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AB 1611 - Limits What Hospitals Can Charge for Emergency Care - California Key Vote

Timeline

Issues Related to AB 1611

Stage Details

Legislation - Signed (Executive) -

Title: Limits What Hospitals Can Charge for Emergency Care

Legislation - Bill Passed (Senate) (29-10) - (Key vote)
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Title: Limits What Hospitals Can Charge for Emergency Care

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Vote Smart's Synopsis:

Vote to pass a bill that limits what hospitals can charge for emergency care.

Highlights:

 

  • Requires a hospital to not charge more than the reasonable and customary value of the hospital services or the average contracted rate for the same or similar hospital services in the general geographic region in which the services were rendered (Sec. 1).

  • Defines “average contracted rate” as the average of the contracted commercial rates paid by the health plan or delegated entity for the same or similar emergency services in the geographic location (Sec. 1).

  • Requires a hospital that provides care to a patient to charge that patient no more than the same cost sharing that the patient would be charged from a contracting hospital, and that amount will be referred to as “in-network cost-sharing amount” (Sec. 2).

  • Prohibits an enrollee of an insurer from owing a hospital that provides emergency services more than the in-network cost-sharing amount for services rendered, and the hospital will be provided information on the amount of the in-network cost sharing by the third-party payor (Sec. 2).

  • Defines “reasonable and customary value of the hospital services” as the payment of reasonable and customary value for the health care services rendered based upon statistically credible information that is updated at least annually and takes into consideration all of, but not limited to, the following (Sec. 1):

    • The provider’s training, qualifications, and length of time in practice;

    • The nature of the services provided;

    • The fees usually charged by or paid to the provider, including rates paid by both commercial and governmental payers;

    • Prevailing provider rates charged and paid by both commercial and governmental payers in the general geographic area in which the services were rendered; and 

    • Any unusual circumstances in the case.

  • Defines “in-network cost-sharing amount” as an amount no more than the same cost sharing the insured would pay for the same covered service from a contracting hospital (Sec. 7).

Legislation - Bill Passed (House) (58-13) -

Title: Limits What Hospitals Can Charge for Emergency Care

Legislation - Introduced (Senate) -

Title: Limits What Hospitals Can Charge for Emergency Care

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