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  
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          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  
                                                           
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            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.
                                                           
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          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  
                                                           
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            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  
                                                           
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            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  
                                                           
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          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
                                                           
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          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.  
                                                           
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          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  
                                                           
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               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.  

                                                           
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           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.  
                                                           
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          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  
                                                           
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          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  
                                                           
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            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  
                                                           
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            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:  
                                                           
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                  (1)          A patient who is a self-pay patient,  
                    as defined in subdivision (f) or  an underinsured  
                    patient   a patient with inadequate insurance, as  
                    defined in subdivision (g).  

                  (2)          A patient who has a family income that  
                    does not exceed  400   350 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---



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          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  
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          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  
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          San Bernardino Mountains Community Hospital
          Scripps Health
          South Coast Medical Center
          Southern Humboldt Community Healthcare District
          St. Jude Medical Center
          University of California






                                   -- END --