BILL NUMBER: AB 1142	INTRODUCED
	BILL TEXT


INTRODUCED BY   Assembly Member Price

                        FEBRUARY 27, 2009

   An act to amend Section 14018.2 of the Welfare and Institutions
Code, relating to Medi-Cal.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 1142, as introduced, Price. Medi-Cal: proof of eligibility.
   Existing law establishes the Medi-Cal program, which is
administered by the State Department of Health Care Services and
under which qualified low-income persons receive health care
services. Existing law provides that it is the responsibility of the
Medi-Cal beneficiary to provide information and evidence of Medi-Cal
eligibility to that person's health care provider if that information
is requested by the provider prior to rendering services to that
beneficiary.
   Existing law provides that it is the responsibility of the
provider prior to rendering Medi-Cal reimbursable services to persons
presenting themselves as Medi-Cal beneficiaries to make a good faith
effort to verify the person's identity, if the person is not known
to the provider, otherwise payment for those services may later be
disallowed by the department.
   This bill would provide that it is the responsibility of a
hospital, as soon as proof of Medi-Cal eligibility is supplied by a
person presenting himself or herself as a Medi-Cal beneficiary, to
provide all information regarding that person's Medi-Cal eligibility
to all other providers that bill separately for services rendered to
that person during the same time period for which the hospital is
submitting a claim.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 14018.2 of the Welfare and Institutions Code is
amended to read:
   14018.2.  (a) Reimbursement shall not be denied to any qualified
health care provider for care rendered to an eligible Medi-Cal
beneficiary for the sole reason that a proof of eligibility label
does not accompany the bill.
   Proof of eligibility labels may, however, continue to be used as
such and shall be made available to an eligible Medi-Cal beneficiary
through the local office which has determined the person's
eligibility or through the department. The provider may submit
machine-reproduced copies of the beneficiary Medi-Cal card for
billing purposes as long as the copy is made from the original
unaltered Medi-Cal card under circumstances controlled by the
provider, for example, on the premises of the provider with copying
equipment controlled by the provider.
   (b) It shall remain the responsibility of a Medi-Cal beneficiary
to provide information and evidence of Medi-Cal eligibility,
restrictions on the eligibility, and non-Medi-Cal health coverage, to
that person's health care providers, if this information is
requested by those providers prior to rendering services to that
beneficiary.
   (c) It shall be the responsibility of the provider prior to
rendering Medi-Cal reimbursable services to persons presenting
themselves as Medi-Cal beneficiaries to make a good faith effort to
verify the person's identity, if the person is not known to the
provider, by matching the name and signature on his or her Medi-Cal
card against the signature on a valid California driver's license, or
California identification card issued by the Department of Motor
Vehicles, or another type of picture identification card or other
credible document of identification. When the provider verifies the
beneficiary's identity with a signed Medi-Cal card and one of the
documents described above, the state will deem this to be a good
faith effort. If the provider does not make a good faith effort of
reasonable identification prior to rendering Medi-Cal reimbursable
services and renders services to a presenting person who is
ineligible for those Medi-Cal services, payment for those services
may later be disallowed.
   This provision shall not apply to:
   (1) Persons 17 years of age and under.
   (2) Persons in long-term care.
   (3) Persons receiving emergency services.
   (d) Notwithstanding subdivision (b) of this section, county
welfare departments may provide Medi-Cal eligibility information to
other governmental agencies and their designated agents as necessary
for proper administration of the Medi-Cal program. 
   (e) It shall be the responsibility of a hospital, as soon as proof
of Medi-Cal eligibility is supplied by a person presenting himself
or herself as a Medi-Cal beneficiary, to provide all information
regarding that person's Medi-Cal eligibility to all other providers
that bill separately for services rendered to that person during the
same time period for which the hospital is submitting a claim.