2005 California Health and Safety Code Sections 1339.50-1339.59 Article 11. Payers\' Bill of Rights

HEALTH AND SAFETY CODE
SECTION 1339.50-1339.59

1339.50.  This article shall be known and may be cited as the Payers'
Bill of Rights.
1339.51.  (a) (1) Beginning July 1, 2004, a hospital, as defined in
paragraph (2) of subdivision (b), shall make a written or electronic
copy of its charge description master available, either by posting an
electronic copy of the charge description master on the hospital's
Internet Web site, or by making one written or electronic copy
available at the hospital location.
   (2) A small and rural hospital, as defined in Section 124840,
shall be exempt from paragraph (1).
   (b) For purposes of this article, the following definitions shall
apply:
   (1) "Charge description master" means a uniform schedule of
charges represented by the hospital as its gross billed charge for a
given service or item, regardless of payer type.
   (2) "Hospital" means a hospital, as defined in subdivision (a),
(b), or (f) of Section 1250, that uses a charge description master.
   (3) "Office" means the Office of Statewide Health Planning and
Development.
   (c) The hospital shall post a clear and conspicuous notice in its
emergency department, if any, in its admissions office, and in its
billing office that informs patients that the hospital's charge
description master is available in the manner described in
subdivision (a).
   (d) Any information about charges provided pursuant to subdivision
(a) shall include information about where to obtain information
regarding hospital quality, including hospital outcome studies
available from the office and hospital survey information available
from the Joint Commission for Accreditation of Healthcare
Organizations.
1339.52.  A hospital may not condition acceptance of a contract with
a health care service plan or health insurer upon the health care
service plan or health insurer waiving any provision of this article.
1339.54.  Any person may file a claim with the department alleging a
violation of this article.  The department shall investigate and
inform the complaining person of its determination whether a
violation has occurred and what action it will take.
1339.55.  (a) Beginning July 1, 2004, each hospital shall file a
copy of its charge description master annually with the office, in a
format determined by the office.
   (b) Each hospital shall calculate an estimate of the percentage
increase in the hospital's gross revenue due to any price increase
for charges for patient services during the 12-month period beginning
with the effective date of the charge description master filed with
the office.  Each hospital shall file the calculation and supporting
documentation with the office, in a form prescribed by the office, at
the time that the charge description master is filed.  The office
may compile and publish this information on its Internet Web site.
1339.56.  (a) Each hospital shall compile a list of 25 common
outpatient procedures and shall submit annually to the office a list
of its average charges for those procedures, in a method determined
by the office. The office may develop a uniform reporting form for
the purposes of this subdivision and may require hospitals to file
this completed form with the office. The office shall publish this
information on its Internet Web site.
   (b) The office shall establish a list of the 25 most commonly
performed inpatient procedures in California hospitals, as grouped by
Medicare diagnostic-related group. The office shall develop a list
of each hospital's average charges for those procedures, if
applicable, and shall update the list at least annually. The office
shall publish this information on its Internet Web site.
   (c) Each hospital shall provide a copy of the lists described in
subdivisions (a) and (b) to any person upon request.
1339.58.  Any information provided by the office on its Internet Web
site pursuant to Section 1339.56 or 1339.57 may inform persons where
quality of care information about hospitals may be obtained,
including hospital outcome studies available from the office and
hospital survey information available from the Joint Commission for
Accreditation of Healthcare Organizations.
1339.585.  Upon the request of a person without health coverage, a
hospital shall provide the person with a written estimate of the
amount the hospital will require the person to pay for the health
care services, procedures, and supplies that are reasonably expected
to be provided to the person by the hospital, based upon an average
length of stay and services provided for the person's diagnosis. The
hospital may provide this estimate during normal business office
hours. In addition to the estimate, the hospital shall provide
information about its financial assistance and charity care policies
and contact information for a hospital employee or office from which
the person may obtain further information about these policies. If
requested, the hospital shall also provide the person with an
application form for financial assistance or charity care. This
section shall not apply to emergency services provided to a person
pursuant to Section 1317.
1339.59.  (a) A hospital shall be in violation of this article if it
knowingly or negligently fails to comply with the requirements of
this article.
   (b) A hospital that does not file with the office the information
required by this article may be liable for civil penalties as
specified in Section 128770.


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