Despite physician opposition, rules to prohibit balance billing were revived on both the legislative and regulatory fronts.

In September, two senators were pursuing bills amended with language prohibiting balance billing, while the California Department of Managed Health Care in August filed new proposed regulations that would prevent noncontracted physicians from billing patients for emergency services. Both bills are likely dead for the special legislative session, and the public comment period for the proposed DMHC rules expires Nov. 15.

State Sen. Leland Yee's SB 697 would have prohibited providers from seeking reimbursement from patients enrolled in Healthy Families for any covered services. According to the CMA government relations staff, Assembly Speaker Fabian Nunez held Yee's bill on the Assembly floor, re_moving it from consideration this year.

Senate President Pro Tem Don Perata's balance billing vehicle, SB 981, was similar. It would prohibit noncontracted hospital-based physicians from seeking payment from individual enrollees for medically necessary covered services, requiring physicians to seek reimbursement only from healthcare plans or their risk-bearing organizations. It would also require health plans to report violations to the DMHC, and it would remove from patients the obligation to pay amounts billed in violation. This bill was not passed in the Legislature during the regular session and is unlikely to accompany healthcare reform bills in the special session.

The DMHC's proposal to prevent noncontracted physicians from billing patients for emergency services would create an independent dispute resolution process, require that health plans pay providers an interim amount of 150 percent of 2007 Medicare rates, and expand the standard for determining fair and reasonable payment to include Medicare and contract rates. CMA officials say the association may fight the proposal with litigation, if it harms doctors.