Hospital pricing.

Plain English Breakdown

The bill summary text does not provide specific details on the consequences for patients who do not meet eligibility criteria or how hospitals should handle opt-out requests.

Hospital Pricing Rules

This law requires hospitals to screen patients for eligibility based on certain criteria and provides them with discounted payments or charity care if they qualify, starting July 1, 2027.

What This Bill Does

• Requires hospitals to check if a patient is eligible for discounts or free care starting July 1, 2027.
• If a patient gets CalFresh or CalWORKs benefits, the hospital will assume they are eligible for help with costs.
• Hospitals cannot make patients apply for Medicare or Medi-Cal before checking their eligibility for discounted payments.
• Patients can choose not to be screened by filling out a form.
• Hospitals must give written notice about discounts and free care options to those who qualify.

Who It Names or Affects

• People going to hospitals
• Hospital staff

Terms To Know

Charity Care

Free or low-cost medical care given by a hospital to people who cannot pay for it.

Discount Payment Policy

A plan that hospitals use to offer lower costs to patients based on their financial situation.

Limits and Unknowns

• The law does not specify what happens if a patient is not eligible for discounts or charity care.
• It's unclear how much the hospital will charge people who do not qualify for help with costs.
• The bill doesn't explain how hospitals should handle patients who opt out of screening.

Official Summary Text

AB 1312, Schiavo.
Hospital pricing.
Existing law requires a hospital to provide patients with a written notice containing information about the availability of the hospital’s discount payment and charity care policies, including information about eligibility and the contact information for a hospital employee or office from which a person may obtain further information about these policies. Existing law defines “charity care” and “discount payment” for these purposes. Existing law requires a hospital to provide to the Department of Health Care Access and Information a copy of its discount payment policy, charity care policy, eligibility procedures for those policies, review process, and the application for charity care or discounted payment programs, among other information. A violation of these provisions results in an administrative penalty, as specified.
This bill would,
commencing July 1, 2027, require a hospital to screen a patient to determine if they meet specific criteria, including that the patient is enrolled in CalFresh or CalWORKs, and, if they do, presumptively determine that a patient is eligible for participation under the hospital’s charity care policy and discount payment policy. The bill would require a hospital to screen a patient for eligibility if the patient meets other specified criteria, including, among others, that the patient is uninsured. The bill would prohibit a hospital from requiring a patient to apply for the federal Medicare program, the Medi-Cal program, or other coverage before the patient is screened for or provided with discounted payment, as specified. The bill would require a hospital to provide patients with the ability to opt out of the screening process through a specified form. The bill would authorize a hospital, at its discretion or as established in its charity care policy or discount payment policy, to make presumptive
determinations of eligibility or to conduct screening for patients that do not meet the criteria described above. The bill would authorize certain procedures and tools for screening, including, among others, allowing a hospital to use third-party software tools or services or to contract with a third party under specified conditions. The bill would require a hospital to provide a specified written notice to those patients determined to be eligible, presumptively or otherwise, under these provisions and would prohibit any billing statements from being sent prior to the written notice. The bill would require the billing statements to reflect the adjustments made to the patient’s hospital charges under the hospital’s charity care policy or discount payment policy.

Current Bill Text

Download Bill PDF