BILL NUMBER: SB 93	ENROLLED
	BILL TEXT

	PASSED THE SENATE  SEPTEMBER 11, 2007
	PASSED THE ASSEMBLY  SEPTEMBER 10, 2007
	AMENDED IN ASSEMBLY  SEPTEMBER 6, 2007
	AMENDED IN ASSEMBLY  JULY 16, 2007

INTRODUCED BY   Senator Corbett
   (Coauthors: Assembly Members Jones and Laird)

                        JANUARY 17, 2007

   An act to amend Section 14124.70 of the Welfare and Institutions
Code, relating to Medi-Cal.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 93, Corbett.  Medi-Cal: third-party liability.
   Existing law provides for the Medi-Cal program, administered by
the State Department of Health Care Services, under which basic
health care services are provided to qualified low-income persons.
   Existing law authorizes the Director of Health Care Services, as
well as the Attorney General, and other specified officials, to bring
an action to recover the reasonable value of benefits provided or
that will be provided to a Medi-Cal recipient against a 3rd party,
including an insurance carrier, because of any injury for which the
3rd party is liable.
   Existing law contains procedures governing these actions, as well
as provisions pertaining to the director's right to claim
reimbursement when the claim against a 3rd party is brought by
another person, including the recipient. Existing law prohibits the
director's claim for exceeding 1/2 of the beneficiary's recovery
after deducting fees and costs.
   Existing law defines the term "lien" as the director's claim for
recovery, from a beneficiary's tort action or claim, of the
reasonable value of benefits provided on behalf of the beneficiary.
   This bill would prohibit the amount paid by Medi-Cal from being
considered as evidence of past medical damages or for the purpose of
reducing the 3rd party's liability to the beneficiary in any
3rd-party action.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 14124.70 of the Welfare and Institutions Code
is amended to read:
   14124.70.  As used in this article:
   (a) "Carrier" includes any insurer as defined in Section 23 of the
Insurance Code, including any private company, corporation, mutual
association, trust fund, reciprocal or interinsurance exchange
authorized under the laws of this state to insure persons against
liability or injuries caused to another, and also any insurer
providing benefits under a policy of bodily injury liability
insurance covering liability arising out of the ownership,
maintenance or use of a motor vehicle which provides uninsured
motorist endorsement or coverage, pursuant to Section 11580.2 of the
Insurance Code.
   (b) "Beneficiary" means any person who has received benefits or
will be provided benefits under this chapter because of an injury for
which another person or party may be liable. It includes such
beneficiary's guardian, conservator or other personal representative,
his estate or survivors.
   (c) "Reasonable value of benefits" means both of the following:
   (1) Except in a case in which services were provided to a
beneficiary under a managed care arrangement or contract, "reasonable
value of benefits" means the Medi-Cal rate of payment, for the type
of services rendered, under the schedule of maximum allowances
authorized by Section 14106 or, the Medi-Cal rate of payment, for the
type of services rendered, under regulations adopted pursuant to
this chapter, including but not limited, to Section 14105.
   (2) If services were provided to a beneficiary under a managed
care arrangement or contract, "reasonable value of benefits" means
the rate of payment to the provider by the plan for the services
rendered to the beneficiary, except in cases where the plan pays the
provider on a capitated or risk sharing basis, in which case it means
the value of the services rendered to the beneficiary calculated by
the plan as the usual customary and reasonable charge made to the
general public by the provider for similar services.
   (d) "Lien" means the director's claim for recovery, from a
beneficiary's tort action or claim, of the reasonable value of
benefits provided on behalf of the beneficiary. The amount paid by
Medi-Cal shall not be considered as evidence of past medical damages
or for the purpose of reducing the third party's liability to the
beneficiary in any third-party action.