Medi-Cal: proof of eligibility.

Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income persons receive health care services. Existing law provides that it is the responsibility of the Medi-Cal beneficiary to provide information and evidence of Medi-Cal eligibility to that person's health care provider if that information is requested by the provider prior to rendering services to that beneficiary. Existing law provides that it is the responsibility of the provider prior to rendering Medi-Cal reimbursable services to persons presenting themselves as Medi-Cal beneficiaries to make a good faith effort to verify the person's identity, if the person is not known to the provider, otherwise payment for those services may later be disallowed by the department. This bill would provide, if a hospital obtains proof of Medi-Cal eligibility for a patient subsequent to the date of service, that it is the responsibility of a hospital to provide all information regarding that person's Medi-Cal eligibility to certain providers that bill separately for all services associated with the person's treatment in the hospital rendered during the same time period for which the hospital is submitting a claim, as specified. Existing law prohibits any provider of health care services who obtains a label or copy from the Medi-Cal card or other proof of eligibility from seeking reimbursement or attempting to obtain payment for the cost of the covered health care services from the eligible applicant or recipient, or any person other than the department or a 3rd-party payor who provides a contractual or legal entitlement to health care services. This bill would require a Medi-Cal provider, if the provider receives proof of a patient's Medi-Cal eligibility and has previously referred an unpaid bill for services rendered to the patient to a debt collector, to promptly notify the debt collector of the patient's Medi-Cal coverage, instruct the debt collector to cease collection efforts on the unpaid bill for covered services, and notify the patient accordingly. This bill would provide that a provider of health care services who obtains a label from, or copy of, the Medi-Cal card or other proof of eligibility and who subsequently pursues reimbursement or payment for the cost of covered services from the beneficiary or fails to cease collection efforts against the beneficiary for covered services, as prescribed, may be subject to a penalty, payable to the department, not to exceed 3 times the amount payable by the Medi-Cal program. The bill would also require that prescribed mitigating circumstances be considered when assessing the penalty. The bill would require that a provider have the right to appeal the assessed penalty, as specified. Existing law prohibits a person furnishing information on a specific transaction or experience to any consumer credit reporting agency if the person knows or should know the information is incomplete or inaccurate. This bill would provide that if a Medi-Cal provider or debt collector receives proof of Medi-Cal coverage for services rendered and then reports the services rendered to a consumer credit reporting agency or fails to provide corrections of, or instructions to delete, as appropriate, information regarding Medi-Cal covered services to a consumer reporting agency, the provider or debt collector shall be deemed to be in violation of the above-described provisions.