Today's Law As Amended


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AB-1038 Health data: rates for health care services: physicians and surgeons.(2019-2020)



As Amends the Law Today


SECTION 1.

 Chapter 4 (commencing with Section 128900) is added to Part 5 of Division 107 of the Health and Safety Code, to read:

CHAPTER  4. Rates for Health Care Services
128900.
 (a) The Legislature finds and declares that negotiated rates for services provided by physicians and surgeons are not publicly available, impeding the ability of the payers of health care services to determine the price of care and the oversight of the Legislature of health care costs.
(b) It is the intent of the Legislature in enacting this chapter to provide transparency of pricing information for services provided by physicians and surgeons in order to allow payers of health care services to determine the price of care.
128901.
 As used in this chapter, “office” means the Office of Statewide Health Planning and Development.
128902.
 (a) The Medical Board of California shall provide to the office no less than annually a comprehensive list of all physicians and surgeons licensed in California, including the following information:
(1) Name.
(2) Address and contact information.
(3) Specialty.
(4) Certificate number.
(5) Other information as may be required by the office to determine whether a physician and surgeon is subject to this chapter.
(b) A physician and surgeon licensed by the Medical Board of California under the Medical Practice Act (Chapter 5 (commencing with Section 2000) of Division 2 of the Business and Professions Code) shall provide to the office, in a manner and format specified by the office, the following data:
(1) The negotiated rate for each service for each health care service plan or insurer with which the physician and surgeon has a contract.
(2) The charge for each service provided by the physician and surgeon.
(3) If the physician and surgeon is a member of a risk-bearing organization, independent practice association, or other organized medical group, the group may provide this data if the office can determine from the provided data the negotiated rate for each service for each physician and surgeon.
(c) The office shall make public aggregate data indicating the following:
(1) Negotiated rates by physician and surgeon specialty by geographic region.
(2) Negotiated rates compared to Medicare rates by physician and surgeon specialty by geographic region.