Medical services: damages.

Existing law establishes, as a general rule, that compensation is the relief or remedy provided by law for a violation of private rights. Existing law provides that a person suffering detriment from the unlawful act or omission of another may recover damages from the person at fault. Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. Under existing law, when benefits are provided or will be provided to a Medi-Cal beneficiary for which another person or insurer is liable, the Director of Health Care Services may recover from that person or insurer the reasonable value of benefits provided, as defined and as prescribed. This bill would provide that an injured person whose health care is provided through a public or private capitated health care service plan shall be entitled to recover as damages the reasonable and necessary value of medical services. This bill would provide that a Medi-Cal beneficiary shall be entitled to recover from the person or party responsible the reasonable and necessary value of medical services. Existing law provides procedures under which, in any case in which a 3rd person is liable to pay for health services provided by a county to an injured or diseased person, the county may recover from that 3rd person or be subrogated to any right or claim that the injured or diseased person, including identified parties in interest, have against that 3rd person. Under these procedures, the county's right of action abates during the pendency of an action brought for damages against the 3rd person by the injured or diseased person and continues as a first lien against any judgment recovered by the injured or diseased person. This bill would provide that the county's right of action would continue under this provision as a first lien against any judgment, settlement, compromise, arbitration award, mediation settlement, or other recovery for past medical expenses obtained by the injured or diseased person. The bill would make that lien subject to any liens for attorney's fees and costs incurred by the person or person's representative, estate, or survivors. Existing law authorizes a county to compromise, or settle and execute a release of, any claim, as provided. Existing law also authorizes a county to waive that claim, as provided. This bill would require specified factors to be considered when a county is requested to compromise or waive any claim, as provided. This bill would also make a related statement of legislative intent regarding damages for medical services.