BILL NUMBER: AB 1142	AMENDED
	BILL TEXT

	AMENDED IN SENATE  JUNE 28, 2009
	AMENDED IN ASSEMBLY  APRIL 28, 2009
	AMENDED IN ASSEMBLY  APRIL 14, 2009

INTRODUCED BY   Assembly Member Price

                        FEBRUARY 27, 2009

   An act to amend Sections 14018.2 and 14019.4 of the Welfare and
Institutions Code, relating to Medi-Cal.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 1142, as amended, 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 certain providers that bill separately for all services associated
with the person's treatment in the hospital rendered during the same
time period for which the hospital is submitting a claim.
   Existing law prohibits any provider of health care services who
obtains a label or copy from the Medi-Cal card or other proof of
eligibility from seeking reimbursement or attempting to obtain
payment for the cost of the covered health care services from the
eligible applicant or recipient, or any person other than the
department or a 3rd-party payor who provides a contractual or legal
entitlement to health care services.
   This bill would require a Medi-Cal provider, if the provider
receives proof of a patient's Medi-Cal eligibility and has referred
an unpaid bill for services rendered to the patient to a 
3rd-party collection agency   debt collector  , to
promptly  recall the matter from the 3rd-party collection
agency and otherwise ensure collection efforts by the 3rd-party
collection agency   ensure that collection efforts 
are halted and notify the patient accordingly.  The bill
would require, commencing July 1, 2010, that all contracts between a
3rd-party collection agency and a Medi-Cal provider or billing
service that works on behalf of a Medi-Cal provider to include a
provision allowing the Medi-Cal provider to immediately recall a debt
from collection pursuant to the aforementioned provisions. 

   This bill would provide that a provider of health care services
who obtains a label or copy from the Medi-Cal card or other proof of
eligibility and who subsequently attempts to seek reimbursement or to
obtain payment for the cost of covered services from the eligible
applicant or recipient or fails to  recall a debt 
 cease collection efforts against a patient for covered services
 , as this bill would require, may be punished with a fine not
to exceed 3 times the amount the provider could otherwise have
obtained had the provider of health care services billed the Medi-Cal
program.
   Existing law, the Consumer Credit Reporting Agencies Act, governs
the disclosure of consumer credit reports. Existing law prohibits a
person furnishing information on a specific transaction or experience
to any consumer credit reporting agency if the person knows or
should know the information is incomplete or inaccurate.
   This bill would provide that if a Medi-Cal provider or 
3rd-party collection agency   debt collector 
receives proof of Medi-Cal coverage for services rendered and then
reports the services rendered to a consumer credit reporting agency
or fails to  correct a negative credit report regarding the
services rendered   notify the consumer reporting agency
of corrections to information previously furnished  , the
provider or  agency   debt collector  shall
be deemed to be in violation of the above-described provisions.
   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 hospital-based
providers, ambulance transportation services providers, providers
that provide ambulance transportation services through the "911"
emergency response system, and other  hospital-based 
providers of professional services that bill separately for all
services associated with the person's treatment in the hospital
rendered during the same time period for which the hospital is
submitting a claim.
   (f) For purposes of this section, the following definitions apply:

   (1) "Hospital-based provider" means an anesthesiologist,
radiologist, pathologist, emergency room physician, or other
physician or a group of physicians providing medical services at the
hospital. 
   (2) "Professional services" includes, but is not limited to,

    (2)     "Hospital-based professional
services" means services performed for a patient while at a hospital,
related to the patient's hospital stay, and known to the hospital,
including, but not limited to,    diagnostic,
laboratory, therapeutic, and radiologic services.
  SEC. 2.  Section 14019.4 of the Welfare and Institutions Code is
amended to read:
   14019.4.  (a) Any provider of health care services who obtains a
label or copy from the Medi-Cal card or other proof of eligibility
pursuant to this chapter shall not seek reimbursement nor attempt to
obtain payment for the cost of those covered health care services
from the eligible applicant or recipient, or any person other than
the department or a third-party payor who provides a contractual or
legal entitlement to health care services.
   (b) Whenever a service or set of services rendered to a Medi-Cal
beneficiary results in the submission of a claim in excess of five
hundred dollars ($500), and the beneficiary has given the provider
proof of eligibility to receive the service or services, the provider
shall issue the beneficiary a receipt to document that appropriate
proof of eligibility has been provided. The form and content of those
receipts shall be determined by the provider but shall be sufficient
to comply with the intent of this subdivision. Nursing facilities
and all categories of intermediate care facilities for the
developmentally disabled are exempt from the requirements of this
subdivision.
   (c) In addition to being subject to any applicable penalties set
forth in law or regulation, a provider of health care services who
obtains a label or copy from the Medi-Cal card or other proof of
eligibility pursuant to this chapter, and who subsequently attempts
to seek reimbursement or to obtain payment for the cost of covered
services from the eligible applicant or recipient or fails to
 recall a debt   cease collection efforts
against a patient for covered services  as required by
subdivision (d), may be  punished with   subject
to  a fine not to exceed three times the amount the provider
could otherwise have obtained had the provider billed the Medi-Cal
program.  In implementing this subdivision, the department shall
follow the rules and procedures for collecting civil money penalties
as provided in subdivisions (f) to (l), inclusive, of Section 514851
of Title 22 of the California Code of Regulations. 
   (d) If a Medi-Cal provider receives proof of a patient's Medi-Cal
eligibility pursuant to this chapter and that provider has referred
an unpaid bill for services rendered to the patient to a 
third-party collection agency   debt collector  ,
the Medi-Cal provider shall promptly  recall the matter from
the third-party collection agency and otherwise ensure collection
efforts by the third-party collection agency are  
ensure that collection efforts against the patient by the debt
collector are  halted and notify the patient accordingly.

   (e) Commencing July 1, 2010, all contracts between a third-party
collection agency and a Medi-Cal provider or billing service that
works on behalf of a Medi-Cal provider shall include a provision
allowing the Medi-Cal provider to immediately recall a debt from
collection pursuant to subdivision (d).  
   (f) 
    (e)  If a patient provides proof of Medi-Cal eligibility
to a third-party collection agency and the  third-party
collection agency   debt collector, and the debt
collector  fails to notify the provider of this proof, the
provider shall not be responsible for  recalling the debt
  ensuring that collection efforts against the patient
cease  pursuant to subdivision (d) until either the patient or
the  third-party collection agency   debt
collector  provides the provider with proof of the patient's
Medi-Cal eligibility. 
   (g) If a Medi-Cal provider or third-party collection agency
receives proof of Medi-Cal coverage for services rendered, the
provider or third-party collection agency shall be deemed to be in
violation of subdivision (a) of Section 1785.25 of the Civil Code if
they do either of the following:  
   (1) Report the rendering of the Medi-Cal-covered services to a
consumer credit reporting agency.  
   (2) Fail to correct a negative credit report regarding the
Medi-Cal-covered services the Medi-Cal provider or third-party
collection agency reported to a consumer credit reporting agency.
 
   (f) A Medi-Cal provider or debt collector shall be deemed to be in
violation of subdivision (a) of Section 1785.25 of the Civil Code if
more than 30 days after receiving proof of Medi-Cal coverage the
provider or debt collector does either of the following:  
   (1) Furnishes information regarding the rendering of the
Medi-Cal-covered services to a consumer credit reporting agency.
 
   (2) Fails to notify a consumer credit reporting agency of
corrections to information previously furnished by that Medi-Cal
provider or debt collector regarding Medi-Cal-covered services. 

   (g) This section shall not apply to the Medi-Cal share of cost
owed by a Medi-Cal beneficiary, unless the beneficiary's share of
cost has been met for the month in which services were rendered.
 
   (h) For purposes of this section, "debt collector" includes any
person who regularly engages in debt collection, as defined by
Section 1788.2 of the Civil Code, but does not include the original
Medi-Cal provider.