Today's Law As Amended


Bill PDF |Add To My Favorites | print page

AB-676 Health care coverage: postdischarge care needs.(2013-2014)



As Amends the Law Today


SECTION 1.

 Section 1367.52 is added to the Health and Safety Code, to read:

1367.52.
 (a) A health care service plan that provides coverage for inpatient hospital care shall not cause an enrollee to remain in a health facility licensed under subdivision (a) or (b) of Section 1250, if the attending physician on the medical staff has determined that the enrollee no longer requires inpatient hospital care. Within 24 hours of receipt of notice of discharge, the health care service plan shall be in direct communication with hospital staff to provide information, support, and assistance to facilitate the ability of hospital personnel to do all of the following:
(1) Locate and secure an appropriate community setting for the enrollee that is consistent with postdischarge care needs.
(2) Ensure there is an appropriate arrangement to transfer the enrollee to the community setting.
(3) Follow up with the enrollee or his or her designee to coordinate postdischarge care needs.
(b) Failure of the health care service plan to satisfy the requirements of subdivision (a) within 72 hours of receipt of the notice of discharge shall result in a daily penalty amount equal to 75 percent of the applicable inpatient rate, or pro rata calculated rate if case based, or the diagnosis-related group rate. The penalty shall be paid by the health care service plan to the health facility under the standard billing cycle, and final payment of the penalty shall be paid within 10 days of the enrollee’s discharge.

SEC. 2.

 Section 10117.6 is added to the Insurance Code, to read:

10117.6.
 (a) A health insurer that provides coverage for inpatient hospital care shall not cause an insured to remain in a health facility licensed under subdivision (a) or (b) of Section 1250 of the Health and Safety Code, if the attending physician on the medical staff has determined that the insured no longer requires inpatient hospital care. Within 24 hours of receipt of notice of discharge, the health insurer shall be in direct communication with hospital staff to provide information, support, and assistance to facilitate the ability of hospital personnel to do all of the following:
(1) Locate and secure an appropriate community setting for the insured that is consistent with postdischarge care needs.
(2) Ensure there is an appropriate arrangement to transfer the insured to the community setting.
(3) Follow up with the insured or his or her designee to coordinate postdischarge care needs.
(b) Failure of the health insurer to satisfy the requirements of subdivision (a) within 72 hours of receipt of the notice of discharge shall result in a daily penalty amount equal to 75 percent of the applicable inpatient rate, or pro rata calculated rate if case based, or the diagnosis-related group rate. The penalty shall be paid by the health insurer to the health facility under the standard billing cycle, and final payment of the penalty shall be paid within 10 days of the insured’s discharge.

SEC. 3.

 Section 14109.7 is added to the Welfare and Institutions Code, to read:

14109.7.
 (a) The department, or the Medi-Cal managed care plan, if applicable, shall not cause a Medi-Cal beneficiary to remain in a health facility licensed under subdivision (a) or (b) of Section 1250 of the Health and Safety Code, if the attending physician on the medical staff has determined that the beneficiary no longer requires inpatient hospital care. Within 24 hours of receipt of notice of discharge, the department or the Medi-Cal managed care plan shall be in direct communication with hospital staff to provide information, support, and assistance to facilitate the ability of hospital personnel to do all of the following:
(1) Locate and secure an appropriate community setting for the beneficiary that is consistent with postdischarge care needs.
(2) Ensure there is an appropriate arrangement to transfer the beneficiary to the community setting.
(3) Follow up with the beneficiary or his or her designee to coordinate postdischarge care needs.
(b) Failure of the department or the Medi-Cal managed care plan to satisfy the requirements of subdivision (a) within 72 hours of receipt of the notice of discharge shall result in a daily penalty amount equal to 75 percent of the applicable inpatient rate, or pro rata calculated rate if case based, or the diagnosis-related group rate. The penalty shall be paid by the department or the Medi-Cal managed care plan to the health facility under the standard billing cycle, and final payment of the penalty shall be paid within 10 days of the beneficiary’s discharge.
SEC. 4.
 No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.