CA Welf & Inst Code Section 14199.51

The following definitions shall apply for the purposes of this article:

(a)

“Alternate Health Care Service Plan” or “AHCSP” means a nonprofit health care service plan with at least four million enrollees statewide, that owns or operates pharmacies, and provides professional medical services to enrollees in specific geographic regions through an exclusive contract with a single medical group in each specific geographic region in which it is licensed.

(b)

“AHCSP enrollee” means an individual enrolled in an AHCSP, as defined in subdivision (a), who is not a Medi-Cal beneficiary.

(c)

“AHCSP enrollee tax amount” means the amount of tax assessed per countable enrollee within an AHCSP taxing tier.

(d)

“AHCSP taxing tier” means a range of cumulative enrollment of countable AHCSP enrollees for the base year.

(e)

“Base year” means the 12-month period of October 1, 2014, through September 30, 2015.

(f)

“Base data source” means the quarterly financial statement filings submitted by health plans to the Department of Managed Health Care retrieved by the department as of January 1, 2016, and supplemented by, as necessary, Medi-Cal enrollment data for the base year as maintained by the department and retrieved as of January 1, 2016.

(g)

“Countable enrollee” means an individual enrolled in a health plan, as defined in subdivision (k), during a month of the base year according to the base data source. “Countable enrollee” does not include an individual enrolled in a Medicare plan, a plan-to-plan enrollee, as defined in subdivision (r), or an individual enrolled in a health plan pursuant to the Federal Employees Health Benefits Act of 1959 (Public Law 86-382) to the extent the imposition of the tax under this article is preempted pursuant to Section 8909(f) of Title 5 of the United States Code.

(h)

“Department” means the State Department of Health Care Services.

(i)

“Director” means the Director of Health Care Services.

(j)

“Excluded plan” means any of the following:

(1)

A health plan licensed pursuant to Section 1351.2 of the Health and Safety Code.

(2)

A health plan that is owned and operated by a 501(c)(3) hospital or health system or multiple 501(c)(3) hospitals or health systems if that health plan has both a substantial amount of its enrollment in and is headquartered in either the County of Sacramento or San Diego.

(k)

“Health care service plan” or “health plan” means a health care service plan, other than a plan that provides only specialized or discount services, that is licensed by the Department of Managed Health Care under the Knox-Keene Health Care Service Plan Act of 1975 (Chapter 2.2 (commencing with Section 1340) of Division 2 of the Health and Safety Code) or a managed care plan contracted with the State Department of Health Care Services to provide Medi-Cal services.

(l)

“Medi-Cal enrollee” means an individual enrolled in a health plan, as defined in subdivision (k), who is a Medi-Cal beneficiary for whom the department directly pays the health plan a capitated payment.

(m)

“Medi-Cal per enrollee tax amount” means the amount of tax assessed per countable Medi-Cal enrollee within a Medi-Cal taxing tier.

(n)

“Medi-Cal taxing tier” means a range of cumulative enrollment of countable Medi-Cal enrollees for the base year.

(o)

“Other enrollee” means an individual enrolled in a health plan, as defined in subdivision (k), who is not a Medi-Cal beneficiary or an AHCSP enrollee.

(p)

“Other per enrollee tax amount” means the amount of tax assessed per countable other enrollee within another taxing tier.

(q)

“Other taxing tier” means a range of cumulative enrollment of countable other enrollees for the base year.

(r)

“Plan-to-plan enrollee” means an individual who receives his or her health care services through a health plan pursuant to a subcontract from another health plan.