California AB 225

Existing law establishes the Department of Health Care Access and Information to oversee various aspects of the health care market, including oversight of hospital facilities and community benefit plans. 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 the act's requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law provides for the licensure and regulation of general acute care hospitals and clinics by the State Department of Public Health. This bill would, beginning on January 1, 2028, prohibit a health care provider, hospital, or health system from charging, billing, or collecting a facility fee for any outpatient services in specified circumstances, including for specified preventative health care services and health care services furnished via telehealth. The bill would not prohibit the billing of a professional fee. The bill would require a health care provider, hospital, or health system to provide notice, as specified, to a patient at the time of scheduling and at check-in if a facility fee will be charged. The bill would require the Director of the Department of Health Care Access and Information to impose an administrative penalty pursuant to a specified process for each violation against a health care provider, hospital, or health system that fails to comply with these provisions. The bill would specify that multiple violations identified during the same investigation constitute a single violation for purposes of assessing an administrative penalty. The bill would require a health care provider, hospital, or health system to reimburse the patient or patients any amount actually paid for a prohibited facility fee. The bill would, beginning on January 1, 2028, prohibit a health care service plan or health insurer from reimbursing, paying, or otherwise providing coverage for any prohibited facility fee. The bill would prohibit a plan from including in any contract or provider agreement any term permitting payment of a prohibited facility fee, and would prohibit a plan or insurer from passing through or otherwise shifting the fee to an enrollee or insured. Because a willful violation of these provisions relative to health care service plans would be a crime, this bill would impose a state-mandated local program. The bill would, beginning on January 1, 2028, require a hospital or health system, as defined, to file a report with the Department of Health Care Access and Information regarding specified information on the facility fees charged, including the number of patient visits at each facility where a facility fee was charged or billed and the total amount of fees charged. The bill would authorize the department to incorporate this report into an existing reporting requirement to minimize costs. 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.