AB 2843 Cost-Sharing Waiver Requirements

By January 1, 2025: (1) Billing team must update billing system to automatically identify and flag claims submitted with ICD-10 diagnosis codes related to rape or sexual assault (reference CMS ICD-10 codes at https://www.cms.gov/medicare/coding-billing/icd-10-codes). (2) Implement system rules to prevent billing, collection, or balance billing of copayments, coinsurance, deductibles, and other cost-sharing amounts for these flagged claims for nine months from date of treatment initiation. (3) Update encounter forms and member-facing materials (website, benefit summaries, notices) to communicate the cost-sharing waiver. (4) Create internal procedures to track and audit compliance with AB 2843 requirements. (5) Communicate AB 2843 requirements to all contracted and non-contracted providers via provider notices, policy updates, and operational guidance, emphasizing the prohibition on collecting cost-sharing amounts. (6) Establish documentation and oversight controls to support compliance audits. (7) Train billing staff on identifying qualifying diagnosis codes and processing compliant claims. Failure to waive cost-sharing for eligible members violates contractual obligations to L.A. Care and California law. Contact L.A. Care Provider Line at 1-866-522-2736 (Monday-Friday, 7am-6pm PT) for claims submission questions.