BILL ANALYSIS
AB 235
Page 1
CONCURRENCE IN SENATE AMENDMENTS
AB 235 (Hayashi)
As Amended June 11, 2009
Majority vote
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|ASSEMBLY: |78-0 |(May 11, 2009) |SENATE: |34-3 |(August 27, |
| | | | | |2009) |
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Original Committee Reference: HEALTH
SUMMARY : Defines a "psychiatric emergency medical condition"
for purposes of the obligation of hospitals with emergency
departments to provide emergency care and services for
psychiatric emergency medical conditions, and the obligations of
health plans in such cases, and by reference, makes changes to
provisions in the Knox-Keene Health Care Service Plan Act of
1975 (Knox-Keene) requiring health plans to reimburse for
emergency services under specified conditions. Specifically,
this bill :
1)Defines a "psychiatric emergency medical condition" as a
mental disorder that manifests itself by acute symptoms of
sufficient severity that renders the patient as being either
of the following:
a) An immediate danger to himself or herself, or to others;
or,
b) Immediately unable to provide for, or utilize, food,
shelter, or clothing, due to a mental disorder.
2)Clarifies that the definition in 1) above does not expand,
restrict, or otherwise affect the scope of licensure or
clinical privileges for clinical psychologists or medical
personnel.
3)Includes as what may be necessary to relieve a psychiatric
emergency medical condition, the admission or transfer of the
patient to a psychiatric unit within a general acute care
hospital or to an acute psychiatric hospital. The definitions
in this bill are applicable to the statutory obligation
imposed on Knox-Keene health plans to pay for emergency care
and services until the care results in stabilization of the
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health plan's enrollee.
4)Allows the transfer of a patient to a psychiatric unit of a
hospital, or to an acute psychiatric hospital, where necessary
to relieve or eliminate the psychiatric emergency, to only
occur if in the opinion of the treating provider, the
patient's psychiatric emergency is such that, within
reasonable medical probability, no material deterioration of
the patient's emergency condition is likely to result from, or
occur during the transfer.
5)Imposes specific obligations, and limitations, related to the
duties of a hospital transferring a patient pursuant to #3)
above, and to the duties of the hospital to which the patient
is transferred. Requires the initial treating hospital to
seek to obtain the name and contact information of the
patient's health plan, and notify the health plan or the
health plan's contracting medical provider (medical group) of
the transfer, as specified. Requires the receiving hospital
to notify the health plan or medical group if the hospital has
the name and contact information of the patient's health plan.
Specifies that a hospital is not required to make more than
one telephone call to the health plan, if the health plan can
reach a hospital representative should the health plan or its
contracting medical group need to return the call.
6)Requires health plans to provide all hospitals in the state to
which one of the health plan's members might be transferred
with specific health plan contract information needed to make
the contact required by this bill; and, to update the
information as necessary, but at least once a year.
7)Excludes screening, examination, and evaluation by a physician
to determine if a psychiatric medical condition exists from
coverage in Medi-Cal managed care plan contracts, to the
extent that those services are excluded from coverage under
those contracts.
8)Clarifies that nothing in this bill would require providers to
seek authorization to provide emergency care and services to a
patient with a psychiatric medical emergency condition.
The Senate amendments exclude screening, examination, and
evaluation by a physician to determine if a psychiatric medical
condition exists from coverage in Medi-Cal managed care plan
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contracts, to the extent that those services are excluded from
coverage under those contracts.
EXISTING LAW :
1)Establishes Knox-Keene for the licensure and regulation of
health care service plans and specialized health care service
plans, including specialized plans covering mental health
services, by the Department of Managed Health Care.
2)Requires in federal law, under provisions of the federal
Emergency Medical Treatment and Active Labor Act (EMTALA),
hospital emergency departments to provide emergency screening
and stabilization services without regard to the patient's
insurance status or ability to pay. EMTALA requires hospitals
to maintain an on-call roster of specialists in a manner that
best meets the needs of its patients.
3)Requires in state law, licensed hospitals which maintain and
operate an emergency department, to provide emergency care and
services to any person requesting the emergency services or
care, or for whom emergency services or care is requested, for
any life-threatening or serious injury or illness, including a
psychiatric emergency medical condition.
4)Prohibits a hospital from conditioning the provision of
emergency services required, pursuant to 3) above, on the
person's ethnicity, citizenship, age, preexisting medical
condition, insurance status, economic status, ability to pay,
or other specified characteristics. Also requires a hospital
to render emergency care and services without first
questioning the patient's ability to pay.
5)Defines "emergency care and services" for purposes of 3) above
to mean medical screening, examination, and evaluation by a
physician, or, other appropriate personnel under the
supervision of a physician, as permitted by law, to determine
if an emergency medical condition exists and, if it does, the
care, treatment, and surgery by a physician necessary to
relieve or eliminate the emergency medical condition, within
the capability of the facility.
6)Includes within the meaning of emergency care and services,
for purposes of 3) above an evaluation to determine if a
psychiatric emergency medical condition exists and the care
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and treatment necessary to relieve or eliminate that
psychiatric emergency medical condition. This bill would
further define psychiatric emergency medical condition for
purposes of this requirement.
7)Prohibits a health plan from requiring a provider to obtain
authorization prior to the provision of emergency services and
care. Authorizes a health plan to require prior authorization
as a prerequisite for payment for necessary medical care
following stabilization of an emergency medical condition.
8)Prohibits a non-contracting hospital from billing an enrollee
of a Knox-Keene licensed health plan for post-stabilization
care following an emergency, unless one of the following
apply: a) the hospital is unable to obtain the name and
contact information of the enrollee's health plan; or, b) if
the patient (or the spouse or legal guardian) refuses to
consent to transfer to a facility contracted with the health
plan after stabilization.
9)Establishes uniform and specific requirements governing
communications between health plans and non-contracting
hospitals related to post-stabilization care of the health
plan's enrollee following an emergency.
10)Requires a health plan or its contracting medical provider
contacted by a non-contracting hospital seeking authorization
for post-stabilization care to do either of the following
within 30 minutes of the contact:
a) Authorize post-stabilization care; or,
b) Inform the non-contracting hospital that the health plan
will arrange for the prompt transfer of the enrollee to
another hospital.
11)Requires the non-contracting hospital, in cases where the
patient, the patient's spouse or the patient's legal guardian
refuses to consent to the patient's transfer to a contracted
facility, to provide a written notice to the patient, spouse,
or guardian indicating that the patient will be financially
responsible for further post-stabilization care at the
hospital.
12)Authorizes under provisions of the Lanterman Petris Short Act
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the involuntary commitment of individuals who by reason of a
mental disorder are a danger to themselves or others, or
gravely disabled, under specified conditions, but only if the
individual cannot be served voluntarily.
AS PASSED BY THE ASSEMBLY , this bill defined a "psychiatric
emergency medical condition" for purposes of the obligation of
hospitals with emergency departments to provide emergency care
and services for psychiatric emergency medical conditions, and
the obligations of health plans in such cases, and by reference,
makes changes to provisions in Knox-Keene requiring health plans
to reimburse for emergency services under specified conditions.
FISCAL EFFECT : According to the Senate Appropriations
Committee, any costs to hospitals and health plans to implement
the provisions of this bill would be absorbable.
Analysis Prepared by : Deborah Kelch / HEALTH / (916)
319-2097FN: 0001807