BILL NUMBER: AB 658 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY MAY 5, 2015
INTRODUCED BY Assembly Member Wilk
FEBRUARY 24, 2015
An act to amend Section 4011.10 of the Penal Code, relating to
health care.
LEGISLATIVE COUNSEL'S DIGEST
AB 658, as amended, Wilk. County jails: inmate health care
services: rates.
Existing federal law provides for the federal Medicare Program,
which is a public health insurance program for persons 65 years of
age and older and specified persons with disabilities who are under
65 years of age.
Existing law authorizes a county sheriff, police chief, or other
public agency that contracts for health care services, to contract
with providers of health care services for care to local law
enforcement patients. Existing law requires hospitals that do not
contract with the county sheriff, police chief, or other public
agency that contracts for health care services to provide health care
services to local law enforcement patients at a rate equal to 110%
of the hospital's actual costs according to the most recent Hospital
Annual Financial Data report issued by the Office of Statewide Health
Planning and Development, as calculated using a cost-to-charge
ratio.
This bill would authorize, in the alternative,
for claims that have not previously been paid or adjudicated by
local law enforcement, those costs to be calculated according
to the most recent approved cost-to-charge ratio from the Medicare
Program. The bill would authorize the hospital, with the
approval of the county sheriff, police chief, or other public agency
that contracts or is responsible for providing health care services
to local law enforcement patients, to choose which cost-to-charge
ratio is most appropriate, and would require the hospital to give
notice of any change. If the hospital chooses to use the
cost-to-charge ratio from the Medicare Program, the bill
would require the hospital to attach supporting Medicare
documentation and an expected payment calculation to the claim. If a
claim does not contain that documentation and payment calculation, or
if, within 60 days of the hospital's request for approval to use the
cost-to-charge ratio from the Medicare Program, approval is not
granted by the county sheriff, police chief, or other public agency
that contracts or is responsible for providing health care
services to local law enforcement patients, the bill would require
the Office of Statewide Health Planning and Development
cost-to-charge ratio to be used to calculate the payment. The
bill would also make technical technical,
nonsubstantive changes.
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 4011.10 of the Penal Code is amended to read:
4011.10. (a) It is the intent of the Legislature in enacting this
section to provide county sheriffs, chiefs of police, and directors
or administrators of local detention facilities with an incentive to
not engage in practices designed to avoid payment of legitimate
health care costs for the treatment or examination of persons
lawfully in their custody, and to promptly pay those costs as
requested by the provider of services. Further, it is the intent of
the Legislature to encourage county sheriffs, chiefs of police, and
directors or administrators of local detention facilities to bargain
in good faith when negotiating a service contract with hospitals
providing health care services.
(b) Notwithstanding any other provision of law,
a county sheriff, police chief chief,
or other public agency that contracts for health care services, may
contract with providers of health care services for care to local law
enforcement patients. Hospitals that do not contract with the county
sheriff, police chief, or other public agency that contracts for
health care services shall provide health care services to local law
enforcement patients at a rate equal to 110 percent of the hospital's
actual costs according to the most recent Hospital Annual Financial
Data report issued by the Office of Statewide Health Planning and
Development, as calculated using a cost-to-charge ratio, or
or, for claims that have not previously been paid or
otherwise determined by local law enforcement, according to the
most recent approved cost-to-charge ratio from the Medicare Program.
The hospital, with the approval of the county sheriff, police
chief, or other public agency that contracts or is responsible for
providing health care services to local law enforcement patients, may
choose the most appropriate cost -to-charge ratio and
shall provide notice to the county sheriff, police chief, or other
public agency, as applicable, of any change. If the hospital uses the
cost-to-charge ratio from the Medicare Program, the hospital shall
attach supporting Medicare documentation and an expected
payment calculation to the claim. If a claim does not contain the
supporting Medicare documentation and expected payment calculation,
or if, within 60 days of the hospital's request for approval to use
the cost-to-charge ratio from the Medicare Program, approval is not
granted by the county sheriff, police chief, or other public agency
that contracts or is responsible for providing health care services
to local law enforcement patients, the Office of Statewide Health
Planning and Development cost-to-charge ratio shall be used to
calculate the payment.
(c) A county sheriff or police chief shall not request the release
of an inmate from custody for the purpose of allowing the inmate to
seek medical care at a hospital, and then immediately rearrest the
same individual upon discharge from the hospital, unless the hospital
determines this action would enable it to bill and collect from a
third-party payment source.
(d) The California Hospital Association, the University of
California, the California State Sheriffs' Association, and the
California Police Chiefs Association shall, immediately upon
enactment of this section, convene the Inmate Health Care and Medical
Provider Fair Pricing Working Group. The working group shall consist
of at least six members from the California Hospital Association and
the University of California, and six members from the California
State Sheriffs' Association and the California Police Chiefs
Association. Each organization should give great weight and
consideration to appointing members of the working group with diverse
geographic and demographic interests. The working group shall meet
as needed to identify and resolve industry issues that create fiscal
barriers to timely and affordable inmate health care. In addition,
the working group shall address issues including, but not limited to,
inmates being admitted for care and later rearrested and any other
fiscal barriers to hospitals being able to enter into fair market
contracts with public agencies. To the extent that the rate
provisions of this statute result in a disproportionate share of
local law enforcement patients being treated at any one hospital or
system of hospitals, the working group shall address this issue. No
reimbursement is required under this provision.
(e) Nothing in this section shall This
section does not require or encourage a hospital or public
agency to replace any existing arrangements that any city police
chief, county sheriff, or other public agency that contracts for
health care services for local law enforcement patients has with
health care providers.
(f) An entity that provides ambulance or any other emergency or
nonemergency response service to a sheriff or police chief, and that
does not contract with their departments for that service, shall be
reimbursed for the service at the rate established by Medicare.
Neither the sheriff nor the police chief shall reimburse a provider
of any of these services that his or her department has not
contracted with at a rate that exceeds the provider's reasonable and
allowable costs, regardless of whether the provider is located within
or outside of California.
(g) For the purposes of this section, "reasonable and allowable
costs" shall be defined in accordance with Part 413 of Title 42 of
the Code of Federal Regulations and federal Centers for Medicare and
Medicaid Services Publication Numbers 15-1 and 15-2.
(h) For purposes of this section, in those counties in which the
sheriff does not administer a jail facility, a director or
administrator of a local department of corrections established
pursuant to Section 23013 of the Government Code is the person who
may contract for services provided to jail inmates in the facilities
he or she administers in those counties.