BILL ANALYSIS
AB 1503
Page 1
ASSEMBLY THIRD READING
AB 1503 (Lieu)
As Introduced February 27, 2009
Majority vote
HEALTH 17-0 APPROPRIATIONS 16-0
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|Ayes:|Jones, Fletcher, Adams, |Ayes:|De Leon, Nielsen, |
| |Ammiano, Block, Carter, | |Ammiano, Charles |
| |Conway, De Leon, Gaines, | |Calderon, Davis, Duvall, |
| |Hall, Hayashi, Hernandez, | |Krekorian, Hall, Harkey, |
| |Bonnie Lowenthal, Nava, | |Miller, John A. Perez, |
| |V. Manuel Perez, Salas, | |Price, Skinner, Solorio, |
| |Audra Strickland | |Audra Strickland, |
| | | |Torlakson |
| | | | |
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SUMMARY : Requires emergency room physicians (physician) to
provide a discount payment policy for uninsured and specified
low-income patients and revises the conditions under which
physicians may seek uncompensated care payments through a Maddy
Emergency Medical Services Fund (Maddy Fund). Specifically,
this bill :
1)Requires physicians seeking payment for services through the
Maddy Fund to have and implement a discount payment policy
consistent with this bill.
2)Requires a physician to determine if a patient qualifies for a
hospital's charity care payment policy, and, if the patient
does qualify, authorizes the physician to bill the Maddy Fund.
3)Makes uninsured patients, and patients with incomes below 350%
of the federal poverty level with medical costs exceeding 10%
of their income, eligible to apply for a discount payment from
the physician, and requires the physician to limit payment for
services from an eligible patient to the amount the physician
would receive through Medicare, Medi-Cal, the Healthy Families
Program, or another governmental program, whichever is
greater.
4)Requires physicians to provide patients receiving emergency
care, not admitted to the hospital, with specified written
AB 1503
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notice describing the availability of a discount program and
the eligibility standards for that program.
5)Prohibits wage garnishments or liens, and prohibits sale of a
patient's home during their lifetime, as a means of collecting
debts for persons participating in the discounted cost
program. Prohibits sending unpaid bills to collection if an
eligible individual is making a good faith effort to settle an
outstanding bill. Imposes other specified limits on
collections.
EXISTING LAW :
1)Authorizes each county to establish a Maddy Fund supported by
penalty assessments on criminal and traffic violations and
specifies that the fund be used to reimburse hospitals and
physicians for uncompensated emergency medical services.
2)Requires each hospital, as a condition of licensure, to
maintain policies providing reduced cost care, as defined, to
uninsured and low-income individuals.
FISCAL EFFECT : According to the Assembly Appropriations
Committee, no direct fiscal effect to the Department of Health
Care Services or to the Department of Public Health. The
Appropriations Committee found unknown effects on Maddy Funds
resulting from simplified access to the funds.
COMMENTS : Health Access California, sponsor of this bill,
states the intent of this legislation is to provide uninsured
and underinsured consumers affordable physician care in
emergency rooms and to provide consumer protections from overly
aggressive medical collections activity. Uninsured individuals,
according to Health Access, treated in emergency rooms, are
frequently charged much more than insured patients are charged
for the same service. Health Access also reports that debt
collections from uninsured patients are routinely and vigorously
employed to recover medical debt. The author notes that this
bill is modeled on a very similar program instituted in
hospitals last year.
Existing law authorizes each county to establish a Maddy Fund.
The Maddy Fund is dedicated to reimbursement of physicians and
hospitals for uncompensated emergency medical care.
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Approximately 50 counties have established Maddy Funds.
Counties finance these funds principally through penalty
assessments on criminal and traffic violations.
The UCLA Center for Health Policy Research reports that job
based health insurance coverage continues to decline in this
state. More than 6.5 million Californians under age 65 (more
than one in five nonelderly residents) went without health
insurance at some point in 2007. Employment based coverage of
adults has declined from 56.4% of employees to 54.3% in recent
years. UCLA reports that the erosion of job-based insurance is
most severe for low- and moderate-income adults who usually do
not qualify for any public insurance programs.
Previous legislation: AB 774 (Chan), Chapter 755, Statutes of
2006 requires hospitals to provide discounted services to
uninsured and underinsured consumers in a program substantially
similar to that required by this bill. Under AB 774, hospitals
may charge eligible patients the higher rates of Medicare,
Medi-Cal, or another government program. AB 774 directs
hospitals to give uninsured and underinsured individuals a
specified period of time to qualify for insurance coverage or to
negotiate a payment plan with the hospital.
The Western Center on Law and Poverty supports the bill because
so many Californians, more than six million individuals, depend
on emergency rooms for their health care, but pay very high
charges because uninsured individuals have no insurer to
negotiate rates on their behalf. The California Immigrant
Policy Center notes that medical debt is the leading cause of
personal bankruptcy in the United States, and that this bill
will help low-income consumers avoid unmanageable levels of
debt.
Analysis Prepared by : John Miller/ HEALTH / (916) 319-2097
FN: 0000952