Bill Text: CA AB3275 | 2023-2024 | Regular Session | Amended
Bill Title: Health care coverage: claim reimbursement.
Spectrum: Partisan Bill (Democrat 3-0)
Status: (Introduced) 2024-04-22 - Re-referred to Com. on APPR. [AB3275 Detail]
Download: California-2023-AB3275-Amended.html
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Amended
IN
Assembly
April 18, 2024 |
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Amended
IN
Assembly
April 01, 2024 |
CALIFORNIA LEGISLATURE—
2023–2024 REGULAR SESSION
Assembly Bill
No. 3275
| Introduced by Assembly Members Soria and Robert Rivas (Coauthor: Assembly Member Aguiar-Curry) |
February 16, 2024 |
An act to amend Sections 1371 and 1371.35 of the Health and Safety Code, and to amend Section 10123.13 of the Insurance Code, relating to health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
AB 3275, as amended, Soria.
Health care coverage: claim reimbursement.
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 a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health insurer or health care service plan, including a specialized health care service plan, to reimburse a claim or portion of a claim no later than 30 working days after receipt of the claim, unless the plan contests or denies the claim, in which case the plan is required to notify the claimant within 30 working days that the claim is contested or denied. Under existing law, if a claim or portion thereof is contested on the basis that a health insurer or health care service plan has not received all information necessary to determine payer
liability for the claim or portion thereof and notice has been provided, the health insurer or health care service plan has 30 working days after receipt of the additional information to complete reconsideration of the claim. Existing law extends these timelines to 45 working days for a health care service plan that is a health maintenance organization. Under existing law, if a claim is not reimbursed, contested, or denied pursuant to these timelines, as specified, interest accrues at a rate of 15% per annum for a health care service plan and 10% per annum for a health insurer.
This bill would increase that interest accrual rate for a health insurer to 15% per annum. The bill, notwithstanding the above-described timelines, would require a health care service plan or health insurer to reimburse a claim for a small and rural provider, critical access provider, or distressed provider within 10 business days after receipt of the claim, or, if the health care service
plan or health insurer contests or denies the claim, to notify the claimant within 5 business days that the claim is contested or denied. Under the bill, if a claim for reimbursement to a small and rural provider, critical access provider, or distressed provider is contested on the basis that the health care service plan or health insurer has not received all information necessary to determine payer liability for the claim and notice has been provided, the health care service plan or health insurer would have 15 business days after receipt of the additional information to complete reconsideration of the claim. Under the bill, if a claim is not reimbursed, contested, or denied pursuant to these timelines, as specified, interest would accrue at a rate of 15% per annum for health care service plans and health insurers. The bill would require the departments to develop respective lists for categories of claims that
that, commencing January 1, 2026, would be required to be paid by a health insurer or health care service plan to a small and rural provider, critical access provider, or distressed provider no later than 5 days after receipt of the claim, as specified.
Existing law requires a health care service plan to automatically include in its payment of a claim all interest that has accrued, as specified.
This bill would also require a health insurer to automatically include all interest accrued in its payment of a claim.
Existing law requires a health care service plan that fails to comply with the requirement to include all interest in its payment of a claim to pay the claimant a $10 fee.
This bill would instead require a health insurer or health care service plan that fails to comply with that requirement to
pay the claimant a fee of no less than 10% of the interest accrued.
Because a willful violation of these provisions by a health care service plan would be a crime, the 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.
Digest Key
Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YESBill Text
The people of the State of California do enact as follows:
SECTION 1.
Section 1371 of the Health and Safety Code is amended to read:1371.
(a) (1) (A) A health care service plan, including a specialized health care service plan, shall reimburse claims or a portion of a claim, whether in state or out of state, as soon as practicable, but no later than 30 working days after receipt of the claim by the health care service plan, or if the health care service plan is a health maintenance organization, 45 working days after receipt of the claim by the health care service plan, unless the claim or portion thereof is contested by the plan, in which case the claimant shall be notified, in writing, that the claim is contested or denied, within 30 working days after receipt of the claim by the health care service plan, or if the health care service plan is a health maintenance organization, 45 working days after receipt of the claim by the health care service plan.(B) Notwithstanding subparagraph (A), a health care service plan, including a specialized health care service plan, shall reimburse a claim or portion of a claim for a small and rural provider, critical access provider, or distressed provider within 10 business days, unless the claim or portion thereof is contested by the plan, in which case the claimant shall be notified that the claim is contested, in writing or via electronic means, within five 5 business days after receipt of the claim by the health care service plan.
(C) The notice that a claim is being contested shall identify the portion of the claim that is contested and the specific reasons for contesting the claim. A health care service plan shall be responsible for documenting that a provider has received notice of a contested claim.
(2) If an uncontested claim is not reimbursed by delivery to the claimants’ address of record within the
timelines provided in paragraph (1), interest shall accrue at the rate of 15 percent per annum beginning with the first calendar day after the 30- or 45-working-day or 10-business-day period, as applicable. A health care service plan shall automatically include in its payment of the claim all interest that has accrued pursuant to this section without requiring the claimant to submit a request for the interest amount. A plan failing to comply with this requirement shall pay the claimant a fee of no less than 10 percent of the accrued interest.
(3) For the purposes of this section, a claim, or portion thereof, is reasonably contested if the plan has not received the completed claim and all information necessary to determine payer liability for the claim, or has not been granted reasonable access to information concerning provider
services. Information necessary to determine payer liability for the claim includes, but is not limited to, reports of investigations concerning fraud and misrepresentation, and necessary consents, releases, and assignments, a claim on appeal, or other information necessary for the plan to determine the medical necessity for the health care services provided.
(4) (A) If a claim or portion thereof is contested on the basis that the plan has not received all information necessary to determine payer liability for the claim or portion thereof and notice has been provided pursuant to this section, the plan shall have 30 working days or, if the health care service plan is a health maintenance organization, 45 working days after receipt of this additional information to complete reconsideration of the claim. If a plan
has received all of the information necessary to determine payer liability for a contested claim and has not reimbursed a claim it has determined to be payable within 30 working days of the receipt of that information, or if the plan is a health maintenance organization, within 45 working days of receipt of that information, interest shall accrue and be payable at a rate of 15 percent per annum beginning with the first calendar day after the 30- or 45-working-day period.
(B) Notwithstanding subparagraph (A), if a claim or portion thereof for reimbursement to a small and rural provider, critical
access provider, or distressed provider is contested on the basis that the plan has not received all information necessary to determine payer liability for the claim or portion thereof and notice has been provided pursuant to this section, the plan shall have 15 business days after receipt of this additional information to complete reconsideration of the claim. If a plan has received all of the information necessary to determine payer liability for a contested claim and has not reimbursed a claim it has determined to be payable within 10 business days of receipt of that information, interest shall accrue and be payable at a rate of 15 percent per annum beginning with the first calendar day after the 10-business-day period.
(b) Notwithstanding any other law, a specialized health care service plan that undertakes solely to arrange
for the provision of vision care services may use a statistically reliable method to
investigate suspected fraud and to recover overpayments made as a result of fraud only if the specialized health care service plan complies with this subdivision.
(1) A specialized health care service plan’s statistically reliable method, and how the specialized health care service plan intends to utilize that method to determine recovery of overpayments made as a result of fraud, shall be submitted to, and approved by, the department as elements of the specialized health care service plan’s antifraud plan established and approved pursuant to Section 1348. The specialized health care service plan’s utilization of a statistically reliable method shall help protect and promote the interests of enrollees and shall help ensure a stable health care delivery system. The statistically reliable method shall be consistent with
direction provided by the International Standards for the Professional Practice of Internal Auditing and the guidance provided by the International Professional Practices Framework guide, which are both produced by the Institute of Internal Auditors.
(2) Pursuant to its antifraud plan established and approved pursuant to Section 1348, a specialized health care service plan shall provide a written notice of suspected fraud to a provider that includes, at a minimum, all of the following:
(A) A clear description of the specialized health care service plan’s statistically reliable methodology. The description shall include information that ensures that the sample size used to calculate the repayment amount is consistent with the professional guidance provided in the 2009 edition
of the American Institute of Certified Public Accountants’ Audit Sampling Considerations of Circular A-133 Compliance Audits.
(B) A clear description of the universe of claims from which the statistical random sample was drawn and, if different, the universe of claims upon which the statistical analysis was applied to generate the recovery amount.
(C) A clear explanation of how the specialized health care service plan’s statistically reliable methodology was utilized in the specialized health care service plan’s findings of suspected fraud.
(D) Notice that a provider may dispute the specialized health care service plan’s findings within 45 working days from the date of receipt of the notice of suspected fraud.
(E) The following information for each of the claims in the statistical sample that was utilized in the specialized health care service plan’s findings:
(i) The claim number.
(ii) The name of the patient.
(iii) The date of service.
(iv) The date of payment.
(v) A clear explanation of the basis upon which the specialized health care service plan suspects the claim is fraudulent.
(3) A specialized health care service plan that undertakes solely to arrange for the provision of
vision care services may use a statistically reliable method to recover overpayments made as a result of suspected fraud only if the universe of claims upon which the statistical analysis is performed consists only of those claims made between 365 days from the date of payment of the earliest in time claim and the date of payment of the latest in time claim. Notice shall be mailed to the provider no later than 60 days following the date of payment of the latest in time claim.
(4) If the provider contests the specialized health care service plan’s notice of suspected fraud, the provider, within 45 working days of the date of receipt of the notice of suspected fraud, shall send written notice to the specialized health care service plan stating the basis upon which the provider believes that the claims are not fraudulent. The specialized
health care service plan shall receive and process this contested notice of suspected fraud as a provider dispute pursuant to subdivision (a) of this section, paragraph (1) of subdivision (h) of Section 1367, and the regulations promulgated thereunder.
(5) A specialized health care service plan may offset the amount the specialized health care service plan disclosed as overpaid to the provider in an uncontested notice of suspected fraud against the provider’s current claim submissions only if all of the following requirements are met:
(A) The provider fails to reimburse the specialized health care service plan within 45 working days from the date of receipt by the provider of the notice of suspected fraud.
(B) The
specialized health care service plan sends written notice to the provider no less than 10 working days prior to withholding current claim payments in which the specialized health care service plan, at a minimum, states its intent to withhold current claim payments and identifies the claim payments that the specialized health care service plan intends to withhold.
(C) The withheld claim payments do not exceed the amount asserted by the specialized health care service plan to be owed to the specialized health care service plan in its notice of suspected fraud.
(6) This section does not limit or remove a specialized health care service plan’s obligation to comply with its antifraud plan established pursuant to Section 1348, or to limit or remove the specialized health care service
plan’s obligation to comply with the requirements for claims subject to subdivision (a).
(7) This subdivision does not limit or remove a specialized health care service plan’s ability to recover overpayments as long as recovery is consistent with applicable law, including subdivision (a) and the regulations promulgated thereunder.
(8) This subdivision does not apply to claims submitted by a physician and surgeon for medical or surgical services that are outside the scope of practice of an optometrist pursuant to the Optometry Practice Act (Chapter 7 (commencing with Section 3000) of Division 2 of the Business and Professions Code).
(c) The obligation of a plan to comply with this section shall not be deemed to be waived
when the plan requires its medical groups, independent practice associations, or other contracting entities to pay claims for covered services.
(d) The department shall develop a list of categories of claims that that, commencing January 1, 2026, shall be paid by a health care service plan to a small and rural provider, critical access provider, or distressed provider no later than five days after receipt of the claim, so long as the provider can document that care was provided. Categories may include, but are not limited to, emergency care levels 1 and 2, uncomplicated labor and delivery, or skilled nursing facility care provided in a swing bed.
(e) To facilitate compliance with this section, a health care service plan shall maintain a registry of small and rural providers, critical access providers, and distressed providers. The registry shall be available to the department for verification and to providers to determine if they qualify for shorter reimbursement timeframes. No action shall be required on the part of the provider in order to qualify for shorter reimbursement timeframes.
(f) For purposes of this section and Section 1371.35, the following definitions apply:
(1) “Critical access provider” means a hospital that is certified as a critical access hospital by the Secretary of the United States Department of Health and Human Services under the federal Medicare
Rural Hospital Flexibility Program. A critical access provider includes a physician with privileges at a critical access hospital.
(2) “Distressed provider” means a hospital that meets the standards established by the Department of Health Care Access and Information for a hospital in financial distress under the Distressed Hospital Loan Program (Chapter 4 (commencing with Section 129380) of Part 6 of Division 107) and for one year after the department has determined that the hospital no longer meets the standards for a hospital in financial distress. A distressed provider includes a physician with privileges at a hospital as described in this paragraph.
(3) “Small and rural
provider” means a small and rural hospital, as defined in Section 124840. A small and rural provider includes a physician with privileges at a small and rural hospital.
(g) This section applies to Medi-Cal managed care plans. “Medi-Cal managed care plan” has the same meaning as defined in subdivision (j) of Section 14184.101 of the Welfare and Institutions Code.
SEC. 2.
Section 1371.35 of the Health and Safety Code is amended to read:1371.35.
(a) (1) A health care service plan, including a specialized health care service plan, shall reimburse each complete claim, or portion thereof, whether in state or out of state, as soon as practical, but no later than 30 working days after receipt of the complete claim by the health care service plan, or if the health care service plan is a health maintenance organization, 45 working days after receipt of the complete claim by the health care service plan.(2) However, a plan may contest or deny a claim, or portion thereof, by notifying the claimant, in writing, that the claim is contested or denied, within 30 working days after receipt of
the claim by the health care service plan, or if the health care service plan is a health maintenance organization, 45 working days after receipt of the claim by the health care service plan. The notice that a claim, or portion thereof, is contested shall identify the portion of the claim that is contested, by revenue code, and the specific information needed from the provider to reconsider the claim.
(3) Notwithstanding paragraphs (1) and (2), a health care service plan, including a specialized health care service plan, shall reimburse an uncontested claim or uncontested portion of a claim for a small and rural provider, critical access provider, or distressed provider within 10 business days. A health care service plan shall provide notice that a claim is contested in writing or via electronic means within five business days.
(4) The notice that a claim, or portion thereof, is denied shall identify the portion of the claim that is denied, by revenue code, and the specific reasons for the denial. A plan may delay payment of an uncontested portion of a complete claim for reconsideration of a contested portion of that claim so long as the plan pays those
charges specified in subdivision (b). A health care service plan shall be responsible for documenting that a provider has received notice of a contested claim.
(b) If a complete claim, or portion thereof, that is neither contested nor denied, is not reimbursed by delivery to the claimant’s address of record within the respective 30 or 45 working days or 10 business days after receipt, the plan shall pay interest at the rate of 15 percent per annum beginning with the first calendar day after the 30- or 45-working-day or 10-business-day period. A health care service plan shall automatically include all interest that has accrued pursuant to this section in the payment made to the claimant, without requiring a request therefor. A plan failing to comply with this requirement shall pay the claimant a fee of no less than 10
percent of the accrued interest.
(c) For the purposes of this section, a claim, or portion thereof, is reasonably contested if the plan has not received the completed claim. A paper claim from an institutional provider shall be deemed complete upon submission of a legible emergency department report and a completed UB 92 or other format adopted by the National Uniform Billing Committee, and reasonable relevant information requested by the plan within 30 working days of receipt of the claim. An electronic claim from an institutional provider shall be deemed complete upon submission of an electronic equivalent to the UB 92 or other format adopted by the National Uniform Billing Committee, and reasonable relevant information requested by the plan within 30 working days of receipt of the claim. However, if the plan requests a copy of the emergency
department report within the 30 working days after receipt of the electronic claim from the institutional provider, the plan may also request additional reasonable relevant information within 30 working days of receipt of the emergency department report, at which time the claim shall be deemed complete. A claim from a professional provider shall be deemed complete upon submission of a completed HCFA 1500 or its electronic equivalent or other format adopted by the National Uniform Billing Committee, and reasonable relevant information requested by the plan within 30 working days of receipt of the claim. The provider shall provide the plan reasonable relevant information within 10 working days of receipt of a written request that is clear and specific regarding the information sought. If, as a result of reviewing the reasonable relevant information, the plan requires further information, the plan
shall have an additional 15 working days after receipt of the reasonable relevant information to request the further information, notwithstanding any time limit to the contrary in this section, at which time the claim shall be deemed complete.
(d) This section shall not apply to claims about which there is evidence of fraud and misrepresentation, to eligibility determinations, or in instances where the plan has not been granted reasonable access to information under the provider’s control. A plan shall specify, in a written notice sent to the provider within the respective 30 or 45 working days or 10 business days of receipt of the claim, which, if any, of these exceptions applies to a claim.
(e) (1) If a claim or portion thereof is contested on the basis that
the plan has not received information reasonably necessary to determine payer liability for the claim or portion thereof, then the plan shall have 30 working days or, if the health care service plan is a health maintenance organization, 45 working days after receipt of this additional information to complete reconsideration of the claim.
(2) Notwithstanding paragraph (1), if a claim or portion thereof for reimbursement to a small and rural provider, critical access provider, or distressed provider is contested on the basis that the plan has not received information reasonably necessary to determine payer liability for the claim or portion thereof, the plan shall have 15 business days after receipt of this additional information to complete reconsideration of the claim.
(3) If a
claim, or portion thereof, undergoing reconsideration is not reimbursed by delivery to the claimant’s address of record within the respective 30 or 45 working days or 15 business days after receipt of the additional information, the plan shall pay
interest at the rate of 15 percent per annum beginning with the first calendar day after the 30- or 45-working-day or 15-business-day period. A health care service plan shall automatically include the interest due in the payment made to the claimant, without requiring a request therefor.
(f) The obligation of the plan to comply with this section shall not be deemed to be waived when the plan requires its medical groups, independent practice associations, or other contracting entities to pay claims for covered services. This section shall not be construed to prevent a plan from assigning, by a written contract, the responsibility to pay interest and late charges pursuant to this section to medical groups, independent practice associations, or other entities.
(g) A plan shall not delay payment on a claim from a physician or other provider to await the submission of a claim from a hospital or other provider, without citing specific rationale as to why the delay was necessary and providing a monthly update regarding the status of the claim and the plan’s actions to resolve the claim, to the provider that submitted the claim.
(h) A health care service plan shall not request or require that a provider waive its rights pursuant to this section.
(i) This section shall not apply to capitated payments.
(j) This section shall apply only to claims for services rendered to a patient who was provided emergency services and care as defined in Section 1317.1 in the United States on or after September
1, 1999.
(k) This section shall not be construed to affect the rights or obligations of any person pursuant to Section 1371.
(l) This section shall not be construed to affect a written agreement, if any, of a provider to submit bills within a specified time period.
(m) The department shall develop a list of categories of claims that that, commencing January 1, 2026, shall be paid by a health care service plan to a small and rural provider, critical access provider, or distressed provider no later than five days after receipt of the claim, so
long as the provider can document that care was provided. Categories may include, but are not limited to, emergency care levels 1 and 2, uncomplicated labor and delivery, or skilled nursing facility care provided in a swing bed.
(n) To facilitate compliance with this section, a health care service plan shall maintain a registry of small and rural providers, critical access providers, and distressed providers. The registry shall be available to the department for verification and to providers to determine if they qualify for shorter reimbursement timeframes. No action shall be required on the part of the provider in order to qualify for shorter reimbursement timeframes.
(o) This section applies to Medi-Cal managed care plans. “Medi-Cal managed care plan” has the same meaning as
defined in subdivision (j) of Section 14184.101 of the Welfare and Institutions Code.
SEC. 3.
Section 10123.13 of the Insurance Code is amended to read:10123.13.
(a) (1) Every insurer issuing group or individual policies of health insurance that covers hospital, medical, or surgical expenses, including those telehealth services covered by the insurer as defined in subdivision (a) of Section 2290.5 of the Business and Professions Code, shall reimburse claims or any portion of any claim, whether in state or out of state, for those expenses as soon as practical, but no later than 30 working days after receipt of the claim by the insurer unless the claim or portion thereof is contested by the insurer, in which case the claimant shall be notified, in writing, that the claim is contested or denied, within 30 working days after receipt of the claim by the insurer.(2) Notwithstanding paragraph (1), an insurer shall reimburse a claim or any portion of any claim for a small and rural provider, critical access provider, or distressed provider for those expenses as soon as practical, but no later than 10 business days after receipt of the claim by the insurer unless the claim or portion thereof is contested by the insurer, in which case the claimant shall be notified, in writing, that the claim is contested or denied, within five 5 business days after receipt of the claim by the insurer.
(3) The notice that a claim is being contested or denied shall identify the portion of
the claim that is contested or denied and the specific reasons including for each reason the factual and legal basis known at that time by the insurer for contesting or denying the claim. If the reason is based solely on facts or solely on law, the insurer is required to provide only the factual or the legal basis for its reason for contesting or denying the claim. The insurer shall provide a copy of the notice to each insured who received services pursuant to the claim that was contested or denied and to the insured’s health care provider that provided the services at issue. The notice shall advise the provider who submitted the claim on behalf of the insured or pursuant to a contract for alternative rates of payment and the insured that either may seek review by the department of a claim that the insurer contested or denied, and the notice shall include the address, internet website address, and
telephone number of the unit within the department that performs this review function. The notice to the provider may be included on either the explanation of benefits or remittance advice and shall also contain a statement advising the provider of its right to enter into the dispute resolution process described in Section 10123.137. The notice to the insured may also be included on the explanation of benefits. An insurer shall be responsible for documenting that a provider has received notice of a contested claim.
(b) (1) If an uncontested claim is not reimbursed by delivery to the claimant’s address of record within 30 working days after
receipt, interest shall accrue and shall be payable at the rate of 15 percent per annum beginning with the first calendar day after the 30-working day 30-working-day period.
(2) Notwithstanding paragraph (1), if an uncontested claim for a small and rural provider, critical access provider, or distressed provider is not reimbursed by delivery to the claimant’s address of record within 10 business days after receipt, interest shall accrue and shall be payable at the rate of 15 percent per annum beginning with the first calendar day after the 10-business-day period.
(3) An insurer shall automatically include
in its payment of the claim all interest that has accrued pursuant to this section without requiring the claimant to submit a request for the interest amount. An insurer failing to comply with this requirement shall pay the claimant a fee of no less than 10 percent of the accrued interest.
(c) (1) For purposes of this section, a claim, or portion thereof, is reasonably contested when the insurer has not received a completed claim and all information necessary to determine payer liability for the claim, or has not been granted reasonable access to information concerning provider services. Information necessary to determine liability for the claims includes, but is not limited to, reports of investigations concerning fraud and misrepresentation, and necessary consents, releases, and assignments, a claim on appeal, or other
information necessary for the insurer to determine the medical necessity for the health care services provided to the claimant.
(2) (A) If an insurer has received all of the information necessary to determine payer liability for a contested claim and has not reimbursed a claim determined to be payable within 30 working days of receipt of that information, interest shall accrue and be payable at a rate of 15 percent per annum beginning with the first calendar day after the 30-working day 30-working-day period.
(B) If an insurer has received all of the information necessary to determine payer
liability for a contested claim for a small and rural hospital, critical access hospital, or distressed hospital and has not reimbursed a claim determined to be payable within 15 business days of receipt of that information, interest shall accrue and be payable at a rate of 15 percent per annum beginning with the first calendar day after the 15-business-day period.
(d) The obligation of the insurer to comply with this section shall not be deemed to be waived when the insurer requires its contracting entities to pay claims for covered services.
(e) The department shall develop a list of categories of claims that that, commencing
January 1, 2026, shall be paid by an insurer to a small and rural provider, critical access provider, or distressed provider no later than five days after receipt of the claim, so long as the provider can document that care was provided. Categories may include, but are not limited to, emergency care levels 1 and 2, uncomplicated labor and delivery, or skilled nursing facility care provided in a swing bed.
(f) To facilitate compliance with this section, an insurer shall maintain a registry of small and rural providers, critical access providers, and distressed providers. The registry shall be available to the department for verification and to providers to determine if they qualify for shorter reimbursement timeframes. No action shall be required on the part of the provider in order to qualify for shorter reimbursement
timeframes.
(g) For purposes of this section, the following definitions apply:
(1) “Critical access provider” means a hospital that is certified as a critical access hospital by the Secretary of the United States Department of Health and Human Services under the federal Medicare Rural Hospital Flexibility Program. A critical access provider includes a physician with privileges at a critical access hospital.
(2) “Distressed provider” means a hospital that meets the standards established by the Department of Health Care Access and Information for a hospital in financial distress under the Distressed Hospital Loan Program
(Chapter 4 (commencing with Section 129380) of Part 6 of Division 107 of the Health and Safety Code) and for one year after the department has determined that the hospital no longer meets the standards for a hospital in financial distress. A distressed provider includes a physician with privileges at a hospital as described in this paragraph.
(3) “Small and rural provider” means a small and rural hospital, as defined in Section 124840 of the Health and Safety Code. A small and rural provider includes a physician with privileges at a small and rural hospital.
