BILL NUMBER: AB 1503 AMENDED
BILL TEXT
AMENDED IN SENATE AUGUST 19, 2010
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 physicians : 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
the emergency physician, as defined, 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
emergency physician 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
emergency physician's discount payment policy,
as specified.
The 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 the emergency
physician who provides emergency medical services
care 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 the emergency physician , 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
an emergency physician, as defined in Section 127450, 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. This statement
shall not be construed to impose any additional responsibilities upon
the hospital.
(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. 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
Emergency Physician 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 emergency care
rendered to a financially qualified patient, an allowance that is
applied after the physician and surgeon's
emergency physician's charges are imposed on the patient, due
to the patient's determined financial inability to pay the charges.
(b) "Emergency care" means emergency medical services and
care, as defined in Section 1317.1, that is provided by an emergency
physician in the emergency department of a hospital.
(c) "Emergency physician" means a physician and surgeon licensed
pursuant to Chapter 2 (commencing with Section 2000) of the Business
and Professions Code who is credentialed by a hospital and either
employed or contracted by the hospital to provide emergency medical
services in the emergency department of the hospital, except that an
"emergency physician" shall not include a physician specialist who is
called into the emergency department of a hospital or who is on
staff or has privileges at the hospital outside of the emergency
department.
(d) "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)
(e) "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)
(f) "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)
(g) "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 emergency physician . 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 emergency physician
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
emergency physician may waive the request for
documentation.
(3) A lower level determined by the physician and surgeon
emergency physician in accordance with the
physician and surgeon's emergency physician'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
an emergency physician for a discount payment
pursuant to a discount payment policy. Notwithstanding any other
provision of this article, a physician and surgeon
an emergency physician 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 An emergency
physician 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
emergency physician's 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 physicians
physician and surgeons 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 an
emergency physician seeks reimbursement from the Maddy Fund
pursuant to Section 1797.98c, then the physician and surgeon
emergency physician shall, at that time, cease
any further billing or collection activity for that patient.
(2) If the physician and surgeon emergency
physician 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 emergency
physician 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
emergency physician shall make every reasonable effort to
provide the physician and surgeon emergency
physician with documentation of income and health benefits
coverage, if the physician and surgeon
emergency physician 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 emergency
physician to make a determination, the physician and
surgeon emergency physician may consider that
failure in making its determination.
(1) For purposes of determining eligibility for discounted
payment, the physician and surgeon emergency
physician may rely on the determination made by the hospital at
which emergency care was provided. If the physician and
surgeon emergency physician 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
emergency physician, 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
emergency physician , collection agency, or
assignee independent of the eligibility process for discounted
payment.
(3) Eligibility for discounted payments may be determined at any
time the physician and surgeon emergency
physician is in receipt of information specified in paragraph
(1) or (2), respectively.
127454. (a) Each physician and surgeon
emergency physician 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 care rendered by
the emergency physician 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 Children's Services Program, or other publicly funded
programs designed to provide comprehensive health coverage.
(b) If a physician and surgeon the
emergency physician or his or her representative 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 emergency
physician 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 emergency physician .
(2) A request that the patient inform the physician and
surgeon emergency physician 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 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 the emergency physician's employee or
office from whom or which the patient may obtain information about
the physician and surgeon's emergency
physician's discount payment policy, and how to apply for that
assistance.
(c) (1) In addition to the statement of the charges, if a
physician and surgeon the emergency physician's
uses the following notice in any billing, that physician
and surgeon emergency physician 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 for which you may be eligible,
including the Medi-Cal program. If you have coverage, please
tell us so that we may bill your plan."
(2) If a physician and surgeon the
emergency physician or the assignee of the physician
and surgeon emergency physician lacks the
capacity to provide the notice specified in paragraph (1), the
physician and surgeon emergency physician
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
emergency physician shall have a written policy about when and
under whose authority patient debt is advanced for collection.
(b) Each physician and surgeon emergency
physician 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 emergency physician receivables that it
will adhere to the physician and surgeon's
emergency physician'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 emergency physician 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
the emergency physician may seek to recover from
patients who are eligible under the physician and surgeon's
emergency physician's charity care policy or
discount payment policy, the physician and surgeon
emergency physician may consider only income and monetary
assets as limited by Section 127452.
(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 the
emergency physician , any assignee of the physician
and surgeon emergency physician , 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.
(d) If a patient is attempting to qualify for eligibility under
the physician and surgeon's emergency
physician'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, emergency physician or his or her assignee,
including a collection agency, shall not report adverse information
to a consumer credit agency or commence a civil action unless
that entity has agreed to comply with this article.
(e) (1) The physician and surgeon
emergency physician or other assignee shall not, in dealing
with patients eligible under the physician and surgeon's
emergency physician's discount payment policies,
use wage garnishments or liens on primary residences as a means of
collecting unpaid physician and surgeon
emergency physician bills.
(2) A collection agency or other assignee shall not, in dealing
with any patient under the physician and surgeon's
emergency physician's discount payment policy, use as a
means of collecting unpaid physician and surgeon
emergency physician 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 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 the emergency physician , 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.
(f) Any extended payment plans offered by a physician and
surgeon an emergency physician to assist
patients eligible under the physician and surgeon's
emergency physician's discount payment policy or
any other policy adopted by the physician and surgeon
emergency physician for assisting low-income
patients with no insurance or high medical costs in settling
outstanding past due physician and surgeon
emergency physician bills, shall be interest free. The
physician and surgeon's emergency physician'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
emergency physician's extended payment plan no
longer operative, the physician and surgeon
emergency physician , collection agency, or assignee shall make
a reasonable attempt to contact the patient by telephone , if
the telephone number is known, 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 emergency physician's
extended payment plan being declared inoperative, the
physician and surgeon emergency physician ,
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 emergency
physician , 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
telephone call to the patient may be made to the last known
telephone number and address of the patient.
(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 emergency physician
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 (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 emergency physician 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) 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 emergency physician
, any assignee of the physician and surgeon
emergency physician , or other owner of the patient debt,
including a collection agency, shall provide the patient
not report adverse information to a consumer credit
reporting agency or commence a civil action, until after the patient
has been provided 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
reporting adverse information to a consumer credit reporting agency
or commencing a civil action against the patient . If
a physician and surgeon an emergency physician
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
emergency physician 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 emergency physician 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 physician and surgeon emergency
physician . However, a physician and surgeon
an emergency physician is not required to reimburse the
patient or pay interest if the amount due is less than five dollars
($5). The physician and surgeon emergency
physician 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 the emergency
physician 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
an emergency physician'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 an emergency physician'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 emergency
physician services because a physician and surgeon
an emergency physician has waived, or
will waive, collection of all or a portion of a patient's bill for
physician and surgeon emergency physician
services in accordance with the physician and surgeon'
s emergency physician'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 an emergency
physician's discounted payment policy shall not constitute
a physician and surgeon's an emergency
physician'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
an emergency physician's median non-Medicare or
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 an emergency physician'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
emergency physicians . 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.