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Hospital Fair Billing Program Laws & Regulations

Assembly Bill (AB) 1020

On January 1, 2024, the Hospital Fair Billing Program (formerly known as the Fair Pricing Policies Program) assumed enforcement of the Hospital Fair Pricing Act from the California Department of Public Health. AB 1020 (Chapter 473, Statutes of 2021) expanded current notice and reporting requirements, established a patient complaint process, and authorized the assessment of administrative penalties against hospitals for violations of the Hospital Fair Pricing Act.

AB 1020 also created the following new requirements:

  • Raises the income level for financial assistance from 350 percent of the Federal Poverty Level (FPL) to 400 percent.
  • Prohibits hospitals from selling patient debt unless specified conditions are met, including that the hospital has found the patient ineligible for financial assistance or the patient has not responded to attempts to bill or offer financial assistance for 180 days.
  • Extends adverse credit reporting and commencement of civil action from 150 to 180 days after initial billing.
  • Requires debt collectors to certify that the patient has been screened for public health coverage programs and financial assistance before filing a lawsuit.

Final Rulemaking File (Approved)

HCAI’s newly adopted regulations (Title 22 of the California Code of Regulations sections 96051 to 96051.37), effective January 1, 2024, outline the hospital policy submission process, the patient complaint process, accessibility requirements, and notice requirements. The regulations also outline how penalty assessments are determined for violations of the Hospital Fair Pricing Act and establish a process for how a hospital may appeal HCAI’s determination and penalty assessment.

Repealed Sections: 96040, 96041, 96042, 96043, 96044, 96045, 96046, and 96050 of the California Code of Regulations, Title 22, Division 7, Chapter 9: Hospital Charges and Fair Pricing Policies Reporting.

Adopted Sections: Adopted Sections 96051, 96051.1, 96051.2, 96051.3, 96051.4, 96051.5, 96051.6, 96051.7, 96051.8, 96051.9, 96051.10, 96051.11, 96051.12, 96051.13, 96051.14, 96051.15, 96051.16, 96051.17, 96051.18, 96051.19, 96051.20, 96051.21, 96051.22, 96051.23, 96051.24, 96051.25, 96051.26, 96051.27, 96051.28, 96051.29, 96051.30, 96051.31, 96051.32, 96051.33, 96051.34, 96051.35, 96051.36, and 96051.37.

History of Fair Pricing Policies Legislation

AB 774 (Chapter 755, Statutes of 2006) established Hospital Fair Pricing Policies effective January 1, 2007. This legislation required each licensed general acute care hospital, psychiatric acute hospital, and special hospital to increase public awareness of the availability of charity care, payment discounts, government-sponsored health insurance, and to standardize its billing and collections procedures.

Assembly Bill 774 required HCAI to collect and make available to the public a copy of each hospital’s charity care and discount payment policies, eligibility procedures for those policies, review processes, and application forms.

Laws and Regulations

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