AB 2297

Bill Subjects

Abstract

Existing law requires a hospital to maintain a written charity care policy and a discount payment policy for uninsured patients or patients with high medical costs who are at or below 400 percent of the federal poverty level. Existing law requires the written policy regarding discount payments to also include a statement that an emergency physician 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 400 percent of the federal poverty level. Existing law authorizes an emergency physician to choose to grant eligibility for a discount payment policy to patients with incomes over 350% of the federal poverty level. Existing law defines "high medical costs" for these purposes to mean, among other things, specified annual out-of-pocket costs incurred by the individual at the hospital or a hospital that provided emergency care. This bill would authorize an emergency physician to choose to grant eligibility for a discount payment policy to patients with incomes over 400% of the federal poverty level. The bill would also clarify that out-of-pocket costs for the above-described definition of "high medical costs" means any expenses for medical care that are not reimbursed by insurance or a health coverage program, such as Medicare copays or Medi-Cal cost sharing. Existing law requires a hospital's discount payment policy to clearly state the eligibility criteria based upon income, and authorizes a hospital to consider the income and monetary assets of the patient or the patient's family, as defined, in determining eligibility under its charity care policy. This bill would prohibit a hospital from considering the monetary assets of the patient in determining eligibility for both the charity care and the discount payment policies, but would authorize the hospital to consider the availability of a patient's health savings account held by the patient or the patient's family, as specified. The bill would revise the definition of patient's family, as specified. The bill would instead require that the eligibility for charity care or discounted payments be determined at any time the hospital is in receipt of, among other things, recent pay stubs or income tax returns. The bill would prohibit a hospital or an emergency physician from imposing time limits for applying for charity care or discounted payments, and would prohibit a hospital or emergency physician from denying eligibility based on the timing of a patient's application. The bill would authorize a hospital or emergency physician to waive or reduce Medi-Cal and Medicare cost-sharing amounts as part of its charity care program or discount payment program, as specified. Existing law requires a hospital or an emergency physician to establish a written policy defining standards and practices for the collection of debt. Existing law authorizes a hospital or emergency physician to consider only income and monetary assets, as specified, in determining the amount of debt a hospital or emergency physician may seek to recover from patients who are eligible under the hospital's or emergency physician's charity care or discount payment policy. This bill would eliminate the authorization for a hospital or an emergency physician to consider monetary assets in determining the amount of debt the hospital or emergency physician may seek to recover from patients who are eligible under these policies. Existing law prohibits a hospital, in dealing with patients eligible under the hospital's charity care or discount payment policies, or emergency physician, in dealing with patients eligible under the emergency physician's discount payment policies, from using liens on primary residences as a means of collecting unpaid hospital or emergency physician bills. Existing law prohibits a collection agency, in dealing with a patient under a hospital's charity care or discount payment policies or in dealing with a patient under the emergency physician's discount payment policy, from conducting a sale of a patient's primary residence, as specified, as a means of collecting unpaid hospital or emergency physician bills. This bill would prohibit a hospital or emergency physician from using liens on any real property as a means of collecting unpaid hospital or emergency physician bills, and would prohibit a collection agency from conducting a sale of any real property owned, in part or completely, by a patient or placing a lien on any real property as a means of collecting unpaid hospital or emergency physician bills. The bill would define "charity care" and "discount payment" for the purposes described above. Existing law requires a hospital to reimburse a patient any amount actually paid in excess of the amount due, including interest. Under existing law, a hospital is not required to reimburse the patient or pay interest if the amount due is less than $5. This bill would authorize the hospital to reimburse the patient, but is not required to do so, if the hospital or the department determines that a patient qualified for financial assistance at the time the patient was first billed and it has been 5 years or more since the last payment to the hospital, hospital assignee, or debt buyer or the patient debt was sold to a debt buyer in accordance with state law in effect at the time the debt was sold, if sold before January 1, 2022. Existing law requires the State Department of Public Health to be responsible for the enforcement of the hospital pricing policy provisions for violations occurring prior to January 1, 2024. Existing law requires the Department of Health Care Access and Information to be responsible for the enforcement of these provisions for violations occurring on or after January 1, 2024. This bill would require the Department of Health Care Access and Information to also have enforcement authority to assess penalties for violations that occurred on or after January 1, 2022, that arise out of the same investigation for investigations involving hospital actions occurring on or after January 1, 2024, as specified. This bill would incorporate additional changes to Section 127425 of the Health and Safety Code proposed by Senate Bill 1061, to be operative only if this bill and Senate Bill 1061 are enacted and this bill is enacted last.