AB 533 (Bonta) introduced last year failed passage on the last day of session in 2015. As we reported last year the bill was only one aye vote short for passage and a number of members abstained. Reconsideration was granted so that the bill could be taken up again on the Assembly Floor when the Legislature reconvened in January. The author continues to focus on removing the insured patient from the middle of the reimbursement dispute when the patient receives services from an in network hospital or other facility and receives a "surprise" bill from a physician who also provides services and is not contracted to that plan or is out of network.

 

The current version of AB 533 would prohibit the out of network physician from charging or collecting from the patient any more than their co-insurance and deductible under their policy. It would prohibit balance billing and require the plan to reimburse that physician/group at the comparable Medicare rate.

AB 533 would exempt hospital emergency services that are used to stabilize the patient, which would include some radiology/imaging services. Providers remain unhappy with an interim payment rate would use an Independent Dispute Resolution Process (IDRP) that is undefined and not loser pays format. The bill lacks any provisions to incentivize or require the plan to have an adequate network or contracts with hospital based physician groups.

Assemblyman Bonta convened a meeting of the stakeholders this week to indicate his hope to find an acceptable compromise through discussions in the short term. The CRS continues to work with the CMA and other specialty societies on an interim payment solution that uses the Fair Health Payment Database rather than Medicare rates as a default or interim payment rate. Physicians may seek to introduce a competing legislative proposal that is more equitable.