BILL NUMBER: SB 799	INTRODUCED
	BILL TEXT


INTRODUCED BY   Senator Calderon

                        FEBRUARY 22, 2013

   An act to amend Section 127405 of the Health and Safety Code,
relating to hospitals.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 799, as introduced, Calderon. Hospitals: fair pricing.
   Existing law requires each hospital to maintain an understandable
written policy regarding discount payments for financially qualified
patients as well as an understandable written charity care policy.
Uninsured patients or patients with high medical costs who are at or
below 350% of the federal poverty level, as defined, are eligible to
apply for participation under a hospital's charity care policy or
discount payment policy.
   This bill would make a technical, nonsubstantive change to that
provision.
   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 127405 of the Health and Safety Code is amended
to read:
   127405.  (a) (1) (A) Each hospital shall maintain an
understandable written policy regarding discount payments for
financially qualified patients as well as an understandable written
charity care policy. Uninsured patients or patients with high medical
costs who are at or below 350 percent of the federal poverty level,
as defined in subdivision (b) of Section 127400, shall be eligible to
apply for participation under a hospital's charity care policy or
discount payment policy. Notwithstanding any other provision of this
article, a hospital may choose to grant eligibility for its discount
payment policy or charity care policies to patients with incomes over
350 percent of the federal poverty level. Both the charity care
policy and the discount payment policy shall state the process
 used by  the hospital  uses  to determine
whether a patient is eligible for charity care or discounted payment.
In the event of a dispute, a patient may seek review from the
business manager, chief financial officer, or other appropriate
manager as designated in the charity care policy and the discount
payment policy.
   (B) The written policy regarding discount payments shall also
include a statement that an emergency physician, as defined in
Section 127450, who provides emergency medical services in a hospital
that provides emergency care is also required by law to provide
discounts to uninsured patients or patients with high medical costs
who are at or below 350 percent of the federal poverty level. This
statement shall not be construed to impose any additional
responsibilities upon the hospital.
   (2) Rural hospitals, as defined in Section 124840, may establish
eligibility levels for financial assistance and charity care at less
than 350 percent of the federal poverty level as appropriate to
maintain their financial and operational integrity.
   (b) A hospital's discount payment policy shall clearly state
eligibility criteria based upon income consistent with the
application of the federal poverty level. The discount payment policy
shall also include an extended payment plan to allow payment of the
discounted price over time. The policy shall provide that the
hospital and the patient may negotiate the terms of the payment plan.

   (c) The charity care policy shall state clearly the eligibility
criteria for charity care. In determining eligibility under its
charity care policy, a hospital may consider income and monetary
assets of the patient. For purposes of this determination, monetary
assets shall not include retirement or deferred compensation plans
qualified under the Internal Revenue Code, or nonqualified deferred
compensation plans. Furthermore, the first ten thousand dollars
($10,000) of a patient's monetary assets shall not be counted in
determining eligibility, nor shall 50 percent of a patient's monetary
assets over the first ten thousand dollars ($10,000) be counted in
determining eligibility.
   (d) A hospital shall limit expected payment for services it
provides to a patient at or below 350 percent of the federal poverty
level, as defined in subdivision (b) of Section 127400, eligible
under its discount payment policy to the amount of payment the
hospital would expect, in good faith, to receive for providing
services from Medicare, Medi-Cal, the Healthy Families Program, or
another government-sponsored health program of health benefits in
which the hospital participates, whichever is greater. If the
hospital provides a service for which there is no established payment
by Medicare or any other government-sponsored program of health
benefits in which the hospital participates, the hospital shall
establish an appropriate discounted payment.
   (e) A patient, or patient's legal representative, who requests a
discounted payment, charity care, or other assistance in meeting his
or her financial obligation to the hospital shall make every
reasonable effort to provide the hospital with documentation of
income and health benefits coverage. If the person requests charity
care or a discounted payment and fails to provide information that is
reasonable and necessary for the hospital to make a determination,
the hospital may consider that failure in making its determination.
   (1) For purposes of determining eligibility for discounted
payment, documentation of income shall be limited to recent pay stubs
or income tax returns.
   (2) For purposes of determining eligibility for charity care,
documentation of assets may include information on all monetary
assets, but shall not include statements on retirement or deferred
compensation plans qualified under the Internal Revenue Code, or
nonqualified deferred compensation plans. A hospital may require
waivers or releases from the patient or the patient's family,
authorizing the hospital to obtain account information from financial
or commercial institutions, or other entities that hold or maintain
the monetary assets, to verify their value.
   (3) Information obtained pursuant to paragraph (1) or (2) shall
not be used for collections activities. This paragraph does not
prohibit the use of information obtained by the hospital, collection
agency, or assignee independently of the eligibility process for
charity care or discounted payment.
   (4) Eligibility for discounted payments or charity care may be
determined at any time the hospital is in receipt of information
specified in paragraph (1) or (2), respectively.