{"id":2262,"date":"2022-04-23T09:08:56","date_gmt":"2022-04-23T09:08:56","guid":{"rendered":"https:\/\/crowdsourcelawyers.com\/california-statutes\/?page_id=2262"},"modified":"2022-05-20T23:45:40","modified_gmt":"2022-05-20T23:45:40","slug":"health-and-safety-code-hsc-1375-8","status":"publish","type":"page","link":"https:\/\/crowdsourcelawyers.com\/california-statutes\/california-statutes\/health-and-safety-code-hsc-1375-8\/","title":{"rendered":"Health and Safety Code &#8211; HSC 1375.8"},"content":{"rendered":"\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-l2bmxwk6-04255801dc1a1b8a24dfb744193b65a7\">\n#top .av-special-heading.av-l2bmxwk6-04255801dc1a1b8a24dfb744193b65a7{\npadding-bottom:10px;\n}\nbody .av-special-heading.av-l2bmxwk6-04255801dc1a1b8a24dfb744193b65a7 .av-special-heading-tag .heading-char{\nfont-size:25px;\n}\n.av-special-heading.av-l2bmxwk6-04255801dc1a1b8a24dfb744193b65a7 .av-subheading{\nfont-size:22px;\n}\n<\/style>\n<div  class='av-special-heading av-l2bmxwk6-04255801dc1a1b8a24dfb744193b65a7 av-special-heading-h1 blockquote modern-quote  avia-builder-el-0  el_before_av_hr  avia-builder-el-first '><div class='av-subheading av-subheading_above'><p>California<\/p>\n<\/div><h1 class='av-special-heading-tag '  itemprop=\"headline\"  >Health and Safety Code &#8211; HSC \u00a7 1375.8<\/h1><div class=\"special-heading-border\"><div class=\"special-heading-inner-border\"><\/div><\/div><\/div>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-av_hr-3a876428eececa9d35452247ddb053af\">\n#top .hr.hr-invisible.av-av_hr-3a876428eececa9d35452247ddb053af{\nheight:50px;\n}\n<\/style>\n<div  class='hr av-av_hr-3a876428eececa9d35452247ddb053af hr-invisible  avia-builder-el-1  el_after_av_heading  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n<section  class='av_textblock_section av-av_textblock-e878f05c31dff72941bf1e49a00d9ff5 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><p><a href=\"https:\/\/crowdsourcelawyers.com\/\">CrowdSourceLawyers.com<\/a><\/p>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-avia_sc_search-4ee94ae86cde3b232e718bb4ac84e6ad\">\n#top .avia_search_element.av-avia_sc_search-4ee94ae86cde3b232e718bb4ac84e6ad .av_searchform_wrapper{\nborder-color:#edae44;\nbackground-color:#edae44;\n}\n#top .avia_search_element.av-avia_sc_search-4ee94ae86cde3b232e718bb4ac84e6ad #s.av-input-field{\ncolor:#edae44;\n}\n#top .avia_search_element.av-avia_sc_search-4ee94ae86cde3b232e718bb4ac84e6ad .av-input-field-icon.av-search-icon{\ncolor:#edae44;\n}\n#top .avia_search_element.av-avia_sc_search-4ee94ae86cde3b232e718bb4ac84e6ad .av-input-field-icon.av-search-icon.avia-svg-icon svg:first-child{\nfill:#edae44;\nstroke:#edae44;\n}\n#top .avia_search_element.av-avia_sc_search-4ee94ae86cde3b232e718bb4ac84e6ad #searchsubmit{\nbackground-color:#edae44;\n}\n#top .avia_search_element.av-avia_sc_search-4ee94ae86cde3b232e718bb4ac84e6ad .av_searchsubmit_wrapper{\nbackground-color:#edae44;\n}\n<\/style>\n<div  class='avia_search_element av-avia_sc_search-4ee94ae86cde3b232e718bb4ac84e6ad  avia-builder-el-3  el_after_av_textblock  el_before_av_hr '><search><form action='https:\/\/crowdsourcelawyers.com\/california-statutes\/' id='searchform_element' method='get' class='' data-element_id='av-avia_sc_search-4ee94ae86cde3b232e718bb4ac84e6ad' ><div class='av_searchform_wrapper'><input type='search' value='' id='s' name='s' placeholder='Search CA statutes' aria-label='Search CA statutes' class='av-input-field ' required \/><div class='av_searchsubmit_wrapper '><input type='submit' value='Find' id='searchsubmit' class='button ' title='View results on search page' aria-label='View results on search page' \/><\/div><input type='hidden' name='numberposts' value='10' \/><input type='hidden' name='results_hide_fields' value='' \/><\/div><\/form><\/search><\/div>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-av_hr-3a876428eececa9d35452247ddb053af\">\n#top .hr.hr-invisible.av-av_hr-3a876428eececa9d35452247ddb053af{\nheight:50px;\n}\n<\/style>\n<div  class='hr av-av_hr-3a876428eececa9d35452247ddb053af hr-invisible  avia-builder-el-4  el_after_avia_sc_search  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n<section  class='av_textblock_section av-l2bn3esk-464bc7d5f0542bdd328bae2efe75118e '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><div class=\"row\">\n<div class=\"subsection\"><\/div>\n<div class=\"subsection\">\n<div class=\"subsection\">\n<p>(a)\u2002The Legislature finds the following:<\/p>\n<div class=\"subsection\">\n<p>(1)\u2002Because of the nature and cost of certain medical items, the financial risk of these items is better retained by the health care service plan than by a health care service provider.<\/p>\n<\/div>\n<div class=\"subsection\">\n<p>(2)\u2002Allowing a health care service provider to take the financial risk for the items described in this section only if the provider specifically requests in writing to assume that risk, will assist in maintaining patient access to health care service providers.<\/p>\n<\/div>\n<\/div>\n<div class=\"subsection\">\n<div class=\"subsection\">\n<p>(b)(1)\u2002Notwithstanding\u00a0<span class=\"cite\">Section 1375.5\u00a0<\/span>, no health care service plan contract that is issued, amended, delivered, or renewed in this state on or after July 1, 2003, shall require or allow a health care service provider to assume or be at any financial risk for any item described in subparagraphs (A) to (F), inclusive, of paragraph (2) when covered under the applicable plan contract and administered in the office of a physician and surgeon or prescribed by a physician and surgeon for self-administration by the patient. \u201c<span class=\"wordphrase\">Self-administration<\/span>,\u201d for the purposes of this section, means an injectable medication that can be safely given intramuscularly, or in the muscle, or subcutaneously, or under the skin, by the patient or his or her family member.<\/p>\n<\/div>\n<div class=\"subsection\">\n<p>(2)\u2002The items described in subparagraphs (A) to (F), inclusive, shall, instead, be reimbursed on a fee-for-service basis at the negotiated contract rate or through an alternate funding mechanism mutually agreed to by the health care service plan and the health care service provider, subject to any applicable copayment or deductible, by the health care service plan.<\/p>\n<div class=\"subsection\">\n<p>(A)\u2002Injectable chemotherapeutic medications and injectable adjunct pharmaceutical therapies for side effects.<\/p>\n<\/div>\n<div class=\"subsection\">\n<p>(B)\u2002Injectable medications or blood products used for hemophilia.<\/p>\n<\/div>\n<div class=\"subsection\">\n<p>(C)\u2002Injectable medications related to transplant services.<\/p>\n<\/div>\n<div class=\"subsection\">\n<p>(D)\u2002Adult vaccines.<\/p>\n<\/div>\n<div class=\"subsection\">\n<p>(E)\u2002Self-injectable medications.<\/p>\n<\/div>\n<div class=\"subsection\">\n<p>(F)\u2002Other injectable medication or medication in an implantable dosage form costing more than two hundred fifty dollars ($250) per dose.<\/p>\n<\/div>\n<\/div>\n<div class=\"subsection\">\n<p>(3)\u2002Notwithstanding the provisions of paragraphs (1) and (2), a health care service provider may assume financial risk for the items described in subparagraphs (A) to (F), inclusive, of paragraph (2) after making the request in writing at the time of negotiating an initial contract or renewing a contract with a health care service plan. \u2002No health care service plan may request or require that as a condition of the contract agreement a health care service provider shall request to assume the financial risk for any of those items.<\/p>\n<\/div>\n<\/div>\n<div class=\"subsection\">\n<p>(c)\u2002The following definitions apply for the purposes of this section:<\/p>\n<div class=\"subsection\">\n<p>(1)\u2002\u201c<span class=\"wordphrase\">Financial risk<\/span>\u201d means any contractual financial agreement between a health care service provider and a health care service plan for services rendered to a patient or enrollee if the reimbursement from a health care service plan is other than a fee for service rate structure. \u201c<span class=\"wordphrase\">Financial risk<\/span>\u201d includes, but is not limited to, capitation payments, case rates, and risk pools.<\/p>\n<\/div>\n<div class=\"subsection\">\n<p>(2)\u2002\u201c<span class=\"wordphrase\">Health care service provider<\/span>\u201d means an individual, partnership, group, or corporation lawfully licensed or organized under Division 2 (commencing with\u00a0<span class=\"cite\">Section 500) of the Business and Professions Code\u00a0<\/span>, unless specifically exempt from those provisions, or licensed under\u00a0<span class=\"cite\">Section 1204\u00a0<\/span>or exempt from licensure under\u00a0<span class=\"cite\">Section 1206\u00a0<\/span>that delivers, furnishes, or otherwise arranges for or provides health care services. \u201cHealth care service provider\u201d does not include a health facility as defined in\u00a0<span class=\"cite\">Section 1250\u00a0<\/span>, a hospice, a surgical center, or a home infusion provider.<\/p>\n<\/div>\n<\/div>\n<div class=\"subsection\">\n<p>(d)\u2002This section shall not preclude any payment by a health care service plan to a health care service provider for the performance of any services related to quality measures and programs.<\/p>\n<\/div>\n<div class=\"subsection\">\n<p>(e)\u2002This section shall not apply to a contract that is between a health care service plan and a health care service provider or a provider organization that meets either of the requirements set forth in\u00a0<span class=\"cite\">paragraph (2) of subdivision (g) of Section 1375.4\u00a0<\/span>or to a contract between licensed health care service plans or to a contract between a health care service plan and a health care service plan with waivers.<\/p>\n<\/div>\n<p><br class=\"avia-permanent-lb\" \/><br class=\"avia-permanent-lb\" \/><\/p>\n<\/div>\n<\/div>\n<hr \/>\n<p><a href=\"https:\/\/crowdsourcelawyers.com\/\">CrowdSourceLawyers.com<\/a><\/p>\n<\/div><\/section>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":7,"featured_media":0,"parent":2019,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-2262","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - 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