BILL ANALYSIS SENATE HEALTH COMMITTEE ANALYSIS Senator Deborah V. Ortiz, Chair BILL NO: AB 774 A AUTHOR: Chan B AMENDED: June 22, 2005 HEARING DATE: June 28, 2006 7 FISCAL: Appropriations 7 4 CONSULTANT: Hansel / ag SUBJECT Hospital charity care and discount payment policies SUMMARY This bill requires hospitals to develop policies regarding discount payments and charity care for financially qualified patients, as defined. Requires hospitals to limit expected payment for services provided to patients with family incomes below 350 percent of the federal poverty level who are eligible for discount payments. Requires hospitals to post notices of and to provide patients with a written summary of their policies for financially qualified patients at the time of discharge or when the service is provided. Requires hospitals to notify patients at the time of billing of their potential eligibility for government programs and for the hospital's charity care and discount payment programs. Prohibits hospitals from reporting adverse information to a credit agency or commence civil action against a patient for nonpayment prior to 150 days after initial billing for patients who are uninsured or underinsured. Prohibits hospitals from using wage garnishments or liens on primary residences as a means of collecting unpaid bills for patients who are eligible for the hospital's charity care Continued--- STAFF ANALYSIS OF ASSEMBLY BILL 774 (Chan) Page 2 of discount payment policies. Authorizes the Director of the Department of Health Services (DHS) to levy administrative penalties for violations of the of the bill's provisions. Provides that compliance with the bill's provisions constitute a condition of hospital licensure. ABSTRACT Existing law: 1.Establishes the Office of Statewide Health Planning and Development (OSHPD), which is charged with enforcement of various provisions of law relating to health facilities, including hospitals. 2.Requires hospitals to report financial and utilization data to OSHPD in accordance with procedures and forms established by OSHPD. 3.Requires every private, non-profit hospital to submit annually to OSHPD a community benefits plan that details how the hospital identifies and addresses community needs within the hospital's service area. 4.Provides that a community benefits plan may include: a. a description of the health care services rendered to uninsured, underinsured and individuals eligible for public programs; b. a description of other services rendered to the community, such as health promotion, medical research and medical education; and, c. an accounting of the cost of providing these services. This bill: 1.Establishes requirements for general acute care, psychiatric and special hospitals pertaining to the development and implementation of charity care and discount payment policies, as well as hospital billing and collection practices for financially qualified patients, as defined; requires general acute care hospitals to comply with the requirements as a condition Continued--- STAFF ANALYSIS OF ASSEMBLY BILL 774 (Chan) Page 3 of licensure. 2.Requires general acute care, psychiatric and special hospitals to maintain understandable, written policies regarding charity care and discount payments for financially qualified patients. 3.Defines "financially qualified patient" as a patient who is a self-pay patient, as defined, or a patient with inadequate insurance, as defined, and who has a family income that does not exceed 350 percent of the federal poverty level (FPL). 4.Defines a "patient with inadequate insurance" as a person whose family income does not exceed 350 percent of the federal poverty level and whose annual deductibles exceed five percent of the patient's annual income or a lower level, if applicable under the hospital's charity care policy. 5.Provides that uninsured or patients with inadequate insurance who are at or below 350 percent of the federal poverty level, or a higher level at the discretion of the hospital, shall be eligible to apply for a hospital's charity care or discount payment policy 6.Allows hospitals, in determining eligibility for charity care, to consider income and monetary assets of the patient. Provides that monetary assets shall not include retirement and deferred compensation plans, the first $10,000 of monetary assets, and 50 percent of assets over the first $10,000 from the consideration of eligibility. 7.Requires hospitals to limit expected payment for services to patients at or below 350 percent of the federal poverty level who are eligible for discount payments to the greater of the amount of payment the hospital would receive from Medicare, Medi-Cal, Healthy Families or any other government-sponsored health program in which the hospital participates. 8.Requires patients, or their legal representatives, who request discount payments or charity care to provide the hospital with documentation of income. Continued--- STAFF ANALYSIS OF ASSEMBLY BILL 774 (Chan) Page 4 9.Requires hospitals to provide patients with a written summary of the hospital's policy for financially qualified and self-pay patients at the time of admission or provision of service, as specified, and to post notice of their policies in visible locations including, but not limited to, the emergency department, billing office, admissions office and other outpatient settings. 10. Requires hospitals to make reasonable efforts to obtain from the patient, or their representative, information about whether private or public health insurance may fully or partially cover the charges for care provided, as specified. 11. Requires a hospital that bills a patient who did not provide proof of third party coverage at the time care was provided or upon discharge, to provide the patient with a clear and conspicuous notice that includes specified information, including a statement that if the consumer does not have health insurance coverage he or she may be eligible for Medicare, Medi-Cal, the Healthy Families program, the California Children's Services program or charity care and how the patient can obtain applications for these programs. Requires hospitals to include similar information in bills that it sends to patients. 12. Requires hospitals to provide the applications for Medi-Cal and the Healthy Families program in the billing for any patient who does not show proof of coverage by a third party at the time care is provided. 13. Prohibits a hospital or any assignee of the hospital from reporting adverse information to a credit agency or commencing civil action against a patient for nonpayment prior to 150 days after initial billing if the patient lacks coverage or provides information that he or she may be underinsured, as defined. Provides that the time period shall be extended if the patient has a pending appeal for coverage of services, as specified. 14. Prohibits hospitals from sending any unpaid bill to a collection agency if doing so may negatively impact a Continued--- STAFF ANALYSIS OF ASSEMBLY BILL 774 (Chan) Page 5 patient's credit, if the patient qualifies for eligibility under the hospital's charity care or discount payment policy and is attempting in good faith to settle an outstanding bill. 15. Prohibits hospitals or collection agencies operating on their behalf from using wage garnishments or liens on primary residences as a means of collecting unpaid hospital bills for patients eligible under the hospital's charity care or discounted payment policies. 16. Requires any extended payment plans offered by hospitals to patients eligible under the hospital's charity care or discount payment policy, or any other policy for assisting low-income patients in settling past due bills, to be interest free. 17. Provides that the provisions of the bill do not diminish any protections consumers have under existing federal or state debt collection or consumer protection laws, as specified. 18. Requires hospitals and their assignees, prior to commencing collection activities against patients, to provide a clear and conspicuous written notice containing information about the patient's rights pursuant to state and federal debt collections statutes, as specified. 19. Requires hospitals to provide the OSHPD with a copy of their charity care and discount payment policies, including eligibility procedures, review process and the applications. 20. Allows the Director of DHS (Director), after notice and opportunity for hearing, to levy administrative penalties against hospitals for violations of the bill's provisions. Requires the Director, in determining the amount of the penalty to consider the nature, scope and gravity of the violation; the facility's history of violations; the demonstrated willfulness of the violation; and the behavior of the facility with respect to violations, including whether the facility mitigated any damage or injury resulting from the violation. 21. In lieu of an administrative penalty, provides that Continued--- STAFF ANALYSIS OF ASSEMBLY BILL 774 (Chan) Page 6 the Director may require the hospital to provide care at no cost to financially qualified persons in an amount comparable to three times the amount billed in excess of the limits allowed by the bill for patients eligible for charity care or discount payments. 22. Requires the Director to order the hospital to reimburse patients who were overcharged, as specified; provides that the hospital must use an equivalent amount of funds to provide charity care to financially qualified patients if the hospital is unable to locate any such patients. 23. Allows a facility to appeal an administrative penalty, as specified, including through adjudication of the violation. 24. Provides that amounts paid for services by patients who qualify for the hospital's policy do not constitute the hospital's uniform, published, prevailing, or customary charges or preclude recognition of the hospital's established charge schedule for purposes of payment limits under Medi-Cal, Medicare, worker's compensation, or other public programs. 25. Contains a severability clause in the event that a hospital's limits on expected payments established by the bill result in a federal determination that the hospital's established charge schedule does not reflect the hospital's customary or prevailing charges. FISCAL IMPACT Unknown costs (special fund) for OSHPD and DHS related to administrative and enforcement provisions of the bill. Unknown costs to University of California hospitals and state-funded health care programs related to the restrictions on hospital billing and collections established by the bill. BACKGROUND AND DISCUSSION According to the author, AB 774 creates consumer and Continued--- STAFF ANALYSIS OF ASSEMBLY BILL 774 (Chan) Page 7 financial protections so that uninsured and underinsured families can get the hospital care they need without facing financial ruin. The author points out that there is no current law regarding the prices that uninsured and underinsured consumers pay for health care or regarding collection practices for health care debt. The author points to a February 2005 study published in the journal Health Affairs which surveyed 1,771 personal bankruptcy filers and which found that about half cited medical causes for their bankruptcy. The study found that among those whose illnesses led to bankruptcy, out-of-pocket costs averaged $11,854 since the start of illness, and that medical debtors were 42 percent more likely than other debtors to experience lapses in health insurance coverage. The author asserts that requiring hospitals to develop and disseminate policies on payment allowances and to provide payment allowances are modest steps to protect low-income uninsured and underinsured patients when they experience a need for hospital services. The author intends for the provisions of AB 774 to supercede similar provisions contained in the pending tobacco tax initiative (Tobacco Tax Act of 2006) related to hospital charity care and billing practices, which are summarized below. Previous legislative efforts related to hospital billing and collections practices The issue of hospital's billing and collections practices has received considerable attention since 2002, resulting in numerous articles and several bills calling attention to what were being perceived to be overly aggressive billing and collections practices of hospitals vis-?-vis uninsured and low-income patients. The author introduced similar legislation in the 2003 - 04 session (AB 232), which died on the Senate floor. The same session the Legislature passed SB 379 (Ortiz), which would have required hospitals to develop, post and disseminate charity care and reduced payment policies, and would have limited allowable charges for patients with incomes below 400 percent of the federal poverty to the greater of Medicare, Medicaid, or workers compensation payment amounts. The bill was vetoed by the Governor Continued--- STAFF ANALYSIS OF ASSEMBLY BILL 774 (Chan) Page 8 In response to press attention and pending legislation, in February 2004, several hospital organizations, including the California Healthcare Association (CHA), issued voluntary guidelines to protect consumers from hospital overcharging. CHA's guidelines state that regulatory reform is needed to enable hospitals to effectively respond to the individual needs of low-income uninsured patients and that CHA anticipates that the United States Department of Health and Human Services (HHS) will provide guidance on how hospitals can appropriately bill the uninsured. In the meantime, CHA urged its member hospitals to adopt the voluntary principles and guidelines to better meet the needs of patients who cannot afford the health care services they receive. The guidelines encourage hospitals to do a number of things with regards to low-income, uninsured patients, including: 1.Ensuring that financial assistance policies clearly state the eligibility criteria (i.e., income, assets) and the process used to determine whether a patient is eligible for financial assistance. 2.Limiting expected payments from patients eligible for financial assistance to amounts that do not exceed the payment the hospital would receive from Medicare, other government sponsored health programs, or as otherwise deemed appropriate by the hospital. 3.Having written policies about when and under whose authority patient debt is advanced for collection, and using the hospital's best efforts to ensure that patient accounts are processed fairly and consistently. 4.Posting notices regarding the availability of financial assistance to low-income uninsured patients in visible locations throughout the hospital, such as admitting/registration, billing office, emergency department, and other outpatient settings. 5.Sharing financial assistance policies with appropriate community health and health services agencies and other organizations that assist such patients. Continued--- STAFF ANALYSIS OF ASSEMBLY BILL 774 (Chan) Page 9 6.Attempting to communicate with patients in their primary language when discussing the hospitals financial assistance policies; and ensure that staff are knowledgeable about the existence of the hospital's financial assistance policies. In vetoing SB 379, the Governor stated: "Recently, the hospital community voluntarily adopted guidelines to assist low-income uninsured Californians who receive services at a hospital but cannot afford to pay the bill in full. At a minimum, these guidelines allow patients who are at or below 300 percent of the federal poverty level to apply to the hospital for financial assistance. Additionally, the guidelines limit the costs of procedures to reflect the prices paid by government payers, require hospitals to post their financial assistance policies and their eligibility criteria and encourage hospitals to help eligible patients apply for public health programs. By choice, many hospital systems have adopted guidelines that exceed the aforementioned minimum standards adopted by the hospital community, further protecting patients at risk of financial harm. I recognize the proponents desire to assist self-pay patients with large hospital bills by requiring price discounts but I also recognize that the hospital community took a significant step in adopting these guidelines, especially those hospitals that are struggling financially themselves. Ultimately, I Continued--- STAFF ANALYSIS OF ASSEMBLY BILL 774 (Chan) Page 10 decided that the voluntary guidelines must be given time to be implemented and reviewed." In light of continued pressures from the Legislature and consumer advocates, the pending tobacco tax initiative contains provisions dealing with charity care and billing and collections that would apply to hospitals that receive allocations of tobacco tax revenues under the initiative. Under the proposed initiative each hospital receiving an allocation of funds would be required to: Maintain an understandable, written charity care and discount payment policy. Provide that patients whose income is at or below 350 percent of the federal poverty level are eligible to apply for hospital's charity care and discount payment policy, except for rural hospitals, which may establish lower levels of eligibility. Limit expected payment for services to the greater of the amount the hospital would receive from Medicare or any other government-sponsored health program. Post notices regarding availability of its charity care and discount payment policy in visible locations including, but not limited to, admissions, billing office, emergency department, and other outpatient settings. Notices must include instructions on how to apply for the hospital's policy and contact number for more information. Establish a written policy defining standards and practices for the collection of debt. Include at the time of billing a statement that indicates that if the patient meets certain low-income requirements, they may be eligible for a government-sponsored program or the hospital's policy and contact information for additional information about the hospital's policy. Continued--- STAFF ANALYSIS OF ASSEMBLY BILL 774 (Chan) Page 11 Not knowingly send that patient's bill to a collection agency prior to 120 days from the time of initial billing, and without first having made more than one attempt to collect the bill, or while the completed application is being processed by a government agency or the hospital if the patient has completed an application for government-sponsored coverage or under the hospital's charity care or discount payment policy. Not send the unpaid bill to any collection agency if the hospital knows that doing so may negatively impact the patient's credit, if a patient qualifies for the hospital's policy and is attempting in good faith to settle an outstanding bill. Not use wage garnishments or liens on primary residences as a means of collecting unpaid hospital bills from patients who are eligible for the hospital's charity care and discount payment policy. The initiative provides that it does not limit the ability of the Legislature to enact charity care or discount payment policies applicable to all acute hospitals as a condition of licensure and further allows the Legislature to amend its provisions to further its purposes with a statute passed by a 2/3 vote. Arguments in support Health Access, the sponsor of AB 774, and other consumer groups state that hospitals can and do charge patients the highest sticker price and some are successful in collecting higher payments from the uninsured than from insured patients. Health Access states that hospitals publicly report spending about one percent of revenue on charity care, but are not required to disclose the circumstances under which a patient might qualify for such free care. Proponents point out that hospitals can refer patients, both insured and uninsured, to collections within weeks after care is provided and that sending a patient to collections within 30 to 60 days puts the credit rating of even insured patients at risk if insurers fail to pay in that narrow window, and provides little time for uninsured patients to arrange their finances so that payment can be made. Continued--- STAFF ANALYSIS OF ASSEMBLY BILL 774 (Chan) Page 12 Health Access and consumer groups note that while hospitals have adopted voluntary guidelines with regard to their billing and collections practices, "mystery shopping" studies conducted by Health Access and the California Health Care Foundation have shown that many self-pay patients do not get basic information from hospitals about their consumer rights and financial options, suggesting that the voluntary guidelines are not being complied with. Health Access argues that by including provisions in the pending tobacco tax initiative that are substantially similar to AB 774, that would apply to hospitals that receive allocations of funding under the initiative, hospitals have acknowledged that voluntary guideline are not sufficient to ensure that hospitals improve their billing and collections practices. Finally, Health Access points out that as amended AB 774 reflects several concessions and modifications, including a reduction in the income level to qualify for charity care and reduced payments from 400 percent of FPL to 350 percent, making underinsured patients (as opposed to uninsured) eligible for discounted payments only, reducing the waiting period before hospitals can commence hard collections from 180 days to 150 days, eliminating civil penalties for violations of the bill's provisions, and allowing hospitals to use an asset test in determining patients' eligibility for charity care. Arguments in opposition The California Hospital Association (CHA) states that AB 774 places the burden of a dysfunctional health care system on hospitals. Hospitals must provide emergency care to anyone who needs it but are finding it difficult to keep their doors open because of the growing number of uninsured, inadequate reimbursement from Medi-Cal and Medicare, and a long list of unfunded mandates. CHA and other hospitals argue that AB 774 imposes rigid and punitive requirements on hospitals without recognizing any of the underlying factors that are creating the growing problem of the uninsured. They also argue that, unlike the hospitals' voluntary guidelines, AB 774 does not allow California's hospitals the flexibility to adapt their policies to variations in the patient populations and Continued--- STAFF ANALYSIS OF ASSEMBLY BILL 774 (Chan) Page 13 resources that they face. In addition, opponents argue that hospitals should not be required to provide charity care to patients with insurance with high deductibles. Health plans are increasingly marketing high deductible products so that employers and enrollees can obtain premium savings; the changes proposed by AB 774 would exacerbate that trend and encourage underinsurance as an option for many persons. CHA and other hospitals point out that hospitals face numerous unfunded mandates and that this bill will make it increasingly difficult to provide care and operate emergency rooms and trauma centers to serve those who need help. Finally, opponents argue that the penalties in the legislation will unnecessarily punish innocent mistakes, invite litigation over technical discrepancies, and funnel scarce resources away from providing care. Writing in reference to the previous version of the bill, the California Association of Collectors opposes provisions of the bill that impose a blanket prohibition on the use of wage garnishments or liens to obtain payment of hospital bills irrespective of the debtor's ability to pay the debt, and states that existing requirements governing the use of wage garnishments and judgment liens provide substantial consumer protections to debtors. Previous legislation SB 24 (Ortiz, 2005) - would have required hospitals to develop, post and disseminate charity care and reduced payment policies for hospitals, and limit allowable charges for patients with incomes below 400 percent of the federal poverty to the greater of Medicare, Medicaid, or workers compensation payment amounts, and would have required non-profit hospitals to provide a minimum threshold of charity care. Died in the Senate Appropriations Committee. SB 379 (Ortiz, 2003) - would have required, effective June 1, 2005, hospitals to develop, post and disseminate charity care and reduced payment policies, which include minimum eligibility requirements of 400 percent of the federal poverty level, limitations on expected payments from qualified patients, and limits on billing and Continued--- STAFF ANALYSIS OF ASSEMBLY BILL 774 (Chan) Page 14 collection activities. Vetoed by the Governor. AB 232 (Chan, 2003) - would have required each hospital to develop a self-pay policy specifying how the hospital determines prices to be paid by self-pay patients, as defined, and limits these prices for patients below specified income levels. Would have established limits on billing and collection activities of hospitals and their agents. Died on the Senate floor. SB 1394 (Ortiz, 2001) - would have required hospitals to establish and publicize charity care policies and established a reduced payment schedule for uninsured and underinsured persons. Would have limited collections and billing activities of hospitals for 120 days following discharge. Died on the Senate floor. COMMENTS AND QUESTIONS 1.Bill amended substantially since it was last heard. Senate Health Committee heard this bill on June 22, 2005, where it failed passage and was granted reconsideration. The bill has been amended substantially since then and the bill before the committee now reflects the efforts of the author and sponsor to reach a compromise with the California Hospital Association and other hospital groups that would supercede the provisions of the pending tobacco tax initiative dealing with this issue. Among the changes from the version previously heard by the committee, the bill reduces the income threshold for patients to qualify for charity care or reduced payments from 400 percent of the FPL to 350 percent of FPL, makes underinsured patients (as opposed to uninsured) eligible only for discount payments, allows hospitals to take into account both income and assets of patients in determining eligibility for charity care, reduces the time hospitals must wait before engaging in "hard" collections on unpaid bills from 180 to 150 days, and reduces the enforcement provisions to eliminate civil penalties for violations. Another significant change is that the bill in its current form would make compliance with the bill's provisions a condition of licensure for general acute care hospitals. 2.Similarity to other bills heard by Health Committee. AB Continued--- STAFF ANALYSIS OF ASSEMBLY BILL 774 (Chan) Page 15 774 is similar to SB 24 (Ortiz) which was heard by the Committee on March 30, 2005, and to SB 379 (Ortiz) and AB 232 (Chan), heard by the committee in the 2003-04 session. SB 379 would have required hospitals to develop and post charity care and reduced payment policies and placed limits on allowable charges and collection practices for persons eligible to receive charity care or payment allowances, similar to this bill; however, the bill was vetoed by the Governor. SB 24 (Ortiz), as it was heard by the committee, contained additional provisions requiring nonprofit hospitals, as a condition of maintaining their tax exempt status, to demonstrate compliance with the provisions of the bill dealing with development and posting of charity care and reduced payment policies and limits on charges and collection practices for persons eligible to receive charity care or payment allowances. The bill also established a minimum threshold for charity care expenditures for nonprofit hospitals. The bill died in the Senate Appropriations Committee. 3.Interaction of bill with proposed tobacco tax initiative. The proposed Tobacco Tax Act of 2006 provides that its charity care and discount payment provisions do not limit the ability of the Legislature to enact charity care or discount payment policies applicable to all acute care hospitals as a condition of licensure. By providing that it's provisions apply to acute care hospitals as a condition of licensure, the author intends for the provisions in AB 774 to supercede those in the proposed initiative, with respect to acute care hospitals. AB 774 also applies to acute psychiatric and special hospitals, which in some cases, may receive allocations under the proposed initiative should it be enacted; for those which do receive allocations, the provisions in the proposed initiative would presumably take precedence. 4.Suggested technical amendments: a. On page 3, lines 15 - 21, amend Section 127400 (c) as follows: (c) "Financially qualified patient" means a patient who is both of the following: Continued--- STAFF ANALYSIS OF ASSEMBLY BILL 774 (Chan) Page 16 (1) A patient who is a self-pay patient, as defined in subdivision (f) oran underinsured patienta patient with inadequate insurance, as defined in subdivision (g). (2) A patient who has a family income that does not exceed400350 percent of the federal poverty level. b. On page 6, line 31, delete "and self-pay" as redundant language. c. On page 6, line 33, replace "written estimate" with "summary". d. Make consistent the information that hospitals must provide patients as part of billing for services in Section 127420 (b) (page 8, lines 4 - 33) and Section 127425(c) and (d) (page 10, lines 10 - 26). e. On page 10, line 11, replace "Section 124710" with "Section 127410." f. On page 10, line 28, replace "underinsured" with "a patient with inadequate insurance." PRIOR ACTIONS Senate Health Committee: 5 - 4 Failed Passage, Reconsideration Granted Assembly Floor: 43 - 34 Pass Assembly Appropriations: 13 - 5 Do Pass Assembly Health: 10 - 4 Do Pass POSITIONS Support (to the current version of the bill) Health Access California (sponsor) AARP California Applied Research Center California ACORN Continued--- STAFF ANALYSIS OF ASSEMBLY BILL 774 (Chan) Page 17 California Commission on the Status of Women California Federation of Teachers California Labor Federation California Public Interest Research Group Community Health Councils Congress of California Seniors Consumer's Union Gray Panthers California JustHealth Latino Coalition for a Healthy California Western Centers on Law & Poverty Support (to the prior version of the bill) American Federation of State, County, and Municipal Employees Asian and Pacific Islander American Health Forum California Alliance for Retired Americans California Church Impact California Council of Churches California Immigrant Welfare Collaborative California National Organization for Women Coalition for Community Health Coalition for Humane Immigrant Rights of Los Angeles East Bay Alliance for a Sustainable Economy Greenlining Institute Health Care for All - California Insure the Uninsured Project JERICHO Lawyers' Committee for Civil Rights Local Health Plans of California Multicultural Area Health Education Center Screen Actors Guild Santa Cruz Chapter of Healthcare for All United Nurses Association of California/Union of Health Care Professionals Valley Seniors Opposition (to the current version of the bill) Continued--- STAFF ANALYSIS OF ASSEMBLY BILL 774 (Chan) Page 18 Continued--- Adventist Healthcare Coalition Alliance of Catholic Health Care Anaheim Memorial Medical Center Barlow Respiratory Hospital California Hospital Association Cedars-Sinai Health Systems Centinela Freeman HealthSystem Children's Hospital Los Angeles Eden Medical Center El Camino Hospital El Centro Regional Medical Center Fairchild Medical Center Fallbrook Hospital Feather River Hospital Glendale Adventist Medical Center Glenn Medical Center Henry Mayo Newhall Memorial Hospital Hospital Corporation of America John F. Kennedy Memorial Hospital John Muir Health Kaweah Delta Health Care District Lodi Memorial Hospital Loma Linda University Medical Center Long Beach Memorial Medical Center Los Robles Hospital & Medical Center Mammoth Hospital Marshall Medical Center Mayers Memorial Hospital District Mercy Medical Center Redding Miller Children's Hospital Mission Community Hospital Oroville Hospital Pacific Hospital of Long Beach Patient's Hospital of Redding Plumas District Hospital Presbyterian Intercommunity Hospital Queen of the Valley Hospital Redbud Community Hospital Regional Medical Center of San Jose Riverside Community Hospital Saddleback Memorial Medical Center San Antonio Community Hospital San Joaquin Community Hospital San Ramon Regional Medical Center Continued--- STAFF ANALYSIS OF ASSEMBLY BILL 774 (Chan) Page 20 Seneca Healthcare District Sharp HealthCare Sierra View District Hospital Sonora Regional Medical Center St. Elizabeth Community Hospital St. Helena Hospital St. Joseph Hospital Redwood Memorial Hospital Stanford Hospital & Clinics Surprise Valley Health Care District Sutter Auburn Faith Hospital Ukiah Valley Medical Center Valley Health System Watsonville Community Hospital Western Medical Center Anaheim West Hills Hospital White Memorial Medical Center Opposition (to the prior version of the bill) Biggs-Gridley Memorial Hospital California Association of Collectors Californians for Patient Care Catholic Healthcare West Citrus Valley Health Partners Community Hospital of San Buenaventura Community Hospital of the Monterey Peninsula Continental Rehabilitation Hospital of San Diego Cottage Health System Fountain Valley Regional Hospital and Medical Center Frank R. Howard Memorial Hospital Kindred Hospital Westminster Memorial Hospital of Gardena Mission Hospital Regional Medical Center Pacific Alliance Medical Center Paradise Valley Hospital Providence Holy Cross Medical Center Providence Saint Joseph Medical Center Ridgecrest Regional Hospital Salinas Valley Memorial Healthcare System Saint Louise Regional Hospital STAFF ANALYSIS OF ASSEMBLY BILL 774 (Chan) Page 21 San Bernardino Mountains Community Hospital Scripps Health South Coast Medical Center Southern Humboldt Community Healthcare District St. Jude Medical Center University of California -- END --