Bill Text: CA AB1126 | 2009-2010 | Regular Session | Introduced
Bill Title: The Public Employees' Health Care Act: billing disputes.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2010-02-02 - From committee: Filed with the Chief Clerk pursuant to Joint Rule 56. [AB1126 Detail]
Download: California-2009-AB1126-Introduced.html
BILL NUMBER: AB 1126 INTRODUCED
BILL TEXT
INTRODUCED BY Assembly Member Hernandez
FEBRUARY 27, 2009
An act to amend Section 22850 of the Government Code, relating to
the Public Employees' Health Care Act.
LEGISLATIVE COUNSEL'S DIGEST
AB 1126, as introduced, Hernandez. The Public Employees' Health
Care Act: billing disputes.
The Public Employees' Health Care Act (PEMHCA) allows an employee
or annuitant to enroll in an approved health benefit plan, as
specified. PEMHCA also authorizes the Board of Administration of the
Public Employees' Retirement System to enter into contracts with
carriers offering health benefit plans or with entities offering
services relating to the administration of health benefit plans, as
specified.
The Knox-Keene Health Care Service Plan Act of 1975 requires
billing disputes over emergency medical care to be resolved solely
between the emergency room health care providers, who are entitled to
a reasonable payment for their services, and the HMO, which is
obligated to make that payment. The emergency room health care
providers are prohibited from billing the patient for the disputed
amount. Existing regulations define balance billing as an unfair
billing pattern.
This bill would prohibit a health care provider giving emergency
services and care, as defined, from seeking reimbursement or
attempting to obtain payment for any covered services provided to an
employee or annuitant other than from the participating health
benefit plan covering that employee or annuitant. The bill would
specify that that provision would not apply to any copayments,
coinsurance, or deductibles required for the covered services
provided to that employee or annuitant other than from the
participating health plan covering that employee or annuitant.
Vote: majority. Appropriation: no. Fiscal committee: no.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 22850 of the Government Code is amended to
read:
22850. (a) The board may, without compliance with any provision
of law relating to competitive bidding, enter into contracts with
carriers offering health benefit plans or with entities offering
services relating to the administration of health benefit plans.
(b) The board may contract with carriers for health benefit plans
or approve health benefit plans offered by employee organizations,
provided that the carriers have operated successfully in the hospital
and medical care fields prior to the contracting for or approval
thereof. The plans may include hospital benefits, surgical benefits,
inpatient medical benefits, outpatient benefits, obstetrical
benefits, and benefits offered by a bona fide church, sect,
denomination, or organization whose principles include healing
entirely by prayer or spiritual means.
(c) Notwithstanding any other provision of this part, the board
may contract with health benefit plans offering unique or specialized
health services.
(d) The board may administer self-funded or minimum premium health
benefit plans.
(e) The board may contract for or implement employee cost
containment and cost reduction incentive programs that involve the
employee, the annuitant, and family members as active participants,
along with the carrier and the provider, in a joint effort toward
containing and reducing the cost of providing medical and hospital
health care services to public employees. In developing these plans,
the board, in cooperation with the Department of Personnel
Administration, may request proposals from carriers and certified
public employee representatives.
(f) Notwithstanding any other provision of this part, the board
may do any of the following:
(1) Contract for, or approve, health benefit plans that charge a
contracting agency and its employees and annuitants rates based on
regional variations in the costs of health care services.
(2) Contract for, or approve, health benefit plans exclusively for
the employees and annuitants of contracting agencies. State
employees and annuitants may not enroll in these plans. The board may
offer health benefit plans exclusively for employees and annuitants
of contracting agencies in addition to or in lieu of other health
benefit plans offered under this part. The governing body of a
contracting agency may elect, upon filing a resolution with the
board, to provide those health benefit plans to its employees and
annuitants. The resolution shall be subject to mutual agreement
between the contracting agency and the recognized employee
organization, if any.
(g) The board shall approve any employee association health
benefit plan that was approved by the board in the 1987-88 contract
year or prior, provided the plan continues to meet the minimum
standards prescribed by the board. The trustees of an employee
association health benefit plan are responsible for providing health
benefit plan administration and services to its enrollees.
Notwithstanding any other provision of this part, the California
Correctional Peace Officer Association Health Benefits Trust may
offer different health benefit plan designs with varying premiums in
different areas of the state.
(h) Irrespective of any other provision of law, the sponsors of a
health benefit plan approved under this section may reinsure the
operation of the plan with an admitted insurer authorized to write
disability insurance, if the premium includes the entire prepayment
fee.
(i) Notwithstanding any other provision of law, a health care
provider giving emergency services and care shall not seek
reimbursement or attempt to obtain payment for any covered services
provided to that employee or annuitant covered in Article 4
(commencing with Section 227500) of Part 5 of Division 5 of Title 2,
other than from the participating health benefit plan covering that
employee or annuitant.
(1) For purposes of this subdivision, "health care provider"
includes, but is not limited to, hospitals and hospital-based
physicians such as radiologists, pathologists, anesthesiologists, and
on-call specialists.
(2) For purposes of this subdivision, "emergency services and care"
shall have the same meaning as set forth in Section 1317.1 of the
Health and Safety Code.
(3) The provisions of this subdivision shall not apply to any
copayments, coinsurance, or deductibles required for the covered
services provided to that employee or annuitant other than from the
participating health plan covering that employee or annuitant.
