BILL NUMBER: AB 676	INTRODUCED
	BILL TEXT


INTRODUCED BY   Assembly Member Fox

                        FEBRUARY 21, 2013

   An act to add Section 1367.52 to the Health and Safety Code, to
add Section 10117.6 to the Insurance Code, and to add Section 14109.7
to the Welfare and Institutions Code, relating to health care
coverage.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 676, as introduced, Fox. Health care coverage: postdischarge
care needs.
   Existing law, the Knox-Keene Health Care Service Plan Act of 1975,
provides for the licensure and regulation of health care service
plans by the Department of Managed Health Care and makes a willful
violation of the act a crime. Existing law also provides for the
regulation of insurers by the Department of Insurance. Existing law
provides for the Medi-Cal program, which is administered by the State
Department of Health Care Services, under which qualified low-income
individuals receive health care services. The Medi-Cal program is,
in part, governed and funded by federal Medicaid Program provisions.
   This bill would prohibit health care service plans, health
insurers, and the Department of Health Care Services or Medi-Cal
managed care plans, as applicable, from causing an enrollee, insured,
or beneficiary to remain in a general acute care hospital or an
acute psychiatric hospital upon determination by the attending
physician on the medical staff that the individual no longer requires
inpatient hospital care. The bill would require the health care
service plan, health insurer, or the State Department of Health Care
Services or Medi-Cal managed care plan to perform specified duties
within 24 hours of receipt of notice of the discharge. The bill would
provide that failure of the health care service plan, health
insurer, or the State Department of Health Care Services or Medi-Cal
managed care plan to transfer the patient within 72 hours from the
health facility to an appropriate community setting would result in a
daily penalty amount, as specified, to be paid within 10 days of the
patient's discharge.
   Because a willful violation of these provisions by a health care
service plan would be a crime, the 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 1367.52 is added to the Health and Safety Code,
to read:
   1367.52.  (a) A health care service plan that provides coverage
for inpatient hospital care shall not cause an enrollee to remain in
a health facility licensed under subdivision (a) or (b) of Section
1250, upon a determination by the attending physician on the medical
staff that the enrollee no longer requires inpatient hospital care.
Within 24 hours of receipt of notice of discharge, the health care
service plan shall be in direct communication with hospital staff to
provide information, support, and assistance to facilitate the
ability of hospital personnel to do all of the following:
   (1) Locate and secure an appropriate community setting for the
enrollee that is consistent with postdischarge care needs.
   (2) Ensure there is an appropriate arrangement to transfer the
enrollee to the community setting.
   (3) Follow up with the enrollee or his or her designee to
coordinate postdischarge care needs.
   (b) Failure of the health care service plan to transfer the
enrollee within 72 hours from a health facility described in
subdivision (a) to an appropriate community setting shall result in a
daily penalty amount equal to the applicable inpatient rate, or pro
rata calculated rate if case based, or the diagnosis-related group
rate. The penalty shall be paid by the health care service plan to
the health facility under the standard billing cycle, and final
payment of the penalty shall be paid within 10 days of the enrollee's
discharge.
  SEC. 2.  Section 10117.6 is added to the Insurance Code, to read:
   10117.6.  (a) A health insurer that provides coverage for
inpatient hospital care shall not cause an insured to remain in a
health facility licensed under subdivision (a) or (b) of Section 1250
of the Health and Safety Code, upon a determination by the attending
physician on the medical staff that the insured no longer requires
inpatient hospital care. Within 24 hours of receipt of notice of
discharge, the health insurer shall be in direct communication with
hospital staff to provide information, support, and assistance to
facilitate the ability of hospital personnel to do all of the
following:
   (1) Locate and secure an appropriate community setting for the
insured that is consistent with postdischarge care needs.
   (2) Ensure there is an appropriate arrangement to transfer the
insured to the community setting.
   (3) Follow up with the insured or his or her designee to
coordinate postdischarge care needs.
   (b) Failure of the health insurer to transfer the insured within
72 hours from a health facility described in subdivision (a) to an
appropriate community setting shall result in a daily penalty amount
equal to the applicable inpatient rate, or pro rata calculated rate
if case based, or the diagnosis-related group rate. The penalty shall
be paid by the health insurer to the health facility under the
standard billing cycle, and final payment of the penalty shall be
paid within 10 days of the insured's discharge.
  SEC. 3.  Section 14109.7 is added to the Welfare and Institutions
Code, to read:
   14109.7.  (a) The department, or the Medi-Cal managed care plan,
if applicable, shall not cause a Medi-Cal beneficiary to remain in a
health facility licensed under subdivision (a) or (b) of Section 1250
of the Health and Safety Code, upon a determination by the attending
physician on the medical staff that the beneficiary no longer
requires inpatient hospital care. Within 24 hours of receipt of
notice of discharge, the department or the Medi-Cal managed care plan
shall be in direct communication with hospital staff to provide
information, support, and assistance to facilitate the ability of
hospital personnel to do all of the following:
   (1) Locate and secure an appropriate community setting for the
beneficiary that is consistent with postdischarge care needs.
   (2) Ensure there is an appropriate arrangement to transfer the
beneficiary to the community setting.
   (3) Follow up with the beneficiary or his or her designee to
coordinate postdischarge care needs.
   (b) Failure of the department or the Medi-Cal managed care plan to
transfer the beneficiary within 72 hours from a health facility
described in subdivision (a) to an appropriate community setting
shall result in a daily penalty amount equal to the applicable
inpatient rate, or pro rata calculated rate if case based, or the
diagnosis-related group rate. The penalty shall be paid by the
department or the Medi-Cal managed care plan to the health facility
under the standard billing cycle, and final payment of the penalty
shall be paid within 10 days of the beneficiary's discharge.
  SEC. 4.  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.