BILL ANALYSIS
AB 235
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Date of Hearing: April 29, 2009
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Kevin De Leon, Chair
AB 235 (Hayashi) - As Amended: April 14, 2009
Policy Committee: Health Vote:19-0
Urgency: No State Mandated Local Program:
Yes Reimbursable: No
SUMMARY
This bill clarifies hospital and health plan responsibilities
with respect to psychiatric emergencies. Specifically, this
bill:
1)Defines "psychiatric emergency medical condition." Specifies
that inpatient admission may be required to relieve or
eliminate a psychiatric emergency.
2)Establishes specific criteria for the safe and appropriate
transfer of patients to an inpatient psychiatric unit or to
another facility. Authorizes health plans to make a subsequent
transfer to a contracting facility, if safe and necessary.
3)Establishes hospital transfer procedures with respect to
documentation, health coverage information, health plan
notification, and communication.
FISCAL EFFECT
No direct fiscal impact as a result of these clarifying changes.
The services, providers, and payers addressed in this bill are
required under state and federal laws to provide emergency
services, including psychiatric emergencies, in a specified
manner. This bill clarifies and enumerates specific process and
communication requirements to improve quality of care and reduce
payment disputes between hospitals and health plans.
COMMENTS
1)Rationale . This bill is sponsored by the California Hospital
Association (CHA) to reduce payment denials by health plans
AB 235
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for hospital treatment of emergency psychiatric conditions.
This bill defines a psychiatric emergency and specifies
processes and communication that need to happen during and
after various transfers of patients who have received
psychiatric services. The author and sponsor indicate this
bill will improve care and reduce disputed claims for services
and treatment.
2)Federal Emergency Treatment Mandate . The Emergency Medical
Treatment and Active Labor Act (EMTALA), enacted in 1986,
prohibits the practice of patient dumping, treatment denial,
and patient discharge based on anticipated high emergency
treatment costs. The mandate to treat psychiatric and other
emergency medical needs is included in EMTALA transport and
treatment mandates. Hospitals are required to provide
appropriate screening examinations to determine whether
emergency medical conditions exist, regardless of patients'
ability to pay. When emergency medical needs are identified,
EMTALA requires hospitals to stabilize patients. This bill
addresses transfers related to psychiatric post-stabilization
services specifically. Current state law requires
non-contracting hospitals to make certain contacts with health
plans during an emergency, including to obtain medical record
information. However, some contact requirements differ
depending on whether a patient is receiving pre- or
post-stabilization care.
3)Related Legislation . AB 2861 (Hayashi), in 2008, was similar
to this bill and was vetoed. The veto message indicated that a
drafting error would make the provisions unworkable. This bill
addresses that concern.
AB 1203 (Salas), Chapter 603, Statutes of 2008 established
uniform requirements about communications between health plans
and non-contracting hospitals related to post-stabilization
care following an emergency, and generally prohibits a
non-contracting hospital from billing a patient who is a
health plan enrollee for post-stabilization services.
Analysis Prepared by : Mary Ader / APPR. / (916) 319-2081