BILL NUMBER: AB 2533 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY MARCH 28, 2014
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 add Sections
1367.031 and 1374.37 to the Health and Safety Code, and to add
Sections 10133.51 and 10169.6 to the Insurance Code, relating to
health care coverage .
LEGISLATIVE COUNSEL'S DIGEST
AB 2533, as amended, Ammiano. Noncontracting hospitals.
Health care coverage: noncontracting
providers.
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 health insurers by the Department of Insurance.
Existing law requires the Department of Managed Care and the
Insurance Commissioner to adopt regulations to ensure that enrollee's
and insureds have access to needed health care services in a timely
manner, as specified. Existing law authorizes the Department of
Managed Care to assess administrative penalties for noncompliance
with the requirements, which are paid into the Managed Care
Administrative Fines and Penalties Fund.
This bill would require a health care service plan or health
insurer to arrange for the provision of a medically necessary service
by a licensed noncontracting provider if the plan or insurer is
unable to meet timely access standards established by the Department
of Managed Care or the Insurance Commissioner. The bill would require
the noncontracting provider to seek reimbursement for the covered
service solely from the health care service plan or health insurer,
except for allowable copayments, coinsurance, and deductibles. The
bill would authorize the Director of Managed Care and the Insurance
Commissioner to assess administrative penalties of $1,000 per
violation against a health care service plan or health insurer that
fails to comply with these requirements. The bill would require that
the penalties assessed against health care service plans be deposited
into the Managed Care Administrative Fines and Penalties Fund. The
bill would establish the Health Insurance Administrative Fines and
Penalties Account in the Insurance Fund and would require penalties
assessed against health insurers to be deposited into that account to
be used, upon appropriation by the Legislature, to support the
Department of Insurance.
Existing law establishes independent medical review (IMR) systems
to provide enrollees and insureds with the opportunity to seek an IMR
whenever health care services have been denied, modified, or delayed
by a health care service plan or health insurer, or by one of its
contracting providers, if the decision was based in whole or in part
on a finding that the proposed health care services are not medically
necessary.
This bill would require a health care service plan contract or
health insurance policy issued, amended, renewed, or delivered on or
after January 1, 2015, to provide an enrollee or insured with the
opportunity to seek an IMR to examine the health insurer's coverage
decisions regarding services not offered by the health care service
plan contract or health insurance policy and provided by
noncontracting providers. If a determination is made that the health
care service plan or health insurer shall cover the service rendered
by the noncontracting provider, the bill would require the
noncontracting provider to seek reimbursement for the covered service
solely from the health care service plan or health insurer, except
for allowable copayments, coinsurance, and deductibles.
Because a willful violation of these requirements with respect to
health care service plans 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.
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
yes . State-mandated local program: no
yes .
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 1367.031 is added to the
Health and Safety Code , immediately following
Section 1367.03 , to read:
1367.031. (a) If a health care service plan is unable to meet
timely access standards established pursuant to Section 1367.03, and
is thereby unable to ensure timely access by an enrollee to a
medically necessary covered service provided by a contracted
provider, the health care service plan shall arrange for the
provision of the service by a licensed noncontracting provider in the
area of practice appropriate to treat the enrollee's condition.
(1) A noncontracting provider providing a service to an enrollee
pursuant to subdivision (a) shall seek reimbursement for a covered
service solely from an enrollee's health care service plan, and shall
not seek payment from the enrollee for the covered service, except
for allowable copayments, coinsurance, and deductibles.
(2) A health care service plan referring an enrollee to a
noncontracting provider shall ensure that the location of the
facilities of the noncontracting provider is within reasonable
proximity of the business or personal residence of the enrollee, and
that the hours of operation and provision for after-hours care is
reasonable so as not to result in barriers to accessibility.
(3) The health care service plan shall consider referral to a
specific noncontracting provider preferred by the enrollee. If the
health care service plan does not refer the enrollee to the enrollee'
s preferred noncontracting provider, the health care service plan
shall provide the enrollee with a written explanation outlining the
reasons why the enrollee's preferred noncontracting provider was not
selected to provide the covered service.
(4) If an enrollee prefers to wait for a contracted provider to
provide the covered service, the health care service plan shall
accommodate the enrollee's preference.
(b) Pursuant to subdivision (g) of Section 1367.03, the department
may assess an administrative penalty of one thousand dollars
($1,000) per violation against any health care service plan that
fails to comply with this section.
SEC. 2. Section 1374.37 is added to the
Health and Safety Code , immediately following
Section 1374.36 , to read:
1374.37. (a) Every health care service plan contract that is
issued, amended, renewed, or delivered on or after January 1, 2015,
shall provide an enrollee with an opportunity to seek an independent
medical review under the process established pursuant to this article
to examine the plan's coverage decisions regarding services not
covered by the health care service plan contract and provided by
noncontracting providers.
(b) If a health care service plan modifies, delays, or denies a
claim for a service rendered by a noncontracting provider because the
provision of the service is excluded as a covered benefit, the
enrollee may appeal the modification, delay, or denial by submitting
a written statement from the enrollee's attending physician, who
shall be a licensed, board-certified, or board-eligible physician
qualified to practice in the area of practice appropriate to treat
the enrollee for the health care service sought, certifying that the
service provided by the noncontracting provider is medically
necessary.
(c) Claims for services rendered by a noncontracting provider that
are modified, delayed, or denied because the service is excluded as
a covered benefit shall qualify for the independent medical review
process established pursuant to this article if the enrollee's
physician, as specified in subdivision (b), certifies the service is
medically necessary.
(d) If a health care service plan modifies, delays, or denies a
claim for a service rendered by a noncontracting provider because the
health care service plan offers an alternative service that is
included as a covered benefit and provided by a contracting provider,
the enrollee of the health care service plan may appeal the
modification, delay, or denial of the claim by submitting both of the
following:
(1) A written statement from the enrollee's attending physician,
who shall be a licensed, board-certified, or board-eligible physician
qualified to practice in the specialty area of practice appropriate
to treat the enrollee for the health service sought, that the service
provided by the noncontracting provider is materially different from
a health care service the health care service plan approved to treat
the enrollee.
(2) Two documents from the available medical and scientific
evidence that the service provided by the noncontracting provider is
likely to be more beneficial to the enrollee than the alternate
service recommended by the health care service plan.
(e) An external appeal agent shall review the health care service
plan's coverage decision to modify, delay, or deny claims for
services described in subdivision (a), and shall make a determination
within seven days of receipt of the appeal as to whether the claim
for the service rendered by a noncontracting provider shall be
covered by the plan. The external appeal agent shall make a
determination within 48 hours in cases where an enrollee has an
imminent need for the services in question.
(f) If a determination is made by the external appeal agent that
the service rendered by the noncontracting provider is materially
different from, and more beneficial than, the alternate service
recommended by the plan, the health care service plan shall cover the
service rendered by the noncontracting provider.
(g) The noncontracting provider providing a service to an enrollee
that is required to be covered by the health care service plan as a
result of an independent medical review pursuant to this section
shall seek reimbursement for the service solely from the enrollee's
health care service plan, and shall not seek payment from the
enrollee for the covered service, except for allowable copayments,
coinsurance, and deductibles.
SEC. 3. Section 10133.51 is added to the
Insurance Code , immediately following Section
10133.5 , to read:
10133.51. (a) If a health insurer that contracts with providers
for alternative rates pursuant to Section 10133 is unable to meet
timely access standards established pursuant to Section 10133.5, and
is thereby unable to ensure timely access by an insured to a
medically necessary covered service provided by a contracted
provider, the health insurer shall arrange for the provision of the
service by a licensed noncontracting provider in the area of practice
appropriate to treat the insured's condition.
(1) A noncontracting provider providing a service to an insured
pursuant to subdivision (a) shall seek reimbursement for the covered
service solely from the insured's health insurer, and shall not seek
payment from the insured for the covered service, except for
allowable copayments, coinsurance, and deductibles.
(2) A health insurer referring an insured to a noncontracting
provider shall ensure that the location of the facilities of the
noncontracting provider is within reasonable proximity of the
business or personal residence of the insured, and that the hours of
operation and provision for after-hours care is reasonable so as not
to result in barriers to accessibility.
(3) The health insurer shall consider referral to a specific
noncontracting provider preferred by the insured. If the health
insurer does not refer the insured to the insured's preferred
noncontracting provider, the health insurer shall provide the insured
with a written explanation outlining the reasons why the insured's
preferred noncontracting provider was not selected to provide the
covered service.
(4) If an insured prefers to wait for a contracted provider to
provide the covered service, the health insurer shall accommodate the
insured's preference.
(b) (1) The commissioner may investigate and take enforcement
action against health insurers regarding noncompliance with the
requirements of this section.
(2) The commissioner may, by order, assess an administrative
penalty of one thousand dollars ($1,000) per violation against a
health insurer that fails to comply with this section, subject to
appropriate notice and the opportunity for a hearing in accordance
with Chapter 5 (commencing with Section 11500) of Part 1 of Division
3 of Title 2 of the Government Code. The health insurer may provide
to the commissioner, and the commissioner may consider, information
regarding the health insurer's overall compliance with the
requirements of this section. The administrative penalties shall not
be deemed an exclusive remedy available to the commissioner.
(3) There is hereby created the Health Insurance Administrative
Fines and Penalties Account in the Insurance Fund established
pursuant to Section 12975.7. All moneys in the account shall be
subject to annual appropriation each fiscal year for the support of
the Department of Insurance.
SEC. 4. Section 10169.6 is added to the
Insurance Code , immediately following Section
10169.5 , to read:
10169.6. (a) Every health insurance policy that is issued,
amended, renewed, or delivered on or after January 1, 2015, shall
provide an insured with an opportunity to seek an independent medical
review under the process established pursuant to this article to
examine the health insurer's coverage decisions regarding services
not covered by the health insurance policy and provided by
noncontracting providers.
(b) If a health insurer modifies, delays, or denies a claim for a
service rendered by a noncontracting provider because the provision
of the service is excluded as a covered benefit, the insured may
appeal the modification, delay, or denial by submitting a written
statement from the insured's attending physician, who shall be a
licensed, board-certified, or board-eligible physician qualified to
practice in the area of practice appropriate to treat the insured for
the health care service sought, certifying that the service provided
by the noncontracting provider is medically necessary.
(c) Claims for services rendered by a noncontracting provider that
are modified, delayed, or denied because the service is excluded as
a covered benefit shall qualify for the independent medical review
process established pursuant to this article if the insured's
physician, as specified in subdivision (b), certifies the service is
medically necessary.
(d) If a health insurer modifies, delays, or denies a claim for a
service rendered by a noncontracting provider because the health
insurer offers an alternative service that is included as a covered
benefit and provided by a contracting provider, the insured of the
health insurance policy may appeal by the modification, delay, or
denial of the claim by submitting both of the following:
(1) A written statement from the insured's attending physician,
who shall be a licensed, board-certified, or board-eligible physician
qualified to practice in the specialty area of practice appropriate
to treat the insured for the health service sought, that the service
provided by the noncontracting provider is materially different from
a health care service the health insurer approved to treat the
insured.
(2) Two documents from the available medical and scientific
evidence that the service provided by the noncontracting provider is
likely to be more beneficial to the insured than the alternate
service recommended by the health insurer.
(e) An external appeal agent shall review the health insurer's
coverage decision to modify, delay, or deny claims for services
described in subdivision (a), and shall make a determination within
seven days of receipt of the appeal as to whether the claim for the
service rendered by a noncontracting provider shall be covered by the
health insurer. The external appeal agent shall make a determination
within 48 hours in cases where an insured has an imminent need for
the services in question.
(f) If a determination is made by the external appeal agent that
the service rendered by the noncontracting provider is materially
different from, and more beneficial than, the alternate service
recommended by the health insurer, the health insurer shall cover the
service rendered by the noncontracting provider.
(g) The noncontracting provider providing a service to an insured
that is required to be covered by the health insurer as a result of
an independent medical review pursuant to this section shall seek
reimbursement for the service solely from the insured's health care
service plan, and shall not seek payment from the insured for the
covered service, except for allowable copayments, coinsurance, and
deductibles.
SEC. 5. 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 are the result of a program for which
legislative authority was requested by that local agency or school
district, within the meaning of Section 17556 of the Government Code
and Section 6 of Article XIII B of the California Constitution.
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) 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) 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.