SB 1285 Summary

• Requires hospitals with an out-of-network emergency utilization rate of 50% or more to cap total billed charges for prestabilization emergency services at no more than 150% of the Medicare reimbursement amount for those services.

• Exempts charges billed by emergency physicians, workers' compensation injuries, and cases where Medicare, Medi-Cal, or other government programs are the primary payer from the billing adjustment requirements.

• Requires health care service plans and contracting medical providers to reimburse hospitals in accordance with these pricing provisions.

• Does not apply to designated public hospitals, hospitals owned or operated by governmental entities, health care districts, or the University of California.

• Allows hospitals to provide refunds with interest for amounts paid in excess of what is due under the article, accruing at the rate specified in Section 685.010 of the Code of Civil Procedure.