BILL NUMBER: AB 1503 INTRODUCED
BILL TEXT
INTRODUCED BY Assembly Member Lieu
FEBRUARY 27, 2009
An act to amend Section 1797.98c of, to amend and renumber the
heading of Article 3 (commencing with Section 127400) of Chapter 2
of, to add the heading of Chapter 2.5 (commencing with Section
127400) to, and to add Article 2 (commencing with Section 127450) to
Chapter 2.5 of, Part 2 of Division 107 of the Health and Safety Code,
relating to emergency medical care billing.
LEGISLATIVE COUNSEL'S DIGEST
AB 1503, as introduced, Lieu. Emergency medical care: billing.
(1) Existing law establishes the Maddy Emergency Medical Services
(EMS) Fund, authorizing each county to establish an emergency medical
services fund and provides for deposit of certain penalties,
forfeitures, and fines into the fund. Existing law requires use of
the local fund for reimbursement of physicians and surgeons and
hospitals for uncompensated emergency medical services pursuant to a
prescribed schedule. Under this schedule, 58% of the balance in the
fund is to be used for emergency medical services provided by all
physicians and surgeons, except those employed in county hospitals,
in general acute care hospitals that provide basic, comprehensive, or
standby emergency medical services pursuant to prescribed provisions
of law relating to standby emergency rooms or departments in certain
small and rural hospitals and hospitals located in Los Angeles
County that meet prescribed requirements, up to the time the patient
is stabilized.
Existing law limits reimbursement from the local fund of claims
for emergency services provided by a physician and surgeon to a
patient who does not have health insurance coverage for emergency
services and care, cannot afford to pay for those services, and for
whom payment will not be made through any private coverage or by any
program funded in whole or in part by the federal government, except
as specified, when the several conditions are met.
This bill would revise the conditions for reimbursement to require
the physician and surgeon to comply with the provisions of this bill
set forth below, except as specified.
(2) Existing law also provides for the licensure and regulation of
health facilities by the State Department of Public Health. Existing
law requires each hospital, as a condition of licensure, to maintain
written policies about discount payment and charity care for
financially qualified patients, as defined. These policies are
required to include, among other things, a section addressing
eligibility criteria, as prescribed. Existing law requires each
hospital to perform various functions in connection with the hospital
charity care and discount pay policies, including providing patients
with notice that contains information about the hospital's discount
payment and charity care policies, including information about
eligibility and attempting to determine the availability of private
or public health insurance coverage for each patient. Existing law
also specifies billing and collection procedures to be followed by a
hospital, its assignee, collection agency, or billing service.
This bill would provide that uninsured patients or patients with
high medical costs who are at or below 350% of the federal poverty
level are eligible to apply to a physician and surgeon who provides
emergency medical services in a general acute care hospital for a
discount payment pursuant to a discount payment policy. The bill
would require the physician and surgeon to limit expected payment for
services provided to a patient at or below 350% of the federal
poverty level and who is eligible under the physician and surgeon's
discount payment policy to the amount of payment the physician and
surgeon would expect, in good faith, to receive for providing
services from specified government-sponsored health programs.
The bill would require the physician and surgeon to perform
various functions in connection with the discount payment policy,
including providing patients with notice that contains information
about the physician and surgeon's discount payment policy, including
information about eligibility and attempting to determine the
availability of private or public health insurance coverage for each
patient. The bill would also specify billing and collection
procedures to be followed by a physician and surgeon, its assignee,
collection agency, or billing service.
This bill would provide that a violation of the above provisions
shall not constitute a violation of the terms of a physician and
surgeon's licensure.
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 1797.98c of the Health and Safety Code is
amended to read:
1797.98c. (a) Physicians and surgeons wishing to be reimbursed
shall submit their claims for emergency services provided to patients
who do not make any payment for services and for whom no responsible
third party makes any payment.
(b) If, after receiving payment from the fund, a physician and
surgeon is reimbursed by a patient or a responsible third party, the
physician and surgeon shall do one of the following:
(1) Notify the administering agency, and, after notification, the
administering agency shall reduce the physician and surgeon's future
payment of claims from the fund. In the event there is not a
subsequent submission of a claim for reimbursement within one year,
the physician and surgeon shall reimburse the fund in an amount equal
to the amount collected from the patient or third-party payer, but
not more than the amount of reimbursement received from the fund.
(2) Notify the administering agency of the payment and reimburse
the fund in an amount equal to the amount collected from the patient
or third-party payer, but not more than the amount of the
reimbursement received from the fund for that patient's care.
(c) Reimbursement of claims for emergency services provided to
patients by any physician and surgeon shall be limited to services
provided to a patient who does not have health insurance coverage for
emergency services and care, cannot afford to pay for those
services, and for whom payment will not be made through any private
coverage or by any program funded in whole or in part by the federal
government, with the exception of claims submitted for reimbursement
through Section 1011 of the federal Medicare Prescription Drug,
Improvement and Modernization Act of 2003, and where all
any of the following conditions have been met:
(1) The physician and surgeon has inquired if there is a
responsible third-party source of payment.
(2) The physician and surgeon has billed for payment of services.
(3) Either of the following:
(A) At least three months have passed from the date the physician
and surgeon billed the patient or responsible third party, during
which time the physician and surgeon has made two attempts to obtain
reimbursement and has not received reimbursement for any portion of
the amount billed.
(B) The physician and surgeon has received actual notification
from the patient or responsible third party that no payment will be
made for the services rendered by the physician and surgeon.
(4) The physician and surgeon has stopped any current, and waives
any future, collection efforts to obtain reimbursement from the
patient, upon receipt of moneys from the fund
(1) If the physician and surgeon
attempts to seek payment from a patient, the physician and surgeon
shall comply with Article 2 (commencing with Section 127450) of
Chapter 2.5 of Part 2 of Division 107.
(2) The physician and surgeon shall seek information from the
hospital regarding whether the patient has provided information
indicating that the patient may qualify for the hospital's charity
care or discount payment policy pursuant to Article 1 (commencing
with Section 127400) of Chapter 2.5 of Part 2 of Division 107 or has
otherwise sought to qualify pursuant to that article. If the hospital
has determined that the patient qualifies for its charity care or
discount payment policy, the physician and surgeon may bill the Maddy
Fund. If the physician and surgeon seeks payment from the Maddy
Fund, the physician and surgeon shall cease any billing or collection
activity involving the patient.
(3) If the physician and surgeon receives reimbursement from the
Maddy Fund, that reimbursement shall be considered payment in full
and the physician and surgeon shall not seek additional payment from
the patient. If the Maddy Fund does not reimburse the physician and
surgeon, the physician and surgeon may seek payment from the patient
pursuant to Article 2 (commencing with Section 127450) of Chapter 2.5
of Part 2 of Division 107.
(d) A listing of patient names shall accompany a physician and
surgeon's submission, and those names shall be given full
confidentiality protections by the administering agency.
(e) Notwithstanding any other restriction on reimbursement, a
county shall adopt a fee schedule and reimbursement methodology to
establish a uniform reasonable level of reimbursement from the county'
s emergency medical services fund for reimbursable services.
(f) For the purposes of submission and reimbursement of physician
and surgeon claims, the administering agency shall adopt and use the
current version of the Physicians' Current Procedural Terminology,
published by the American Medical Association, or a similar
procedural terminology reference.
(g) Each administering agency of a fund under this chapter shall
make all reasonable efforts to notify physicians and surgeons who
provide, or are likely to provide, emergency services in the county
as to the availability of the fund and the process by which to submit
a claim against the fund. The administering agency may satisfy this
requirement by sending materials that provide information about the
fund and the process to submit a claim against the fund to local
medical societies, hospitals, emergency rooms, or other
organizations, including materials that are prepared to be posted in
visible locations.
SEC. 2. The heading of Chapter 2.5 (commencing with Section
127400) is added to Part 2 of Division 107 of the Health and Safety
Code, immediately preceding Section 127400, to read:
CHAPTER 2.5. FAIR PRICING POLICIES
SEC. 3. The heading of Article 3 (commencing with Section 127400)
of Chapter 2 of Part 2 of Division 107 of the Health and Safety Code
is amended and renumbered to read:
Article 3. 1. Hospital Fair
Pricing Policies
SEC. 4. Article 2 (commencing with Section 127450) is added to
Chapter 2.5 of Part 2 of Division 107 of the Health and Safety Code,
to read:
Article 2. Physician and Surgeon Fair Pricing Policies
127450. As used in this article, the following terms have the
following meanings:
(a) "Allowance for financially qualified patient" means, with
respect to services rendered to a financially qualified patient, an
allowance that is applied after the physician and surgeon's charges
are imposed on the patient, due to the patient's determined financial
inability to pay the charges.
(b) "Federal poverty level" means the poverty guidelines updated
periodically in the Federal Register by the United States Department
of Health and Human Services under authority of subsection (2) of
Section 9902 of Title 42 of the United States Code.
(c) "Financially qualified patient" means a patient who is both of
the following:
(1) A patient who is a self-pay patient or a patient with high
medical costs.
(2) A patient who has a family income that does not exceed 350
percent of the federal poverty level.
(d) "Emergency care" means care provided in the emergency
department of a hospital.
(e) "Hospital" means a facility that is required to be licensed
under subdivision (a) of Section 1250, except a facility operated by
the State Department of Mental Health or the Department of
Corrections and Rehabilitation.
(f) "Office" means the Office of Statewide Health Planning and
Development.
(g) "Physician and surgeon" means a physician and surgeon licensed
pursuant to Chapter 2 (commencing with Section 2000) of the Business
and Professions Code who provides emergency medical services in a
hospital that provides emergency care.
(h) "Self-pay patient" means a patient who does not have
third-party coverage from a health insurer, health care service plan,
Medicare, or Medicaid, and whose injury is not a compensable injury
for purposes of workers' compensation, automobile insurance, or other
insurance as determined and documented by the physician and surgeon.
Self-pay patients may include charity care patients.
(i) "A patient with high medical costs" means a person whose
family income does not exceed 350 percent of the federal poverty
level if that individual does not receive a discounted rate from the
physician and surgeon as a result of his or her third-party coverage.
For these purposes, "high medical costs" means any of the following:
(1) Annual out-of-pocket costs incurred by the individual at the
hospital that provided emergency care that exceed 10 percent of the
patient's family income in the prior 12 months.
(2) Annual out-of-pocket expenses that exceed 10 percent of the
patient's family income, if the patient provides documentation of the
patient's medical expenses paid by the patient or the patient's
family in the prior 12 months.
(3) A lower level determined by the physician and surgeon in
accordance with the physician and surgeon's discounted payment
policy.
(j) "Patient's family" means the following:
(1) For persons 18 years of age and older, spouse, domestic
partner, as defined in Section 297 of the Family Code, and dependent
children under 21 years of age, whether living at home or not.
(2) For persons under 18 years of age, parent, caretaker
relatives, and other children under 21 years of age of the parent or
caretaker relative.
127451. A violation of this article shall not constitute a
violation of the terms of a physician and surgeon's licensure.
127452. (a) Uninsured patients or patients with high medical
costs who are at or below 350 percent of the federal poverty level
shall be eligible to apply to a physician and surgeon for a discount
payment pursuant to a discount payment policy. Notwithstanding any
other provision of this article, a physician and surgeon may choose
to grant eligibility for a discount payment policy to patients with
incomes over 350 percent of the federal poverty level.
(b) A physician and surgeon shall limit expected payment for
services provided to a patient at or below 350 percent of the federal
poverty level and who is eligible under the physician and surgeon's
discount payment policy to the amount of payment the physician and
surgeon would expect, in good faith, to receive for providing
services from Medicare, Medi-Cal, Healthy Families, or another
government-sponsored health program of health benefits in which the
physician and surgeon participates, whichever is greater. If the
physician and surgeon provides a service for which there is no
established payment by Medicare or any other government-sponsored
program of health benefits in which the physician and surgeon
participates, the physician and surgeon shall establish an
appropriate discounted payment.
(c) (1) If a physician and surgeon seeks reimbursement from the
Maddy Fund pursuant to Section 1797.98c, then the physician and
surgeon shall, at that time, cease any further billing or collection
activity for that patient.
(2) If the physician and surgeon does not receive reimbursement
from the Maddy Fund after attempting to obtain reimbursement from the
Maddy Fund, then the provisions of this article shall apply.
(3) If the physician and surgeon does not attempt to seek
reimbursement from the Maddy Fund, the provisions of this article
shall apply.
(d) A patient, or patient's legal representative, who requests a
discounted payment or other assistance in meeting his or her
financial obligation to the physician and surgeon shall make every
reasonable effort to provide the physician and surgeon with
documentation of income and health benefits coverage. If the person
requests a discounted payment and fails to provide information that
is reasonable and necessary for the physician and surgeon to make a
determination, the physician and surgeon may consider that failure in
making its determination.
(1) For purposes of determining eligibility for discounted
payment, the physician and surgeon may rely on the determination made
by the hospital at which emergency care was provided. If the
physician and surgeon chooses to make a separate determination of
eligibility for discounted payment, documentation of income shall be
limited to recent pay stubs or income tax returns.
(2) Information obtained pursuant to paragraph (1) shall not be
used for collections activities. This paragraph does not prohibit the
use of information obtained by the physician and surgeon, collection
agency, or assignee independently of the eligibility process for
discounted payment.
(3) Eligibility for discounted payments may be determined at any
time the physician and surgeon is in receipt of information specified
in paragraph (1) or (2), respectively.
127453. Each physician and surgeon providing emergency medical
services shall provide patients with a written notice that shall
contain information about availability of the physician and surgeon's
discount payment policy, including information about eligibility, as
well as contact information for an employee of the physician and
surgeon or other entity from which the person may obtain further
information about this policy. The notice shall also be provided to
patients who receive emergency care and who may be billed for that
care, but who were not admitted. The notice shall be provided in
English, and in languages other than English. The languages to be
provided shall be determined in a manner similar to that required
pursuant to Section 12693.30 of the Insurance Code. Written
correspondence to the patient required by this article shall also be
in the language spoken by the patient, consistent with Section
12693.30 of the Insurance Code and applicable state and federal law.
127454. (a) Each physician and surgeon shall make all reasonable
efforts to obtain from the patient or his or her representative
information about whether private or public health insurance or
sponsorship may fully or partially cover the charges for emergency
services rendered by the physician and surgeon to a patient,
including, but not limited to, any of the following:
(1) Private health insurance.
(2) Medicare.
(3) The Medi-Cal program, the Healthy Families Program, the
California Childrens' Services Program, or other state-funded
programs designed to provide health coverage.
(b) If a physician and surgeon bills a patient who has not
provided proof of coverage by a third party at the time the care is
provided or upon discharge, as a part of that billing, the physician
and surgeon shall provide the patient with a clear and conspicuous
notice that includes all of the following:
(1) A statement of charges for services rendered by the physician
and surgeon.
(2) A request that the patient inform the physician and surgeon if
the patient has health insurance coverage, Medicare, Healthy
Families, Medi-Cal, or other coverage.
(3) A statement that if the consumer does not have health
insurance coverage, the consumer may be eligible for Medicare,
Healthy Families, Medi-Cal, California Childrens' Services Program,
or discounted payment care.
(4) Information regarding the financially qualified patient and
discounted payment application, including the following:
(A) A statement that indicates that if the patient lacks, or has
inadequate, insurance, and meets certain low-and moderate-income
requirements, the patient may qualify for discounted payment.
(B) The name and telephone number of a physician and surgeon
employee or office from whom or which the patient may obtain
information about the physician and surgeon's discount payment and
policy, and how to apply for that assistance.
127455. (a) Each physician and surgeon shall have a written
policy about when and under whose authority patient debt is advanced
for collection.
(b) Each physician and surgeon shall establish a written policy
defining standards and practices for the collection of debt, and
shall obtain a written agreement from any agency that collects
physician and surgeon receivables that it will adhere to the
physician and surgeon's standards and scope of practice. The policy
shall not conflict with other applicable laws and shall not be
construed to create a joint venture between the physician and surgeon
and the external entity, or otherwise to allow physician and surgeon
governance of an external entity that collects physician and surgeon
receivables. In determining the amount of a debt a physician and
surgeon may seek to recover from patients who are eligible under the
physician and surgeon's charity care policy or discount payment
policy, the physician and surgeon may consider only income and
monetary assets as limited by Section 127452.
(c) At time of billing, if any, each physician and surgeon shall
provide a written summary consistent with Section 127453, which
includes the same information concerning services and charges
provided to all other patients who receive care from the physician
and surgeon.
(d) For a patient that lacks coverage, or for a patient that
provides information that he or she may be a patient with high
medical costs a physician and surgeon, any assignee of the physician
and surgeon, or other owner of the patient debt, including a
collection agency, shall not report adverse information to a consumer
credit reporting agency or commence civil action against the patient
for nonpayment at any time prior to 150 days after initial billing.
(e) If a patient is attempting to qualify for eligibility under
the physician and surgeon's discount payment policy and is attempting
in good faith to settle an outstanding bill with the physician and
surgeon by negotiating a reasonable payment plan or by making regular
partial payments of a reasonable amount, the physician and surgeon
shall not send the unpaid bill to any collection agency or other
assignee, unless that entity has agreed to comply with this article.
(f) (1) The physician and surgeon or other assignee shall not, in
dealing with patients eligible under the physician and surgeon's
discount payment policies, use wage garnishments or liens on primary
residences as a means of collecting unpaid physician and surgeon
bills.
(2) A collection agency or other assignee shall not, in dealing
with any patient under the physician and surgeon's discount payment
policy, use as a means of collecting unpaid physician and surgeon
bills, any of the following:
(A) A wage garnishment, except by order of the court upon noticed
motion, supported by a declaration filed by the movant identifying
the basis for that it believes that the patient has the ability to
make payments on the judgment under the wage garnishment, that the
court shall consider in light of the size of the judgment and
additional information provided by the patient prior to, or at, the
hearing concerning the patient's ability to pay, including
information about probable future medical expenses based on the
current condition of the patient and other obligations of the
patient.
(B) Notice or conduct a sale of the patient's primary residence
during the life of the patient or his or her spouse, or during the
period a child of the patient is a minor, or a child of the patient
who has attained the age of majority is unable to take care of
himself or herself and resides in the dwelling as his or her primary
residence. In the event a person protected by this paragraph owns
more than one dwelling, the primary residence shall be the dwelling
that is the patient's current homestead, as defined in Section
704.710 of the Code of Civil Procedure or was the patient's homestead
at the time of the death of a person other than the patient who is
asserting the protections of this paragraph.
(3) This requirement does not preclude a physician and surgeon,
collection agency, or other assignee from pursuing reimbursement and
any enforcement remedy or remedies from third-party liability
settlements, tortfeasors, or other legally responsible parties.
(g) Any extended payment plans offered by a physician and surgeon
to assist patients eligible under the physician and surgeon's
discount payment policy or any other policy adopted by the physician
and surgeon for assisting low-income patients with no insurance or
high medical costs in settling outstanding past due physician and
surgeon bills, shall be interest free. The physician and surgeon's
extended payment plan may be declared no longer operative after the
patient's failure to make all consecutive payments due during a
90-day period. Before declaring the physician and surgeon's extended
payment plan no longer operative, the physician and surgeon,
collection agency, or assignee shall make a reasonable attempt to
contact the patient by phone and to give notice in writing that the
extended payment plan may become inoperative, and of the opportunity
to renegotiate the extended payment plan. Prior to the physician and
surgeon's extended payment plan being declared inoperative, the
physician and surgeon, collection agency, or assignee shall attempt
to renegotiate the terms of the defaulted extended payment plan, if
requested by the patient. The physician and surgeon, collection
agency, or assignee shall not report adverse information to a
consumer credit reporting agency or commence a civil action against
the patient or responsible party for nonpayment prior to the time the
extended payment plan is declared to be no longer operative. For
purposes of this section, the notice and phone call to the patient
may be made to the last known phone number and address of the
patient.
(h) Nothing in this section shall be construed to diminish or
eliminate any protections consumers have under existing federal and
state debt collection laws, or any other consumer protections
available under state or federal law. If the patient fails to make
all consecutive payments for 90 days and fails to renegotiate a
payment plan, this subdivision does not limit or alter the obligation
of the patient to make payments on the obligation owing to the
physician and surgeon pursuant to any contract or applicable statute
from the date that the extended payment plan is declared no longer
operative, as set forth in subdivision (g).
127456. (a) The period described in Section 127455 shall be
extended if the patient has a pending appeal for coverage of the
services, until a final determination of that appeal is made, if the
patient makes a reasonable effort to communicate with the physician
and surgeon about the progress of any pending appeals.
(b) For purposes of this section, "pending appeal" includes any of
the following:
(1) A grievance against a contracting health care service plan, as
described in Chapter 2.2 (commencing with Section 1340) of Division
2, or against an insurer, as described in Chapter 1 (commencing with
Section 10110) of Part 2 of Division 2 of the Insurance Code.
(2) An independent medical review, as described in Section 10145.3
or 10169 of the Insurance Code.
(3) A fair hearing for a review of a Medi-Cal claim pursuant to
Section 10950 of the Welfare and Institutions Code.
(4) An appeal regarding Medicare coverage consistent with federal
law and regulations.
127457. (a) Prior to commencing collection activities against a
patient, the physician and surgeon, any assignee of the physician and
surgeon, or other owner of the patient debt, including a collection
agency, shall provide the patient with a clear and conspicuous
written notice containing both of the following:
(1) A plain language summary of the patient's rights pursuant to
this article, the Rosenthal Fair Debt Collection Practices Act (Title
1.6C (commencing with Section 1788) of Part 4 of Division 3 of the
Civil Code), and the federal Fair Debt Collection Practices Act
(Subchapter V (commencing with Section 1692) of Chapter 41 of Title
15 of the United States Code). The summary shall include a statement
that the Federal Trade Commission enforces the federal act. The
summary shall be sufficient if it appears in substantially the
following form: "State and federal law require debt collectors to
treat you fairly and prohibit debt collectors from making false
statements or threats of violence, using obscene or profane language,
and making improper communications with third parties, including
your employer. Except under unusual circumstances, debt collectors
may not contact you before 8:00 a.m. or after 9:00 p.m. In general, a
debt collector may not give information about your debt to another
person, other than your attorney or spouse. A debt collector may
contact another person to confirm your location or to enforce a
judgment. For more information about debt collection activities, you
may contact the Federal Trade Commission by telephone at
1-877-FTC-HELP (382-4357) or online at www.ftc.gov."
(2) A statement that nonprofit credit counseling services may be
available in the area.
(b) The notice required by subdivision (a) shall also accompany
any document indicating that the commencement of collection
activities may occur.
(c) The requirements of this section shall apply to the entity
engaged in the collection activities. If a physician and surgeon
assigns or sells the debt to another entity, the obligations shall
apply to the entity, including a collection agency, engaged in the
debt collection activity.
127458. The physician and surgeon shall reimburse the patient or
patients any amount actually paid in excess of the amount due under
this article, including interest. Interest owed by the physician and
surgeon to the patient shall accrue at the rate set forth in Section
685.010 of the Code of Civil Procedure, beginning on the date payment
by the patient is received by the hospital. However, a physician and
surgeon is not required to reimburse the patient or pay interest if
the amount due is less than five dollars ($5). The physician and
surgeon shall give the patient a credit for the amount due for at
least 60 days from the date the amount is due.
127459. The rights, remedies, and penalties established by this
article are cumulative, and shall not supersede the rights, remedies,
or penalties established under other laws.
127460. Nothing in this article shall be construed to prohibit a
physician and surgeon from uniformly imposing charges from its
established charge schedule or published rates, nor shall this
article preclude the recognition of a physician and surgeon's
established charge schedule or published rates for purposes of
applying any payment limit,
interim payment amount, or other payment calculation based upon a
physician and surgeon's rates or charges under the Medi-Cal program,
the Medicare Program, workers' compensation, or other federal, state,
or local public program of health benefits. No health care service
plan, insurer, or any other person shall reduce the amount it would
otherwise reimburse a claim for physician and surgeon services
because a physician and surgeon has waived, or will waive, collection
of all or a portion of a patient's bill for physician and surgeon
services in accordance with the physician and surgeon's discount
payment policy, notwithstanding any contractual provision.
127461. Notwithstanding any other provision of law, the amounts
paid by parties for services resulting from reduced or waived charges
under a physician and surgeon's discounted payment policy shall not
constitute a physician and surgeon's uniform, published, prevailing,
or customary charges, its usual fees to the general public, or its
charges to non-Medi-Cal purchasers under comparable circumstances,
and shall not be used to calculate a physician and surgeon's median
non-Medicare or Medi-Cal charges, for purposes of any payment limit
under the federal Medicare Program, the Medi-Cal program, or any
other federal or state-financed health care program.
127462. To the extent that any requirement of this article
results in a federal determination that a physician and surgeon's
established charge schedule or published rates are not the physician
and surgeon's customary or prevailing charges for services, the
requirement in question shall be inoperative for all physician and
surgeons. The State Department of Public Health shall seek federal
guidance regarding modifications to the requirement in question. All
other requirements of this article shall remain in effect.