Notable California Bills Introduced in 2019
“Balance Billing” occurs when: ü Patient is treated by an out-of-network physician or at an out-of-network hospital ü Patient is treated at an in-network hospital but by an out-of-network (usually ancillary) physician
“Balance Billing” occurs when: In such cases, the patient’s insurance does not cover the full cost of care, leaving a balance in the medical bill. Out-of-Network hospitals or physicians then charge that balance directly to the patient, holding the patient responsible for the remainder of the bill.
AB 1611. Emergency Hospital Services: Costs § Addresses balance billing § Prohibits hospitals from balance billing patients; establishes payment rates for emergency services § Not the first; CA has existing laws which protect patients from surprise medical bills
What’s different about AB 1611? Year Type of Setting Type of Plan Target Emerg Post Non- DMHC CDI Others ency Stabiliz emerg ation ency AB 2008 X X Caps 1203 cost AB 2016 X X X Caps 72 cost AB 2019 X X X X X Caps 1611 cost Adopted from http://sourceonhealthcare.org/2019s-ab-1611-is-californias- latest- attempt-in-its-long-litigious-history-to-eliminate-balance-billing/
Six Senators’ Request for Information to Industry Groups § Letter sent to health plans and providers Bill Cassidy, Michael § Bennet, Todd Young, Tom Carper, Lisa Murkowski, Maggie Hassan Response requested by § 2/18/2019
AB 204. Hospitals: Community Benefits Plan Reporting Creates standard for how nonprofit hospitals calculate § and report the value of community benefits by 7/1/2020 Requires systems with more than one hospital to § report the information separately for each of its facilities § Prohibits hospitals from including fundraising and compliance expense in community benefit costs Allows OSHPD to assess fines against hospitals §
SB 66. Medi-Cal: Federally Qualified Health Center and Rural Health Clinic Services § Same as SB 1125 vetoed by Governor Brown on 9/27/2018 § Allows FQHC or RHC to bill for a maximum of two visits taking place on the same day at a single location (can be a medical visit plus a mental health visit or a dental visit)
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