California 'Balance Billing' Rules Kick In, But Lawsuits Loom

Mon Nov 17 22:15:29 PST 2008

California
'Balance Billing' Rules Kick In, But Lawsuits Loom

Source: The California Healthline ( http://www.californiahealthline.org
)

Date: October 17, 2008

Although the rules officially changed this week, the dust
has yet to settle on the issue of balance billing in California.

Two lawsuits challenging new state regulations keep the
issue alive in the courts, even as state regulators begin to enforce new rules
banning the practice of balance billing for emergency care. Under new state
regulations that took effect Wednesday, patients can no longer be billed when
emergency department physicians or hospitals say they’ve been underpaid by
patients' insurers.

The California Medical Association, along with other groups,
sued the state hoping to prevent the new rules from taking effect. In another
case addressing the issue, the California Supreme Court is scheduled to hear a
lawsuit next month that the state Department of Managed Health Care filed
against Prime Healthcare Services, a Victorville-based hospital chain. 

The department alleges that Prime improperly billed insured
patients for fees that health plans declined to pay.

DMHC Director Cindy Ehnes said she is proceeding with the
rules because of the burden that she says balance billing imposes on consumers.

While the suits make their way through the courts, health
care stakeholders will be reviewing health care measures that Gov. Arnold
Schwarzenegger (R) signed and vetoed this year. 
Here's a look at measures dealing with health care professionals.

Doctors and Nurses

Signed

AB 638 by Assembly members Karen Bass (D-Los Angeles) and Alan Nakanishi (R-Lodi) will
create the California Physician Assistant Loan Assumption Program for physician
assistants who work in underserved areas (Bill Text, 8/14).

Under SB 1729 by Sen. Carole Migden (D-San Francisco), health
care personnel at skilled nursing facilities and other residential care
facilities must complete a training session aimed at preventing discrimination
based on sexual orientation and gender identity (Bill Text, 8/26).

Assembly member Nicole Parra's (D-Bakersfield) AB 994 will
extend a pilot program that provides scholarships for students seeking associate
nursing degrees through 2014.  The
program was due to expire in 2009 (Bill Text, 8/27).

Vetoed

The governor vetoed:

* AB 2220 by Assembly member Dave Jones (D-Sacramento), which
would have permitted emergency physicians, emergency physician groups, health
care service plans or risk-bearing organizations to call for a mediation
process during contract negotiations (Bill Text, 9/5).

* SB 1151 by Sen. Don Perata (D-Oakland), which would have
required hospitals to use lift teams or lift devices for transferring patients
in non-emergency situations (Bill Text, 9/2).

* AB 2443 by Nakanishi, which would have required the
Medical Board of California to create a wellness program for physicians and
surgeons (Bill Text, 8/21).

* AB 547 by Assembly member Fiona Ma (D-San Francisco), which
would have frozen doctors' licensing fees and required the Bureau of State
Audits to review of the California Medical Board's finances (Bill Text, 8/8).

For more information, please visit:

http://www.californiahealthline.org/theweekly.aspx?theweeklydate=10/17/2008

Abid Mogannam &
Brian Potts MD, MBA
Managing Editors, CAL/AAEM News Service
University of California, Irvine

The CAL/AAEM Archives are available at: http://maillists.uci.edu/mailman/public/calaaem/

CAL/AAEM, a nonprofit professional organization for emergency physicians, operates the CAL/AAEM News Service solely as an educational resource for physicians. Dissemination of an article by CAL/AAEM News Service does not imply endorsement, agreement, or recommendation by CAL/AAEM News Service, CAL/AAEM, or AAEM.  

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