SB 359 Summary

• Requires hospitals with an out-of-network emergency utilization rate of 50% or more to notify payers that total billed charges for pre-stabilization emergency services may be adjusted such that expected payment equals 60% of the payer's average in-network payments, but not less than 150% of what Medicare would pay for similar services.

• Exempts from adjustment requirements: charges billed by physicians or licensed professionals on hospital medical staff, workers' compensation cases, Medicare/Medi-Cal primary payers, and cases governed by existing contracts between hospitals and payers.

• Applies only to private insurance patients (health insurers, health care service plans, and employer plans) and excludes designated public hospitals, government-owned facilities, rural hospitals, and hospitals in medically underserved areas.

• Requires hospitals to refund any amounts paid in excess of the adjusted payment amount, with interest accruing at the rate specified in Code of Civil Procedure Section 685.010.

• Sunsets on January 1, 2017, unless extended by later enacted legislation.