligible for Medicare with counseling and advocacy services on a
statewide basis.  HICAP offers information and assistance regarding
Medicare, managed health care, health and long-term care related life
and disability insurance, and related health care coverage plans.
444.21.  (a) All communications between a representative of the
program described in subdivision (c) of Section 444.20 and a
subscriber or enrollee, or agent of the subscriber or enrollee, or
any other recipient of health care services or any individual
assisting the recipient of health care services, seeking assistance
regarding a grievance or complaint, if reasonably related to the
requirements of the representative's responsibilities for the
program, and made in good faith, shall be privileged subject to
Division 8 (commencing with Section 900) of the Evidence Code.  The
subscriber, enrollee, or other recipient of health care services
shall be the holder of the privilege and may refuse to disclose, and
may prevent others from disclosing, a communication described in this
subdivision.  Any communication described in this subdivision shall
be a privileged communication, which shall serve as a defense to any
civil action in libel or slander against any of the persons described
in this subdivision.
   (b) All records and files of a program described in subdivision
(c) of Section 444.20 relating to any complaint or request for
assistance regarding a subscriber or enrollee, or any other recipient
of health care services, and their identity, shall remain
confidential, and shall not be subject to discovery, unless
disclosure is authorized by the subscriber or enrollee, or any other
recipient of health care services, or his or her legal
representative.  No disclosures shall be made outside of the program
without the consent of the subscriber or enrollee, or any other
recipient of health care services, that is the subject of the record
or file, unless disclosure is made without disclosing the identity of
that individual.
   (c) Any representative of the program described in subdivision (c)
of Section 444.20 shall be exempt from being required to testify in
court as to any communications described in subdivision (a) except as
the court may deem necessary to fulfill the purposes of the program.
   (d) Nothing in this section shall affect the right of a person or
entity to discover if the communication was not made in good faith
pursuant to an in camera inspection of the communication by a court.
444.22.  (a) The Legislature recognizes that the Health Rights
Hotline, serving the greater Sacramento area, and the Health Consumer
Alliance (HCA) programs serving the Counties of Alameda, Fresno, Los
Angeles, Orange, San Diego, San Francisco, and San Mateo, provide
needed education and assistance to individual consumers and provide
the public with critical information about the health care system and
how consumers can best be assisted.  While most of their financial
support is from private sources, the programs serve an important
public interest, as does HICAP which statewide serves Medicare
beneficiaries and persons imminent of becoming eligible for Medicare.
   (b) No discriminatory, disciplinary, or retaliatory action shall
be taken against any health facility, health care service plan,
provider, or an employee thereof, or any subscriber, enrollee, or
agent of the subscriber or enrollee, or any other recipient of health
care services or individual assisting the recipient of health care
services, if the communication is made to a program described in
subdivision (a) regarding a grievance or complaint and is intended to
assist the program in carrying out its duties and responsibilities,
unless the action was done maliciously or without good faith.  This
subdivision is not intended to allow for the unapproved release of
confidential or proprietary information by an employee or contractor,
or to otherwise infringe on the rights of an employer to supervise,
discipline, or terminate an employee for other reasons.
444.23.  (a) Nothing in this part shall be construed to limit the
authority and ability of the California Department of Aging or its
contractors, or the direct service providers of the Health Insurance
Counseling and Advocacy Program (HICAP), from accessing, monitoring,
or reviewing case files and records developed by, or for, any
components of these programs that contractually act as a HICAP
provider.  For those programs, all case records and files of HICAP
clients are, and shall remain, the property of HICAP, subject to case
file and record retention and disposal requirements established by
the Department of Aging.  For the purposes of this section, "HICAP
clients" are defined as those accepted, initiated, and undertaken on
behalf of consumers and clients who are 60 years of age or older,
Medicare beneficiaries regardless of age, or their legal
representatives.
   (b) Nothing in this part shall be construed to limit the ability
of the subscriber or enrollee, or any other recipient of health care
services, to waive the privileges and protections provided by this
section for the purpose of providing information to a regulatory
agency, including, but not limited to, the Department of
Corporations, the Department of Managed Care, and the Department of
Insurance.
   (c) Nothing in this part shall be construed to supercede the
procedures set forth in Sections 1368, 1368.01, 1368.02, and 1368.03,
when the programs are providing assistance to a subscriber or
enrollee in connection with a complaint against a health care service
plan.
   (d) For purposes of this part, a health care service plan,
provider, subscriber, or enrollee shall have the same meaning as set
forth in Section 1345, an agent of a subscriber or enrollee shall
have the same meaning as set forth in subdivision (b) of Section
1368, and a health facility shall have the same meaning as set forth
in Section 1250.
444.24.  This part shall remain in effect only until  January 1,
2011, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2011, deletes or extends
that date.  Notwithstanding this date of repeal, the privileges and
protections provided under this part shall continue to apply to any
actions taken or materials collected after January 1, 2011, if they
relate to communications or actions made on or before January 1,
2011.