BILL NUMBER: SB 266	AMENDED
	BILL TEXT

	AMENDED IN SENATE  APRIL 24, 2013
	AMENDED IN SENATE  APRIL 3, 2013
	AMENDED IN SENATE  MARCH 18, 2013

INTRODUCED BY   Senator Lieu

                        FEBRUARY 13, 2013

   An act to add Section 687 to the Business and Professions Code,
and to add Section 1250.04 to the Health and Safety Code, relating to
health care coverage.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 266, as amended, Lieu. Health care coverage: out-of-network
coverage.
   Existing law provides for the licensure and regulation of health
care practitioners by various healing arts boards within the
Department of Consumer Affairs. Existing law also provides for the
licensure and regulation of health facilities by the State Department
of Public Health. A violation of these provisions is a crime.
    This bill would prohibit a  provider  
medical  group or clinic, as defined, from stating, verbally or
in writing, that it is within a plan network or a provider network
unless all of the individual providers providing services with the
 provider   medical  group or clinic are
within the plan network or provider network. The bill would require a
provider group or clinic to recommend that the patient contact his
or her health care service plan or health insurer for information
about providers who are within the patient's plan network or 
provider   medical  network  if any of the
providers in that medical group or clinic are not within the plan
network or provider network  . Those provisions would not apply
to emergency services and care.
    This bill would also require a hospital, before providing
nonemergency services and care, to provide a specified written notice
to the patient stating that individual providers providing services
within the hospital may not be in the patient's plan network or
provider network, except as specified. By expanding the scope of a
crime, this 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 687 is added to the Business and Professions
Code, to read:
   687.  (a) (1) A  provider   medical 
group or clinic shall not state, verbally or in writing, that it is
within a patient's plan network or provider network unless all of the
individual providers providing services with the  provider
  medical  group or clinic are within that plan
network or provider network.
   (2)  The provider   If   any of the
providers are not within the plan network or provider network, then
the medical  group or clinic shall recommend that the patient
contact his or her health care service plan or health insurer for
information about providers who are within the patient's plan network
or  provider   medical  network.
   (b) For purposes of this section, the following definitions shall
apply:
   (1) "Clinic" means a surgical center as defined in paragraph (1)
of subdivision (b) of Section 1204 of the Health and Safety Code, an
outpatient setting as defined in paragraph (1) of subdivision (b) of
Section 1248 of the Health and Safety Code, or an ambulatory surgical
center certified to participate in the Medicare Program under Title
XVIII of the federal Social Security Act (42 U.S.C. Sec. 1395 et
seq.).
   (2) "Plan network" means any entity, group of providers, or
individual providers contracted with a preferred provider
organization plan contract or point-of-service plan contract.
   (3) "Provider network" means any entity, group of providers, or
provider contracted with a preferred provider organization health
insurance policy.
   (4)  "Provider   "Medical  group" means
 a medical group, independent practice association, 
 any entity, group of providers,  or any other similar
organization  that contracts with a preferred provider
organization  .
   (c) This section shall not apply to emergency services and care.
  SEC. 2.  Section 1250.04 is added to the Health and Safety Code, to
read:
   1250.04.  (a) (1) Prior to providing nonemergency services and
care to a patient, a hospital shall provide a written notice to the
patient stating that individual providers providing services within
the hospital may not be in the patient's plan network or provider
network.
   (2) The hospital notice shall recommend that the patient contact
his or her health care service plan or health insurer for information
about providers who are within the patient's plan network or
provider network.
   (b) For purposes of this section, the following definitions shall
apply:
   (1) "Hospital" means a general acute care hospital as defined in
subdivision (a) of Section 1250.
   (2) "Plan network" means any entity, group of providers, or
individual providers contracted with a preferred provider
organization plan contract or point-of-service plan contract.
   (3) "Provider network" means any entity, group of providers, or
provider contracted with a preferred provider organization health
insurance policy.
   (c) This section shall not apply to emergency services and care.
   (d) This section shall not apply if all of the providers providing
services within the hospital are within the same plan network or
provider network as the hospital.
  SEC. 3.  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.