BILL ANALYSIS
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|SENATE RULES COMMITTEE | AB 1142|
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THIRD READING
Bill No: AB 1142
Author: Price (D)
Amended: 9/1/09 in Senate
Vote: 21
SENATE HEALTH COMMITTEE : 8-3, 6/25/09
AYES: Alquist, Aanestad, Cedillo, DeSaulnier, Leno,
Negrete McLeod, Pavley, Wolk
NOES: Strickland, Cox, Maldonado
SENATE APPROPRIATIONS COMMITTEE : 8-5, 8/27/09
AYES: Kehoe, Corbett, Hancock, Leno, Oropeza, Price, Wolk,
Yee
NOES: Cox, Denham, Runner, Walters, Wyland
ASSEMBLY FLOOR : 47-29, 5/26/09 - See last page for vote
SUBJECT : Medi-Cal: proof of eligibility
SOURCE : Western Center on Law and Poverty
DIGEST : This bill places responsibility of providing all
information regarding a patients Medi-Cal eligibility to
all hospital-based providers on the hospital treating the
patient if a hospital obtains proof of Medi-Cal eligibility
for a patient subsequent to the date of service. This bill
provides for a fine not to exceed three times the amount a
provider could otherwise have obtained had he/she billed
the Medi-Cal program on a provider who attempts to seek
payment from or fails to cease collection efforts against a
CONTINUED
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patient the provider knows to be a Medi-Cal beneficiary.
ANALYSIS :
Existing law:
1. Establishes the Medi-Cal program, administered by the
Department of Health Care Services (DHCS), which
provides comprehensive health care coverage for
low-income individuals and their families; pregnant
women; elderly, blind, or disabled persons; nursing home
residents; and refugees who meet specified eligibility
criteria.
2. Prohibits any provider of health care services under
Medi-Cal from seeking reimbursement or attempting to
obtain payment for the cost of those covered health care
services from the eligible applicant or recipient.
Federal regulations have a similar requirement.
3. Prohibits, under the Civil Code, a person from
furnishing information to any consumer credit reporting
agency if the person knows, or should know, the
information is incomplete or inaccurate.
Existing law makes it the responsibility of a Medi-Cal
beneficiary to provide evidence of Medi-Cal eligibility to
this/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 requires 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 if the hospital
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obtains proof of Medi-Cal eligibility for a patient
subsequent to the date of service. Additionally,
hospital-based providers have access to patient Medi-Cal
information through the Medi-Cal Eligibility Data System.
This bill allows the hospital to inform the provider that
the person's Medi-Cal eligibility is pending, before a
final determination is made on the patient's Medi-Cal
application, to satisfy the requirements of this
subdivision. If the provider or the provider's agent
obtains this information from the hospital, the requirement
has been satisfied.
This bill provides 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 demanded of
the beneficiary or that was referred to a collection agency
payable by Medi-Cal. In implementing this subdivision,
mitigating circumstances, which include, but are not
limited to, clerical error and good faith mistake, shall be
considered when assessing the fine. Providers subject to
fines under this subdivision shall have the opportunity to
appeal the assessed fine, consistent with department
procedures.
This bill provides 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 provides 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
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agency if the person knows that the information is
incomplete or inaccurate.
This bill deems 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/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.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Senate Appropriations Committee:
Fiscal Impact (in thousands)
Major Provisions 2009-10 2010-11 2011-12 Fund
Potential costs to $190-$285 $380-$570
$380-$570 General/*
non-contract hospitals
Federal
* October 1, 2008-December 31, 2010 FMAP = 38% GF /
62% FF
January 1, 2011-ongoing FMAP = 50% GF / 50% FF
FMAP = Federal Medical Assistance Percentage - the
percent of total costs paid by the federal government
SUPPORT : (Verified 9/2/09)
Western Center on Law and Poverty (source)
100% Campaign, a collaboration of Children's Defense Fund
California,
California NOW, the Children's Partnership, and PICO
California
American Federation of State, County and Municipal
Employees
California Chapter of the American College of Emergency
Physicians
California Society for Clinical Social Work
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County Welfare Directors Association of California
Health Access California
Health Rights Hotline
Legal Aid Society of San Mateo County
Neighborhood Legal Services of Los Angeles County
OPPOSITION : (Verified 9/2/09)
California Hospital Association (unless amended)
ARGUMENTS IN SUPPORT : This bill is sponsored by the
Western Center on Law and Poverty (WCLP) to address the
longstanding problem of Medi-Cal beneficiaries who are
wrongly billed for services covered by Medi-Cal. WCLP
states that, even though it is against the law for a health
care provider to bill a Medi-Cal beneficiary for covered
services, such situations occur for a variety of reasons,
and this bill addresses several of the underlying causes.
Additionally, WCLP argues that this bill addresses the
problem of a Medi-Cal beneficiary having his/her account
sent to collections. WCLP indicates that providers
sometimes refuse to pull debt back from collection, even
when they are shown proof of Medi-Cal eligibility. WCLP
also indicates it has seen multiple cases where pharmacists
or dentists tell a Medi-Cal patient that a service or
medication is not covered by Medi-Cal and that the patient
must pay out-of-pocket when the service or medication could
have been covered if the provider submitted the required
authorization to Medi-Cal. In other instances, the
provider made an error in billing and is denied payment
through Medi-Cal, so the provider bills the patient even
though they know Medi-Cal would have paid had the claim
been billed timely and accurately.
ARGUMENTS IN OPPOSITION : The California Hospital
Association (CHA) opposes the bill, unless amended, because
of the burden the bill would place on hospitals. CHA
states that hospitals routinely provide Medi-Cal
information to providers, but on a voluntary basis. They
also argue that Medi-Cal provides a variety of electronic
methods that allow providers to establish and verify
recipient eligibility, including an interactive voice
response system, the Medi-Cal website and a
point-of-service device offered by the Medi-Cal program.
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ASSEMBLY FLOOR :
AYES: Ammiano, Arambula, Beall, Block, Blumenfield,
Brownley, Caballero, Charles Calderon, Carter, Coto,
Davis, De La Torre, De Leon, Eng, Evans, Feuer, Fong,
Furutani, Galgiani, Hall, Hayashi, Hernandez, Hill,
Huffman, Jones, Krekorian, Lieu, Bonnie Lowenthal, Ma,
Mendoza, Monning, Nava, John A. Perez, V. Manuel Perez,
Portantino, Price, Ruskin, Salas, Saldana, Skinner,
Solorio, Swanson, Torlakson, Torres, Torrico, Yamada,
Bass
NOES: Adams, Anderson, Bill Berryhill, Tom Berryhill,
Blakeslee, Conway, Cook, DeVore, Duvall, Emmerson,
Fuller, Gaines, Garrick, Gilmore, Hagman, Harkey, Huber,
Jeffries, Knight, Logue, Miller, Nestande, Niello,
Nielsen, Silva, Smyth, Audra Strickland, Tran, Villines
NO VOTE RECORDED: Buchanan, Chesbro, Fletcher, Fuentes
CTW/DLW:mw 9/2/09 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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