BILL NUMBER: AB 2146	AMENDED
	BILL TEXT

	AMENDED IN SENATE  JULY 2, 2008
	AMENDED IN SENATE  JUNE 19, 2008
	AMENDED IN ASSEMBLY  MAY 23, 2008
	AMENDED IN ASSEMBLY  APRIL 23, 2008
	AMENDED IN ASSEMBLY  APRIL 3, 2008

INTRODUCED BY   Assembly Member Feuer

                        FEBRUARY 20, 2008

   An act to add Sections  1279.4   1279.4,
1279.5,  and 1371.6 to the Health and Safety Code, to add
Sections 10133.57 and 12693.55 to the Insurance Code, and to add
Section 14110.25 to the Welfare and Institutions Code, relating to
health coverage.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 2146, as amended, Feuer. Health care providers: billing.
   Existing law provides for the licensure and regulation of health
facilities including hospitals by the State Department of Public
Health. Violations of these provisions is a misdemeanor. 
Existing law provides for the licensure and regulation of health care
providers. 
   Existing law, the Knox-Keene Health Care Service Plan Act of 1975,
provides for the regulation of health care service plans by the
Department of Managed Health Care. Existing law requires a health
care service plan to provide specified coverage to its enrollees and
subscribers. Existing law provides that a willful violation of the
act is a crime.
   Existing law provides for the regulation of health insurers by the
Department of Insurance. Existing law requires a health insurance
policy to provide specified coverage to insured persons.
   Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Care Services and
under which qualified low-income persons receive health care
benefits.
   Existing law establishes the Healthy Families Program,
administered by the Managed Risk Medical Insurance Board, to arrange
for the provision of health services to an eligible person.
   This bill would require the development and implementation of
policies governing the payment of health care providers for
hospital-acquired conditions by the Healthy Families Program and the
Medi-Cal program,  and to the extent feasible, all other state
public health programs,  consistent with the policies developed
by the federal Centers for Medicare and Medicaid Services. The bill
would prohibit a contract between a  contracting 
 health care  provider and a health care service plan or an
insurer from prohibiting the adoption, implementation, or exercise of
nonpayment policies  and practice  for hospital-acquired
conditions. The bill would preclude a patient from being charged by a
 contracting   health care  provider for
care and services for which payment has been denied by  a
 the Healthy Families Program, the Medi-Cal program, a
health care service plan, or an insurer according to the nonpayment
policies  and practices  established pursuant to the bill.
   This bill would require the medical director and the director of
nursing of a hospital to report annually to the facility's board of
directors regarding hospital-acquired conditions, as provided.
 The bill would require the Secretary of California Health
and Human Services to report to the Governor and the Legislature, on
or before January 1, 2011, and biannually thereafter, specified
information relating to the nonpayment policies for the Healthy
Families Program and the Medi-Cal program, and the prevention of
hospital-acquired conditions. 
   By changing the definition of existing crimes, this bill would
impose a state-mandated local program.
   The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
   This bill would provide that no reimbursement is required by this
act for a specified reason.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 1279.4 is added to the Health and Safety Code,
to read:
   1279.4.   (a)     (1)
   The medical director and the director of
nursing of each health facility, as defined by subdivision (a), (b),
or (f) of Section 1250, shall report annually to the board of
directors or other similar governing body the following: 
   (A) 
    (a)  The number of hospital-acquired conditions that
occurred in the facility  in the most recent 12-month period
 . 
   (B) 
    (b)  The outcomes for each patient involved. 
   (C) 
    (c)  Comparison to comparable institutions of rates of
hospital-acquired conditions, if this data exists and is publicly
available. 
   (2) The report prepared pursuant to paragraph (1) shall be made
available by the health facility to the department or to any member
of the public upon request. 
   (3) A health facility shall include in its annual report a
statement of compliance with this section.  
   (b) The secretary, on or before January 1, 2011, and biannually
thereafter, shall report to the Legislature and the Governor on all
of the following:  
   (1) The status and efficacy of nonpayment policies for the
Medi-Cal program and the Healthy Families Program.  

   (2) The status and efficacy of nonpayment policies adopted by
private health plans.  
   (3) Other opportunities and strategies to improve patient safety
through prevention of hospital-acquired conditions. 
   SEC. 2.    Section 1279.5 is added to the  
Health and Safety Code   , to read:  
   1279.5.  (a) A health care provider shall not charge a patient or
any third-party payer that provides health benefits coverage to a
patient for a hospital-acquired condition that would be subject to
nonpayment policies and practices, as defined by the State Department
of Health Care Services and the Managed Risk Medical Insurance Board
pursuant to Section 14110.25 of the Welfare and Institutions Code
and Section 12693.55 of the Insurance Code.
   (b) For the purposes of this section, "health care provider" means
either of the following:
   (1) A health facility, as defined in subdivision (a), (b), or (f)
of Section 1250.
   (2) A health care provider licensed under Division 2 (commencing
with Section 500) of the Business and Professions Code. 
   SEC. 2.   SEC. 3.   Section 1371.6 is
added to the Health and Safety Code, to read:
   1371.6.  (a) A contract entered into between a 
contracting   health care  provider and a health
care service plan shall not prohibit the adoption, implementation, or
exercise of nonpayment policies  and practices  for
hospital-acquired conditions consistent with those  policies and
practices  adopted pursuant to Section 14110.25 of the Welfare
and Institutions Code or Section 12693.55 of the Insurance Code.
   (b) A  contracting   health care 
provider shall be precluded from charging a patient for care and
services for which payment is denied by a health care service plan
pursuant to nonpayment policies  and practices  for
hospital-acquired conditions pursuant to this section.
   (c) A  contracting   health care 
provider shall be precluded from charging an uninsured patient for
any condition that would be subject to the nonpayment policies 
and practices  of the Medi-Cal program or the Healthy Families
Program adopted pursuant to Section 14110.25 of the Welfare and
Institutions Code or Section 12693.55 of the Insurance Code. 
   (d) For the purposes of this section, "health care provider" means
either of the following:  
   (1) A health facility, as defined in subdivision (a), (b), or (f)
of Section 1250.  
   (2) A health care provider licensed under Division 2 (commencing
with Section 500) of the Business and Professions Code. 
   SEC. 3.   SEC. 4.   Section 10133.57 is
added to the Insurance Code, to read:
   10133.57.  (a) A contract entered into between a 
contracting   health care  provider and an insurer
shall not prohibit the adoption, implementation, or exercise of
nonpayment policies  and practices  for hospital-acquired
conditions consistent with those adopted pursuant to Section 14110.25
of the Welfare and Institutions Code or Section 12693.55.
   (b) A  contracting   health care 
provider shall be precluded from charging a patient for care and
services for which payment is denied by an insurer pursuant to
nonpayment policies  and practices  for hospital-acquired
conditions pursuant to this section.
   (c) A  contracting   health care 
provider shall be precluded from charging an uninsured patient for
any condition that would be subject to the nonpayment policies 
and practices  of the Medi-Cal Program or the Healthy Families
 Program  adopted pursuant to Section 14110.25 of the
Welfare and Institutions Code or Section 12693.55. 
   (d) For the purposes of this section, "health care provider" means
either of the following:  
   (1) A health facility, as defined in subdivision (a), (b), or (f)
of Section 1250.  
   (2) A health care provider licensed under Division 2 (commencing
with Section 500) of the Business and Professions Code. 

  SEC. 4.    Section 12693.55 is added to the
Insurance Code, to read:
   12693.55.  The board, in collaboration with the State Department
of Health Care Services, shall develop and implement policies
governing the payment of health care providers for hospital-acquired
conditions by the Healthy Families Program as follows:
   (a) The board shall adopt payment policies consistent with those
developed by the federal Centers for Medicare and Medicaid Services
(CMS) pursuant to Section 5001(c) of the Deficit Reduction Act of
2005 (42 U.S.C. Sec. 1395ww(d)(4)), regarding nonpayment for
hospital-acquired conditions.
   (b) The board, in collaboration with the State Department of
Health Care Services, shall, to the extent feasible, synchronize its
definitions, coding and practices with CMS regarding nonpayment
policies for hospital-acquired conditions pursuant to paragraph (1).
   (c) The board shall annually evaluate additional hospital-acquired
conditions that are appropriate for nonpayment policies and shall
incorporate those hospital-acquired conditions into its nonpayment
policies.
   (d) A contracting provider shall be precluded from charging a
patient for care and services for which payment is denied by the
Healthy Families Program pursuant to this section.  

  SEC. 5.    Section 14110.25 is added to the
Welfare and Institutions Code, to read:
   14110.25.  The department shall develop and implement policies
governing the payment of health care providers for hospital-acquired
conditions under this chapter, as follows:
   (a) The department shall adopt payment policies consistent with
those developed by the federal Centers for Medicare and Medicaid
Services (CMS) pursuant to Section 5001(c) of the Deficit Reduction
Act of 2005 (42 U.S.C. Sec. 1395ww(d)(4)), regarding nonpayment for
hospital-acquired conditions.
   (b) The department shall, to the extent feasible, synchronize its
definitions, coding, and practices with CMS regarding nonpayment
policies for hospital-acquired conditions pursuant to paragraph (1).
   (c) The department shall annually evaluate additional
hospital-acquired conditions that are appropriate for nonpayment
policies and shall incorporate those hospital-acquired conditions
into its nonpayment policies.
   (d) A contracting provider shall be precluded from charging a
patient for care and services for which payment is denied by the
Medi-Cal program pursuant to this section. 
   SEC. 5.    Section 12693.55 is added to the 
 Insurance Code   , to read:  
   12693.55.  (a) The board, in collaboration with the State
Department of Health Care Services and in accordance with Section
14110.25 of the Welfare and Institutions Code, shall develop uniform
policies and practices governing the payment of health care providers
for hospital-acquired conditions by state public health programs as
follows:
   (1) Adopt payment policies and practices consistent with those
developed by the federal Centers for Medicare and Medicaid Services
(CMS) pursuant to Section 5001(c) of the Deficit Reduction Act of
2005 (42 U.S.C. Sec. 1395ww(d)(4)), regarding nonpayment for
hospital-acquired conditions.
   (2) Synchronize its definitions, coding, and practices, to the
extent feasible, with CMS regarding nonpayment policies and practices
for hospital-acquired conditions pursuant to paragraph (1).
   (3) Annually evaluate additional hospital-acquired conditions and
health care providers that are appropriate for nonpayment policies
and practices, and incorporate those hospital-acquired conditions or
health care providers into its nonpayment policies. The board, in
collaboration with the State Department of Health Care Services and
in accordance with Section 14110.25 of the Welfare and Institutions
Code, may do any of the following:
   (A) Adopt, without regulation, additional hospital-acquired
conditions if the adoption of those hospital-acquired conditions is
consistent with the policy and practices of the federal Centers for
Medicare and Medicaid Services.
   (B) Adopt, by regulation, additional hospital-acquired conditions
that are not consistent with the policy and practices of the federal
Centers for Medicare and Medicaid Services.
   (C) Adopt, by regulation, additional health care providers that
would be subject to nonpayment policies and practices for
hospital-acquired conditions.
   (b) The board shall implement the nonpayment policies and
practices developed pursuant to this section for the Healthy Families
Program, and to the extent feasible, for all other programs
administered by the board.
   (c) A health care provider shall be precluded from charging a
patient for care and services for which payment is denied by the
Healthy Families Program or any other program administered by the
board pursuant to this section.
   (d) For the purposes of this section, "health care provider" means
either of the following:
   (1) A health facility, as defined in subdivision (a), (b), or (f)
of Section 1250.
   (2) A health care provider licensed under Division 2 (commencing
with Section 500) of the Business and Professions Code. 
   SEC. 6.    Section 14110.25 is added to the 
 Welfare and Institutions Code   , to read:  
   14110.25.  (a) The department, in collaboration with the State
Managed Risk Medical Insurance Board and in accordance with Section
12693.55 of the Insurance Code, shall develop uniform policies and
practices governing the payment of health care providers for
hospital-acquired conditions by state public health programs as
follows:
   (1) Adopt payment policies and practices consistent with those
developed by the federal Centers for Medicare and Medicaid Services
(CMS) pursuant to Section 5001(c) of the Deficit Reduction Act of
2005 (42 U.S.C. Sec. 1395ww(d)(4)), regarding nonpayment for
hospital-acquired conditions.
   (2) Synchronize its definitions, coding, and practices, to the
extent feasible, with CMS regarding nonpayment policies and practices
for hospital-acquired conditions pursuant to paragraph (1).
   (3) Annually evaluate additional hospital-acquired conditions and
health care providers that are appropriate for nonpayment policies
and practices, and incorporate those hospital-acquired conditions or
health care providers into its nonpayment policies. The department,
in collaboration with the State Managed Risk Medical Insurance Board
and in accordance with Section 12693.55 of the Insurance Code, may do
any of the following:
   (A) Adopt, without regulation, additional hospital-acquired
conditions if the adoption of those hospital-acquired conditions is
consistent with the policy and practices of the federal Centers for
Medicare and Medicaid Services.
   (B) Adopt, by regulation, additional hospital-acquired conditions
that are not consistent with the policy and practices of the federal
Centers for Medicare and Medicaid Services.
   (C) Adopt, by regulation, additional health care providers that
would be subject to nonpayment policies and practices for
hospital-acquired conditions.
   (b) The department shall implement the nonpayment policies and
practices developed pursuant to this section for the Medi-Cal
program, and to the extent feasible, for all other programs
administered by the department.
   (c) A health care provider shall be precluded from charging a
patient for care and services for which payment is denied by the
Medi-Cal program or any other program administered by the department
pursuant to this section.
   (d) For the purposes of this section, "health care provider" means
either of the following:
   (1) A health facility, as defined in subdivision (a), (b), or (f)
of Section 1250.
   (2) A health care provider licensed under Division 2 (commencing
with Section 500) of the Business and Professions Code. 
   SEC. 6.   SEC. 7.   No reimbursement is
required by this act pursuant to Section 6 of Article XIII B of the
California Constitution because the only costs that may be incurred
by a local agency or school district will be incurred because this
act creates a new crime or infraction, eliminates a crime or
infraction, or changes the penalty for a crime or infraction, within
the meaning of Section 17556 of the Government Code, or changes the
definition of a crime within the meaning of Section 6 of Article XIII
B of the California Constitution.