CHAPTER 2.5. Fair Pricing Policies [127400. - 127471.]

Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1.

§§ 127400–127471 · 32 sections

1. ARTICLE 1. Hospital Fair Pricing Policies §§ 127400–127446 · 18 sections

   • § 127400 As used in this article, the following terms have the following meanings: (a) “Allowance for financially qualified patient” means, with respect to services…
   • § 127400.5 For purposes of this chapter, the following terms have the following meanings: (a) “Charity care” means free care. (b) “Discounted payment” or “discount…
   • § 127401 (a) The State Department of Public Health shall be responsible for the enforcement of the provisions of this article for violations occurring prior to January…
   • § 127405 (a) (1) (A) Each hospital shall maintain an understandable written policy regarding discount payments for financially qualified patients as well as an…
   • § 127406 (a) For purposes of this section, the following terms shall have the following meanings: (1) “Presumptively determine” means a determination made by a hospital…
   • § 127410 (a) Each hospital shall provide patients with a written notice that shall contain information about availability of the hospital’s discount payment and charity…
   • § 127420 (a) Each hospital shall make all reasonable efforts to obtain from the patient or the patient’s representative information about whether private or public…
   • § 127425 (a) A hospital shall not sell patient debt to a debt buyer, as defined in Section 1788.50 of the Civil Code, unless all of the following apply: (1) The…
   • § 127426 (a) The period described in Section 127425 shall be extended if the patient has a pending appeal for coverage of the services, until a final determination of…
   • § 127430 (a) Prior to commencing collection activities against a patient, the hospital, any assignee of the hospital, or other owner of the patient debt, including a…
   • § 127435 (a) A hospital shall provide to the department a copy of its discount payment policy, charity care policy, eligibility procedures for those policies, review…
   • § 127436 (a) Upon promulgation of regulations as required in subdivisions (b) and (c) no later than January 1, 2024, the Director of the Department of Health Care…
   • § 127437 The Hospital Fair Pricing Penalties Fund is created in the State Treasury. Any moneys collected from administrative penalties pursuant to this article shall be…
   • § 127440 (a) The hospital shall reimburse the patient or patients any amount actually paid in excess of the amount due under this article, including interest. Interest…
   • § 127443 The rights, remedies, and penalties established by this article are cumulative, and shall not supersede the rights, remedies, or penalties established under…
   • § 127444 (a) This article does not prohibit a hospital from uniformly imposing charges from its established charge schedule or published rates or preclude the…
   • § 127445 Notwithstanding any other provision of law, the amounts paid by parties for services resulting from reduced or waived charges under a hospital’s discounted…
   • § 127446 To the extent that any requirement of Section 127400, 127401, or 127405 results in a federal determination that a hospital’s established charge schedule or…
2. ARTICLE 2. Emergency Physician Fair Pricing Policies §§ 127450–127462 · 12 sections

   • § 127450 As used in this article, the following terms have the following meanings: (a) “Allowance for financially qualified patient” means, with respect to emergency…
   • § 127451 A violation of this article shall not constitute a violation of the terms of a physician and surgeon’s licensure.
   • § 127452 (a) Uninsured patients or patients with high medical costs who are at or below 400 percent of the federal poverty level shall be eligible to apply to an…
   • § 127454 (a) Each emergency physician shall make all reasonable efforts to obtain from the patient, or his or her representative, information about whether private or…
   • § 127455 (a) Each emergency physician shall have a written policy about when and under whose authority patient debt is advanced for collection. (b) Each emergency…
   • § 127456 (a) The period described in Section 127455 shall be extended if the patient has a pending appeal for coverage of the services, until a final determination of…
   • § 127457 (a) After the period described in Section 127455, and upon the completion of appeals consistent with Section 127456, prior to commencing further collection…
   • § 127458 The emergency physician shall reimburse the patient or patients any amount actually paid in excess of the amount due under this article, including interest.…
   • § 127459 The rights, remedies, and penalties established by this article are cumulative, and shall not supersede the rights, remedies, or penalties established under…
   • § 127460 Nothing in this article shall be construed to prohibit the emergency physician from uniformly imposing charges from its established charge schedule or…
   • § 127461 Notwithstanding any other provision of law, the amounts paid by parties for services resulting from reduced or waived charges under an emergency physician’s…
   • § 127462 To the extent that any requirement of this article results in a federal determination that an emergency physician’s established charge schedule or published…
3. ARTICLE 3. Prescription Drug Pricing for Covered Entities §§ 127470–127471 · 2 sections

   • § 127470 For purposes of this article: (a) “Covered drug” means a drug purchased by a covered entity that is subject to the federal pricing requirements set forth in…
   • § 127471 (a) A pharmacy benefit manager shall not impose any requirements, conditions, or exclusions that do either of the following: (1) Discriminate against a covered…