Existing law, the California Health Care Quality and Affordability Act, establishes within the Department of Health Care Access and Information the Office of Health Care Affordability to analyze the health care market for cost trends and drivers of spending, develop data-informed policies for lowering health care costs for consumers and purchasers, set and enforce cost targets, and create a state strategy for controlling the cost of health care and ensuring affordability for consumers and purchasers. Existing law requires the office to conduct ongoing research and evaluation on payers, fully integrated delivery systems, and providers to determine whether the definitions or other provisions of the act include those entities that significantly affect health care cost, quality, equity, and workforce stability. Existing law defines multiple terms relating to these provisions, including a health care entity to mean a payer, provider, or a fully integrated delivery system and a provider to mean specified entities delivering or furnishing health care services. This bill would update the definitions applying to these provisions, including defining a provider to mean specified entities delivering or furnishing health care services. The bill would include additional definitions, including, but not limited to, a hedge fund to mean a pool of funds managed by investors for the purpose of earning a return on those funds, regardless of strategies used to manage the funds, subject to certain exceptions. The bill would require the office to conduct ongoing research and evaluation on management services organizations, as specified, and to establish requirements for management services organizations to submit data and other information as necessary to carry out the functions of the office. Existing law requires a health care entity to provide the Office of Health Care Affordability with written notice of agreements or transactions that do specified actions, including sell or transfer, among other things, a material amount of its assets to one or more entities. The bill would similarly require a noticing entity, as defined, to provide the office written notice of agreements or transactions between the noticing entity and a health care entity or management services organization, or an entity that owns, or controls the health care entity or management services organization that perform the same specified actions described above. The bill would additionally require a management services organization to provide the office with written notice of any agreement or transaction between the organization and any other entity.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act's requirements a crime. Existing law provides for the regulation of disability and health insurers by the Department of Insurance. This bill would require every full service health care service plan or health insurer, or its delegate, to subscribe to and use the Council for Affordable Quality Healthcare credentialing form on and after January 1, 2028, except as specified. Existing law requires a health care service plan or disability insurer that provides coverage for mental health and substance use disorders and that credentials health care providers of those services for its networks to assess and verify the qualifications of a health care provider within 60 days after receiving a completed provider credentialing application. This bill would, except as provided above and within one year of the bill's operative date, require every health care service plan or health insurer, or its delegate, that credentials health care providers for its networks to make a determination regarding the credentials of a provider within 90 days after receiving a completed provider credentialing application. The bill would require every health care service plan or health insurer to activate the provider upon successful approval and notify the applicant of the activation, as specified. If the health care service plan or health insurer, or its delegate, does not meet the 90-day requirement, the bill would require the applicant's credentials to be provisionally approved for 120 days unless specified circumstances apply, including that the applicant is subject to discipline by the licensing entity for that applicant. The bill would exclude Medi-Cal managed care plans from these provisions. Because a willful violation of these provisions by a health care service plan would be a crime, this bill would impose a state-mandated local program. The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that no reimbursement is required by this act for a specified reason.
Existing law requires the Department of Health Care Access and Information, formerly known as the Office of Statewide Health Planning and Development, to establish a program to contract with programs that train certified nurse-midwives and programs that train licensed midwives in accordance with the global standards for midwifery education and the international definition of "midwife" as established by the International Confederation of Midwives in order to increase the number of students receiving quality education and training as a certified nurse-midwife or as a licensed midwife. Existing law requires these provisions to be implemented only upon an appropriation by the Legislature for these purposes in the annual Budget Act or another act. This bill would require the Department of Health Care Access and Information, upon appropriation from the Legislature for this purpose, to administer funding for a statewide study on midwifery education. The bill would require the study to be conducted by an outside consultant familiar with the health care and midwifery landscapes and workforce in California that would, among other things, identify viable education programs that can serve both rural and urban geographic areas. The bill would require the department to submit a report from the study's findings to the Legislature, to post the report on the department's internet website, and to notify all persons in the department's reproductive health and maternity care electronic mailing list, as specified. The bill would define "reproductive health care professionals" as, among others, medical doctors and licensed midwives.
(1) Under existing law, a licensed health care provider who is authorized by law to prescribe an opioid antagonist may issue standing orders for the distribution of an opioid antagonist to a person at risk of an opioid-related overdose or to a family member, friend, or other person in a position to assist a person at risk of an opioid-related overdose. Existing law exempts a health care provider who acts with reasonable care in issuing a prescription or order for an opioid antagonist from professional review, civil action, or criminal prosecution, under certain circumstances. Existing law requires that a person who receives an opioid antagonist pursuant to a standing order or otherwise possesses an opioid antagonist receive training, as specified. Existing law provides that a person who is trained in the use of an opioid antagonist and acts with reasonable care and in good faith is not subject to professional review, liable in a civil action, or subject to criminal prosecution. This bill would expand the above-described authorizations to those who are at risk of or any person who may be in a position to assist a person experiencing any overdose and would strike the requirement that those who receive and possess opioid antagonists receive training. The bill would authorize a person in a position to assist a person at risk of an overdose to possess an opioid antagonist and subsequently dispense or distribute an opioid antagonist to a person at risk of an overdose or another person in a position to assist a person at risk of an overdose. The bill would instead exempt a person who administers an opioid antagonist in good faith, whether or not they were trained, from liability for civil damages, as specified, and would instead exempt a health care provider who acts with reasonable care from liability in a civil action for any injuries or damages relating to or resulting from the acts or omissions of any person who administers the opioid antagonist in good faith, as specified. (2) Existing law imposes a drug program fee for each separate controlled substance offense, as specified, to be deposited by the county treasurer in a drug program fund. Existing law requires that a portion of the fund be allocated to primary prevention programs in the community. This bill would state that primary prevention programs may include those activities aligned with evidence-based best practices, as specified. (3) Existing law requires the State Department of Health Care Services to license and regulate facilities that provide residential nonmedical services to adults who are recovering from problems related to alcohol, drug, or alcohol and drug misuse or abuse, and who need alcohol, drug, or alcohol and drug recovery treatment or detoxification services. Existing law authorizes a licensed alcohol or other drug recovery or treatment facility to permit incidental medical services, as defined, to be provided to a resident at the facility premises by a licensed physician and surgeon or other health care practitioner under specified limited circumstances, including that the resident has signed an admission agreement. Existing law requires a licensee to develop a plan to address when a resident relapses, including when a resident is on the licensed premises after consuming alcohol or using illicit drugs. This bill would require the department, on or before January 1, 2027, to offer a combined application for entities seeking licensure as an alcohol or other drug recovery or treatment facility and to provide incidental medical services, as defined. The bill would prohibit the department from requiring an admission agreement to require a person to be abstinent and not intoxicated in order to be admitted to care or continue treatment. The bill would require a licensee to prioritize the individual maintaining some level of connection to treatment, following a relapse. (4) Existing law defines "drug- or alcohol-related program" as any program designed to reduce the unlawful use of, or assist those who engage in the unlawful use of, drugs or alcohol, through various means, such as intervention, treatment, and enforcement, among others. Existing law prohibits the encumbrance of state funds for a drug- or alcohol-related program unless it contains a component that explains that there is no unlawful use of drugs or alcohol and requires all aspects of a drug- or alcohol-related program receiving state funds to be consistent with the "no lawful use" message. This bill would redefine that term to mean any program designed to assist persons with substance use disorders and would strike enforcement from the specified means. The bill would repeal the above-described provisions related to the "no lawful use" message.
(1) Existing law, the California Nutrition Monitoring Development Act of 1986, requires the State Department of Public Health to assess the availability and adequacy of existing state and local food and nutrition data systems. The act requires different state departments, including the State Department of Education, to provide to the State Department of Public Health, upon request, nutrition-related data collection forms, documentation, and reports of various programs. This bill would define "ultraprocessed food" for certain school-related purposes and would require the State Department of Public Health to adopt regulations, on or before June 1, 2028, to define "ultraprocessed foods of concern" and "restricted school foods," as specified. The bill would require the department, when defining ultraprocessed foods of concern and restricted school foods, to consider specified factors, including, among others, whether, based on reputable peer-reviewed scientific evidence, a substance or group of substances are linked to health harms or adverse health consequences, as specified. The bill would require schools, as defined, to begin to phase out restricted school foods and ultraprocessed foods of concern by no later than July 1, 2029. Beginning July 1, 2032, the bill would prohibit a vendor from offering restricted school foods and ultraprocessed foods of concern to a school. This bill, on or before February 1, 2028, and on or before February 1 of each year thereafter through February 1, 2032, would require a vendor to report specified information to the State Department of Public Health for each food product sold to a school in the past calendar year, including, among others, the total quantity of food product sold to schools and whether that food product is an ultraprocessed food, a restricted school food, or an ultraprocessed food of concern. The bill, on or before July 1, 2028, and on or before July 1 of each year thereafter through July 1, 2032, would require the State Department of Public Health, in consultation with the State Department of Education, to submit to the Legislature and the Governor a report that contains, among other things, a summary and analysis of the information reported to the State Department of Public Health by vendors and recommendations for state and local legislative actions that could reduce the consumption of ultraprocessed foods, restricted school foods, and ultraprocessed foods of concern in schools. The bill would require the State Department of Public Health to consult with the State Department of Education regarding compliance training and technical assistance for school food service and procurement staff for these purposes and would require the State Department of Public Health to establish a structure to deliver training and technical assistance to local educational agencies. (2) Existing law requires the State Department of Education to develop and maintain nutrition guidelines for school lunches and breakfasts, and for all food and beverages sold on public school campuses, consistent with the requirements for a nutritionally adequate breakfast and a nutritionally adequate lunch. Existing law defines a nutritionally adequate breakfast and a nutritionally adequate lunch for these purposes to mean those that qualify for reimbursement under the most current meal pattern for the federal School Breakfast Program and the federal National School Lunch Program, respectively. Existing law requires a school district, county superintendent of schools, or charter school maintaining kindergarten or any of grades 1 to 12, inclusive, to make available a nutritionally adequate breakfast and a nutritionally adequate lunch, free of charge, during each schoolday to any pupil who requests a meal without consideration of the pupil's eligibility for a federally funded free or reduced-price meal. Existing law authorizes a school operated and maintained by a school district or county office of education, from the midnight before to 30 minutes after the end of the official schoolday, to sell food and beverages other than meals reimbursed by specified federal nutrition programs, only if the food or beverages meet dietary guidelines, as specified, depending on grade level. This bill, beginning July 1, 2035, would prohibit a school district, county superintendent of schools, or charter school maintaining kindergarten or any of grades 1 to 12, inclusive, from offering a nutritionally adequate breakfast or lunch that includes restricted school foods or ultraprocessed foods of concern, as provided, and would prohibit a school operated and maintained by a school district or county office of education from selling food or beverages, except for food items sold as part of a school fundraising event, containing those restricted school foods or ultraprocessed foods of concern, as provided. (3) To the extent this bill would impose additional requirements on public schools, the bill would impose a state-mandated local program. (4) The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.
Existing law requires a hospital to provide patients with a written notice containing information about the availability of the hospital's discount payment and charity care policies, including information about eligibility and the contact information for a hospital employee or office from which a person may obtain further information about these policies. Existing law defines "charity care" and "discount payment" for these purposes. Existing law requires a hospital to provide to the Department of Health Care Access and Information a copy of its discount payment policy, charity care policy, eligibility procedures for those policies, review process, and the application for charity care or discounted payment programs, among other information. A violation of these provisions results in an administrative penalty, as specified. This bill would, commencing July 1, 2027, require a hospital to screen a patient to determine if they meet specific criteria, including that the patient is enrolled in CalFresh or CalWORKs, and, if they do, presumptively determine that a patient is eligible for participation under the hospital's charity care policy and discount payment policy. The bill would require a hospital to screen a patient for eligibility if the patient meets other specified criteria, including, among others, that the patient is uninsured. The bill would prohibit a hospital from requiring a patient to apply for the federal Medicare program, the Medi-Cal program, or other coverage before the patient is screened for or provided with discounted payment, as specified. The bill would require a hospital to provide patients with the ability to opt out of the screening process through a specified form. The bill would authorize a hospital, at its discretion or as established in its charity care policy or discount payment policy, to make presumptive determinations of eligibility or to conduct screening for patients that do not meet the criteria described above. The bill would authorize certain procedures and tools for screening, including, among others, allowing a hospital to use third-party software tools or services or to contract with a third party under specified conditions. The bill would require a hospital to provide a specified written notice to those patients determined to be eligible, presumptively or otherwise, under these provisions and would prohibit any billing statements from being sent prior to the written notice. The bill would require the billing statements to reflect the adjustments made to the patient's hospital charges under the hospital's charity care policy or discount payment policy.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services, under fee-for-service or managed care delivery systems. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law establishes, until January 1, 2026, certain time and distance and appointment time standards for specified Medi-Cal managed care covered services, consistent with federal regulations relating to network adequacy standards, to ensure that those services are available and accessible to enrollees of Medi-Cal managed care plans in a timely manner, as specified. This bill would extend the operation of those standards to January 1, 2029. The bill would also require a managed care plan to ensure that each subcontractor network complies with certain appointment time standards unless already required to do so. The bill would require a plan to demonstrate to the department each subcontractor network's compliance with time or distance and appointment time standards, as specified. Existing law permits the department to authorize a managed care plan to use clinically appropriate video synchronous interaction, as defined, as a means of demonstrating compliance with the time or distance standards. Under this bill, the use of telehealth providers to meet time or distance standards would not absolve the managed care plan of responsibility to provide a beneficiary with access, including transportation, to in-person services if the beneficiary prefers. The bill would set forth other related provisions with regard to the use of telehealth. Existing law permits the department, upon request of a managed care plan, to authorize alternative access standards for the time or distance standards under certain conditions. This bill would, effective for contract periods commencing on or after January 1, 2027, require the department to consider the sufficiency of payment rates offered by the Medi-Cal managed care plan to the provider type or for the service type when evaluating requests for the utilization of alternative access standards. The bill would require a Medi-Cal managed care plan that does not meet time or distance standards without the use of an alternative access standards request to submit to the department documentation demonstrating efforts to contract with providers, as specified. The bill would require a Medi-Cal managed care plan, effective no sooner than contract periods commencing on or after January 1, 2026, to inform enrollees of their option to use or not use telehealth, covered transportation services, or out-of-network providers to access covered services if the health care provider is located outside of the time or distance standards. Existing law requires the department to annually evaluate a managed care plan's compliance with the time or distance and appointment time standards and to annually publish a report of its findings, as specified. This bill would require, effective for contract periods commencing on or after January 1, 2029, the evaluation by the department for appointment time standards compliance to be performed using a direct testing method, as specified. The bill would authorize the department to require enhanced time or distance standards that are more stringent than the time or distance standards described above in its contracts with Medi-Cal managed care plans. The bill would require the department to ensure that these enhanced standards are consistent across contracts for similar geographic classifications. The bill would require the department to publish all enhanced time and distance standards adopted by contract with a rationale for the enhanced standards. Under the bill, in alignment with federal regulation that requires the department to conduct analyses when developing or adjusting network adequacy standards, the department would be required to publish on its internet website by January 1, 2027, a specified workplan. The bill would also require the department to convene a stakeholder workgroup and to provide a 30-day public comment period, as specified. Existing law requires the department, to the extent permitted under federal law, to require a Medi-Cal managed care plan that is not licensed by the Department of Managed Health Care to comply with applicable requirements, under specified provisions relating to health equity and quality, for the purpose of serving applicable Medi-Cal beneficiaries. Under this bill, for purposes of implementing specified federal final rules relating to Medicaid, the department would be authorized to enter into contracts, or amend existing contracts, as specified. The bill would make this provision inoperative on January 1, 2029. The bill would authorize the department to implement the above-described provisions, relating to the health equity and quality requirements and to the Medicaid final rules, through all-county letters or similar instructions without taking any further regulatory action.
Existing law, the Robert F. Kennedy Farm Workers Medical Plan, is a nonprofit voluntary employees beneficiary association, organized under federal law, that provides payments for health care and other benefits to its members. Existing law, until January 1, 2031, requires the State Department of Health Care Services to annually reimburse the plan up to $3,000,000 per year for claim payments that exceed $70,000 made by the plan on behalf of an eligible employee or dependent for a single episode of care on or after September 1, 2016. This bill would require the department to annually reimburse the Robert F. Kennedy Farm Workers Medical Plan up to $3,000,000 per year for claim payments that exceed $50,000 made by the plan on behalf of an eligible employee or dependent for a single episode of care.
Existing law establishes the Health Care Benefits Fund to support the University of California's implementation of the California Health Benefit Review Program. Under the program, the University of California assesses legislation proposing to repeal or mandate a benefit or service requirement on health care insurance plans or health insurers. Under the program, the University of California provides a written analysis that includes, among other data, financial impacts of legislation on publicly funded state health insurance programs, including the Medi-Cal program and the Healthy Families Program. Existing law imposes an annual charge on health care service plans and health insurers for the 2022–23 to 2026–27 fiscal years, inclusive, as specified, to be deposited into the fund. Existing law prohibits the total annual assessment on health care service plans and health insurers from exceeding $2,200,000. Under existing law, the fund and the program become inoperative on July 1, 2027, and are repealed as of January 1, 2028. This bill would extend the operation of the California Health Benefit Review Program and the Health Care Benefits Fund through July 1, 2033, and would authorize the continued assessment of the annual charge on health care service plans and health insurers for that purpose for the 2026–27 to 2032–33 fiscal years, inclusive. The bill would increase the allowable total annual assessment on health care service plans and health insurers to $3,200,000. The bill would remove the Healthy Families Program as an example of the publicly funded state health insurance programs within an analysis of financial impacts of legislation. This bill would make these provisions inoperative on July 1, 2033, and would repeal it as of January 1, 2034. This bill would include a change in state statute that would result in a taxpayer paying a higher tax within the meaning of Section 3 of Article XIIIA of the California Constitution, and thus would require for passage the approval of 23 of the membership of each house of the Legislature.
Existing law, the Nevaeh Youth Sports Safety Act, requires a youth sports organization to ensure, by January 1, 2027, that its athletes have access to an automated external defibrillator (AED) during any practice or match. Existing law requires the AED to be administered by a medical professional or other certified and qualified person designated by a youth sports organization. This bill would delay the requirement to have access to an AED until January 1, 2028, would remove the requirement that it be administered by a medical professional, and would also require, by January 1, 2027, a youth sports organization to ensure that its coaches are certified, as specified, to perform cardiopulmonary resuscitation and to operate an AED. The bill would require, by January 1, 2027, a youth sports organization to have a written emergency response plan that includes certain information, including the location and procedures to be followed during a sudden cardiac event. The bill would require, by January 1, 2028, a youth sports organization to properly maintain and test its AED, as specified.
