Welfare and Institutions Code § 14199.91

14199.91.

For purposes of this article, the following definitions apply:

(a) “Base data source” means the quarterly financial statement filings or annual enrollment data submitted by health plans to the Department of Managed Health Care retrieved by the department no later than June 30, 2026, and supplemented by, as necessary, Medi-Cal enrollment data for the base year as maintained by the department and retrieved no later than June 30, 2026, and as modified by the department to account for known or anticipated changes that will affect Medi-Cal enrollment on or after January 1, 2027. However, if the department elects to update the base year pursuant to subdivision (b), “base data source” means the most recently available quarterly financial statement filings or annual enrollment data submitted by health plans to the Department of Managed Health Care for that updated base year, retrieved by the department, and supplemented by, as necessary, Medi-Cal enrollment data for the updated base year as maintained by the department, and as modified by the department to account for known or anticipated changes that will affect Medi-Cal enrollment.

(b) “Base year” for the 2027 calendar year tax period means either the 12-month period of January 1, 2024, through December 31, 2024, or the 12-month period of January 1, 2025, through December 31, 2025, as determined by the department. For subsequent tax periods, the department may elect to update the base year to the extent that it deems such action to be consistent with the requirements of federal law or regulations, or necessary to obtain or maintain federal approval or to ensure that federal financial participation is available or is not otherwise jeopardized.

(c) “Countable enrollee” means an individual enrolled in a health plan, as described in subdivision (f), 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 (h), 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 that the imposition of the tax under this article is preempted pursuant to Section 8909(f) of Title 5 of the United States Code.

(d) “Department” means the State Department of Health Care Services.

(e) “Director” means the Director of Health Care Services.

(f) “Enrollee” means an individual enrolled in a health plan, as defined in subdivision (g), unless otherwise specified.

(g) “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 full-scope Medi-Cal services.

(h) “Plan-to-plan enrollee” means an individual who receives their health care services through a health plan pursuant to a subcontract from another health plan.

(i) “Tax amount” means the amount of tax assessed per countable enrollee.

(j) “Tax period” means a period of not more than 12 months for which the tax authorized by this article is assessed, in accordance with the requirements described in Section 14199.94.