Date of Hearing: April 23, 2019

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

ABPCA Bill Id:AB 370

Author:(Voepel) – As Amended Ver:March 12, 2019

SUBJECT: Physicians and surgeons: forms: fee limitations.

SUMMARY: Permits physicians and surgeons to charge a reasonable fee associated with filling out medical forms, including those applying for state disability insurance. Specifically, this bill:

1. Authorizes fees charged for filling out medical forms to be reasonable and based on actual time and cost for filling out the forms.
2. Exempts initial forms filled out by the licensee from the specified fee limitations.
3. Declares that it is the intent of the Legislature that completed medical forms be made available at the lowest possible cost to the patient.
4. Specifies that a violation of these provisions does not constitute as a misdemeanor.

EXISTING LAW:

1. Prohibits a health care provider from charging more than a reasonable fee for preparing a summary of a patient’s record for inspection and copying by the patient, based on actual time and cost for the preparation of the summary.
2. Establishes the Medical Practice Act, which provides for the state’s licensure and regulation of physicians and surgeons.
3. Establishes the Medical Board of California (MBC), a regulatory board within the Department of Consumer Affairs comprised of 15 appointed members to enforce the Medical Practice Act.

FISCAL EFFECT: This bill has not yet been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, this bill protects Californian’s who are disabled from being taken advantage of doctors that charge high prices for individuals, including seniors who cannot afford to pay extra fees.
2. BACKGROUND. In addition to providing professional health care services, licensed providers provide an evaluation and certification of medical conditions to verify a patient’s eligibility for certain benefits, or for other purposes. For example, if an individual is applying for State Disability Insurance, they are required to have a medical examination to verify their need for assistance, and in order to receive payments.

Currently, there is no provision of law dictating what fees a physician may charge a patient to complete a medical form such as the certificate required for state disability insurance. According to the author, some physicians charge fees between $50 and $140 per form. Under this bill, the MBC would be responsible for determining if a fee for medical forms is reasonable.

1. OPPOSITION. According to the California Society of Plastic Surgeons and the California Chapter of the American College of Cardiology, there are a variety of different forms a patient may have a physician fill out. Some forms patients bring to their physicians can be quite lengthy and take a considerable amount of time to review and complete.
2. POLICY COMMENT. Existing law is currently silent on fees that physicians and/or surgeons can charge for medical forms. Under the provisions of this bill, if a physician or surgeon can prove that complex forms require a significant amount of their time, then the current fees associated with medical forms, including those required for state disability insurance, may be reasonable. Thus, while the intention of this bill is to protect individuals that may be out of work and financially disadvantaged from high fees for medical forms, the current provisions may actually result in allowing even higher charges for patients to get necessary forms filled out by their physician.
3. DOUBLE REFERRAL. This bill is double referred; it passed the Assembly Business and Professions Committee on April 9, 2019 with a vote of 20-0.

REGISTERED SUPPORT / OPPOSITION:

Support

None on file.

Opposition

California Chapter American College of Cardiology
California Orthopedic Association
California Society of Plastic Surgeons

Analysis Prepared by: Marissa Kraynak / HEALTH / (916) 319-2097

Date of Hearing:

ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS

Evan Low, Chair

ABPCA Bill Id:AB 370

Author:(Voepel) – As Amended Ver:March 12, 2019

SUBJECT: Physicians and surgeons: forms: fee limitations.

SUMMARY: Prohibits a physician and surgeon from charging a patient more than $25 for each medical form filled out for the patient, including forms to apply for state disability insurance.

EXISTING LAW:

1. Establishes the Medical Practice Act, which provides for the state’s licensure and regulation of physicians and surgeons. (Business and Professions Code (BPC) §§ 2000 et seq.)
2. Establishes the Medical Board of California (MBC), a regulatory board within the Department of Consumer Affairs comprised of 15 appointed members. (BPC § 2001)
3. Prohibits a health care provider from charging more than a reasonable fee for preparing a summary of a patient’s record for inspection and copying by the patient, based on actual time and cost for the preparation of the summary. (Health and Safety Code § 123130)

THIS BILL:

1. Prohibits a physician and surgeon from charging a fee to a patient for filling out medical forms, including forms to apply for state disability insurance that exceeds $25 for each form.
2. States that the limitation on fees applies only to forms subsequently filled out by the licensee after the initial form is completed.
3. Authorizes the MBC to annually increase the fee permitted to be charged for filling out medical forms by an amount equal to the increase in the California Consumer Price Index.

FISCAL EFFECT: Unknown; this bill is keyed fiscal by the Legislative Counsel.

COMMENTS:

Purpose. This bill is sponsored by the author. According to the author, “AB 370 works to protect individuals from being taken advantage of physicians who charge their patience enormous amount of money to fill our SDI form to be submitted by the patient.”

Background. In addition to providing professional health care services, licensed practitioners sometimes participate in the evaluation and certification of medical conditions to verify a patient’s eligibility for benefits or for other purposes. One example is with state disability insurance. In order for a patient to ultimately receive payments, there must be a completed Physician/Practitioner’s Certificate following an independent medical examination.

Currently, there is no provision of law dictating what fees a physician may charge a patient to complete a medical form such as the certificate required for state disability insurance. According to the author, some physicians charge fees between $50 and $140 per form. The intent of this bill is to cap the fee that may be charged for completion of a form at $25, with the MBC authorized to increase that fee annually by an amount no greater than the increase in the Consumer Price Index.

ARGUMENTS IN SUPPORT:

None on file.

ARGUMENTS IN OPPOSITION:

The California Society of Plastic Surgeons (CSPS) and the California Chapter of the American College of Cardiology (CA-ACC) each oppose this bill. According to the CSPS and the CA-ACC, “There are a variety of different forms a patient may have a physician fill out which have varying lengths and complexity. The bill draws no distinction to this and simply limits the amount to no more than $25. Some forms patients bring to their physicians can be quite lengthy and take a considerable amount of time to review and complete. We believe it is more appropriate to allow for the fair and reasonable reimbursement for having physicians fill out forms.”

POLICY ISSUE(S) FOR CONSIDERATION:

It is easily argued that patients—especially those faced with a disability or other vulnerable circumstances—should not be charged excessive fees by a physician for the completion of a medical form. However, as has been stated by the opposition, this bill is not limited exclusively to the state disability insurance form and it potentially encompasses a wide range of forms that may be of greater complexity than the author’s principal example. As such, a universal $25 fee cap may be an inappropriate reflection of what might be involved in a physician’s completion of a medical form. Instead of specifying a maximum dollar amount in statute, the author should consider codifying a prohibition against a physician charging an amount for the preparation of a medical form that is in excess of the work actually required to complete the form.

IMPLEMENTATION ISSUES:

As currently drafted, the bill allows the MBC to annually increase the $25 cap on a physician’s completion of medical forms by an amount not exceeding the increase in the Consumer Price Index. If this law were in effect beginning January 1, 2019, an annual increase to the cap by the MBC would have been $0.39. It is uncertain if the MBC would ever see any value in providing for such a minor increase to the cap as provided under the bill.

AMENDMENTS:

1. To replace the bill’s provisions specifically capping the amount a physician may charge a patient for completing a medical form at $25 with provisions that disallow the charging of a fee that is unreasonable or in excess of the actual cost of filling out the form:

Amend the bill as follows:

2380. (a) Subject to subdivision (b), a physician and surgeon shall not may charge a fee to a patient for filling out medical forms no more than a reasonable fee based on actual time and cost for filling out the forms, including forms to apply for state disability insurance, that exceeds twenty-five dollars ($25) for each form.

(b) The limitation on fees applies only to forms subsequently filled out by the licensee after the initial form is completed.

(c) Subject to Section 2001.1, the Medical Board of California may annually increase the amount of fees permitted to be charged under this section by an amount equal to the increase in the California Consumer Price Index. It is the intent of the Legislature that completed medical forms be made available at the lowest possible cost to the patient.

(d) Section 2314 shall not apply to a violation of this section.

REGISTERED SUPPORT:

None on file.

REGISTERED OPPOSITION:

California Chapter of the American College of Cardiology
California Orthopaedic Association
California Society of Plastic Surgeons

Analysis Prepared by: Robert Sumner / B. & P. / (916) 319-3301