BILL ANALYSIS
Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair
1142 (Price)
Hearing Date: 8/24/2009 Amended: 8/17/2009
Consultant: Katie Johnson Policy Vote: Health 8-3
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BILL SUMMARY: AB 1142 would place responsibility of providing
all information regarding a patient's Medi-Cal eligibility to
all hospital-based providers on the hospital treating the
patient. The bill would impose a fine not to exceed three times
the amount a provider could otherwise have obtained had he or
she billed the Medi-Cal program on a provider who attempts to
seek payment from or fails to cease collection efforts against a
patient the provider knows to be a Medi-Cal beneficiary. The
bill would also require a provider or a collection agency to
cease collection efforts against a patient if he or she provides
proof of Medi-Cal eligibility.
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Fiscal Impact (in thousands)
Major Provisions 2009-10 2010-11 2011-12 Fund
DHCS administration minor and absorbable General/*
to fine violators Federal
Potential costs to CA hospitals unknown, potentially in the
hundreds Local
to increase staff capacity of thousands per health facility
*50% General Fund, 50% Federal Fund
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STAFF COMMENTS:
Existing law establishes the Medi-Cal program, California's
version of the federal Medicaid program, which provides health
care services to eligible low-income Californians, including the
aged, blind, disabled, children, and pregnant women. The
Department of Health Care Services (DHCS) administers Medi-Cal.
Existing law makes it the responsibility of a Medi-Cal
beneficiary to provide evidence of Medi-Cal eligibility to his
or her health care provider if that information is requested.
Existing law also states that it is the responsibility of a
provider to make a good faith effort to verify a person
presenting a Medi-Cal card's identity.
This bill would require a hospital to assume the responsibility
of providing a Medi-Cal beneficiary's information to all
hospital-based providers, including anesthesiologists,
radiologists, pathologists, and emergency room physicians,
ambulance transportation services providers, and providers that
provide ambulance transportation services through the "911"
system, among others, once the hospital receives proof of a
person's Medi-Cal eligibility. In current practice, hospitals
provide this information upon the request of any hospital-based
provider. Additionally, hospital-based providers have access to
patient Medi-Cal information through the Medi-Cal Eligibility
Data System (MEDS).
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AB 1142 (Price)
This bill would provide that a provider of health care services
who obtains proof of an individual's Medi-Cal eligibility and
who subsequently attempts to seek payment for the cost of
covered services from or fails to cease collection efforts
against the individual may be subject to a fine not to exceed
three times the amount the provider could otherwise have
obtained had the provider billed Medi-Cal.
This bill would provide that if a Medi-Cal provider receives
proof of a patient's Medi-Cal eligibility and that provider has
referred an unpaid bill to a debt collector, the provider must
cease collection efforts against the patient by a debt collector
and notify the patient.
This bill would provide that if a patient provides proof of
Medi-Cal eligibility to a collection agency or debt collector,
and the debt collector fails to notify the provider of this
proof, the provider would not be responsible for ensuring the
cessation of collection efforts until the provider is provided
with proof of a patient's Medi-Cal eligibility.
Existing law prohibits a person from furnishing information on a
specific transaction to any consumer credit reporting agency if
the person knows that the information is incomplete or
inaccurate.
This bill would deem a provider or debt collector in violation
of existing law if, after more than 30 days of receiving proof
of a person's Medi-Cal coverage, he or she 1) furnishes
information regarding the rendering of the Medi-Cal covered
services to a consumer credit reporting agency, and 2) fails to
notify a consumer credit reporting agency of corrections to
information previously furnished by that provider or debt
collector.
Any administrative impact on DHCS to assess and collect fines
would be minor and absorbable. Due to the high rate of treatment
of Medi-Cal beneficiaries at some of the California's 400
hospitals, this bill could necessitate the hiring of additional
staff at an estimated cost in the hundreds of thousands of
dollars and could place cost pressure on the state's health
system.