As used in this article, the following terms have the following meanings: (a) âAllowance for financially qualified patientâ means, with respect to emergency care rendered to a financially qualified patient, an allowance that is applied after the emergency physicianâs charges are imposed on the patient, due to the patientâs determined financial inability to pay the charges. (b) âEmergency careâ means emergency medical services and care, as defined in Section 1317.1, that is provided by an emergency physician in the emergency department of a hospital. (c) âEmergency physicianâ means a physician and surgeon licensed pursuant to Chapter 5 (commencing with Section 2000) of Division 2 of the Business and Professions Code who is credentialed by a hospital and either employed or contracted by the hospital to provide emergency medical services in the emergency department of the hospital, except that an âemergency physicianâ shall not include a physician specialist who is called into the emergency department of a hospital or who is on staff or has privileges at the hospital outside of the emergency department. (d) âFederal poverty levelâ means the poverty guidelines updated periodically in the Federal Register by the United States Department of Health and Human Services under authority of subsection (2) of Section 9902 of Title 42 of the United States Code. (e) âFinancially qualified patientâ means a patient who is both of the following: (1) A patient who is a self-pay patient or a patient with high medical costs. (2) A patient who has a family income that does not exceed 400 percent of the federal poverty level. (f) âHospitalâ means a facility that is required to be licensed under subdivision (a) of Section 1250, except a facility operated by the State Department of State Hospitals, the State Department of Developmental Services, or the Department of Corrections and Rehabilitation. (g) âDepartmentâ means the Department of Health Care Access and Information. (h) âSelf-pay patientâ means a patient who does not have third-party coverage from a health insurer, health care service plan, Medicare, or Medicaid, and whose injury is not a compensable injury for purposes of workersâ compensation, automobile insurance, or other insurance as determined and documented by the emergency physician. Self-pay patients may include charity care patients. (i) âA patient with high medical costsâ means a person whose family income does not exceed 400 percent of the federal poverty level if that individual does not receive a discounted rate from the emergency physician as a result of their third-party coverage. For these purposes, âhigh medical costsâ means any of the following: (1) Annual out-of-pocket costs incurred by the individual at the hospital that provided emergency care that exceed 10 percent of the patientâs family income in the prior 12 months. Out-of-pocket costs means any expenses for medical care that are not reimbursed by insurance or a health coverage program, such as Medicare copays or Medi-Cal cost sharing. (2) Annual out-of-pocket expenses that exceed 10 percent of the patientâs family income, if the patient provides documentation of the patientâs medical expenses paid by the patient or the patientâs family in the prior 12 months. Out-of-pocket expenses means any expenses for medical care that are not reimbursed by insurance or a health coverage program, such as Medicare copays or Medi-Cal cost sharing. The emergency physician may waive the request for documentation. (3) A lower level determined by the emergency physician in accordance with the emergency physicianâs discounted payment policy. (j) âPatientâs familyâ means the following: (1) For persons 18 years of age and older, spouse, domestic partner, as defined in Section 297 of the Family Code, and dependent children under 21 years of age, or any age if disabled, consistent with Section 1614(a) of Part A of Title XVI of
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