Existing law requires a hospital to provide patients with a written notice containing information about the availability of the hospital's discount payment and charity care policies, including information about eligibility and the contact information for a hospital employee or office from which a person may obtain further information about these policies. Existing law defines "charity care" and "discount payment" for these purposes. Existing law requires a hospital to provide to the Department of Health Care Access and Information a copy of its discount payment policy, charity care policy, eligibility procedures for those policies, review process, and the application for charity care or discounted payment programs, among other information. A violation of these provisions results in an administrative penalty, as specified.
This bill would require a hospital to automatically determine a patient to be presumptively eligible for participation under the hospital's charity care policy and discount payment policy, if the patient meets specific criteria, including, among others, that the patient is enrolled in CalFresh or CalWORKs. The bill would require a hospital to prescreen a patient for presumptive eligibility if the patient meets other specified criteria, including, among others, that the patient is uninsured. The bill would authorize a hospital to prescreen a patient at the hospital's discretion or as established in the hospital's charity care policy and discount payment policy. The bill would require hospital charges for patients determined to be eligible for charity care or discount payment programs under these provisions to be adjusted prior to sending a billing statement. The bill would authorize procedures and tools for prescreening, including, among others, allowing a hospital to use third-party presumptive eligibility software tools or services or to contract with a third party under specified conditions. The bill would also require a hospital to provide written notices of determination to those patients determined to be presumptively eligible under these provisions, as specified.