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 provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan and a health insurer that contracts with providers for alternative rates of payment to publish and maintain a provider directory or directories with information on contracting providers that deliver health care services enrollees or insureds, and requires a health care service plan and health insurer to regularly update its printed and online provider directory or directories, as specified. Existing law authorizes the departments to require a plan or insurer to provide coverage for all covered health care services provided to an enrollee or insured who reasonably relied on materially inaccurate, incomplete, or misleading information contained in a plan's or insurer's provider directory or directories. This bill would require the Department of Managed Health Care to select a central utility and develop uniform provider directory standards requiring a health care service plan to use the designated central utility to collect, manage, and verify the consistency and completeness of their provider directories. The bill would also require health insurers to use the designated central utility and follow the uniform provider directory standards. The bill would require plans and health insurers to submit their provider directories to the central utility for analysis, and would require the central utility to create a consistency report for each directory. This bill would require a plan or insurer to provide coverage for all covered benefits provided to an enrollee or insured who reasonably relied on inaccurate, incomplete, or misleading information contained in the plan's or insurer's provider directory or directories and to reimburse the provider the agreed upon amount, or, if none, a reasonable and customary amount, as specified, for those services. The bill would prohibit a provider from collecting an additional amount from an enrollee or insured other than the applicable in-network cost sharing, which would count toward the in-network deductible and out-of-pocket maximum. The bill would require the health care service plan or the insurer, as applicable, to ensure the accuracy of a request to add back a provider who was previously removed from a directory and approve the request within 10 business days of receipt, if accurate. The bill would authorize a health care service plan or insurer to include a specified statement in the provider listing before removing the provider from the directory if the provider does not respond within 5 calendar days of the plan's or insurer's annual notification. The bill would require a plan or insurer to comply with its provisions on and after July 1, 2027. Because a violation of the bill's requirements by a health care service plan would be a crime, 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.
Existing law generally provides for the compensation of victims and derivative victims of specified types of crimes by the California Victim Compensation Board from the Restitution Fund, a continuously appropriated fund, for specified losses suffered as a result of those crimes. Existing law sets forth eligibility requirements and limits on the amount of compensation that the board may award, and requires the application for compensation to be verified under penalty of perjury. This bill would create a pilot program, the Trauma Healing and Resilience Investment for Victimized and Exposed Youth Act (T.H.R.I.V.E.) , to be administered by the State Department of Health Care Services, upon appropriation by the Legislature, for the administration of grants to the County of Los Angeles to establish and administer a program to pay for mental health and counseling services for youth survivors of gun violence, as defined, who request those services and who reside in that county. The bill would require policies and procedures for distributing funds to meet certain requirements, including, among other things, allowing youth survivors of gun violence, or their parents or guardians for survivors who are minors, to attest to their experiences of gun violence without requiring external documentation of the gun violence incident. The bill would create the Trauma Healing and Resilience Investment for Victimized and Exposed Youth Fund to be used by the department for the purposes of this program, upon appropriation by the Legislature. The bill would make client information and records of mental health services provided to these provisions confidential. The bill would make implementation of these provisions contingent upon appropriation by the Legislature. The bill would repeal these provisions on January 1, 2032. Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest. This bill would make legislative findings to that effect.
Existing law establishes the California Reproductive and TGI Health Equity Program within the Department of Health Care Access and Information for the purpose of ensuring abortion, contraception, and gender-affirming care are affordable for and accessible to all patients, regardless of their ability to pay, and to provide financial support for safety net providers of these services to offset the costs of providing uncompensated care to patients with low incomes who would otherwise lack access to care. Existing law authorizes a Medi-Cal enrolled provider to apply for a grant, and a continuation award after the initial grant, if they agree to provide abortion, contraception, and gender-affirming care services in accordance with specified requirements, including that the services are provided at no cost or a reduced cost to individuals with a household income at or below 400% of the federal poverty level who are uninsured or have health care coverage that does not include both abortion and contraception or does not include gender-affirming care and are not otherwise eligible to receive both abortion and contraception care at no cost through the Medi-Cal and Family PACT programs or receive gender-affirming care at no cost through the Medi-Cal program. This bill would additionally authorize a Medi-Cal enrolled provider to apply for a grant or a continuation of a grant if they provide the above-described services to patients who are veterans, as defined, who are uninsured or have health care coverage that does not include both abortion and contraception and are not otherwise eligible to receive both abortion and contraception care at no cost through the Medi-Cal and Family PACT programs. The bill would make other conforming changes and would make related findings and declarations. Existing law establishes the Department of Veterans Affairs and vests the department with specified duties related to veterans in the state, including the development of a transition program to assist veterans in successfully transitioning from military to civilian life by providing information related to, among other things, health care programs and services. This bill would require the Department of Veterans Affairs to publish a link to the State Department of Public Health's abortion information internet website on the women veterans resources page of its internet website.
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 provides for the regulation of disability insurers by the Department of Insurance. Existing law requires a health care service plan or disability insurer to allow an individual to enroll in or change their health benefit plan as a result of a specified triggering event. This bill would make pregnancy a triggering event for purposes of enrollment or changing a health benefit plan. Because a willful violation of this provision by a health care service plan would be a crime, 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.
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 provides for the regulation of health insurers by the Department of Insurance. Existing law requires coverage by health care service plans and health insurers for various screening and treatment services with respect to cancer. This bill would require a large group health care service plan contract or health insurance policy that is issued, amended, or renewed on and after January 1, 2027, to provide coverage for scalp cooling, when prescribed by a health care provider to reduce the incidence or severity of alopecia before, during, or after chemotherapy in which alopecia-inducing chemotherapeutic agents are used. The bill would define scalp cooling for these purposes. Because a violation of these provisions with respect to a health care service plan would be a crime, this bill would impose a state-mandated local program. Existing law also 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 pursuant to a schedule of benefits, including various cancer screenings and benefits relating to cancer treatment. Subject to the extent that federal financial participation is available and not otherwise jeopardized, and any necessary federal approvals have been obtained, this bill would expand the Medi-Cal schedule of benefits to include scalp cooling, when prescribed by a health care provider to reduce the incidence or severity of alopecia before, during, or after chemotherapy in which alopecia-inducing chemotherapeutic agents are used. The bill would subject scalp cooling to utilization controls and medical necessity. 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 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 by, and funded pursuant to, federal Medicaid program provisions. Existing federal law generally requires, commencing in 2027, Medicaid beneficiaries between 19 and 64 years of age, inclusive, with income up to 138% of the federal poverty level, commonly known as Medicaid expansion adults, to demonstrate community engagement as a condition of Medicaid eligibility. Existing state law sets forth various provisions to conform to that federal requirement. Existing law requires, no sooner than January 1, 2027, as specified, an applicable individual to demonstrate work or community engagement. Existing law sets forth the mechanisms for an applicable individual to comply with that requirement on a monthly basis, including, among others, a minimum of 80 hours of work, community service, or participation in a work program, or a minimum of half-time enrollment in an educational program. This bill would make changes to the definitions of "applicable individual," "work program," and "educational program," and to some of the compliance mechanisms regarding monthly income, for purposes of the above-described provisions. When there is a conflict in reliable data sources that adversely impacts the eligibility of an applicant or beneficiary, the bill would require the county to request the applicant or beneficiary to confirm information before taking any adverse action on the application or renewal. Existing law requires a county, if it is unable to verify that an applicable individual either has met the requirement to demonstrate work or community engagement or was deemed to have demonstrated work or community engagement, to provide the individual with a notice of noncompliance, as specified, and to continue to provide the individual with Medi-Cal services during a 30-calendar-day period if the individual is enrolled in the Medi-Cal program. This bill would require the county to notify applicable individuals enrolled in the Medi-Cal program of the requirement to demonstrate work or community engagement based on certain delivery formats. For an applicable individual renewing their Medi-Cal enrollment during a 6-month redetermination period and who otherwise meets all other eligibility criteria, the bill would require the county to maintain active eligibility pending verification of work or community engagement until at least the last day of the month of the 30-calendar-day period. Under the bill, an applicable individual would be deemed to have received the notice of noncompliance 5 days after the date on the notice. Under the bill, self-attestation that the individual did not receive a timely notice would constitute good cause for not providing a satisfactory showing within the 30-calendar-day period. If no satisfactory showing is made after the 30-calendar-day period, the bill would require the department to consider all other bases of eligibility for medical assistance under the Medi-Cal state plan prior to denying coverage at application or determining that an individual is ineligible. The bill would authorize the department to defer implementation of any of the above-described changes if the change would result in a fiscal impact that would require an additional appropriation and that additional appropriation has not been made, as specified. By creating new duties for counties relating to Medi-Cal eligibility determinations with regard to work or community engagement, 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 California Children's Services (CCS) program, which is administered by the State Department of Health Care Services and counties, to provide medically necessary services, based on financial eligibility, for persons under 21 years of age who have certain medical conditions, including, among others, cystic fibrosis or hemophilia. Existing law provides for the Medi-Cal program, which is administered by the department, 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 authorizes the department to establish a Whole Child Model program, under which managed care plans served by a county organized health system or Regional Health Authority in designated counties provide CCS treatment services to Medi-Cal eligible CCS children and youth. In implementing the program, existing law requires the department to, among other things, establish a statewide Whole Child Model program stakeholder advisory group and to consult with that advisory group on the implementation of the Whole Child Model program, as specified. Existing law terminates the advisory group on December 31, 2026. This bill would rename the statewide Whole Child Model program stakeholder advisory group to the California Children's Services (CCS) advisory group. The bill would require the advisory group to have specified membership, including no more than 6 representatives of CCS clients not enrolled in a managed care plan or enrolled in a managed care plan, but not on a family advisory committee, former CCS clients, and caregivers of former CCS clients, among others. The bill would also require the department to consult with the advisory group on the implementation of the CCS Classic program and to consider the recommendations of the advisory group in developing monitoring processes and outcome measures for the CCS program. The bill would require the department to publish two summary reports on its internet website by specified dates that describe the department's progress and actions on specified matters relating to the CCS program. The bill would delete the December 31, 2026, sunset date, and would instead make the provisions relating to the stakeholder advisory group and the related reporting requirement inoperative on January 1, 2037. This bill would make conforming changes to reflect the renaming of the advisory group.
Existing law establishes the Emergency Medical Services Authority within the California Health and Human Services Agency, and requires the authority to coordinate state activities concerning emergency medical services. Existing law requires a public safety agency that provides "911" call processing services for emergency medical response, by January 1, 2027, to provide prearrival medical instructions to "911" callers requiring medical assistance, including, at a minimum, administration of naloxone for suspected narcotics overdoses. Existing law requires the authority to develop and adopt training, standards, and regulations for all prehospital emergency medical care personnel regarding the use and administration of naloxone hydrochloride and other opioid antagonists. Existing law makes any person who violates these provisions guilty of a misdemeanor. Existing law grants the Division of Occupational Safety and Health, which is within the Department of Industrial Relations, jurisdiction over all employment and places of employment, and the power necessary to enforce and administer all occupational health and safety laws and standards. Exiting law requires the division, before December 1, 2027, to submit a draft rulemaking proposal to revise specified regulations on first aid materials and emergency medical services to require first aid materials in a workplace to include naloxone hydrochloride or another opioid antagonist approved by the United States Food and Drug Administration to reverse opioid overdose and instructions for using the opioid antagonist. Existing law requires the standards board to consider for adoption revised standards for the standards described above on or before December 1, 2028. This bill would require an employer operating in this state that requires cardiopulmonary resuscitation (CPR) certification training of its employees to also require those employees, except as specified, to take an online video module training on the use of naloxone to increase the rate of opioid overdose reversals, as prescribed. Because a violation of this provision would be a crime, the bill would impose a state-mandated local program. The bill would require the Emergency Medical Services Authority to review and approve the online video module trainings to ensure that the training content meets certain minimum standards. 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, the Warren-911-Emergency Assistance Act, requires every local public agency to establish within its jurisdiction a basic emergency telephone system that includes, at a minimum, police, firefighting, and emergency medical and ambulance services. Existing law establishes the Office of Emergency Services within the office of the Governor and requires the office to be responsible for the state's emergency and disaster response services, as specified. Existing law requires the office, at specified intervals, to consult with, among others, the State Fire Marshal and the State Department of Public Health in order to review and update technical and operational standards for public agency systems. Existing law requires a public safety agency that provides "911" call processing services for emergency medical response to, by January 1, 2027, provide prearrival medical instructions to "911" callers requiring medical assistance, as specified. This bill would require a public safety agency described above that was not providing prearrival instructions to the "911" callers described above on or before January 1, 2027, to report to their local emergency medical services agency the status of their compliance with the above-described requirement on or before January 31, 2027.
The Child Care and Development Services Act, administered by the State Department of Social Services, establishes a system of childcare and development services for children up to 13 years of age. The Early Education Act requires the Superintendent of Public Instruction, to, among other things, provide an inclusive and cost-effective preschool program. Under both acts, the cost to a provider agency of providing an early childhood mental health consultation service is reimbursable if certain requirements are met, including that the consultation service uses a relationship-based model that includes specified components, including, among others, that, at least twice per program year, early care- and education setting-based mental health assessments are conducted and that there is, with the consent of parents or legal guardians, at least one screening of each enrolled child for adverse childhood experiences and screening for buffering factors. This bill would remove the requirement that the consultation service use a relationship-based model that includes those components in order to be reimbursable and would instead require that, in order to be reimbursable, the consultation service, among other things, uses a relationship-based model that incorporates, at least once per school or program year, an early care and education classroom observation tool that includes measures on the classroom environment, social-emotional learning climate, and teacher and child interactions to guide the specific activities and support the consultant will provide.
