BILL NUMBER: AB 2533	INTRODUCED
	BILL TEXT


INTRODUCED BY   Assembly Member Ammiano

                        FEBRUARY 21, 2014

   An act to amend Section 1262.8 of the Health and Safety Code,
relating to health facilities.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 2533, as introduced, Ammiano. Noncontracting hospitals.
   Existing law prohibits a noncontracting hospital, as defined, from
billing a patient who is an enrollee of a health care service plan
for poststabilization care, except for applicable copayments,
coinsurance, and deductible, unless certain conditions are met.
   This bill would make technical, nonsubstantive changes to these
provisions.
   Vote: majority. Appropriation: no. Fiscal committee: no.
State-mandated local program: no.


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

  SECTION 1.  Section 1262.8 of the Health and Safety Code is amended
to read:
   1262.8.  (a) A noncontracting hospital shall not bill a patient
who is an enrollee of a health care service plan for
poststabilization care, except for applicable copayments,
coinsurance, and deductibles, unless one of the following conditions
are met:
   (1) The patient or the patient's spouse or legal guardian refuses
to consent, pursuant to subdivision (f), for the patient to be
transferred to the contracting hospital as requested and arranged for
by the patient's health care service plan.
   (2) The hospital is unable to obtain the name and contact
information of the patient's health care service plan as provided in
subdivision (c).
   (b) If a patient with an emergency medical condition, as defined
by Section 1317.1, is covered by a health care service plan that
requires prior authorization for poststabilization care, a
noncontracting hospital, except as provided in subdivision (n),
shall, prior to providing poststabilization care, do all of the
following once the emergency medical condition has been stabilized,
as defined by Section 1317.1:
   (1) Seek to obtain the name and contact information of the patient'
s health care service plan. The hospital shall document its attempt
to ascertain this information in the patient's medical record, which
shall include requesting the patient's health care service plan
member card or asking the patient, or a family member or other person
accompanying the patient, if he or she can identify the patient's
health care service plan, or any other means known to the hospital
for accurately identifying the patient's health care service plan.
   (2) Contact the patient's health care service plan, or the health
plan's contracting medical provider, for authorization to provide
poststabilization care, if identification of the plan was obtained
pursuant to paragraph (1).
   (A) The hospital shall make the contact described in this
subparagraph by either following the instructions on the patient's
health care service plan member card or using the contact information
provided by the patient's health care service plan pursuant to
subdivision (j) or (k).
   (B) A representative of the hospital shall not be required to make
more than one telephone call to the health care service plan, or its
contracting medical provider, provided that in all cases the health
care service plan, or its contracting medical provider, shall be able
to reach a representative of the hospital upon returning the call,
should the plan, or its contracting medical provider, need to call
back. The representative of the hospital who makes the telephone call
may be, but is not required to be, a physician and surgeon.
   (3) Upon request of the patient's health care service plan, or the
health plan's contracting medical provider, provide to the plan, or
its contracting medical provider, the treating physician and surgeon'
s diagnosis and any other relevant information reasonably necessary
for the health care service plan or the plan's contracting medical
provider to make a decision to authorize poststabilization care or to
assume management of the patient's care by prompt transfer.
   (c) A noncontracting hospital that is not able to obtain the name
and contact information of the patient's health care service plan
pursuant to subdivision (b) is not subject to the requirements of
this section.
   (d) (1) A health care service plan, or its contracting medical
provider, that is contacted by a noncontracting hospital pursuant to
paragraph (2) of subdivision (b), shall, within 30 minutes from the
time the noncontracting hospital makes the initial contact, do either
of the following:
   (A) Authorize poststabilization care.
   (B) Inform the noncontracting hospital that it will arrange for
the prompt transfer of the enrollee to another hospital.
   (2) If the health care service plan, or its contracting medical
provider, does not notify the noncontracting hospital of its decision
pursuant to paragraph (1) within 30 minutes, the poststabilization
care shall be deemed authorized, and the health care service plan, or
its contracting medical provider, shall pay charges for the care, in
accordance with the Knox-Keene Health Care Service Plan Act of 1975
(Chapter 2.2 (commencing with Section 1340) of Division 2) and any
regulation adopted thereunder.
   (3) If the health care service plan, or its contracting medical
provider, notified the noncontracting hospital that it would assume
management of the patient's care by prompt transfer, but either the
health care service plan or its contracting medical provider fails to
transfer the patient within a reasonable time, the poststabilization
care shall be deemed authorized, and the health care service plan,
or its contracting medical provider, shall pay charges, in accordance
with the Knox-Keene Health Care Service Plan Act of 1975 (Chapter
2.2 (commencing with Section 1340) of Division 2 of the Health and
Safety Code) and any regulation adopted thereunder, for the care
until the enrollee is transferred.
   (4) If the health care service plan, or its contracting medical
provider, provides authorization to the noncontracting hospital for
specified poststabilization care and services, the health care
service plan, or its contracting medical provider, shall be
responsible to pay for that authorized care.
   (e) If a health care service plan, or its contracting medical
provider, decides to assume management of the patient's care by
prompt transfer, the health care service plan, or its contracting
medical provider, shall do all of the following:
   (1) Arrange and pay the reasonable charges associated with the
transfer of the patient.
   (2) Pay for all of the immediately required medically necessary
care rendered to the patient prior to the transfer in order to
maintain the patient's clinical stability.
   (3) Be responsible for making all arrangements for the patient's
transfer, including, but not limited to, finding a contracted
facility available for the transfer of the patient.
   (f) (1) If the patient, or the patient's spouse or legal guardian
refuses to consent to the patient's transfer under subdivision (e),
the noncontracting hospital shall promptly provide a written notice
to the patient or the patient's spouse or legal guardian indicating
that the patient will be financially responsible for any further
poststabilization care provided by the hospital.
   (2) For patients whose primary language is one of the Medi-Cal
threshold languages, the notice shall be delivered to them in their
primary language.
   (3) The Department of Managed Health Care shall translate the
notice required by this subdivision in all Medi-Cal threshold
languages and make the translations available to the hospitals
subject to this section.
   (4) The written notice provided pursuant to this subdivision shall
include the following statement:

   THIS NOTICE MUST BE PROVIDED TO YOU UNDER CALIFORNIA LAW

   "You have received emergency care at a hospital that is not a part
of your health plan's provider network. Under state law, emergency
care must be paid by your health plan no matter where you get that
care. The doctor who is caring for you has decided that you may be
safely moved to another hospital for the additional care you need.
Because you no longer need emergency care, your health plan has not
authorized further care at this hospital. Your health plan has
arranged for you to be moved to a hospital that is in your health
plan's provider network.
   If you agree to be moved, your health plan will pay for your care
at that hospital. You will only have to pay for your deductible,
copayments, or coinsurance for care. You will not have to pay for
your deductible, copayments, or coinsurance for transportation costs
to another hospital that is covered by your health plan.
   IF YOU CHOOSE TO STAY AT THIS HOSPITAL FOR YOUR ADDITIONAL CARE,
YOU WILL HAVE TO PAY THE FULL COST OF CARE NOW THAT YOU NO LONGER
NEED EMERGENCY CARE. This cost may include the cost of the doctor or
doctors, the hospital, and any laboratory, radiology, or other
services that you receive.
   If you do not think you can be safely moved, talk to the doctor
about your concerns. If you would like additional help, you may
contact:
   Your health plan member services department. Look on your health
plan member card for that phone number. You can file a grievance with
your plan.
   The HMO Helpline at 888-HMO-2219. The HMO Helpline is available 24
hours a day, 7 days a week. The HMO Helpline can work with your
health plan to address your concerns, but you may still have to pay
the full cost of care at this hospital if you stay."

   (5) The hospital shall give one copy of the written notice
required by this subdivision to the patient, or the patient's spouse
or legal guardian, for signature and may retain a copy in the patient'
s medical record.
   (6) The hospital shall ensure prompt delivery of the notice to the
patient or his or her spouse or legal guardian. The hospital shall
obtain signed acceptance of the written notice required by this
subdivision, and signed acceptance of any other documents the
hospital requires for any further poststabilization care, from the
patient or the patient's spouse or legal guardian, and shall provide
the health care service plan, or its contracting medical provider,
with confirmation of the patient's, or his or her spouse or legal
guardian's, receipt of the written notice.
   (7) If the noncontracting hospital fails to meet the requirements
of this subdivision, the hospital shall not bill the patient or the
patient's health care service plan, or its contracting medical
provider, for poststabilization care provided to the patient.
   (8) If the patient, or the patient's spouse or legal guardian,
refuses to sign the notice, the noncontracting hospital shall
document in the patient's medical record that the notice was provided
and signature was refused. Upon the patient's refusal to sign, the
patient shall assume financial responsibility for any further
poststabilization care provided by the hospital.
   (9) The Department of Managed Health Care may, by regulation,
modify the wording of the notice required under this subdivision for
clarity, readability, and accuracy of the information provided.
   (10) The Department of Managed Health Care may, in conjunction
with consumer groups, health care service plans, and hospitals,
modify the wording of the notice to include language regarding
Medicare beneficiaries, if appropriate under Medicare rules. The
initial modification shall not be subject to the Administrative
Procedure Act (Chapter 3.5 (commencing with Section 11340, et. seq.)
of Part 1 of Division 3 of Title 2 of the Government Code).
   (g) If poststabilization care has been authorized by the health
care service plan, the noncontracting hospital shall request the
patient's medical record from the patient's health care service plan
or its contracting medical provider.
   (h) The health care service plan, or its contracting medical
provider, shall, upon conferring with the noncontracting hospital,
transmit any appropriate portion of the patient's medical record, if
the records are in the plan's possession, via facsimile transmission
or electronic mail, whichever method is requested by the
noncontracting hospital's representative or the noncontracting
physician and surgeon. The health care service plan, or its
contracting medical provider, shall transmit the patient's medical
record in a manner that complies with all legal requirements to
protect the patient's privacy.
   (i) A health care service plan, or its contracting medical
provider, that requires prior authorization for poststabilization
care shall provide 24-hour access for patients and providers,
including noncontracting hospitals, to obtain timely authorization
for medically necessary poststabilization care.
   (j) A health care service plan shall provide all noncontracting
hospitals in the state with specific contact information needed to
make the contact required by this section. The contact information
provided to hospitals shall be updated as necessary, but no less than
once a year.
   (k) In addition to meeting the requirements of subdivision (j), a
health care service plan shall provide the contact information
described in subdivision (j) to the Department of Managed Health
Care. The contact information provided pursuant to this subdivision
shall be updated as necessary, but no less than once a year. The
receiving department shall post this contact information on its
Internet Web site no later than January 1 of each calendar year.
   (l) This section shall only apply to a noncontracting hospital.
   (m) For purposes of this section, the following definitions shall
apply:
   (1) "Health care service plan" means a health care service plan
licensed pursuant to Chapter 2.2 (commencing with Section 1340) of
Division 2 that covers hospital, medical, or surgical expenses.
   (2) "Noncontracting hospital" means a general acute care hospital,
as defined in subdivision (a) of Section 1250 or an acute
psychiatric hospital, as defined in subdivision (b) of Section 1250,
that does not have a written contract with the patient's health care
service plan to provide health care services to the patient.
   (3) "Poststabilization care" means medically necessary care
provided after an emergency medical condition has been stabilized, as
defined by subdivision (j) of Section 1317.1.
   (4) "Contracting medical provider" means a medical group,
independent practice association, or any other similar organization
that, pursuant to a signed written contract, has agreed to accept
responsibility for provision or reimbursement of a noncontracting
hospital for emergency and poststabilization services provided to a
health plan's enrollees.
   (n) Subdivisions (b) to (h), inclusive, shall not apply to minor
treatment procedures, if all of the following apply:
   (1) The procedure is provided in the treatment area of the
emergency department.
   (2) The procedure concludes the treatment of the presenting
emergency medical condition of a patient and is related to that
condition, even though the treatment may not resolve the underlying
medical condition.
   (3) The procedure is performed according to accepted standards of
practice.
   (4) The procedure would result in the direct discharge or release
of the patient from the emergency department following this care.
   (o)  Nothing in this section is intended to  
This section shall not  prevent a health care service plan or
its contracting medical provider from assuming management of the
patient's care at any time after the initial provision of
poststabilization care by the noncontracting hospital before the
patient has been discharged. Upon the request of the health care
service plan or its contracting medical provider, the noncontracting
hospital shall provide the health care service plan or its
contracting medical provider with any information specified in
paragraph (3) of subdivision (b).
   (p)  Nothing in this section shall   This
section shall not  authorize a provider of health care services
to bill a Medi-Cal beneficiary enrolled in a Medi-Cal managed care
plan or otherwise alter the provisions of subdivision (a) of Section
14019.3 of the Welfare and Institutions Code.