I guess I don't have to worry about it. Shiela promises that it will be "fair". And also that the payment schedules will be in place for 3 years. ha ha.
It's one thing to spout off about a piece of legislation, it's another to have actively read and critiqued it. LOL.
(6) Providers electing to be compensated by the California
Health Insurance System shall enter into a contract with the
health insurance system pursuant to provisions of this section.
(7) Providers electing to be compensated by persons to whom
they provide services, instead of by the California Health
Insurance System , may establish charges for their services.
Providers may choose to be reimbursed either by a patient or
by the health insurance system for services rendered to a patient.
SB 840 — 46 —
Providers may not be reimbursed by a patient and by the health
insurance system for the same service.
(8) Health care providers who accept any payment under this
division shall not bill a patient for any covered service.
(e) Health care providers licensed or accredited to provide
services in California, who choose to be compensated by the
health insurance system instead of by patients to whom they
provide services, may choose how they wish to be compensated
under this division, as fee-for-service providers or as salaried
providers in health care systems that provide comprehensive,
(f) Notwithstanding provisions of the Business and
Professions Code, nurse practitioners, physician assistants, and
others who under California law must be supervised by a
physician, an osteopathic physician, a dentist, or a podiatrist, may
choose fee-for-service compensation while under lawfully
required supervision. However, nothing in this section shall
interfere with the right of a supervising provider to enter into a
contractual arrangement that provides for salaried compensation
for employees who must be supervised under the law by a
physician, an osteopathic physician, a dentist, or a podiatrist.
(g) The compensation plan shall include all of the following:
(1) Actuarially sound payments that include a just and fair
return for providers in the fee-for-service sector and for providers
working in health systems where comprehensive and coordinated
services are provided, including the actuarial basis for the
(2) Payment schedules which shall be in effect for three years.
(3) Bonus and incentive payments, including, but not limited
to, all the following:
(A) Bonus payments for providers and upper level managers
who, in providing services and managing facilities, practices and
integrated health systems, pursuant to this division, meet
performance standards and outcome goals established by the
California Health Insurance System.
(B) Incentive payments for providers and upper level
managers who provide services to the California Health
Insurance System in areas identi fi ed by the Of fi ce of Health
Planning as medically underserved.
— 47 — SB 840
(C) Incentive payments required to achieve the ratio of
generalist to specialist providers needed in order to meet the
standards of care and health needs of the population.
(D) Incentive payments required to recruit and retain nurse
practitioners and physician assistants in order to provide primary
and preventive care to the population.
(E) No bonus or incentive payment may be made in excess of
the total allocation for provider and manager incentive and bonus
reimbursement established by the commissioner in the health
insurance system budget.
(F) No incentive may adversely affect the care a patient
receives or the care a health provider recommends.
(h) Providers shall be paid for all services provided pursuant to
this division, including care provided to persons who are
subsequently determined to be ineligible for the California
Health Insurance System.
(i) Licensed providers who deliver services not covered under
the California Health Insurance System may establish rates for,
and charge patients for those services.
(j) Reimbursement to providers and managers may not exceed
the amount allocated by the commissioner to provider and
manager annual budgets.
140209. (a) Fee-for-service providers shall choose
representatives of their specialties to negotiate reimbursement
rates with the Payments Board on their behalf.
(b) The Payments Board shall establish a uniform system of
payments for all services provided pursuant to this division.
(c) Payment schedules shall be available to providers in
printed and in electronic documents.
(d) Payment schedules shall be in effect for three years, at
which time payment schedules may be renegotiated. Payment
adjustments may be made at the discretion of the pay board to
meet the goals of the health insurance system.
(e) In establishing a uniform system of payments the Payments
Board shall collaborate with regional health directors and
providers and shall take into consideration regional differences in
the cost of living and the need to recruit and retain skilled
providers in the region.
If you can address any of my bullet point concerns rather than saying, Face it Lisa, we have to do this, I would be more prone to agree with you.