California Senate Bill SB266 Amended / Bill

 BILL NUMBER: SB 266AMENDED BILL TEXT AMENDED IN SENATE APRIL 3, 2013 AMENDED IN SENATE MARCH 18, 2013 INTRODUCED BY Senator Lieu FEBRUARY 13, 2013 An act to add Section 687 to the Business and Professions Code, and to add Section 1250.04 to the Health and Safety Code, relating to health care coverage. LEGISLATIVE COUNSEL'S DIGEST SB 266, as amended, Lieu. Health care coverage: out-of-network coverage. Existing law provides for the licensure and regulation of health care practitioners by various healing arts boards within the Department of Consumer Affairs. Existing law also provides for the licensure and regulation of health facilities by the State Department of Public Health. A violation of these provisions is a crime. This bill would prohibit  a health facility or  a provider group  or clinic, as defined,  from  holding itself out as being   stating, verbally or in writing, that it is  within a plan network or a provider network unless all of the individual providers providing services  at the facility or  with the provider group  or clinic  are within the plan network or provider  network, or the provider group acknowledges to the patient in writing or verbally that individual providers within the provider group may be outside the patient's plan network or provider network and the   network. The bill would require a  provider group  recommends   or clinic to recommend  that the patient contact his or her health care service plan or health insurer for information about providers who are within the patient's plan network or provider network. Those provisions would not apply to emergency services and care.  By   This bill would also require a hospital, before providing nonemergency services and care, to provide a specified written notice to the patient stating that individual providers providing services within the hospital may not be in the patient's plan network or provider network, except as specified. By  expanding the scope of a crime, this bill would impose a state-mandated local program. The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that no reimbursement is required by this act for a specified reason. Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. Section 687 is added to the Business and Professions Code, to read: 687. (a)  (1)    A provider group  or   clinic  shall not  hold itself out as being   state, verbally or in writing, that it is  within a  patient's  plan network or  a  provider network unless  one of the following applies:   (1)     All   all  of the individual providers providing services with the provider group  or clinic  are within that plan network or provider network. (2) The  provider group acknowledges to the patient in writing or verbally that individual providers within the provider group may be outside the patient's plan network or provider network and the  provider group  recommends   or clinic shall recommend  that the patient contact his or her health care service plan or health insurer for information about providers who are within the patient's plan network or provider network. (b) For purposes of this section, the following definitions shall apply:  (1) "Hold itself out" means advertise, refer to, use materials to indicate, let itself be known, assume the appearance of, act as if it is by claiming or presenting to accept payments from, or represent itself as continuing to be in.   (1) "Clinic" means a surgical center as defined in paragraph (1) of subdivision (b) of Section 1204 of the Health and Safety Code, an outpatient setting as defined in paragraph (1) of subdivision (b) of Section 1248 of the Health and Safety Code, or an ambulatory surgical center certified to participate in the Medicare Program under Title XVIII of the federal Social Security Act (42 U.S.C. Sec. 1395 et seq.).  (2) "Plan network" means any entity, group of providers, or individual providers contracted with a preferred provider organization plan contract or point-of-service plan contract. (3) "Provider network" means any entity, group of providers, or provider  contacted   contracted  with a preferred provider organization health insurance policy. (4) "Provider group" means a medical group, independent practice association, or any other similar organization. (c) This section shall not apply to emergency services and care. SEC. 2. Section 1250.04 is added to the Health and Safety Code, to read:  1250.04. (a) A health facility shall not hold itself out as being within a plan network or a provider network unless one of the following applies: (1) All of the individual providers providing services within the health facility are within that plan network or provider network.   1250.04.   (a) (1) Prior to providing nonemergency services and care to a patient, a hospital shall provide a written notice to the patient stating that individual providers providing services within the hospital may not be in the patient's plan network or provider network.  (2) The  health facility acknowledges to the patient in writing or verbally that individual providers providing services within the health facility may be outside the patient's plan network or provider network and the health facility recommends   hospital notice shall recommend  that the patient contact his or her health care service plan or health insurer for information about providers who are within the patient's plan network or provider network. (b) For purposes of this section, the following definitions shall apply: (1)  "Health facility"   "Hospital   "  means a  health facility   general acute care hospital  as defined in subdivision (a) of Section 1250.  (2) "Hold itself out" means advertise, refer to, use materials to indicate, let itself be known, assume the appearance of, act as if it is by claiming or presenting to accept payments from, or represent itself as continuing to be in.   (3)   (   2)  "Plan network" means any entity, group of providers, or individual providers contracted with a preferred provider organization plan contract or point-of-service plan contract.  (4) Provider   (3)     "Provider  network" means any entity, group of providers, or provider  contacted   contracted  with a preferred provider organization health insurance policy. (c) This section shall not apply to emergency services and care.  (d) This section shall not apply if all of the providers providing services within the hospital are within the same plan network or provider network as the hospital.  SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.