Existing law makes it a crime to operate a group advertising and referral service for specified licensed professionals, except as provided.
This bill would prohibit a person, firm, partnership, association, or corporation, or an agent or employee thereof, from making payments for services that recommend any form of medical care or treatment that is provided by an alcohol-related or narcotic-related program, or an alcoholism or drug abuse recovery or treatment program, facility, or dispensary. The bill would also prohibit a person, firm, partnership, association, or corporation, or an agent or employee thereof, from using runners, cappers, steerers, or
other persons to procure clients, patients, or customers for any form of medical care or treatment provided by an alcohol-related or narcotic-related program, facility, or dispensary.
Existing law provides for the licensure and regulation by the State Department of Health Care Services of adult alcoholism and drug abuse recovery and treatment facilities. The department also requires that an individual providing counseling services working within an alcohol and drug abuse recovery and treatment program be registered with or certified by a certifying organization approved by the department to register and certify counselors.
This bill, among other things, would prohibit any alcohol drug treatment program or any certified alcohol drug counselor from offering, delivering,
receiving, or accepting any rebate, refund, commission, preference, patronage dividend, discount, or other consideration, whether in the form of money or otherwise, as compensation or inducement for referring patients, clients, or customers to any person or certified or licensed program. A violation of these provisions would be a misdemeanor and would also be punishable by a fine not exceeding $2,500 per violation. The bill would provide that a violation of the applicable provisions by a certified person or a licensee would be grounds for disciplinary action, as provided. Because a violation of the above-specified provisions would be a crime, the bill would impose a state-mandated local program.
This bill would also prohibit certain persons, programs, or entities, including an alcoholism or drug abuse recovery and
a substance use disorder treatment program and persons employed by that program, from giving or receiving remuneration or anything of value for the referral of a person who is seeking alcoholism or drug abuse recovery and substance use disorder treatment services and would authorize the department to investigate and take specified disciplinary action against those persons or programs for violating those prohibitions.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires group health care service plans to authorize and permit assignment of a Medi-Cal beneficiary’s right to reimbursement for covered services to the State Department of Health Care Services, except as specified. Existing law also provides for the direct payment of group insurance medical benefits by a health insurer to the person or
persons furnishing or paying for hospitalization or medical or surgical aid or, in the case of a Medi-Cal beneficiary, to the State Department of Health Care Services, as specified.
This bill would impose, only with respect to services provided by an out-of-network
provider, that assignment requirement on a group or individual health care service plan or health insurer and would also require those plans to authorize and permit, upon request of the enrollee or subscriber, the assignment of an enrollee’s or subscriber’s right to reimbursement, or, upon request of the insured, the payment of insurance benefits, as specified, for covered addiction treatment services to the provider furnishing those services. The bill would require the provider to provide the plan or insurer with certain information in order to receive reimbursement. The bill would also limit the amount of the reimbursement, if the health care coverage is a health insurance policy, to the amount of the benefit covered by the policy.
Because a willful violation of the bill’s provisions by a health care service plan would be a crime, this bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
The bill would make a person who violates these provisions subject to a civil penalty not to exceed $10,000 for the first violation, and not more than $100,000 for each subsequent violation, as specified. The bill would also make a person who commits a knowing and willful violation of these provisions subject to a civil penalty in an amount not to exceed $50,000 for the first violation, and not more than $250,000 for each subsequent knowing and willful violation, as specified.
The bill would also include a statement of legislative intent.