BILL ANALYSIS
AB 2389
Page 1
CONCURRENCE IN SENATE AMENDMENTS
AB 2389 (Gaines)
As Amended August 20, 2010
Majority vote
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|ASSEMBLY: |61-0 |(May 28, 2010) |SENATE: |29-6 |(August 30, |
| | | | | |2010) |
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Original Committee Reference: HEALTH
SUMMARY : Prohibits a contract between a health facility and a
health care service plan or health insurer (collectively
carriers) from containing a provision that restricts the ability
of the carrier to furnish information on the cost of procedures
or health care quality information to carrier enrollees.
The Senate amendments :
1)Clarify that the cost information provided to carrier
enrollees by a carrier is limited to the range of elective,
uncomplicated procedures performed on patients without
malignancy or comorbidity, with a length of stay consistent
with the diagnosis-related group assignment.
2)Clarify that the quality information provided to carrier
enrollees by a carrier be based on consensus-based, or
nationally recognized evidence-based, clinical recommendations
or guidelines.
3)Require that the information and data used as the basis for
the quality information provided to carrier enrollees be
updated regularly and no less than annually.
4)Require a carrier, prior to furnishing cost and quality
information to its enrollees, to provide to a health facility
being evaluated a summary of the criteria and methodology used
in the development and evaluation of cost range and quality
measurements. Require the summary to be sufficiently detailed
and reasonably understandable to allow the facility to verify
the data against its own records.
5)Clarify that a health facility has the right to provide
supplemental information to the carrier if the facility finds
AB 2389
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discrepancies in the data or cost range criteria used by the
carrier.
6)Require a carrier to provide notice of, and an annual update
of, information furnished to carrier enrollees on the cost
range of procedures at a health facility. Permit a carrier to
satisfy this requirement by providing an electronic copy to
the facility or by providing the facility with access to the
carrier's cost information through Internet Web site or
electronic portal made available by the carrier.
7)Make technical clarifying changes.
EXISTING LAW :
1)Establishes the Office of the Patient Advocate (OPA) within
DMHC, and requires the OPA to prepare and make available a
quality of care report card that includes a rating of health
care service plans.
2)Requires hospitals to make a written or electronic copy of its
charge description master (a list of prices for services)
available, either by posting an electronic copy on the
hospital's Web site, or by making a written or electronic copy
available at the hospital.
3)Requires hospitals to submit their average charges for 25
common outpatient procedures, as specified, annually to Office
of Statewide Health Planning and Development (OSHPD) who is
required to publish this information on its Web site.
Requires OSHPD to publish and update on its Web site, a list
of the 25 inpatient procedures most commonly performed in
California hospitals, along with each hospital's average
charges for those procedures.
4)Requires OSHPD to publish risk-adjusted outcome reports for
medical, surgical, and obstetric conditions or procedures, as
specified.
5)Requires hospitals, upon request, to provide to a person who
has no health coverage, a written estimate of the amount the
hospital will charge for the health care services, procedures,
and supplies that are reasonably expected to be provided to
the person by the hospital, as well as information about its
financial assistance and charity care policies, as specified.
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AS PASSED BY THE ASSEMBLY , this bill was substantially similar
to the version passed by the Senate.
FISCAL EFFECT : None
COMMENTS : According to the author, this bill will ensure
consumers have the quality and cost information that they need
to make purchasing decisions about health products and services.
While the majority of hospitals in this state already allow
this information to be shared, the author argues that some
hospitals are turning to "gag clauses" in contracts with
carriers that preclude carriers from sharing cost and quality
information about hospitals with their enrollees. The author
maintains that consumers are increasingly being required to pay
more attention to the cost of their care when they have a
greater responsibility for paying for it due to deductibles and
other cost sharing arrangements, particularly for a preferred
provider organization (PPO) product where the consumer pays 20%
or more of their total health care bill. The author asserts
that this bill will ensure that carriers are not restricted in
their ability to provide cost and quality information to their
members.
Analysis Prepared by : Tanya Robinson-Taylor / HEALTH / (916)
319-2097
FN: 0006681