Bill on Out of Network Billing for PPOs

SB 1373 ( Lieu) as introduced was trying to provide a specific notice to PPO patients when they would receive services from an out of network physician. The effort was to alert patients that even though they may go a hospital that was in network there might be other physicians, like radiologists, pathologists or anesthesiologists, that were out of network and would bill patients at their UCR. Initially the bill would have required the physician who was out of network in the hospital or office setting to provide a notice, an estimate of the potential charges, and suggest that the patient contact their PPO to get a referral to an in-network provider. It did not apply to emergency services only scheduled in or outpatient visits. It would also have required that any physician group that held themselves out as in-network would warrant that all physicians in that group were participating.

The CRS opposed the early versions both on the practical problems of being able to provide such a notice in the hospital setting, i.e. how would you know the patient's insurance status, and how could you accurately determine the services cost estimate. The CRS worked with the author to refine the bill and remove the objectionable provisions. When it was heard in Senate Health Committee it was amended to require the notice to be provided by the hospital for any patient in that setting and deleted the provisions requiring an estimate or referral to another provider. SB 1373 was still opposed by the hospitals on the basis that most hospital already provide notice of potential charges by physicians on their patient admission form. The bill remained with the Committee due to concerns over all the late amendments and will not move further in this Legislative session.

Breast Density Bill Continues to Move in Senate

Sen. Simitian (D-San Jose)  SB 1538 was passed on a unanimous vote by the Senate Health Committee. It was sent to the Suspense File this week in the Senate Appropriations Committee based upon the likelihood of increased costs to Medi-Cal and the EWC program if women receive additional screening exams as a result of the notice of breast density. Any bill with new state costs exceeding $50,000 go to Suspense for consideration at the end of May. We still expect that the bill will keep moving.

You will recall that last year Governor Brown vetoed SB 791 by Senator Simitian that would have required that women determined to have dense breast tissue during screening mammography be given specific information in their MQSA letter regarding the risks of dense breast tissue, possible benefits of other screening procedures, and that they should discuss this with their physician. SB 1538 contains the same provisions as the vetoed bill.

The CRS has a neutral position on the bill and continues to work to refine the specifics of the notice content to women with dense breast tissue.

Bill on RT Injection of Contrast Material

The CRS sponsored SB 1199 (Dutton) regarding the training and scope of practice for RTs to inject contrast material. Existing law allow an RT to inject contrast material into an upper extremity provided they obtain certain training.

That training includes performing 10 venipunctures. Last year the RHB sent a letter to all RT schools indicating that those 10 venipunctures must be performed on humans. That is an issue for some schools who might use phantom simulators due to liability concerns or shortage of humans for this purpose.

SB 1199 originally would have made two changes (1) to specify that training including performing 10 venipunctures can be done on a human or phantom simulator, and (2) that the RT could be allowed to administer other substances to insure the patency of the IV cannula according to hospital or imaging facility protocol. The latter provision would clarify that injection of a saline solution to flush the line would be specifically permitted.

SB 1199 was amended in the Senate Health Committee to remove the change with regard to use of phantom simulators for venipuncture training due to the lack of such provision in the training of other types of health care personnel. We continue to explore other options for assisting the RT schools who have problems with training only on human subjects. In the meantime SB 1199 will still clarify the saline based solution flush by RTs.  SB 1199 will be heard on the Senate floor in the next few weeks and has no opposition.