Official Summary Text
AB 225, as amended, Bonta.
State hospitals for persons with mental health disorders: patient funds.
Health care: facility fees.
Existing law establishes the Department of Health Care Access and Information to oversee various aspects of the health care market, including oversight of hospital facilities and community benefit plans. Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act’s requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law provides for the licensure and regulation of general acute care hospitals and clinics by the State Department of Public Health.
This bill would prohibit a health care provider, hospital, or health system from charging, billing, or collecting a facility fee for any outpatient services in specified circumstances, including for health care services furnished via telehealth. The bill would not prohibit the billing of a professional fee. The bill would require the Director of the Department of Health Care Access and Information to impose an administrative penalty pursuant to a specified process for each violation against a health care provider, hospital, or health system that fails to comply with these provisions. The bill would specify that multiple violations identified during the same investigation constitute a single violation for purposes of assessing an administrative penalty. The bill would require a health care provider, hospital, or health system to reimburse the patient or patients any amount actually paid for a prohibited facility fee.
The bill would prohibit a health care service plan or health insurer from reimbursing, paying, or otherwise providing coverage for any prohibited facility fee. The bill would prohibit a plan from including in any contract or provider agreement any term permitting payment of a prohibited facility fee, and would prohibit a plan or insurer from passing through or otherwise shifting the fee to an enrollee or insured. Because a willful violation of these provisions relative to health care service plans would be 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.
Existing law sets forth various functions and duties for the State Department of State Hospitals with respect to the administration of state institutions for the care and treatment of persons with mental health disorders. Existing law authorizes the Director of State Hospitals to deposit funds of patients in trust, as specified. Existing law also authorizes the hospital administrator, with the consent of the patient, to deposit the interest or increment on the funds of the patient in the state hospital in a special fund for each state hospital, designated the “Benefit Fund,” and requires the hospital administrator to be the trustee of the fund.
Existing law authorizes the hospital administrator, with the approval of the Director of State Hospitals, to expend moneys in the fund for the education or entertainment of the patients of the institution.
Existing law requires that the hospital administrator take into consideration the recommendations of representatives of patient government and recommendations submitted by patient groups before expending any moneys in the fund.
This bill would additionally authorize the funds to be expended for the welfare of the patients of the institution. The bill would require the hospital administrator of a state hospital to notify patients, patient governments, and patient groups, in writing, about any newly authorized expenditure options for the benefit fund, when applicable.