AB 2843 Cost-Sharing Waiver Requirements

By January 1, 2025: Billing team must implement the following: (1) Update billing system to identify and flag all claims/encounters submitted with ICD-10 diagnosis codes related to rape or sexual assault (reference CMS ICD-10 code list at https://www.cms.gov/medicare/coding-billing/icd-10-codes); (2) Configure system to automatically waive copayments, coinsurance, deductibles, and all cost-sharing amounts for qualifying claims within the nine-month treatment window from date of incident; (3) Ensure claims are submitted with accurate rape/sexual assault diagnosis codes to support waiver identification; (4) Train billing and collections staff to NOT bill, collect, or attempt to collect cost-sharing from members on these claims; (5) Update member-facing materials (benefit documents, website, notices) to communicate the cost-sharing waiver; (6) Establish internal audit and compliance controls to track and document AB 2843 compliance; (7) Communicate AB 2843 requirements and billing procedures to all contracted and non-contracted providers in writing via policy manuals, provider notices, and operational guidance; (8) Maintain documentation of processes, oversight mechanisms, and operational controls for compliance verification. Contact L.A. Care Provider Line (1-866-522-2736, M-F 7am-6pm PT) for claims submission or eligibility questions. Failure to comply will result in improper member billing and potential regulatory violation.