Hospital pricing.

The document was reformatted from a chaptered legislative text (with page numbers, headers like 'Ch. 450', and traditional bill formatting) to a web page rendering that includes navigation menus, search functionality, version history links, and a digest key showing Vote: MAJORITY, Appropriation: NO, Fiscal Committee: YES, Local Program: NO.

Header changed from Assembly/Senate passage format to authenticated chaptered format with 'STATE OF CALIFORNIA AUTHENTICATED ELECTRONIC LEGAL MATERIAL' and Chapter 450 designation.

Governor approval date filled in as October 7, 2025, replacing the blank date field in the enrolled version.

Page numbering and layout reformatted from 'AB 1312' pagination to 'Ch. 450' pagination throughout the document.

Subdivision (b) is restructured so that hospitals must first screen patients to determine if they meet criteria, and then presumptively determine eligibility. Previously, the bill required hospitals to directly presumptively determine eligibility when criteria were met without an explicit separate screening step.

Subdivision (j)(4) now allows hospitals to rely on information 'available to the hospital or voluntarily provided by the patient' when a third-party tool fails to return data, expanding the sources hospitals may use for good faith eligibility evaluation.

The criterion in subdivision (c)(1)(D) requiring screening for patients who would owe $500 or more after insurance adjustments is removed. Hospitals no longer have a mandatory obligation to screen patients based on projected out-of-pocket costs.

The prior eligibility lookback in subdivision (b)(1)(B) is clarified to reference services 'billed or provided during the previous six-month period' rather than simply 'the previous six-month period,' making it clear the lookback is tied to service dates.

Verification of patient eligibility under subdivision (c)(5) is now required 'before billing the patient' rather than 'prior to discharge.' This gives hospitals more time to complete verification after a patient leaves the hospital but before any bill is sent.

The effective date for hospitals to establish written screening processes under subdivision (f) is changed from July 1, 2026 to July 1, 2027, giving hospitals an additional year to develop and implement their processes.

Subdivision (m), which requires written notice when a patient initially appears eligible but is later found ineligible or unverifiable, now applies to screening under both subdivision (b) and (c) rather than only subdivision (c).

The effective date for presumptive determination and screening requirements is delayed from July 1, 2026 to July 1, 2027. The written process documentation requirement is also moved from July 1, 2026 to July 1, 2027.

A new opt-out provision requires hospitals to inform patients of their intent to screen them, tell them they have the right to opt out, and provide a signed form. The form must state that screening was offered, that the patient may revoke the opt-out at any time, and that opting out does not affect future ability to apply for charity care or discounted payment. The signed form must be placed in the patient's medical record.

A more detailed post-screening verification process is added. Hospitals must first attempt to independently verify through their own records prior to discharge, then request written verification from the patient if unable to do so. The hospital must make best efforts to collect all information before discharge but may continue after.

The written notice provision is clarified to state that the notice may be sent prior to or in conjunction with a billing notice, and that no billing statement may be sent before the notice is issued. The subdivision covering ineligible patients is expanded to also cover cases where screening initially suggests a patient may be eligible but they are later determined ineligible, or where the hospital is unable to verify (not just determine) eligibility.

The lookback period for prior eligibility determinations is shortened from 12 months to six months. New sub-provisions allow hospitals to ask patients if their income or insurance has changed; if the patient attests no change, they receive charity care based on the prior determination without reevaluation. If the patient attests a change, the hospital may reevaluate. A patient approved within the prior six months is not considered a new determination.

Hospitals must now accept self-attestation from patients experiencing homelessness as sufficient evidence of eligibility, rather than requiring independent verification.

The term 'prescreen/prescreening' is replaced throughout with 'screen/screening.' The definition of screening is retained but the overall terminology is simplified. Third-party tool references change from 'presumptive eligibility software tools or services' to simply 'software tools or services.'

The language 'if the screening concludes that a patient is financially qualified' is softened to 'may be financially qualified,' giving hospitals more flexibility in how they characterize screening results before making a final determination.

The automatic presumptive eligibility criteria were narrowed. Previously, being uninsured, enrolled in Medi-Cal/HPE, enrolled in Covered California with income at or below 400% FPL, or owing $500+ all triggered automatic determination. Now only enrollment in specific assistance programs (CalFresh, CalWORKs, Tribal TANF, WIC, CARE, LIHEAP, HCV, etc.), prior eligibility within 12 months, or experiencing homelessness trigger automatic determination. The old criteria were moved to a separate 'screening' requirement.

Family members (as defined in Section 127400) are now explicitly included in the automatic eligibility criteria. If any family member is enrolled in CalFresh, CalWORKs, or other listed programs, the patient qualifies for presumptive eligibility.

A verification provision allows hospitals to require patients to verify program enrollment when the hospital cannot independently confirm it, but requires the patient to make reasonable efforts and obligates the hospital to assist when feasible.

A new prohibition prevents hospitals from requiring a patient to apply for Medicare, Medi-Cal, or other coverage before the patient is presumptively determined eligible or provided with charity care or discounted payment. Hospitals may still require participation in a Medi-Cal eligibility screening.

If screening concludes a patient is financially qualified, the hospital must determine them eligible without requiring a separate application. Previously, the prescreening process was not explicitly framed as an alternative to the application process.

Hospitals may now use 'any other information routinely collected or maintained by a hospital that reasonably indicates financial hardship' in the screening process, and may incorporate this into standard intake, registration, or billing workflows. This expands the data sources beyond the previously listed categories.

New billing protections: no billing statement may be sent to an eligible patient before the written notice of determination is issued, and any billing statement must reflect all adjustments made under the hospital's charity care or discount payment policy.

Two new terms are defined: 'presumptively determine' (a determination made without the patient submitting an application or income documentation) and 'screen/screening' (a process that serves as an alternative to requiring an application for eligibility determination).

Third-party software tools are now explicitly described as optional ('may, but is not required to'), with the same conditions applying if a hospital elects to use them. Previously the language simply said 'a hospital may use' without emphasizing the optionality.

Patients meeting paragraph (1) criteria are now automatically determined presumptively eligible for charity care or discount payment, rather than merely being prescreened. This removes hospital discretion for this group.

A new written notice of determination requirement obligates hospitals to notify patients in writing when they are found presumptively eligible for charity care or discounted payment, inform them that additional assistance may be available, and provide notices in English and the patient's spoken language consistent with Insurance Code Section 12693.30.

A new second tier of eligibility (paragraph 2) requires hospitals to prescreen patients who are uninsured, enrolled in Medi-Cal with cost sharing or HPE, enrolled in any Covered California health plan (no income threshold), or will owe $500 or more after adjustments.

The Covered California criterion in the new second tier drops the 400 percent federal poverty level income requirement present in the introduced version, broadening coverage to all Covered California enrollees for prescreening purposes.

New timing requirements: paragraph (1) patients must be determined presumptively eligible prior to discharge with adjustments reflected on the billing statement before it is sent. Paragraph (2) patients require information collection before discharge but the determination may occur after discharge, with notice issued prior to or with any billing statement.