BILL NUMBER: AB 1503 AMENDED
BILL TEXT
AMENDED IN SENATE JULY 15, 2010
AMENDED IN SENATE JUNE 16, 2010
INTRODUCED BY Assembly Member Lieu
FEBRUARY 27, 2009
An act to amend Section 127405 of, to amend and
renumber the heading of Article 3 (commencing with Section 127400) of
Chapter 2 of, to add the heading of Chapter 2.5 (commencing with
Section 127400) to, and to add Article 2 (commencing with Section
127450) to Chapter 2.5 of, Part 2 of Division 107 of the Health and
Safety Code, relating to emergency medical care billing.
LEGISLATIVE COUNSEL'S DIGEST
AB 1503, as amended, Lieu. Health facilities: physicians and
surgeons: emergency medical care: billing.
Existing law provides for the licensure and regulation of health
facilities by the State Department of Public Health. Existing law
requires each hospital, as a condition of licensure, to maintain
written policies about discount payment and charity care for
financially qualified patients, as defined. These policies are
required to include, among other things, a section addressing
eligibility criteria, as prescribed. Existing law requires each
hospital to perform various functions in connection with the hospital
charity care and discount pay policies, including providing patients
with notice that contains information about the hospital's discount
payment and charity care policies, including information about
eligibility and attempting to determine the availability of private
or public health insurance coverage for each patient. Existing law
also specifies billing and collection procedures to be followed by a
hospital, its assignee, collection agency, or billing service.
This bill would provide that uninsured patients or patients with
high medical costs who are at or below 350% of the federal poverty
level are eligible to apply to a physician and surgeon who provides
emergency medical services in a general acute care hospital for a
discount payment pursuant to a discount payment policy. The bill
would require the physician and surgeon to limit expected payment for
services provided to a patient at or below 350% of the federal
poverty level and who is eligible under the physician and surgeon's
discount payment policy to the amount of payment that the
physician and surgeon would expect, in good faith, to receive, as
determined pursuant to a prescribed physician and surgeons rate
database. The bill would, until the database includes California,
limit reimbursement to the higher of rates that the physician and
surgeon would receive for providing services from specified
government-sponsored health programs , as specified
.
The bill would require the physician and surgeon to
perform various functions in connection with the discount payment
policy, including providing patients with notice that contains
information about the physician and surgeon's discount payment
policy, including information about eligibility and attempting to
determine the availability of private or public health insurance
coverage for each patient. bill would require the
above-described written notice that hospitals are required to provide
patients regarding the hospital's charity care and discount pay
policies to include a statement that a physician and
surgeon who provides emergency medical services in a hospital that
provides emergency care is also required by law to provide discounts
to uninsured patients or patients with high medical costs who are at
or below 350% of the federal poverty level. The bill would also
specify billing and collection procedures to be followed by a
physician and surgeon, its assignee, collection agency, or billing
service.
This bill would provide that a violation of the above provisions
shall not constitute a violation of the terms of a physician and
surgeon's licensure.
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. The heading of Chapter 2.5 (commencing with Section
127400) is added to Part 2 of Division 107 of the Health and Safety
Code, immediately preceding Section 127400, to read:
CHAPTER 2.5. FAIR PRICING POLICIES
SEC. 2. The heading of Article 3 (commencing with Section 127400)
of Chapter 2 of Part 2 of Division 107 of the Health and Safety Code
is amended and renumbered to read:
Article 1. Hospital Fair Pricing Policies
SEC. 3. Section 127405 of the Health
and Safety Code is amended to read:
127405. (a) (1) (A) Each hospital shall
maintain an understandable written policy regarding discount payments
for financially qualified patients as well as an understandable
written charity care policy. Uninsured patients or patients with high
medical costs who are at or below 350 percent of the federal poverty
level, as defined in subdivision (b) of Section 127400, shall be
eligible to apply for participation under a hospital's charity care
policy or discount payment policy. Notwithstanding any other
provision of this article, a hospital may choose to grant eligibility
for its discount payment policy or charity care policies to patients
with incomes over 350 percent of the federal poverty level. Both the
charity care policy and the discount payment policy shall state the
process used by the hospital to determine whether a patient is
eligible for charity care or discounted payment. In the event of a
dispute, a patient may seek review from the business manager, chief
financial officer, or other appropriate manager as designated in the
charity care policy and the discount payment policy.
(B) The written policy regarding discount payments shall also
include a statement that a physician and surgeon who provides
emergency medical services in a hospital that provides emergency care
is also required by law to provide discounts to uninsured patients
or patients with high medical costs who are at or below 350 percent
of the federal poverty level.
(2) Rural hospitals, as defined in Section 124840, may establish
eligibility levels for financial assistance and charity care at less
than 350 percent of the federal poverty level as appropriate to
maintain their financial and operational integrity.
(b) A hospital's discount payment policy shall clearly state
eligibility criteria based upon income consistent with the
application of the federal poverty level. The discount payment policy
shall also include an extended payment plan to allow payment of the
discounted price over time. The policy shall provide that the
hospital and the patient may negotiate the terms of the payment plan.
(c) The charity care policy shall state clearly the eligibility
criteria for charity care. In determining eligibility under its
charity care policy, a hospital may consider income and monetary
assets of the patient. For purposes of this determination, monetary
assets shall not include retirement or deferred compensation plans
qualified under the Internal Revenue Code, or nonqualified deferred
compensation plans. Furthermore, the first ten thousand dollars
($10,000) of a patient's monetary assets shall not be counted in
determining eligibility, nor shall 50 percent of a patient's monetary
assets over the first ten thousand dollars ($10,000) be counted in
determining eligibility.
(d) A hospital shall limit expected payment for services it
provides to a patient at or below 350 percent of the federal poverty
level, as defined in subdivision (b) of Section 124700, eligible
under its discount payment policy to the amount of payment the
hospital would expect, in good faith, to receive for providing
services from Medicare, Medi-Cal, Healthy Families, or another
government-sponsored health program of health benefits in which the
hospital participates, whichever is greater. If the hospital provides
a service for which there is no established payment by Medicare or
any other government-sponsored program of health benefits in which
the hospital participates, the hospital shall establish an
appropriate discounted payment.
(e) A patient, or patient's legal representative, who requests a
discounted payment, charity care, or other assistance in meeting his
or her financial obligation to the hospital shall make every
reasonable effort to provide the hospital with documentation of
income and health benefits coverage. If the person requests charity
care or a discounted payment and fails to provide information that is
reasonable and necessary for the hospital to make a determination,
the hospital may consider that failure in making its determination.
(1) For purposes of determining eligibility for discounted
payment, documentation of income shall be limited to recent pay stubs
or income tax returns.
(2) For purposes of determining eligibility for charity care,
documentation of assets may include information on all monetary
assets, but shall not include statements on retirement or deferred
compensation plans qualified under the Internal Revenue Code, or
nonqualified deferred compensation plans. A hospital may require
waivers or releases from the patient or the patient's family,
authorizing the hospital to obtain account information from financial
or commercial institutions, or other entities that hold or maintain
the monetary assets, to verify their value.
(3) Information obtained pursuant to paragraph (1) or (2) shall
not be used for collections activities. This paragraph does not
prohibit the use of information obtained by the hospital, collection
agency, or assignee independently of the eligibility process for
charity care or discounted payment.
(4) Eligibility for discounted payments or charity care may be
determined at any time the hospital is in receipt of information
specified in paragraph (1) or (2), respectively.
SEC. 3. SEC. 4. Article 2
(commencing with Section 127450) is added to Chapter 2.5 of Part 2 of
Division 107 of the Health and Safety Code, to read:
Article 2. Physician and Surgeon Fair Pricing Policies
127450. As used in this article, the following terms have the
following meanings:
(a) "Allowance for financially qualified patient" means, with
respect to services rendered to a financially qualified patient, an
allowance that is applied after the physician and surgeon's charges
are imposed on the patient, due to the patient's determined financial
inability to pay the charges.
(b) "Federal poverty level" means the poverty guidelines updated
periodically in the Federal Register by the United States Department
of Health and Human Services under authority of subsection (2) of
Section 9902 of Title 42 of the United States Code.
(c) "Financially qualified patient" means a patient who is both of
the following:
(1) A patient who is a self-pay patient or a patient with high
medical costs.
(2) A patient who has a family income that does not exceed 350
percent of the federal poverty level.
(d) "Emergency care" means care provided in the emergency
department of a hospital.
(e) "Hospital" means a facility that is required to be licensed
under subdivision (a) of Section 1250, except a facility operated by
the State Department of Mental Health or the Department of
Corrections and Rehabilitation.
(f) "Office" means the Office of Statewide Health Planning and
Development.
(g) "Physician and surgeon" means a physician and surgeon licensed
pursuant to Chapter 2 (commencing with Section 2000) of the Business
and Professions Code who provides emergency medical services in a
hospital that provides emergency care.
(h) "Self-pay patient" means a patient who does not have
third-party coverage from a health insurer, health care service plan,
Medicare, or Medicaid, and whose injury is not a compensable injury
for purposes of workers' compensation, automobile insurance, or other
insurance as determined and documented by the physician and surgeon.
Self-pay patients may include charity care patients.
(i) "A patient with high medical costs" means a person whose
family income does not exceed 350 percent of the federal poverty
level if that individual does not receive a discounted rate from the
physician and surgeon as a result of his or her third-party coverage.
For these purposes, "high medical costs" means any of the following:
(1) Annual out-of-pocket costs incurred by the individual at the
hospital that provided emergency care that exceed 10 percent of the
patient's family income in the prior 12 months.
(2) Annual out-of-pocket expenses that exceed 10 percent of the
patient's family income, if the patient provides documentation of the
patient's medical expenses paid by the patient or the patient's
family in the prior 12 months. The physician and surgeon may waive
the request for documentation.
(3) A lower level determined by the physician and surgeon in
accordance with the physician and surgeon's discounted payment
policy.
(j) "Patient's family" means the following:
(1) For persons 18 years of age and older, spouse, domestic
partner, as defined in Section 297 of the Family Code, and dependent
children under 21 years of age, whether living at home or not.
(2) For persons under 18 years of age, parent, caretaker
relatives, and other children under 21 years of age of the parent or
caretaker relative.
127451. A violation of this article shall not constitute a
violation of the terms of a physician and surgeon's licensure.
127452. (a) Uninsured patients or patients with high medical
costs who are at or below 350 percent of the federal poverty level
shall be eligible to apply to a physician and surgeon for a discount
payment pursuant to a discount payment policy. Notwithstanding any
other provision of this article, a physician and surgeon may choose
to grant eligibility for a discount payment policy to patients with
incomes over 350 percent of the federal poverty level.
(b) A physician and surgeon shall limit expected payment for
services provided to a patient at or below 350 percent of the federal
poverty level and who is eligible under the physician and surgeon's
discount payment policy to the amount of payment that the
physician and surgeon would expect, in good faith, to receive as a
rate, as determined by the nonprofit FAIR Health, a database
established to provide fair and independent research on rates paid to
physicians and surgeons. Until the database contains information for
care provided in California, the amount of payment shall be limited
to the higher of the amount that the physician and surgeon would
receive for providing services under Medicare, Medi-Cal, Healthy
Families, or another government-sponsored health program.
discount payment policy to an amount that is no greater than 50
percent of the median of billed charges based on a nationally
recognized database of physician and surgeon charges until the
nonprofit FAIR Health, Inc. creates a database that makes available
the rate of payment received by physi cians from
commercial insurers for the same services in the same or similar
geographic region. When FAIR Health, Inc. makes available the rate of
payment received by physicians and surgeons from commercial insurers
for the same services in the same or similar geographic region, the
amount of expected payment under this section shall be no greater
than the median or average of rates paid by commercial insurers for
the same or similar services in the same or similar
geographic region.
(c) (1) If a physician and surgeon seeks reimbursement from the
Maddy Fund pursuant to Section 1797.98c, then the physician and
surgeon shall, at that time, cease any further billing or collection
activity for that patient.
(2) If the physician and surgeon does not receive reimbursement
from the Maddy Fund after attempting to obtain reimbursement from the
Maddy Fund, then the provisions of this article shall apply.
(3) If the physician and surgeon does not attempt to seek
reimbursement from the Maddy Fund, the provisions of this article
shall apply.
(d) A patient, or patient's legal representative, who requests a
discounted payment or other assistance in meeting his or her
financial obligation to the physician and surgeon shall make every
reasonable effort to provide the physician and surgeon with
documentation of income and health benefits coverage, if the
physician and surgeon requests the documentation. If the patient, or
the patient's legal representative, requests a discounted payment and
fails to provide information that is reasonable and necessary for
the physician and surgeon to make a determination, the physician and
surgeon may consider that failure in making its determination.
(1) For purposes of determining eligibility for discounted
payment, the physician and surgeon may rely on the determination made
by the hospital at which emergency care was provided. If the
physician and surgeon chooses to make a separate determination of
eligibility for discounted payment, documentation of income shall be
limited to recent pay stubs or income tax returns. The physician and
surgeon at his or her discretion, may accept self-attestation by a
patient, or a patient's legal representative, but shall not request
documentation of income other than that authorized in this paragraph.
(2) Information obtained pursuant to paragraph (1) shall not be
used for collections activities. This paragraph does not prohibit the
use of information obtained by the physician and surgeon, collection
agency, or assignee independently
independent of the eligibility process for discounted payment.
(3) Eligibility for discounted payments may be determined at any
time the physician and surgeon is in receipt of information specified
in paragraph (1) or (2), respectively.
127453. Each physician and surgeon providing emergency medical
services shall provide patients with a written notice that shall
contain information about availability of the physician and surgeon's
discount payment policy, including information about eligibility, as
well as contact information for an employee of the physician and
surgeon or other entity from which the person may obtain further
information about this policy. The notice shall also be provided to
patients who receive emergency care and who may be billed for that
care, but who were not admitted. The notice shall be provided in
English, and in languages other than English. The languages to be
provided shall be determined in a manner similar to that required
pursuant to Section 12693.30 of the Insurance Code. Written
correspondence to the patient required by this article shall also be
in the language spoken by the patient, consistent with Section
12693.30 of the Insurance Code and applicable state and federal law.
127454. (a) Each physician and surgeon shall make all reasonable
efforts to obtain from the patient , or his or her
representative , information about whether private or
public health insurance or sponsorship may fully or partially cover
the charges for emergency services rendered by the physician and
surgeon to a patient, including, but not limited to, any of the
following:
(1) Private health insurance.
(2) Medicare.
(3) The Medi-Cal program, the Healthy Families Program, the
California Childrens' Children's
Services Program, or other publicly funded programs designed to
provide comprehensive health coverage.
(b) If a physician and surgeon bills a patient who has not
provided proof of coverage by a third party at the time the care is
provided or upon discharge, as a part of that billing, the physician
and surgeon shall provide the patient with a clear and conspicuous
notice that includes all of the following:
(1) A statement of charges for services rendered by the physician
and surgeon.
(2) A request that the patient inform the physician and surgeon if
the patient has health insurance coverage, Medicare, Healthy
Families, Medi-Cal, or other coverage.
(3) A statement that if the consumer does not have health
insurance coverage, the consumer may be eligible for Medicare,
Healthy Families, Medi-Cal, California Childrens'
Children's Services Program, or discounted payment care.
(4) Information regarding the financially qualified patient and
discounted payment application, including the following:
(A) A statement that indicates that if the patient lacks, or has
inadequate, insurance, and meets certain low-and moderate-income
requirements, the patient may qualify for discounted payment.
(B) The name and telephone number of a physician and surgeon
employee or office from whom or which the patient may obtain
information about the physician and surgeon's discount payment
and policy, and how to apply for that assistance.
(c) (1) In addition to the statement of the charges, if a
physician and surgeon uses the following notice in any billing, that
physician and surgeon shall be deemed to have complied with the
notice requirements of this section: "If you are uninsured or have
high medical costs, please contact ____ (name of person responsible
for discount payment policy) at ____ (area code and phone number) for
information on discounts and programs like the Medi-Cal program. If
you have coverage, please tell us so that we may bill your plan."
(2) If a physician and surgeon or the assignee of the physician
and surgeon lacks the capacity to provide the notice specified in
paragraph (1), the physician and surgeon or his or her assignee shall
be deemed to have complied with the notice requirements of this
section if the information required under this section is provided
upon request and if the following is printed on the bill in 14-point
bold type: "If uninsured or high medical bill, call re: discount."
127455. (a) Each physician and surgeon shall have a written
policy about when and under whose authority patient debt is advanced
for collection.
(b) Each physician and surgeon shall establish a written policy
defining standards and practices for the collection of debt, and
shall obtain a written agreement from any agency that collects
physician and surgeon receivables that it will adhere to the
physician and surgeon's standards and scope of practice. The policy
shall not conflict with other applicable laws and shall not be
construed to create a joint venture between the physician and surgeon
and the external entity, or otherwise to allow physician and surgeon
governance of an external entity that collects physician and surgeon
receivables. In determining the amount of a debt a physician and
surgeon may seek to recover from patients who are eligible under the
physician and surgeon's charity care policy or discount payment
policy, the physician and surgeon may consider only income and
monetary assets as limited by Section 127452.
(c) At time of billing, if any, each physician and surgeon shall
provide a written summary consistent with Section 127453, which
includes the same information concerning services and charges
provided to all other patients who receive care from the physician
and surgeon.
(d)
(c) For a patient that lacks coverage, or for a patient
that provides information that he or she may be a patient with high
medical costs , a physician and surgeon, any assignee of
the physician and surgeon, or other owner of the patient debt,
including a collection agency, shall not report adverse information
to a consumer credit reporting agency or commence civil action
against the patient for nonpayment at any time prior to 150 days
after initial billing.
(e)
(d) If a patient is attempting to qualify for
eligibility under the physician and surgeon's discount payment policy
and is attempting in good faith to settle an outstanding bill with
the physician and surgeon by negotiating a reasonable payment plan or
by making regular partial payments of a reasonable amount, the
physician and surgeon shall not send the unpaid bill to any
collection agency or other assignee, unless that entity has agreed to
comply with this article.
(f)
(e) (1) The physician and surgeon or other assignee
shall not, in dealing with patients eligible under the physician and
surgeon's discount payment policies, use wage garnishments or liens
on primary residences as a means of collecting unpaid physician and
surgeon bills.
(2) A collection agency or other assignee shall not, in dealing
with any patient under the physician and surgeon's discount payment
policy, use as a means of collecting unpaid physician and surgeon
bills, any of the following:
(A) A wage garnishment, except by order of the court upon noticed
motion, supported by a declaration filed by the movant identifying
the basis for that it believes its belief
that the patient has the ability to make payments on the
judgment under the wage garnishment, that the court shall consider in
light of the size of the judgment and additional information
provided by the patient prior to, or at, the hearing concerning the
patient's ability to pay, including information about probable future
medical expenses based on the current condition of the patient and
other obligations of the patient.
(B) Notice or conduct a sale of the patient's primary residence
during the life of the patient or his or her spouse, or during the
period a child of the patient is a minor, or a child of the patient
who has attained the age of majority is unable to take care of
himself or herself and resides in the dwelling as his or her primary
residence. In the event a person protected by this paragraph owns
more than one dwelling, the primary residence shall be the dwelling
that is the patient's current homestead, as defined in Section
704.710 of the Code of Civil Procedure or was the patient's homestead
at the time of the death of a person other than the patient who is
asserting the protections of this paragraph.
(3) This requirement does not preclude a physician and surgeon,
collection agency, or other assignee from pursuing reimbursement and
any enforcement remedy or remedies from third-party liability
settlements, tortfeasors, or other legally responsible parties.
(g)
(f) Any extended payment plans offered by a physician
and surgeon to assist patients eligible under the physician and
surgeon's discount payment policy or any other policy adopted by the
physician and surgeon for assisting low-income patients with no
insurance or high medical costs in settling outstanding past due
physician and surgeon bills, shall be interest free. The physician
and surgeon's extended payment plan may be declared no longer
operative after the patient's failure to make all consecutive
payments due during a 90-day period. Before declaring the physician
and surgeon's extended payment plan no longer operative, the
physician and surgeon, collection agency, or assignee shall make a
reasonable attempt to contact the patient by phone
telephone and to give notice in writing that the extended
payment plan may become inoperative, and of the opportunity to
renegotiate the extended payment plan. Prior to the physician and
surgeon's extended payment plan being declared inoperative, the
physician and surgeon, collection agency, or assignee shall attempt
to renegotiate the terms of the defaulted extended payment plan, if
requested by the patient. The physician and surgeon, collection
agency, or assignee shall not report adverse information to a
consumer credit reporting agency or commence a civil action against
the patient or responsible party for nonpayment prior to the time the
extended payment plan is declared to be no longer operative. For
purposes of this section, the notice and phone
telephone call to the patient may be made to the last
known phone telephone number and
address of the patient.
(h)
(g) Nothing in this section shall be construed to
diminish or eliminate any protections consumers have under existing
federal and state debt collection laws, or any other consumer
protections available under state or federal law. If the patient
fails to make all consecutive payments for 90 days and fails to
renegotiate a payment plan, this subdivision does not limit or alter
the obligation of the patient to make payments on the obligation
owing to the physician and surgeon pursuant to any contract or
applicable statute from the date that the extended payment plan is
declared no longer operative, as set forth in subdivision
(g) (f) .
127456. (a) The period described in Section 127455 shall be
extended if the patient has a pending appeal for coverage of the
services, until a final determination of that appeal is made, if the
patient makes a reasonable effort to communicate with the physician
and surgeon about the progress of any pending appeals.
(b) For purposes of this section, "pending appeal" includes any of
the following:
(1) A grievance against a contracting health care service plan, as
described in Chapter 2.2 (commencing with Section 1340) of Division
2, or against an insurer, as described in Chapter 1 (commencing with
Section 10110) of Part 2 of Division 2 of the Insurance Code.
(2) An independent medical review, as described in Section 10145.3
or 10169 of the Insurance Code.
(3) A fair hearing for a review of a Medi-Cal claim pursuant to
Section 10950 of the Welfare and Institutions Code.
(4) An appeal regarding Medicare coverage consistent with federal
law and regulations.
127457. (a) Prior After the period
described in Section 127455, and upon the completion of appeals
consistent with Section 127456, prior to commencing
further collection activities against a patient, the physician
and surgeon, any assignee of the physician and surgeon, or other
owner of the patient debt, including a collection agency, shall
provide the patient with a clear and conspicuous written notice
containing both of the following:
(1) A plain language summary of the patient's rights pursuant to
this article, the Rosenthal Fair Debt Collection Practices Act (Title
1.6C (commencing with Section 1788) of Part 4 of Division 3 of the
Civil Code), and the federal Fair Debt Collection
Practices Act (Subchapter V (commencing with
Section 1692) of Chapter 41 of Title 15 of the United States Code).
The summary shall include a statement that the Federal Trade
Commission enforces the federal act. The summary shall be sufficient
if it appears in substantially the following form: "State and federal
law require debt collectors to treat you fairly and prohibit debt
collectors from making false statements or threats of violence, using
obscene or profane language, and making improper communications with
third parties, including your employer. Except under unusual
circumstances, debt collectors may not contact you before 8 a.m. or
after 9 p.m. In general, a debt collector may not give information
about your debt to another person, other than your attorney or
spouse. A debt collector may contact another person to confirm your
location or to enforce a judgment. For more information about debt
collection activities, you may contact the Federal Trade Commission
by telephone at 1-877-FTC-HELP (382-4357) or online at www.ftc.gov."
(2) A statement that nonprofit credit counseling services may be
available in the area.
(b) The notice required by subdivision (a) shall also accompany
any document indicating that the commencement of collection
activities may occur.
(c) The requirements of this section shall apply to the entity
engaged in the collection activities. If a physician and surgeon
assigns or sells the debt to another entity, the obligations shall
apply to the entity, including a collection agency, engaged in the
debt collection activity.
127458. The physician and surgeon shall reimburse the patient or
patients any amount actually paid in excess of the amount due under
this article, including interest. Interest owed by the physician and
surgeon to the patient shall accrue at the rate set forth in Section
685.010 of the Code of Civil Procedure, beginning on the date payment
by the patient is received by the hospital
physician and surgeon . However, a physician and surgeon is not
required to reimburse the patient or pay interest if the amount due
is less than five dollars ($5). The physician and surgeon shall give
the patient a credit for the amount due for at least 60 days from the
date the amount is due.
127459. The rights, remedies, and penalties established by this
article are cumulative, and shall not supersede the rights, remedies,
or penalties established under other laws.
127460. Nothing in this article shall be construed to prohibit a
physician and surgeon from uniformly imposing charges from its
established charge schedule or published rates, nor shall this
article preclude the recognition of a physician and surgeon's
established charge schedule or published rates for purposes of
applying any payment limit, interim payment amount, or other payment
calculation based upon a physician and surgeon's rates or charges
under the Medi-Cal program, the Medicare Program, workers'
compensation, or other federal, state, or local public program of
health benefits. No health care service plan, insurer, or any other
person shall reduce the amount it would otherwise reimburse a claim
for physician and surgeon services because a physician and surgeon
has waived, or will waive, collection of all or a portion of a
patient's bill for physician and surgeon services in accordance with
the physician and surgeon's discount payment policy, notwithstanding
any contractual provision.
127461. Notwithstanding any other provision of law, the amounts
paid by parties for services resulting from reduced or waived charges
under a physician and surgeon's discounted payment policy shall not
constitute a physician and surgeon's uniform, published, prevailing,
or customary charges, its usual fees to the general public, or its
charges to non-Medi-Cal purchasers under comparable circumstances,
and shall not be used to calculate a physician and surgeon's median
non-Medicare or Medi-Cal non-Medi-Cal
charges, for purposes of any payment limit under the federal Medicare
Program, the Medi-Cal program, or any other federal or
state-financed health care program.
127462. To the extent that any requirement of this article
results in a federal determination that a physician and surgeon's
established charge schedule or published rates are not the physician
and surgeon's customary or prevailing charges for services, the
requirement in question shall be inoperative for all physician and
surgeons. The State Department of Public Health shall seek federal
guidance regarding modifications to the requirement in question. All
other requirements of this article shall remain in effect.