MedicaidCoverageHigh impact
AB 2843 Cost-Sharing Waiver Requirements
L.A. Care Health Plan·CA · Emergency Medicine, Psychiatry·Provider Communication
Effective date
Jan 1, 2025
We identified it
Jul 17, 2026
Summary
AB 2843 requires L.A. Care to waive all cost-sharing (copays, coinsurance, deductibles) for emergency department services and follow-up care related to rape or sexual assault for nine months from treatment initiation. Billing teams must identify qualifying claims using rape/sexual assault diagnosis codes, ensure members are never billed for these services, and implement internal processes to track and comply with this requirement.
Action Required
By January 1, 2025: (1) Billing team must configure billing system to identify and flag all claims 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) Implement automated workflow to waive all cost-sharing amounts (copayments, coinsurance, deductibles) on qualifying claims—do not bill or collect from members; (3) Update claim submission processes to ensure accurate diagnosis coding is used to support cost-sharing waiver identification; (4) Train billing staff to never attempt collection on these flagged claims; (5) Establish documentation and oversight controls to track compliance; (6) Update member-facing materials and benefit information to reflect this waiver; (7) Communicate requirements to all contracted and non-contracted providers rendering services to L.A. Care Covered and PASC-SEIU members. Failure to waive cost-sharing will result in member billing violations and potential compliance issues with L.A. Care. Contact L.A. Care Provider Line (1-866-522-2736) for questions on member eligibility or claims submission.