Hospital Fair Pricing Policies

Cal. HSC § 127400

California Statutes

As used in this article, the following terms have the following meanings: (a) “Allowance for financially qualified patient” means, with respect to services rendered to a financially qualified patient, an allowance that is applied after the hospital’s charges are imposed on the patient, due to the patient’s determined financial inability to pay the charges. (b) “Federal poverty level” means the poverty guidelines updated periodically in the Federal Register by the United States Department of Health and Human Services under authority of subsection (2) of

Section of Title of the United States Code. (c) “Financially qualified patient” means a patient who is both of the following:

(1) A patient who is a self-pay patient, as defined in subdivision (f), or a patient with high medical costs, as defined in subdivision (g).

(2) A patient who has a family income that does not exceed percent of the federal poverty level. (d) “Hospital” means a facility that is required to be licensed under subdivision (a), (b), or (

f) of

Section 1250, except a facility operated by the State Department of State Hospitals, the State Department of Developmental Services, or the Department of Corrections and Rehabilitation. (e) “Department” means the Department of Health Care Access and Information. (f) “Self-pay patient” means a patient who does not have third-party coverage from a health insurer, health care service plan, Medicare, or Medicaid, and whose injury is not a compensable injury for purposes of workers’ compensation, automobile insurance, or other insurance as determined and documented by the hospital.

Self-pay patients may include charity care patients. (g) “A patient with high medical costs” means a person whose family income does not exceed percent of the federal poverty level, as defined in subdivision (b). For these purposes, “high medical costs” means any of the following:

(1) Annual out-of-pocket costs incurred by the individual at the hospital that exceed the lesser of percent of the patient’s current family income or family income in the prior months. Out-of-pocket costs means any expenses for medical care that are not reimbursed by insurance or a health coverage program, such as Medicare copays or Medi-Cal cost sharing.

(2) Annual out-of-pocket expenses that exceed percent of the patient’s family income, if the patient provides documentation of the patient’s medical expenses paid by the patient or the patient’s family in the prior months. Out-of-pocket expenses means any expenses for medical care that are not reimbursed by insurance or a health coverage program, such as Medicare copays or Medi-Cal cost sharing.

(3) A lower level determined by the hospital in accordance with the hospital’s charity care policy. (h) “Patient’s family” means the following:

(1) For persons years of age and older, spouse, domestic partner, as defined in

Section of the Family Code, and dependent children under years of age, or any age if disabled, consistent with

Section 1614(

a) of Part A of Title XVI of the Social Security Act, whether living at home or not.

(2) For persons under years of age or for a dependent child to years of age, inclusive, parent, caretaker relatives, and parent’s or caretaker relatives’ other dependent children under years of age, or any age if disabled, consistent with

Section 1614(

a) of Part A of Title XVI of the Social Security Act. (i) “Reasonable payment plan” means monthly payments that are not more than percent of a patient’s family income for a month, excluding deductions for essential living expenses. “Essential living expenses” means, for purposes of this subdivision, expenses for any of the following: rent or house payment and maintenance, food and household supplies, utilities and telephone, clothing, medical and dental payments, insurance, school or child care, child or spousal support, transportation and auto expenses, including insurance, gas, and repairs, installment payments, laundry and cleaning, and other extraordinary expenses. (j) “Guarantor” means a person who has legal financial responsibility for the patient’s health care services.

Document details

CollectionCalifornia Statutes
CitationCal. HSC § 127400
Date2025-01-01
Typestatute
Languageen
SourceCA_STAT
IdentifierHSC127400.20245111

Hospital Fair Pricing Policies

Cal. HSC § 127400

California Statutes

Hospital Fair Pricing Policies

Cal. HSC § 127400

California Statutes

As used in this article, the following terms have the following meanings: (a) “Allowance for financially qualified patient” means, with respect to services rendered to a financially qualified patient, an allowance that is applied after the hospital’s charges are imposed on the patient, due to the patient’s determined financial inability to pay the charges. (b) “Federal poverty level” means the poverty guidelines updated periodically in the Federal Register by the United States Department of Health and Human Services under authority of subsection (2) of

Section of Title of the United States Code. (c) “Financially qualified patient” means a patient who is both of the following:

(1) A patient who is a self-pay patient, as defined in subdivision (f), or a patient with high medical costs, as defined in subdivision (g).

(2) A patient who has a family income that does not exceed percent of the federal poverty level. (d) “Hospital” means a facility that is required to be licensed under subdivision (a), (b), or (

f) of

Section 1250, except a facility operated by the State Department of State Hospitals, the State Department of Developmental Services, or the Department of Corrections and Rehabilitation. (e) “Department” means the Department of Health Care Access and Information. (f) “Self-pay patient” means a patient who does not have third-party coverage from a health insurer, health care service plan, Medicare, or Medicaid, and whose injury is not a compensable injury for purposes of workers’ compensation, automobile insurance, or other insurance as determined and documented by the hospital.

Self-pay patients may include charity care patients. (g) “A patient with high medical costs” means a person whose family income does not exceed percent of the federal poverty level, as defined in subdivision (b). For these purposes, “high medical costs” means any of the following:

(1) Annual out-of-pocket costs incurred by the individual at the hospital that exceed the lesser of percent of the patient’s current family income or family income in the prior months. Out-of-pocket costs means any expenses for medical care that are not reimbursed by insurance or a health coverage program, such as Medicare copays or Medi-Cal cost sharing.

(2) Annual out-of-pocket expenses that exceed percent of the patient’s family income, if the patient provides documentation of the patient’s medical expenses paid by the patient or the patient’s family in the prior months. Out-of-pocket expenses means any expenses for medical care that are not reimbursed by insurance or a health coverage program, such as Medicare copays or Medi-Cal cost sharing.

(3) A lower level determined by the hospital in accordance with the hospital’s charity care policy. (h) “Patient’s family” means the following:

(1) For persons years of age and older, spouse, domestic partner, as defined in

Section of the Family Code, and dependent children under years of age, or any age if disabled, consistent with

Section 1614(

a) of Part A of Title XVI of the Social Security Act, whether living at home or not.

(2) For persons under years of age or for a dependent child to years of age, inclusive, parent, caretaker relatives, and parent’s or caretaker relatives’ other dependent children under years of age, or any age if disabled, consistent with

Section 1614(

a) of Part A of Title XVI of the Social Security Act. (i) “Reasonable payment plan” means monthly payments that are not more than percent of a patient’s family income for a month, excluding deductions for essential living expenses. “Essential living expenses” means, for purposes of this subdivision, expenses for any of the following: rent or house payment and maintenance, food and household supplies, utilities and telephone, clothing, medical and dental payments, insurance, school or child care, child or spousal support, transportation and auto expenses, including insurance, gas, and repairs, installment payments, laundry and cleaning, and other extraordinary expenses. (j) “Guarantor” means a person who has legal financial responsibility for the patient’s health care services.

Document details

CollectionCalifornia Statutes
CitationCal. HSC § 127400
Date2025-01-01
Typestatute
Languageen
SourceCA_STAT
IdentifierHSC127400.20245111