Health care coverage: out-of-network coverage.
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SB 1373 — Health care coverage: out-of-network coverage.
Last action — Returned to Secretary of Senate pursuant to Joint Rule 62(a).
No card. One bill, free forever — alerts when it moves.
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✓Introduced
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2In Committee
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3Passed Senate
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4Passed Assembly
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5To Executive
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6Enacted
This bill died with 2011-2012 Regular Session. It reached “In Committee” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.
This bill is no longer active — its legislative session has ended, so there is no live prognosis. It would have to be reintroduced in the current session to move again.
Summary
Existing law provides for the licensure and regulation of health facilities, including hospitals, by the State Department of Public Health and makes a violation of those provisions a misdemeanor. Existing law, the Payers' Bill of Rights, requires a hospital that uses a charge description master to make a written or electronic copy available in accordance with specified provisions and requires the hospital to post a notice that informs patients that the charge description master is available pursuant to specified provisions. 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 that act a crime. Existing law requires plans to reimburse noncontracting providers for emergency services and care rendered to enrollees of the plan, as specified. Existing law requires plans to, upon request, provide a list of specified contracting providers within the enrollee's or prospective enrollee's general geographic area. Existing law provides for the regulation of health insurers by the Department of Insurance and authorizes health insurers to contract for alternative rates of payment with providers. Existing law requires insurers to provide group policyholders with a current roster of institutional and professional providers under contract to provide services at alternative rates under their group policy and to make that list available for inspection during regular business hours at the insurer's principal office. Under this bill, when a patient seeks services at a hospital for an elective or scheduled procedure and the patient is covered by a specified type of health care service plan contract or health insurance policy that provides out-of-network coverage, the hospital would be required to provide the patient with a notice stating, among other things, that certain hospital-based providers may not be within the network of the patient's plan or insurer. The bill would require that the hospital receive the signature of the patient, or his or her legal representative, on this notice prior to rendering services to the patient. The bill would also require that a health care service plan or health insurer that receives a request from a subscriber, enrollee, policyholder, or insured for a referral to a noncontracting provider based on this hospital notice either authorize the enrollee or subscriber or policyholder or insured to obtain covered services from the noncontracting provider or refer the enrollee to a contracting provider with similar clinical expertise providing similar services in the same geographic region. The bill would also prohibit a hospital or a provider group from holding itself out as being within a plan or provider network unless all of the individual providers providing services at the hospital or with the provider group are within the plan or provider network or the hospital or provider group acknowledges that individual providers within the hospital or provider group may be outside the plan or provider network. Because a violation of certain of the bill's requirements would be a crime, this bill would impose a state-mandated local program by creating a new crime. 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.
Bill Text
- Amended 04/18/12 - Amended Senate Current pdf April 18, 2012
- Amended 04/10/12 - Amended Senate pdf April 10, 2012
- Introduced 02/24/12 - Introduced pdf February 24, 2012
- SB1373 View text html
Action History
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Returned to Secretary of Senate pursuant to Joint Rule 62(a).
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Set, second hearing. Failed passage in committee. (Ayes 1. Noes 5. Page 3307.)
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From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH.
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Set for hearing April 25.
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Set, first hearing. Hearing canceled at the request of author.
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From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH.
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Set for hearing April 18.
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Referred to Com. on HEALTH.
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Read first time.
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From printer. May be acted upon on or after March 26.
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Introduced. To Com. on RLS. for assignment. To print.
Sponsors
- Lieu · Primary
Sponsorship breakdown
Export CSV (upgrade) →1 sponsors · 0 co-sponsors · 121 not signed on
Sponsors (1)
- Lieu
Co-sponsors (0)
None.
Not signed on (121)
121 members have not signed on to this bill.
Show all 121 →"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.
Votes
| Party | Yea | Nay | Present | Not Voting |
|---|---|---|---|---|
| Unaffiliated | 1 | 5 | 0 | 3 |
| Total | 1 | 5 | 0 | 3 |
| % of votes cast | 11% | 56% | 0% | 33% |
How each member voted (9)
| Member | Party | Vote |
|---|---|---|
| Rubio | — | Yea |
| De León | — | Not Voting |
| Anderson | — | Nay |
| Blakeslee | — | Nay |
| Alquist | — | Nay |
| Harman | — | Nay |
| Hernandez | — | Nay |
| Wolk | — | Not Voting |
| DeSaulnier | — | Not Voting |
Subjects
Frequently asked questions
- What does SB 1373 do?
- Existing law provides for the licensure and regulation of health facilities, including hospitals, by the State Department of Public Health and makes a violation of those provisions a misdemeanor. Existing law, the Payers' Bill of Rights, requires a hospital that uses a charge description master to make a written or electronic copy available in accordance with specified provisions and requires the hospital to post a notice that informs patients that the charge description master is available pursuant to specified provisions. 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 that act a crime. Existing law requires plans to reimburse noncontracting providers for emergency services and care rendered to enrollees of the plan, as specified. Existing law requires plans to, upon request, provide a list of specified contracting providers within the enrollee's or prospective enrollee's general geographic area. Existing law provides for the regulation of health insurers by the Department of Insurance and authorizes health insurers to contract for alternative rates of payment with providers. Existing law requires insurers to provide group policyholders with a current roster of institutional and professional providers under contract to provide services at alternative rates under their group policy and to make that list available for inspection during regular business hours at the insurer's principal office. Under this bill, when a patient seeks services at a hospital for an elective or scheduled procedure and the patient is covered by a specified type of health care service plan contract or health insurance policy that provides out-of-network coverage, the hospital would be required to provide the patient with a notice stating, among other things, that certain hospital-based providers may not be within the network of the patient's plan or insurer. The bill would require that the hospital receive the signature of the patient, or his or her legal representative, on this notice prior to rendering services to the patient. The bill would also require that a health care service plan or health insurer that receives a request from a subscriber, enrollee, policyholder, or insured for a referral to a noncontracting provider based on this hospital notice either authorize the enrollee or subscriber or policyholder or insured to obtain covered services from the noncontracting provider or refer the enrollee to a contracting provider with similar clinical expertise providing similar services in the same geographic region. The bill would also prohibit a hospital or a provider group from holding itself out as being within a plan or provider network unless all of the individual providers providing services at the hospital or with the provider group are within the plan or provider network or the hospital or provider group acknowledges that individual providers within the hospital or provider group may be outside the plan or provider network. Because a violation of certain of the bill's requirements would be a crime, this bill would impose a state-mandated local program by creating a new crime. 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.
- Who sponsors SB 1373?
- SB 1373 is sponsored by Lieu.
- What is the current status of SB 1373?
- This bill died with 2011-2012 Regular Session. It reached “In Committee” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.
- Where can I track SB 1373?
- Track SB 1373 free on One Click Politics — get push/email alerts when it moves.
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