Bill Text: CA AB658 | 2015-2016 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: County jails: inmate health care services: rates.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Passed) 2015-07-16 - Chaptered by Secretary of State - Chapter 119, Statutes of 2015. [AB658 Detail]

Download: California-2015-AB658-Amended.html

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BILL NUMBER: AB 658	AMENDED
	BILL TEXT

	AMENDED IN SENATE  JUNE 19, 2015
	AMENDED IN ASSEMBLY  MAY 5, 2015

INTRODUCED BY   Assembly Member Wilk

                        FEBRUARY 24, 2015

   An act to amend Section 4011.10 of the Penal Code, relating to
health care.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 658, as amended, Wilk. County jails: inmate health care
services: rates.
   Existing federal law provides for the federal Medicare Program,
which is a public health insurance program for persons 65 years of
age and older and specified persons with disabilities who are under
65 years of age.
   Existing law authorizes a county sheriff, police chief, or other
public agency that contracts for health care services, to contract
with providers of health care services for care to local law
enforcement patients. Existing law requires hospitals that do not
contract with the county sheriff, police chief, or other public
agency that contracts for health care services to provide health care
services to local law enforcement patients at a rate equal to 110%
of the hospital's actual costs according to the most recent Hospital
Annual Financial Data report issued by the Office of Statewide Health
Planning and Development, as calculated using a cost-to-charge
ratio.
   This bill would authorize, for claims that have not previously
been paid or  adjudicated   otherwise determined
 by local law enforcement, those costs to be calculated
according to the most recent approved cost-to-charge ratio from the
Medicare Program. The bill would authorize the hospital, with the
approval of the county sheriff, police chief, or other public agency
that contracts or is responsible for providing health care services
to local law enforcement patients, to choose which cost-to-charge
ratio is most appropriate, and would require the hospital to give
notice of any change. If the hospital chooses to use the
cost-to-charge ratio from the Medicare Program, the bill would
require the hospital to attach supporting Medicare documentation and
an expected payment calculation to the claim. If a claim does not
contain that documentation and payment calculation, or if, within 60
days of the hospital's request for approval to use the cost-to-charge
ratio from the Medicare Program, approval is not granted by the
county sheriff, police chief, or other public agency that contracts
or is responsible for providing health care services to local law
enforcement patients, the bill would require the Office of Statewide
Health Planning and Development cost-to-charge ratio to be used to
calculate the payment. The bill would also make technical,
nonsubstantive changes.
   Vote: majority. Appropriation: no. Fiscal committee: no.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 4011.10 of the Penal Code is amended to read:
   4011.10.  (a) It is the intent of the Legislature in enacting this
section to provide county sheriffs, chiefs of police, and directors
or administrators of local detention facilities with an incentive to
not engage in practices designed to avoid payment of legitimate
health care costs for the treatment or examination of persons
lawfully in their custody, and to promptly pay those costs as
requested by the provider of services. Further, it is the intent of
the Legislature to encourage county sheriffs, chiefs of police, and
directors or administrators of local detention facilities to bargain
in good faith when negotiating a service contract with hospitals
providing health care services.
   (b) Notwithstanding any other law, a county sheriff, police chief,
or other public agency that contracts for health care services, may
contract with providers of health care services for care to local law
enforcement patients. Hospitals that do not contract  for health
care services  with the county sheriff, police chief, or other
public agency  that contracts for health care services
 shall provide health care services to local law enforcement
patients at a rate equal to 110 percent of the hospital's actual
costs according to the most recent Hospital Annual Financial Data
report issued by the Office of Statewide Health Planning and
Development, as calculated using a cost-to-charge ratio, or, for
claims that have not previously been paid or otherwise determined by
local law enforcement, according to the most  recent
  recently  approved cost-to-charge ratio from the
Medicare Program. The hospital, with the approval of the county
sheriff, police chief, or other public agency  that contracts
or is  responsible for providing health care services to
local law enforcement patients, may choose the most appropriate
cost-to-charge ratio and shall provide notice to the county sheriff,
police chief, or other public agency, as applicable, of any change.
If the hospital uses the cost-to-charge ratio from the Medicare
Program, the hospital shall attach supporting Medicare documentation
and an expected payment calculation to the claim. If a claim does not
contain the supporting Medicare documentation and expected payment
calculation, or if, within 60 days of the hospital's request for
approval to use the cost-to-charge ratio from the Medicare Program,
approval is not granted by the county sheriff, police chief, or other
public agency  that contracts or is  responsible
for providing health care services to local law enforcement patients,
the Office of Statewide Health Planning and Development
cost-to-charge ratio shall be used to calculate the payment.
   (c) A county sheriff or police chief shall not request the release
of an inmate from custody for the purpose of allowing the inmate to
seek medical care at a hospital, and then immediately rearrest the
same individual upon discharge from the hospital, unless the hospital
determines this action would enable it to bill and collect from a
third-party payment source.
   (d) The California Hospital Association, the University of
California, the California State Sheriffs' Association, and the
California Police Chiefs Association shall, immediately upon
enactment of this section, convene the Inmate Health Care and Medical
Provider Fair Pricing Working Group. The working group shall consist
of at least six members from the California Hospital Association and
the University of California, and six members from the California
State Sheriffs' Association and the California Police Chiefs
Association. Each organization should give great weight and
consideration to appointing members of the working group with diverse
geographic and demographic interests. The working group shall meet
as needed to identify and resolve industry issues that create fiscal
barriers to timely and affordable inmate health care. In addition,
the working group shall address  issues  
issues,  including, but not limited to, inmates being admitted
for care and later rearrested and any other fiscal barriers to
hospitals being able to enter into fair market contracts with public
agencies. To the extent that the rate provisions of this statute
result in a disproportionate share of local law enforcement patients
being treated at any one hospital or system of hospitals, the working
group shall address this issue. No reimbursement is required under
this provision.
   (e) This section does not require or encourage a hospital or
public agency to replace any existing arrangements that any city
police chief, county sheriff, or other public agency that contracts
for health care services for local law enforcement patients has with
health care providers.
   (f) An entity that provides ambulance or any other emergency or
nonemergency response service to a sheriff or police chief, and that
does not contract with their departments for that service, shall be
reimbursed for the service at the rate established by Medicare.
Neither the sheriff nor the police chief shall reimburse a provider
of any of these services that his or her department has not
contracted with at a rate that exceeds the provider's reasonable and
allowable costs, regardless of whether the provider is located within
or outside of California.
   (g) For the purposes of this section, "reasonable and allowable
costs" shall be defined in accordance with Part 413 of Title 42 of
the Code of Federal Regulations and federal Centers for Medicare and
Medicaid Services Publication Numbers 15-1 and 15-2.
   (h) For purposes of this section, in those counties in which the
sheriff does not administer a jail facility, a director or
administrator of a local department of corrections established
pursuant to Section 23013 of the Government Code is the person who
may contract for services provided to jail inmates in the facilities
he or she administers in those counties.