Amended in Senate June 19, 2015

Amended in Assembly May 5, 2015

California Legislature—2015–16 Regular Session

Assembly Bill No. 658

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, for claims that have not previously been paid or begin delete adjudicated end delete begin insert otherwise determined end insert 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, 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 law, a county sheriff, police 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 begin insert for health care
services end insert with the county sheriff, police chief, or other public agency
begin delete that contracts for health care services end delete 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, for claims that have not previously been
paid or otherwise determined by local law enforcement, according
to the most begin delete recent end delete begin insert recently end insert approved cost-to-charge ratio from the
Medicare Program. The hospital, with the approval of the county
sheriff, police chief, or other public agency begin delete that contracts or is end delete
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 begin delete that contracts or is end delete
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 begin delete issues end delete
begin insert issues, end insert 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) 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.