BILL ANALYSIS                                                                                                                                                                                                    �



                                                                  AB 1803
                                                                  Page  1

          Date of Hearing:   May 9, 2012

                        ASSEMBLY COMMITTEE ON APPROPRIATIONS
                                Felipe Fuentes, Chair

                  AB 1803 (Mitchell) - As Amended:  April 23, 2012 

          Policy Committee:                              HealthVote:14-4

          Urgency:     No                   State Mandated Local Program: 
          No     Reimbursable:              No

           SUMMARY  

          This bill applies the "reasonable layperson" standard for 
          coverage of emergency room care to the Medi-Cal fee-for-service 
          program.  Specifically, this bill:

          1)Adds emergency services and care for treatment of an emergency 
            medical condition as a covered benefit in the Medi-Cal 
            fee-for-service program, and defines relevant terms by 
            reference, including "emergency medical condition."

          2)Specifies that this bill shall not be construed to change the 
            obligation of a Medi-Cal managed care plan to provide 
            emergency services and care.

           FISCAL EFFECT
           
          As this bill reflects current practice, no fiscal impact is 
          expected.  

           COMMENTS

          1)Rationale  .  This bill would ensure that Medi-Cal would 
            reimburse for all care that meets the reasonable layperson 
            standard, for those enrollees in FFS Medi-Cal. The author 
            maintains this bill would close a gap in California law. Under 
            state law, the reasonable layperson standard for emergency 
            medical services is in place for health plans regulated by the 
            Department of Managed Health Care, including Medi-Cal managed 
            care. The standard is not in place for Medi-Cal fee for 
            service enrollees or health insurance plans regulated by the 
            California Department of Insurance.









                                                                  AB 1803
                                                                  Page  2

           2)Background  . The reasonable layperson standard states that if a 
            reasonable person believes a medical condition which is 
            manifested by acute symptoms of sufficient severity (including 
            severe pain) presents itself in a manner that the absence of 
            immediate medical attention could be reasonably expect to 
            result in harm, the treatment shall be paid by the insurer. 
            These conditions include: 1) placing the patient's health in 
            serious jeopardy, or 2) serious impairment to bodily 
            functions, or 3) serious dysfunction of any bodily organ or 
            part.


           Analysis Prepared by  :    Lisa Murawski / APPR. / (916) 319-2081