BILL NUMBER: AB 1142 ENROLLED
BILL TEXT
PASSED THE SENATE SEPTEMBER 8, 2009
PASSED THE ASSEMBLY SEPTEMBER 10, 2009
AMENDED IN SENATE SEPTEMBER 3, 2009
AMENDED IN SENATE SEPTEMBER 1, 2009
AMENDED IN SENATE AUGUST 17, 2009
AMENDED IN SENATE JUNE 28, 2009
AMENDED IN ASSEMBLY APRIL 28, 2009
AMENDED IN ASSEMBLY APRIL 14, 2009
INTRODUCED BY Assembly Member Price
FEBRUARY 27, 2009
An act to amend Sections 14018.2 and 14019.4 of the Welfare and
Institutions Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
AB 1142, 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, if a hospital obtains proof of Medi-Cal
eligibility for a patient subsequent to the date of service, that it
is the responsibility of a hospital to provide all information
regarding that person's Medi-Cal eligibility to certain providers
that bill separately for all services associated with the person's
treatment in the hospital rendered during the same time period for
which the hospital is submitting a claim, as specified.
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 require a Medi-Cal provider, if the provider
receives proof of a patient's Medi-Cal eligibility and has previously
referred an unpaid bill for services rendered to the patient to a
debt collector, to promptly notify the debt collector of the patient'
s Medi-Cal coverage, instruct the debt collector to cease collection
efforts on the unpaid bill for covered services, and notify the
patient accordingly.
This bill would provide that a provider of health care services
who obtains a label from, or copy of, the Medi-Cal card or other
proof of eligibility and who subsequently pursues reimbursement or
payment for the cost of covered services from the beneficiary or
fails to cease collection efforts against the beneficiary for covered
services, as prescribed, may be subject to a penalty, payable to the
department, not to exceed 3 times the amount payable by the Medi-Cal
program. The bill would also require that prescribed mitigating
circumstances be considered when assessing the penalty. The bill
would require that a provider have the right to appeal the assessed
penalty, as specified.
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 debt
collector receives proof of Medi-Cal coverage for services rendered
and then reports the services rendered to a consumer credit reporting
agency or fails to provide corrections of, or instructions to
delete, as appropriate, information regarding Medi-Cal covered
services to a consumer reporting agency, the provider or debt
collector shall be deemed to be in violation of the above-described
provisions.
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) If a hospital obtains proof of Medi-Cal eligibility for a
patient subsequent to the date of service, it shall be the
responsibility of the hospital to provide all information regarding
that person's Medi-Cal eligibility to all hospital-based providers,
ambulance transportation services providers, providers that provide
ambulance transportation services through the "911" emergency
response system, and other hospital-based providers of professional
services that bill separately for all services associated with the
person's treatment in the hospital rendered during the same time
period for which the hospital is submitting a claim. The hospital may
inform the provider that the person's Medi-Cal eligibility is
pending, before a final determination is made on the patient's
Medi-Cal application, to satisfy the requirements of this
subdivision. If the provider or the provider's agent obtains this
information from the hospital, the requirement has been satisfied.
(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) "Hospital-based professional services" means services
performed for a patient while at a hospital, related to the patient's
hospital stay, and known to the hospital, including, but 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) 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 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 a 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 applicable sanctions set forth
in law or regulation, a provider of health care services who obtains
a label from, or copy of, the Medi-Cal card or other proof of
eligibility pursuant to this chapter, and who subsequently pursues
reimbursement or payment for the cost of covered services from the
beneficiary or fails to cease collection efforts against the
beneficiary for covered services as required by subdivision (d), may
be subject to a penalty, payable to the department, not to exceed
three times the amount payable by the Medi-Cal program. In
implementing this subdivision, mitigating circumstances, which
include, but are not limited to, clerical error and good faith
mistake, shall be considered when assessing the penalty. Providers
subject to penalties under this subdivision shall have the right to
appeal the assessed penalty, consistent with department procedures.
(d) When a Medi-Cal provider receives proof of a patient's
Medi-Cal eligibility and that provider has previously referred an
unpaid bill for services rendered to the patient to a debt collector,
the Medi-Cal provider shall promptly notify the debt collector of
the patient's Medi-Cal coverage, instruct the debt collector to cease
collection efforts on the unpaid bill for the covered services, and
notify the patient accordingly.
(e) If a patient provides proof of Medi-Cal eligibility to a debt
collector, and the debt collector fails to notify the provider of
this proof, the provider shall not be responsible for ensuring that
collection efforts against the patient cease pursuant to subdivision
(d) until either the patient or the debt collector provides the
provider with proof of the patient's Medi-Cal eligibility.
(f) A Medi-Cal provider or debt collector shall be deemed to be in
violation of subdivision (a) of Section 1785.25 of the Civil Code if
more than 30 days after receiving proof of Medi-Cal coverage the
provider or debt collector does either of the following:
(1) Furnishes information regarding the rendering of the Medi-Cal
covered services to a consumer credit reporting agency.
(2) Fails to provide corrections of, or instructions to delete, as
appropriate, information regarding Medi-Cal covered services
previously furnished by that Medi-Cal provider or debt collector to a
consumer reporting agency.
(g) This section shall not apply to the Medi-Cal share of cost
owed by a Medi-Cal beneficiary, unless the beneficiary's share of
cost has been met for the month in which services were rendered.
(h) For purposes of this section, "debt collector" includes any
person who regularly engages in debt collection, as defined by
Section 1788.2 of the Civil Code, but does not include the original
Medi-Cal provider.