BILL NUMBER: AB 1142 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY APRIL 14, 2009
INTRODUCED BY Assembly Member Price
FEBRUARY 27, 2009
An act to amend Section 14018.2 Sections
14018.2 and 14019.4 of the Welfare and Institutions Code,
relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
AB 1142, as amended, Price. Medi-Cal: proof of eligibility.
Existing law establishes 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
services. Existing law provides that it is the responsibility of the
Medi-Cal beneficiary to provide information and evidence of Medi-Cal
eligibility to that person's health care provider if that information
is requested by the provider prior to rendering services to that
beneficiary.
Existing law provides that it is the responsibility of the
provider prior to rendering Medi-Cal reimbursable services to persons
presenting themselves as Medi-Cal beneficiaries to make a good faith
effort to verify the person's identity, if the person is not known
to the provider, otherwise payment for those services may later be
disallowed by the department.
This bill would provide that it is the responsibility of a
hospital, as soon as proof of Medi-Cal eligibility is supplied by a
person presenting himself or herself as a Medi-Cal beneficiary, to
provide all information regarding that person's Medi-Cal eligibility
to all other providers certain providers
that bill separately for services rendered to that person
during the same time period for which the hospital is submitting a
claim.
Existing law, the Consumer Credit Reporting Agencies Act, governs
the disclosure of consumer credit reports. Existing law prohibits a
person furnishing information on a specific transaction or experience
to any consumer credit reporting agency if the person knows or
should know the information is incomplete or inaccurate.
This bill would provide that if a Medi-Cal provider or 3rd-party
collection agency receives proof of Medi-Cal coverage for services
rendered and then reports the services rendered to a consumer credit
reporting agency or fails to correct a negative credit report
regarding the services rendered, the provider or agency shall be
deemed to be in violation of the above-described provisions.
This bill would require each Medi-Cal provider to ensure that
patient debts that are sold or assigned to a 3rd-party collection
agency can and will be recalled by the provider in the event that the
services were covered by the Medi-Cal program and that evidence of
Medi-Cal coverage could have been obtained by the provider.
Existing law prohibits any provider of health care services who
obtains a label or copy from the Medi-Cal card or other proof of
eligibility from seeking reimbursement or attempting to obtain
payment for the cost of the covered health care services from the
eligible applicant or recipient, or any person other than the
department or a 3rd-party payor who provides a contractual or legal
entitlement to health care services.
This bill would provide that a provider of health care services
who obtains a label or copy from the Medi-Cal card or other proof of
eligibility and who attempts to seek reimbursement or to obtain
payment for the cost of covered services from the eligible applicant
or recipient or fails to recall a debt, as this bill would require,
shall be subject to a fine not to exceed 3 times the amount the
provider could otherwise have obtained had the provider of health
care services billed the Medi-Cal program.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 14018.2 of the Welfare and Institutions Code is
amended to read:
14018.2. (a) Reimbursement shall not be denied to any qualified
health care provider for care rendered to an eligible Medi-Cal
beneficiary for the sole reason that a proof of eligibility label
does not accompany the bill.
Proof of eligibility labels may, however, continue to be used as
such and shall be made available to an eligible Medi-Cal beneficiary
through the local office which has determined the person's
eligibility or through the department. The provider may submit
machine-reproduced copies of the beneficiary Medi-Cal card for
billing purposes as long as the copy is made from the original
unaltered Medi-Cal card under circumstances controlled by the
provider, for example, on the premises of the provider with copying
equipment controlled by the provider.
(b) It shall remain the responsibility of a Medi-Cal beneficiary
to provide information and evidence of Medi-Cal eligibility,
restrictions on the eligibility, and non-Medi-Cal health coverage, to
that person's health care providers, if this information is
requested by those providers prior to rendering services to that
beneficiary.
(c) It shall be the responsibility of the provider prior to
rendering Medi-Cal reimbursable services to persons presenting
themselves as Medi-Cal beneficiaries to make a good faith effort to
verify the person's identity, if the person is not known to the
provider, by matching the name and signature on his or her Medi-Cal
card against the signature on a valid California driver's license, or
California identification card issued by the Department of Motor
Vehicles, or another type of picture identification card or other
credible document of identification. When the provider verifies the
beneficiary's identity with a signed Medi-Cal card and one of the
documents described above, the state will deem this to be a good
faith effort. If the provider does not make a good faith effort of
reasonable identification prior to rendering Medi-Cal reimbursable
services and renders services to a presenting person who is
ineligible for those Medi-Cal services, payment for those services
may later be disallowed.
This provision shall not apply to:
(1) Persons 17 years of age and under.
(2) Persons in long-term care.
(3) Persons receiving emergency services.
(d) Notwithstanding subdivision (b) of this section, county
welfare departments may provide Medi-Cal eligibility information to
other governmental agencies and their designated agents as necessary
for proper administration of the Medi-Cal program.
(e) It shall be the responsibility of a hospital, as soon as proof
of Medi-Cal eligibility is supplied by a person presenting himself
or herself as a Medi-Cal beneficiary, to provide all information
regarding that person's Medi-Cal eligibility to all other
providers hospital-based providers, ambulance
transportation services providers, providers that pr ovide
ambulance transportation services through the "911" emergency
response system, and other providers of professional services
that bill separately for services rendered to that person during the
same time period for which the hospital is submitting a claim.
(f) For purposes of this section, the following definitions apply:
(1) "Hospital-based provider" means an anesthesiologist,
radiologist, pathologist, emergency room physician, or other
physician or a group of physicians providing medical services at the
hospital.
(2) "Professional services" includes, but is not limited to,
diagnostic, laboratory, therapeutic, and radiologic services.
SEC. 2. Section 14019.4 of the Welfare
and Institutions Code is amended to read:
14019.4. (a) Any provider of health care services who obtains a
label or copy from the Medi-Cal card or other proof of eligibility
pursuant to this chapter shall not seek reimbursement nor attempt to
obtain payment for the cost of those covered health care services
from the eligible applicant or recipient, or any person other than
the department or a third-party payor who provides a contractual or
legal entitlement to health care services.
(b) Whenever a service or set of services rendered to a Medi-Cal
beneficiary results in the submission of a claim in excess of five
hundred dollars ($500), and the beneficiary has given the provider
proof of eligibility to receive the service or services, the provider
shall issue the beneficiary a receipt to document that appropriate
proof of eligibility has been provided. The form and content of those
receipts shall be determined by the provider but shall be sufficient
to comply with the intent of this subdivision. Nursing facilities
and all categories of intermediate care facilities for the
developmentally disabled are exempt from the requirements of this
subdivision.
(c) In addition to being subject to any applicable penalties set
forth in law or regulation, a provider of health care services who
obtains a label or copy from the Medi-Cal card or other proof of
eligibility pursuant to this chapter, and who attempts to seek
reimbursement or to obtain payment for the cost of covered services
from the eligible applicant or recipient or fails to recall a debt as
required by subdivision (d), shall be subject to a fine not to
exceed three times the amount the provider could otherwise have
obtained had the provider billed the Medi-Cal program.
(d) Each Medi-Cal provider shall ensure that patient debts that
are sold or assigned to a third-party collection agency can and will
be recalled by the provider in the event that the services were
covered by the Medi-Cal program and that evidence of Medi-Cal
coverage could have been obtained by the provider.
(e) If a Medi-Cal provider or third-party collection agency
receives proof of Medi-Cal coverage for services rendered and then
reports the services rendered to a consumer credit reporting agency
or fails to correct a negative credit report regarding the services
rendered, the provider or agency shall be deemed to be in violation
of subdivision (a) of Section 1785.25 of the Civil Code.
(f) If a Medi-Cal provider or third-party collection agency
receives proof of Medi-Cal coverage for services rendered, the
provider or third-party collection agency shall be deemed to be in
violation of subdivision (a) of Section 1785.25 of the Civil Code if
they do either of the following:
(1) Report the rendering of the Medi-Cal-covered services to a
consumer credit reporting agency.
(2) Fail to correct a negative credit report regarding the
Medi-Cal-covered services the Medi-Cal provider or third-party
collection agency reported to a consumer credit reporting agency.