California Assembly Bill AB1503 Amended / Bill

 BILL NUMBER: AB 1503AMENDED BILL TEXT AMENDED IN SENATE AUGUST 19, 2010 AMENDED IN SENATE JULY 15, 2010 AMENDED IN SENATE JUNE 16, 2010 INTRODUCED BY Assembly Member Lieu FEBRUARY 27, 2009 An act to amend Section 127405 of, to amend and renumber the heading of Article 3 (commencing with Section 127400) of Chapter 2 of, to add the heading of Chapter 2.5 (commencing with Section 127400) to, and to add Article 2 (commencing with Section 127450) to Chapter 2.5 of, Part 2 of Division 107 of the Health and Safety Code, relating to emergency medical care billing. LEGISLATIVE COUNSEL'S DIGEST AB 1503, as amended, Lieu. Health facilities:  physicians and surgeons   emergency physicians  : emergency medical care: billing. Existing law provides for the licensure and regulation of health facilities by the State Department of Public Health. Existing law requires each hospital, as a condition of licensure, to maintain written policies about discount payment and charity care for financially qualified patients, as defined. These policies are required to include, among other things, a section addressing eligibility criteria, as prescribed. Existing law requires each hospital to perform various functions in connection with the hospital charity care and discount pay policies, including providing patients with notice that contains information about the hospital's discount payment and charity care policies, including information about eligibility and attempting to determine the availability of private or public health insurance coverage for each patient. Existing law also specifies billing and collection procedures to be followed by a hospital, its assignee, collection agency, or billing service. This bill would provide that uninsured patients or patients with high medical costs who are at or below 350% of the federal poverty level are eligible to apply to  a physician and surgeon   the emergency physician, as defined,  who provides emergency medical services in a general acute care hospital for a discount payment pursuant to a discount payment policy. The bill would require the  physician and surgeon   emergency physician  to limit expected payment for services provided to a patient at or below 350% of the federal poverty level and who is eligible under the  physician and surgeon's   emergency physician's  discount payment policy, as specified. The bill would require the above-described written notice that hospitals are required to provide patients regarding the hospital's charity care and discount pay policies to include a statement that  a physician and surgeon   the emergency physician  who provides emergency medical  services   care  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 350% of the federal poverty level. The bill would also specify billing and collection procedures to be followed by  a physician and surgeon   the emergency physician  , its assignee, collection agency, or billing service. This bill would provide that a violation of the above provisions shall not constitute a violation of the terms of a physician and surgeon's licensure. Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. The heading of Chapter 2.5 (commencing with Section 127400) is added to Part 2 of Division 107 of the Health and Safety Code, immediately preceding Section 127400, to read: CHAPTER 2.5. FAIR PRICING POLICIES SEC. 2. The heading of Article 3 (commencing with Section 127400) of Chapter 2 of Part 2 of Division 107 of the Health and Safety Code is amended and renumbered to read: Article 1. Hospital Fair Pricing Policies SEC. 3. Section 127405 of the Health and Safety Code is amended to read: 127405. (a) (1) (A) Each hospital shall maintain an understandable written policy regarding discount payments for financially qualified patients as well as an understandable written charity care policy. Uninsured patients or patients with high medical costs who are at or below 350 percent of the federal poverty level, as defined in subdivision (b) of Section 127400, shall be eligible to apply for participation under a hospital's charity care policy or discount payment policy. Notwithstanding any other provision of this article, a hospital may choose to grant eligibility for its discount payment policy or charity care policies to patients with incomes over 350 percent of the federal poverty level. Both the charity care policy and the discount payment policy shall state the process used by the hospital to determine whether a patient is eligible for charity care or discounted payment. In the event of a dispute, a patient may seek review from the business manager, chief financial officer, or other appropriate manager as designated in the charity care policy and the discount payment policy. (B) The written policy regarding discount payments shall also include a statement that  a physician and surgeon   an emergency physician, as defined in Section 127450,  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 350 percent of the federal poverty level.  This statement shall not be construed to impose any additional responsibilities upon the hospital.  (2) Rural hospitals, as defined in Section 124840, may establish eligibility levels for financial assistance and charity care at less than 350 percent of the federal poverty level as appropriate to maintain their financial and operational integrity. (b) A hospital's discount payment policy shall clearly state eligibility criteria based upon income consistent with the application of the federal poverty level. The discount payment policy shall also include an extended payment plan to allow payment of the discounted price over time. The policy shall provide that the hospital and the patient may negotiate the terms of the payment plan. (c) The charity care policy shall state clearly the eligibility criteria for charity care. In determining eligibility under its charity care policy, a hospital may consider income and monetary assets of the patient. For purposes of this determination, monetary assets shall not include retirement or deferred compensation plans qualified under the Internal Revenue Code, or nonqualified deferred compensation plans. Furthermore, the first ten thousand dollars ($10,000) of a patient's monetary assets shall not be counted in determining eligibility, nor shall 50 percent of a patient's monetary assets over the first ten thousand dollars ($10,000) be counted in determining eligibility. (d) A hospital shall limit expected payment for services it provides to a patient at or below 350 percent of the federal poverty level, as defined in subdivision (b) of Section 124700, eligible under its discount payment policy to the amount of payment the hospital would expect, in good faith, to receive for providing services from Medicare, Medi-Cal, Healthy Families, or another government-sponsored health program of health benefits in which the hospital participates, whichever is greater. If the hospital provides a service for which there is no established payment by Medicare or any other government-sponsored program of health benefits in which the hospital participates, the hospital shall establish an appropriate discounted payment. (e) A patient, or patient's legal representative, who requests a discounted payment, charity care, or other assistance in meeting his or her financial obligation to the hospital shall make every reasonable effort to provide the hospital with documentation of income and health benefits coverage. If the person requests charity care or a discounted payment and fails to provide information that is reasonable and necessary for the hospital to make a determination, the hospital may consider that failure in making its determination. (1) For purposes of determining eligibility for discounted payment, documentation of income shall be limited to recent pay stubs or income tax returns. (2) For purposes of determining eligibility for charity care, documentation of assets may include information on all monetary assets, but shall not include statements on retirement or deferred compensation plans qualified under the Internal Revenue Code, or nonqualified deferred compensation plans. A hospital may require waivers or releases from the patient or the patient's family, authorizing the hospital to obtain account information from financial or commercial institutions, or other entities that hold or maintain the monetary assets, to verify their value. (3) Information obtained pursuant to paragraph (1) or (2) shall not be used for collections activities. This paragraph does not prohibit the use of information obtained by the hospital, collection agency, or assignee independently of the eligibility process for charity care or discounted payment. (4) Eligibility for discounted payments or charity care may be determined at any time the hospital is in receipt of information specified in paragraph (1) or (2), respectively. SEC. 4. Article 2 (commencing with Section 127450) is added to Chapter 2.5 of Part 2 of Division 107 of the Health and Safety Code, to read: Article 2.  Physician and Surgeon   Emergency Physician  Fair Pricing Policies 127450. As used in this article, the following terms have the following meanings: (a) "Allowance for financially qualified patient" means, with respect to  services   emergency care  rendered to a financially qualified patient, an allowance that is applied after the  physician and surgeon's   emergency physician's  charges are imposed on the patient, due to the patient's determined financial inability to pay the charges. (b)  "Emergency care" means emergency medical services and care, as defined in Section 1317.1, that is provided by an emergency physician in the emergency department of a hospital.   (c) "Emergency physician" means a physician and surgeon licensed pursuant to Chapter 2 (commencing with Section 2000) of the Business and Professions Code who is credentialed by a hospital and either employed or contracted by the hospital to provide emergency medical services in the emergency department of the hospital, except that an "emergency physician" shall not include a physician specialist who is called into the emergency department of a hospital or who is on staff or has privileges at the hospital outside of the emergency department.   (d)    "Federal poverty level" means the poverty guidelines updated periodically in the Federal Register by the United States Department of Health and Human Services under authority of subsection (2) of Section 9902 of Title 42 of the United States Code.  (c)   (e)  "Financially qualified patient" means a patient who is both of the following: (1) A patient who is a self-pay patient or a patient with high medical costs. (2) A patient who has a family income that does not exceed 350 percent of the federal poverty level.  (d) "Emergency care" means care provided in the emergency department of a hospital.   (e)   (f)  "Hospital" means a facility that is required to be licensed under subdivision (a) of Section 1250, except a facility operated by the State Department of Mental Health or the Department of Corrections and Rehabilitation.  (f)   (g)  "Office" means the Office of Statewide Health Planning and Development.  (g) "Physician and surgeon" means a physician and surgeon licensed pursuant to Chapter 2 (commencing with Section 2000) of the Business and Professions Code who provides emergency medical services in a hospital that provides emergency care.  (h) "Self-pay patient" means a patient who does not have third-party coverage from a health insurer, health care service plan, Medicare, or Medicaid, and whose injury is not a compensable injury for purposes of workers' compensation, automobile insurance, or other insurance as determined and documented by the  physician and surgeon   emergency physician . Self-pay patients may include charity care patients. (i) "A patient with high medical costs" means a person whose family income does not exceed 350 percent of the federal poverty level if that individual does not receive a discounted rate from the  physician and surgeon   emergency physician  as a result of his or her third-party coverage. For these purposes, "high medical costs" means any of the following: (1) Annual out-of-pocket costs incurred by the individual at the hospital that provided emergency care that exceed 10 percent of the patient's family income in the prior 12 months. (2) Annual out-of-pocket expenses that exceed 10 percent of the patient's family income, if the patient provides documentation of the patient's medical expenses paid by the patient or the patient's family in the prior 12 months. The  physician and surgeon   emergency physician  may waive the request for documentation. (3) A lower level determined by the  physician and surgeon   emergency physician  in accordance with the  physician and surgeon's   emergency physician's  discounted payment policy. (j) "Patient's family" means the following: (1) For persons 18 years of age and older, spouse, domestic partner, as defined in Section 297 of the Family Code, and dependent children under 21 years of age, whether living at home or not. (2) For persons under 18 years of age, parent, caretaker relatives, and other children under 21 years of age of the parent or caretaker relative. 127451. A violation of this article shall not constitute a violation of the terms of a physician and surgeon's licensure. 127452. (a) Uninsured patients or patients with high medical costs who are at or below 350 percent of the federal poverty level shall be eligible to apply to  a physician and surgeon   an emergency physician  for a discount payment pursuant to a discount payment policy. Notwithstanding any other provision of this article,  a physician and surgeon   an emergency physician  may choose to grant eligibility for a discount payment policy to patients with incomes over 350 percent of the federal poverty level. (b)  A physician and surgeon   An emergency physician  shall limit expected payment for services provided to a patient at or below 350 percent of the federal poverty level and who is eligible under the  physician and surgeon's   emergency physician's  discount payment policy to an amount that is no greater than 50 percent of the median of billed charges based on a nationally recognized database of physician and surgeon charges until the nonprofit FAIR Health, Inc. creates a database that makes available the rate of payment received by  physicians   physician and surgeons  from commercial insurers for the same services in the same or similar geographic region. When FAIR Health, Inc. makes available the rate of payment received by physicians and surgeons from commercial insurers for the same services in the same or similar geographic region, the amount of expected payment under this section shall be no greater than the median or average of rates paid by commercial insurers for the same or similar services in the same or similar geographic region. (c) (1) If  a physician and surgeon   an emergency physician  seeks reimbursement from the Maddy Fund pursuant to Section 1797.98c, then the  physician and surgeon  emergency physician  shall, at that time, cease any further billing or collection activity for that patient. (2) If the  physician and surgeon   emergency physician  does not receive reimbursement from the Maddy Fund after attempting to obtain reimbursement from the Maddy Fund, then the provisions of this article shall apply. (3) If the  physician and surgeon   emergency physician  does not attempt to seek reimbursement from the Maddy Fund, the provisions of this article shall apply. (d) A patient, or patient's legal representative, who requests a discounted payment or other assistance in meeting his or her financial obligation to the  physician and surgeon   emergency physician  shall make every reasonable effort to provide the  physician and surgeon   emergency physician  with documentation of income and health benefits coverage, if the  physician and surgeon   emergency physician  requests the documentation. If the patient, or the patient's legal representative, requests a discounted payment and fails to provide information that is reasonable and necessary for the  physician and surgeon   emergency physician  to make a determination, the  physician and surgeon   emergency physician  may consider that failure in making its determination. (1) For purposes of determining eligibility for discounted payment, the  physician and surgeon   emergency physician  may rely on the determination made by the hospital at which emergency care was provided. If the  physician and surgeon   emergency physician  chooses to make a separate determination of eligibility for discounted payment, documentation of income shall be limited to recent pay stubs or income tax returns. The  physician and surgeon   emergency physician,  at his or her discretion, may accept self-attestation by a patient, or a patient's legal representative, but shall not request documentation of income other than that authorized in this paragraph. (2) Information obtained pursuant to paragraph (1) shall not be used for collections activities. This paragraph does not prohibit the use of information obtained by the  physician and surgeon   emergency physician  , collection agency, or assignee independent of the eligibility process for discounted payment. (3) Eligibility for discounted payments may be determined at any time the physician and surgeon   emergency physician  is in receipt of information specified in paragraph (1) or (2), respectively. 127454. (a) Each  physician and surgeon   emergency physician  shall make all reasonable efforts to obtain from the patient, or his or her representative, information about whether private or public health insurance or sponsorship may fully or partially cover the charges for emergency  services rendered by the physician and surgeon   care rendered by the emergency physician  to a patient, including, but not limited to, any of the following: (1) Private health insurance. (2) Medicare. (3) The Medi-Cal program, the Healthy Families Program, the California Children's Services Program, or other publicly funded programs designed to provide comprehensive health coverage. (b) If  a physician and surgeon  the emergency physician or his or her representative  bills a patient who has not provided proof of coverage by a third party at the time the care is provided or upon discharge, as a part of that billing, the  physician and surgeon   emergency physician  shall provide the patient with a clear and conspicuous notice that includes all of the following: (1) A statement of charges for services rendered by the  physician and surgeon   emergency physician  . (2) A request that the patient inform the  physician and surgeon   emergency physician  if the patient has health insurance coverage, Medicare, Healthy Families, Medi-Cal, or other coverage. (3) A statement that if the consumer does not have health insurance coverage, the consumer may be eligible for Medicare, Healthy Families, Medi-Cal, California Children's Services Program, or discounted payment care. (4) Information regarding the financially qualified patient and discounted payment application, including the following: (A) A statement that indicates that if the patient lacks, or has inadequate, insurance, and meets certain low-and moderate-income requirements, the patient may qualify for discounted payment. (B) The name and telephone number of  a physician and surgeon   the emergency physician's  employee or office from whom or which the patient may obtain information about the  physician and surgeon's   emergency physician's  discount payment policy, and how to apply for that assistance. (c) (1) In addition to the statement of the charges, if  a physician and surgeon   the emergency physician's  uses the following notice in any billing, that  physician and surgeon   emergency physician  shall be deemed to have complied with the notice requirements of this section: "If you are uninsured or have high medical costs, please contact ____ (name of person responsible for discount payment policy) at ____ (area code and phone number) for information on discounts and programs  like   for which you may be eligible, including  the Medi-Cal program. If you have coverage, please tell us so that we may bill your plan." (2) If  a physician and surgeon   the emergency physician  or the assignee of the  physician and surgeon   emergency physician  lacks the capacity to provide the notice specified in paragraph (1), the  physician and surgeon   emergency physician  or his or her assignee shall be deemed to have complied with the notice requirements of this section if the information required under this section is provided upon request and if the following is printed on the bill in 14-point bold type: "If uninsured or high medical bill, call re: discount." 127455. (a) Each  physician and surgeon   emergency physician  shall have a written policy about when and under whose authority patient debt is advanced for collection. (b) Each  physician and surgeon   emergency physician  shall establish a written policy defining standards and practices for the collection of debt, and shall obtain a written agreement from any agency that collects  physician and surgeon   emergency physician  receivables that it will adhere to the  physician and surgeon's   emergency physician's  standards and scope of practice. The policy shall not conflict with other applicable laws and shall not be construed to create a joint venture between the  physician and surgeon   emergency physician  and the external entity, or otherwise to allow physician and surgeon governance of an external entity that collects physician and surgeon receivables. In determining the amount of a debt  a physician and surgeon   the emergency physician  may seek to recover from patients who are eligible under the  physician and surgeon's   emergency physician's  charity care policy or discount payment policy, the  physician and surgeon   emergency physician  may consider only income and monetary assets as limited by Section 127452. (c) For a patient that lacks coverage, or for a patient that provides information that he or she may be a patient with high medical costs,  a physician and surgeon   the emergency physician  , any assignee of the  physician and surgeon   emergency physician  , or other owner of the patient debt, including a collection agency, shall not report adverse information to a consumer credit reporting agency or commence civil action against the patient for nonpayment at any time prior to 150 days after initial billing. (d) If a patient is attempting to qualify for eligibility under the  physician and surgeon's   emergency physician's  discount payment policy and is attempting in good faith to settle an outstanding bill with the physician and surgeon by negotiating a reasonable payment plan or by making regular partial payments of a reasonable amount, the  physician and surgeon shall not send the unpaid bill to any collection agency or other assignee,   emergency physician or his or her assignee, including a collection agency, shall not report adverse information to a consumer credit agency or commence a civil action  unless that entity has agreed to comply with this article. (e) (1) The  physician and surgeon   emergency physician  or other assignee shall not, in dealing with patients eligible under the  physician and surgeon's   emergency physician's  discount payment policies, use wage garnishments or liens on primary residences as a means of collecting unpaid  physician and surgeon   emergency physician  bills. (2) A collection agency or other assignee shall not, in dealing with any patient under the  physician and surgeon's   emergency physician's  discount payment policy, use as a means of collecting unpaid  physician and surgeon   emergency physician  bills, any of the following: (A) A wage garnishment, except by order of the court upon noticed motion, supported by a declaration filed by the movant identifying the basis for its belief that the patient has the ability to make payments on the judgment under the wage garnishment, that the court shall consider in light of the size of the judgment and additional information provided by the patient prior to, or at, the hearing concerning the patient's ability to pay, including information about probable future medical expenses based on the current condition of the patient and other obligations of the patient. (B) Notice or conduct a sale of the patient's primary residence during the life of the patient or his or her spouse, or during the period a child of the patient is a minor, or a child of the patient who has attained the age of majority is unable to take care of himself or herself and resides in the dwelling as his or her primary residence. In the event a person protected by this paragraph owns more than one dwelling, the primary residence shall be the dwelling that is the patient's current homestead, as defined in Section 704.710 of the Code of Civil Procedure or was the patient's homestead at the time of the death of a person other than the patient who is asserting the protections of this paragraph. (3) This requirement does not preclude  a physician and surgeon   the emergency physician  , collection agency, or other assignee from pursuing reimbursement and any enforcement remedy or remedies from third-party liability settlements, tortfeasors, or other legally responsible parties. (f) Any extended payment plans offered by  a physician and surgeon   an emergency physician  to assist patients eligible under the  physician and surgeon's   emergency physician's  discount payment policy or any other policy adopted by the  physician and surgeon   emergency physician  for assisting low-income patients with no insurance or high medical costs in settling outstanding past due  physician and surgeon   emergency physician  bills, shall be interest free. The  physician and surgeon's  emergency physician's  extended payment plan may be declared no longer operative after the patient's failure to make all consecutive payments due during a 90-day period. Before declaring the  physician and surgeon's   emergency physician's  extended payment plan no longer operative, the  physician and surgeon   emergency physician  , collection agency, or assignee shall make a reasonable attempt to contact the patient by telephone  , if the telephone number is known,  and to give notice in writing that the extended payment plan may become inoperative, and of the opportunity to renegotiate the extended payment plan. Prior to the  physician and surgeon's   emergency physician's  extended payment plan being declared inoperative, the  physician and surgeon   emergency physician  , collection agency, or assignee shall attempt to renegotiate the terms of the defaulted extended payment plan, if requested by the patient. The  physician and surgeon   emergency physician  , collection agency, or assignee shall not report adverse information to a consumer credit reporting agency or commence a civil action against the patient or responsible party for nonpayment prior to the time the extended payment plan is declared to be no longer operative. For purposes of this section, the notice and telephone call to the patient may be made to the last known telephone number and address of the patient. (g) Nothing in this section shall be construed to diminish or eliminate any protections consumers have under existing federal and state debt collection laws, or any other consumer protections available under state or federal law. If the patient fails to make all consecutive payments for 90 days and fails to renegotiate a payment plan, this subdivision does not limit or alter the obligation of the patient to make payments on the obligation owing to the  physician and surgeon  emergency physician  pursuant to any contract or applicable statute from the date that the extended payment plan is declared no longer operative, as set forth in subdivision (f). 127456. (a) The period described in Section 127455 shall be extended if the patient has a pending appeal for coverage of the services, until a final determination of that appeal is made, if the patient makes a reasonable effort to communicate with the  physician and surgeon   emergency physician  about the progress of any pending appeals. (b) For purposes of this section, "pending appeal" includes any of the following: (1) A grievance against a contracting health care service plan, as described in Chapter 2.2 (commencing with Section 1340) of Division 2, or against an insurer, as described in Chapter 1 (commencing with Section 10110) of Part 2 of Division 2 of the Insurance Code. (2) An independent medical review, as described in Section 10145.3 or 10169 of the Insurance Code. (3) A fair hearing for a review of a Medi-Cal claim pursuant to Section 10950 of the Welfare and Institutions Code. (4) An appeal regarding Medicare coverage consistent with federal law and regulations. 127457. (a) After the period described in Section 127455, and upon the completion of appeals consistent with Section 127456, prior to commencing further collection activities against a patient, the  physician and surgeon   emergency physician  , any assignee of the  physician and surgeon   emergency physician  , or other owner of the patient debt, including a collection agency, shall  provide the patient   not report adverse information to a consumer credit reporting agency or commence a civil action, until after the patient has been provided  with a clear and conspicuous written notice containing both of the following: (1) A plain language summary of the patient's rights pursuant to this article, the Rosenthal Fair Debt Collection Practices Act (Title 1.6C (commencing with Section 1788) of Part 4 of Division 3 of the Civil Code), and the federal Fair Debt Collection Practices Act (Subchapter V (commencing with Section 1692) of Chapter 41 of Title 15 of the United States Code). The summary shall include a statement that the Federal Trade Commission enforces the federal act. The summary shall be sufficient if it appears in substantially the following form: "State and federal law require debt collectors to treat you fairly and prohibit debt collectors from making false statements or threats of violence, using obscene or profane language, and making improper communications with third parties, including your employer. Except under unusual circumstances, debt collectors may not contact you before 8 a.m. or after 9 p.m. In general, a debt collector may not give information about your debt to another person, other than your attorney or spouse. A debt collector may contact another person to confirm your location or to enforce a judgment. For more information about debt collection activities, you may contact the Federal Trade Commission by telephone at 1-877-FTC-HELP (382-4357) or online at www.ftc.gov." (2) A statement that nonprofit credit counseling services may be available in the area. (b) The notice required by subdivision (a) shall also accompany any document indicating that the commencement of collection activities may occur. (c) The requirements of this section shall apply to the entity engaged in  the collection activities   reporting adverse information to a consumer credit reporting agency or commencing a civil action against the patient  . If  a physician and surgeon   an emergency physician  assigns or sells the debt to another entity, the obligations shall apply to the entity, including a collection agency, engaged in the debt collection activity. 127458. The  physician and surgeon   emergency physician  shall reimburse the patient or patients any amount actually paid in excess of the amount due under this article, including interest. Interest owed by the  physician and surgeon   emergency physician  to the patient shall accrue at the rate set forth in Section 685.010 of the Code of Civil Procedure, beginning on the date payment by the patient is received by the  physician and surgeon   emergency physician  . However,  a physician and surgeon   an emergency physician  is not required to reimburse the patient or pay interest if the amount due is less than five dollars ($5). The  physician and surgeon   emergency physician  shall give the patient a credit for the amount due for at least 60 days from the date the amount is due. 127459. The rights, remedies, and penalties established by this article are cumulative, and shall not supersede the rights, remedies, or penalties established under other laws. 127460. Nothing in this article shall be construed to prohibit  a physician and surgeon   the emergency physician  from uniformly imposing charges from its established charge schedule or published rates, nor shall this article preclude the recognition of  a physician and surgeon's   an emergency physician's  established charge schedule or published rates for purposes of applying any payment limit, interim payment amount, or other payment calculation based upon  a physician and surgeon's   an emergency physician's  rates or charges under the Medi-Cal program, the Medicare Program, workers' compensation, or other federal, state, or local public program of health benefits. No health care service plan, insurer, or any other person shall reduce the amount it would otherwise reimburse a claim for  physician and surgeon   emergency physician  services because  a physician and surgeon   an emergency   physician  has waived, or will waive, collection of all or a portion of a patient's bill for  physician and surgeon   emergency physician  services in accordance with the  physician and surgeon' s   emergency physician's  discount payment policy, notwithstanding any contractual provision. 127461. Notwithstanding any other provision of law, the amounts paid by parties for services resulting from reduced or waived charges under  a physician and surgeon's   an emergency physician's  discounted payment policy shall not constitute  a physician and surgeon's   an emergency physician's  uniform, published, prevailing, or customary charges, its usual fees to the general public, or its charges to non-Medi-Cal purchasers under comparable circumstances, and shall not be used to calculate  a physician and surgeon's   an emergency physician's  median non-Medicare or non-Medi-Cal charges, for purposes of any payment limit under the federal Medicare Program, the Medi-Cal program, or any other federal or state-financed health care program. 127462. To the extent that any requirement of this article results in a federal determination that  a physician and surgeon's   an emergency physician's  established charge schedule or published rates are not the physician and surgeon' s customary or prevailing charges for services, the requirement in question shall be inoperative for all  physician and surgeons   emergency physicians  . The State Department of Public Health shall seek federal guidance regarding modifications to the requirement in question. All other requirements of this article shall remain in effect.