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Notable California Bills Introduced in 2019 Balance Billing occurs - - PowerPoint PPT Presentation
Notable California Bills Introduced in 2019 Balance Billing occurs - - PowerPoint PPT Presentation
Notable California Bills Introduced in 2019 Balance Billing occurs when: Patient is treated by an out-of-network physician or at an out-of-network hospital Patient is treated at an in-network hospital but by an out-of-network
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“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.
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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
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What’s different about AB 1611?
Year Type of Setting Type of Plan Target Emerg ency Post Stabiliz ation Non- emerg ency DMHC CDI Others AB 1203 2008 X X Caps cost AB 72 2016 X X X Caps cost AB 1611 2019 X X X X X Caps cost
Adopted from http://sourceonhealthcare.org/2019s-ab-1611-is-californias- latest- attempt-in-its-long-litigious-history-to-eliminate-balance-billing/
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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
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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
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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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