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, 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 a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan contract or a health insurance policy to provide coverage for behavioral health treatment for pervasive developmental disorder or autism and defines "behavioral health treatment" to mean specified services and treatment programs, including treatment provided pursuant to a treatment plan that is prescribed by a qualified autism service provider and administered either by a qualified autism service provider or by a qualified autism service professional or qualified autism service paraprofessional. Existing law defines "qualified autism service provider," "qualified autism service professional," and "qualified autism service paraprofessional" for those purposes. Those definitions are contained in the Health and Safety Code and the Insurance Code. This bill would move those definitions to the Business and Professions Code. The bill would also make technical and conforming changes. This bill would incorporate additional changes to Section 1367.27 of the Health and Safety Code and Section 10133.15 of the Insurance Code proposed by AB 280 to be operative only if this bill and AB 280 are enacted and this bill is enacted last. This bill would incorporate additional changes to Section 1374.73 of the Health and Safety Code and Section 10144.51 of the Insurance Code proposed by AB 951 to be operative only if this bill and AB 951 are enacted and this bill is enacted last. This bill would incorporate additional changes to Section 11165.7 of the Penal Code proposed by AB 653 and SB 848, to be operative only if this bill and either or both of those bills are enacted and this bill is enacted last.
Existing law grants the State Department of Health Care Services the sole authority in state government to license adult alcoholism or drug abuse recovery or treatment facilities and authorizes the department to issue a license to specified types of facilities if certain criteria are met. Existing law requires an operator of a licensed alcoholism or drug abuse recovery or treatment facility or certified alcohol or other drug program to include on its internet website and intake form paperwork a disclosure that an individual may check the internet website of the department to confirm whether the facility's license or program's certification has been placed in probationary status, been subject to a temporary suspension order, been revoked, or the operator has been given a notice of operation in violation of law. Existing law requires the disclosure to include a link to the department's internet website that contains the Probationary Status, Temporary Suspension Order, Revoked and Notice of Operation in Violation of Law Program List. This bill would require the department to indicate on its internet website containing the above-described list, in a location and font that is easy to see and read, that notices to recovery residences issued for a specified violation are not included in that list. The bill would also require the department to post on its internet website, in a specified manner, an identification and summary of each violation the department has issued for the above-described facilities and programs. The bill would require the department to implement this requirement to protect the public it serves by providing sufficient information regarding those who violate the state laws it administers without posting information that violates privacy rights and protections provided by state or federal law.
(1) Existing law authorizes specified drowning or injury prevention organizations (DIP organization) to provide informational materials, in electronic or hardcopy form, to a public school regarding specified topics relating to drowning prevention. Existing law requires a DIP organization that chooses to provide informational materials to provide, upon request by a public school, the informational materials in the 3 most commonly spoken languages associated with the population attending the school. This bill would instead require a DIP organization that chooses to provide informational materials to provide, upon request by a public school, the informational materials in English and would encourage the DIP organization to provide informational materials in the other most commonly spoken languages associated with the population attending the school. The bill would require a DIP organization that chooses to provide informational materials to a public school to provide those materials at no cost to the public school, allow the school to offer copies of the materials to pupils and parents, and provide written evidence to a school administrator that demonstrates that the informational materials provided by the DIP organization align with the drowning, drowning prevention, water safety, rescue, and swim skills lesson information found on the drowning prevention web page of the federal Centers for Disease Control and Prevention, as provided. The bill also would require the State Department of Education, in consultation with the State Department of Developmental Services and the State Department of Public Health, to gather and make available on its internet website school-based water safety and drowning prevention education resources and curriculum, as provided. The bill would authorize public schools to provide to their pupils those water safety informational materials identified by the department and provided by a DIP organization, as provided. (2) Existing law requires the State Department of Public Health to adopt and enforce regulations relating to public swimming pools, as defined. This bill would expressly authorize the State Department of Public Health to review and evaluate existing statutes and regulations under its jurisdiction recommended by the California Unintentional Injury Prevention Strategic Plan Project to ensure clarity, consistency, and alignment with current public health practices, as provided, and would authorize the department to recommend to the Legislature updates or nonsubstantive technical corrections to support effective implementation and regulatory compliance.
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. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law sets forth various provisions for Medi-Cal coverage of community health worker services, enhanced care management, and community supports, subject to any necessary federal approvals. Under existing law, these benefits are designed to, respectively, provide a link between health and social services and the community; address the clinical and nonclinical needs on a whole-person-care basis for certain target populations of Medi-Cal beneficiaries, including individuals experiencing homelessness; and provide housing transition navigation services, among other supports. This bill would set forth provisions regarding field medicine, as defined, under the Medi-Cal program for persons experiencing homelessness, as defined. The bill would state the intent of the Legislature that the field medicine-related provisions coexist with, and not duplicate, other Medi-Cal provisions, including, but not limited to, those regarding community health worker services, enhanced care management, and community supports. The bill would authorize a Medi-Cal managed care plan to elect to offer Medi-Cal covered services through a field medicine provider, as defined. Under the bill, a managed care plan that elects to do so would be required to allow a Medi-Cal member who is experiencing homelessness to receive those services directly from an in-network, contracted field medicine provider, regardless of the member's in-network assignment, as specified. The bill would also require the managed care plan to allow an in-network, contracted field medicine provider enrolled in Medi-Cal to directly refer a member who is experiencing homelessness for covered services within the appropriate network, as specified. The bill would require a managed care plan to have appropriate mechanisms, procedures, or protocols to ensure timely communication between the in-network, contracted field medicine provider, the Medi-Cal member's plan or independent practice association, and the member's primary care provider for purposes of care coordination and to prevent the duplication of services. The bill would require a managed care plan to provide a method for a Medi-Cal member to inform the managed care plan online, in person, or via telephone that the member is experiencing homelessness. The bill would require the department to inform a managed care plan if a member has indicated that they are experiencing homelessness based on information furnished on the Medi-Cal application. In the case of a Medi-Cal beneficiary who is experiencing homelessness and who receives services within the fee-for-service delivery system, the bill would require the department to reimburse a field medicine provider enrolled in Medi-Cal for providing Medi-Cal covered services. The bill would condition implementation of the above-described provisions on receipt of any necessary federal approvals and the availability of federal financial participation. The bill would require, on or before January 1, 2027, that the standard application form for insurance affordability programs include an optional question for an applicant to identify whether they are experiencing homelessness. The bill would make conforming changes to related provisions under existing law regarding the application process. The bill would also remove obsolete references within related provisions. To the extent that the bill would create new duties for counties with regard to data sharing under Medi-Cal, the 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, 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 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, for policy years beginning on or after January 1, 2024, requires student health insurance coverage, as defined, to be considered individual health insurance coverage. Existing law, except as specified, requires a blanket disability insurance policy that meets the definition of student health insurance coverage to comply with insurance provisions that are applicable to nongrandfathered individual health insurance, including, among others, essential health benefits requirements and annual limits on out-of-pocket expenses. Existing law exempts student health insurance coverage from certain requirements otherwise applicable to health insurers and health benefit plans, including the establishment of specified enrollment periods, guaranteed availability and renewability, specified coverage level requirements, and single risk pool rating requirements. Existing law requires a notice to be provided in the student health insurance enrollment materials stating that California requires residents and their dependents to obtain and maintain health coverage, either through student health insurance, or through a different method, including Medi-Cal, Covered California, or, if under 26 years of age, their parent's coverage. This bill would, commencing July 1, 2026, authorize a student certificate holder to request to terminate their student health insurance coverage during the policy year if the student graduates, takes a leave of absence, or is no longer enrolled at the institution of higher education. The bill would require the request to be provided to the institution of higher education at least 30 days before the effective date of termination and would, upon receipt of the request to terminate coverage, require the institution to terminate coverage effective within the same calendar month if feasible, but no later than the last day of the calendar month in which the 30-day period ends. The bill would authorize the student to pay only the premium through the date of the termination, as specified. The bill would require a student or dependent of a student to be notified of premium liability to them, if any, if they choose not to terminate coverage pursuant to these provisions. The bill would, commencing July 1, 2026, if a student requests a waiver from student health insurance coverage, require the waiver to be granted if the student obtains or maintains health coverage that is minimum essential coverage, as specified. The bill would prohibit charging the student a fee or premium if the waiver is granted. Existing law requires a health insurer to file with the Department of Insurance all required rate information for grandfathered individual and specified group health insurance policies at least 120 days before implementing any rate change. This bill would authorize the department to prohibit a requested rate change if the insurer fails to comply with the above-described timelines. This bill would also authorize the Insurance Commissioner to exercise their existing authority to enforce the above-described provisions and prohibits an administrative penalty, if assessed, from exceeding $5,000 for each violation, or $10,000 for a willful violation. The bill would also state the intent of the Legislature to encourage self-funded student health coverage offered by the University of California Student Health Insurance Plan and the University of California Voluntary Dependent Plan to maintain or exceed coverage standards of the federal Patient Protection and Affordable Care Act and to comply with the above described provisions.
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. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law requires the department, subject to any necessary federal approvals and the availability of federal financial participation, to make Medi-Cal payments to designated public hospitals (DPHs) and their affiliated government entities, as defined, in recognition of the Medi-Cal managed care share of graduate medical education (GME) costs. Existing law requires that the payments consist of direct and indirect GME payments made in recognition and support of the direct costs incurred in the operation of GME programs and the increased operating and patient care costs associated with teaching programs, respectively. Under existing law, the nonfederal share of these payments consists of voluntary intergovernmental transfers (IGTs) of funds provided by DPHs or their affiliated government entities, or other eligible public entities, as specified. Under existing law, the continuously appropriated DPH GME Special Fund is established for these purposes. This bill would require the department, subject to any necessary federal approvals and the availability of federal financial participation, to make additional Medi-Cal payments to district and municipal public hospitals (DMPHs) , defined as nondesignated public hospitals, and to their affiliated government entities, in recognition of the Medi-Cal managed care share of GME costs. Under the bill, these payments would be made in a manner consistent with the methodology for GME payments to DPHs and their affiliated government entities and would consist of the above-described direct and indirect GME payment components. The bill would authorize the department to seek federal approval for other forms of GME payments to DMPHs and their affiliated government entities, as specified. Under the bill, the nonfederal share of payments under these provisions would consist of voluntary IGTs of funds provided by DMPHs or their affiliated government entities, or other eligible public entities, to the extent permitted under certain federal regulations and other applicable federal Medicaid laws, and with no state General Fund moneys being used to fund the nonfederal share of payments. The bill would establish the DMPH GME Special Fund, with moneys deposited being continuously appropriated to the department for purposes of these provisions. The bill would require the department to seek any necessary federal approvals for GME payments, effective no sooner than January 1, 2026. The bill would authorize the Director of Health Care Services to modify the requirements set forth in these provisions to the extent necessary to meet federal requirements or to maximize federal financial participation, as specified.
Existing law, the End of Life Option Act, until January 1, 2031, authorizes an adult who meets certain qualifications, including, among other things, being a resident of the State of California, and who has been determined by their attending physician to be suffering from a terminal disease, as defined, to make a request for an aid-in-dying drug for the purpose of ending their life. Existing law makes specified violations of the act a crime, including knowingly coercing or exerting undue influence on an individual to request or ingest an aid-in-dying drug for the purpose of ending their life. This bill would repeal the January 1, 2031, expiration date of the act, thereby extending the operation of the act indefinitely. By extending the operation of crimes within the act, the 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.
