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 authorizes health care service plans and health insurers that cover prescription drugs to utilize reasonable medical management practices, including prior authorization and step therapy, consistent with applicable law. This bill would prohibit a health care service plan contract or a health insurance policy that is issued, amended, or renewed on or after January 1, 2027, from imposing step therapy as a prerequisite to authorizing coverage of any prescription drug used for the treatment of a serious mental illness or substance use disorder, as those terms are defined, except as specified. The bill would specify that the prohibition on step therapy does not apply when the United States Food and Drug Administration-labeled indications and usage of a drug indicate that some prior medication must be taken. 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 Medical Practice Act, establishes the Medical Board of California to license and regulate the practice of medicine. Former law, repealed as of January 1, 2025, established the Licensed Physicians and Dentists from Mexico Pilot Program, which allowed up to 30 licensed physicians and up to 30 licensed dentists from Mexico to practice medicine or dentistry in California for a period not to exceed 3 years, in accordance with certain requirements. Existing law, operative January 1, 2025, instead, establishes within the act the Licensed Physicians from Mexico Program, which authorizes the board to issue a limited number of nonrenewable 3-year physician's and surgeon's licenses to licensed physicians from Mexico who meet specified criteria. This bill would require the board to issue a full and unrestricted physician's and surgeon's license to a person who has completed 2 3-year terms of the Licensed Physicians from Mexico Program or the former Licensed Physicians and Dentists from Mexico Pilot Program in good standing upon satisfaction of specified requirements, including having an offer of continued employment from a health care facility or practice in California. This bill would establish the California Physician Expansion Act, which would require the board to issue a provisional license to an applicant who holds a full and unrestricted license to practice medicine in another country who meets specified requirements, including that the applicant has not committed any acts or crimes constituting grounds for denial of a certificate, as specified. In this regard, the bill would require the board to submit to the Department of Justice fingerprint images and related information required by the department of all applicants for a provisional license to determine whether the applicant has a criminal conviction record, as specified, and would require the department to provide a state- and federal-level response pursuant to specified provisions for the board to determine whether the applicant is subject to denial of licensure, as specified. The bill would make the provisional license valid for 3 years and would authorize the board to grant a one-time renewal for an additional period of up to 3 years, as specified. The bill would require a provisional licensee to, among other things, be employed by, and practice medicine only within, a sponsoring entity, as specified. The bill would authorize the board to revoke a provisional license or take any other disciplinary action deemed appropriate by the board, as specified. The bill would deem a provisional licensee applicant who meets specified requirements, including having completed at least 36 months of practice under the provisional license without any disciplinary actions, to meet the professional instruction, preliminary education, and postgraduate training requirements for a certificate under the Medical Practice Act. The bill would require the board to establish application, initial licensure, renewal, and conversion fees for the provisional license, as specified. The bill would make findings and declarations relating to its provisions.
(1) 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 contract or health insurance policy issued, amended, or renewed on or after January 1, 2002, to provide coverage for an annual cervical cancer screening test upon the referral of the patient's health care provider. This bill would require a health care service plan contract or health insurance policy, except for a vision-only, dental-only, or Medicare supplement contract or policy, issued, amended, or renewed on or after January 1, 2027, to provide coverage without cost sharing for cervical cancer screening, including the United States Food and Drug Administration (FDA) -authorized or cleared self-collected cervical screening kits, when ordered or provided by an in-network provider and consistent with specified recommendations published by the State Department of Public Health. For health savings account-eligible plans or policies, the bill would require the above-described coverage only to the extent the plan is a high deductible health plan under specified federal law. Because a willful violation of the bill's requirements relative to health care service plans would be a crime, the bill would impose a state-mandated local program. (2) Existing law provides for the Medi-Cal program, administered by the State Department of Health Care Services and under which health care services are provided to low-income individuals pursuant to a schedule of benefits. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. An annual cervical cancer test for screening or diagnostic purposes, upon the referral of a patient's physician, is a covered benefit under the Medi-Cal program to the extent required or permitted by federal law. This bill would instead include cervical cancer tests for screening that are ordered by a patient's health care provider and consistent with specified recommendations published by the State Department of Public Health as a covered benefit under the Medi-Cal program on or after January 1, 2027. The bill would additionally include FDA-authorized or cleared cervical cancer home test kits for screening that are ordered by a patient's health care provider and consistent with specified recommendations published by the State Department of Public Health and Medi-Cal policies as a covered benefit under the Medi-Cal program on or after January 1, 2027, without cost sharing, to the extent that federal financial participation is available and not otherwise jeopardized and any necessary federal approvals have been obtained. (3) 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.
This bill designates June 9, 2026, as FSGS Awareness Day to highlight focal segmental glomerulosclerosis, a rare kidney disease that causes scarring and can lead to kidney failure. The resolution aims to increase public understanding of the condition, which disproportionately affects African American communities and often requires dialysis or transplants. By establishing an official awareness day, the bill seeks to support patients and families while encouraging efforts to improve early diagnosis and access to specialized care.
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 law sets forth different mechanisms for health care coverage for individuals, including the Medi-Cal program, the federal Medicare Program, an employer-sponsored plan, and a plan through the California Health Benefit Exchange, also known as Covered California. Existing law imposes various taxes on residents, such as sales and use taxes and personal income tax, and authorizes cities and counties to impose local sales and use taxes in conformity with the Sales and Use Tax Law. This bill would state that every person who is a resident subject to a tax and whose income is at or below 138% of the federal poverty level using the modified adjusted gross income methodology, as specified, is entitled to access to the public health care coverage their tax dollars support. The bill would require the State Department of Health Care Services to ensure that these individuals have access to public health care coverage through programs it administers, including Medi-Cal. To the extent that these provisions would alter the population of beneficiaries for Medi-Cal, the bill would impose a state-mandated local program. The bill would make related findings and declarations. 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 provides for the licensing and regulation of health facilities by the State Department of Public Health and generally makes a violation of those provisions a crime. 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 generally makes a willful violation of the act a crime. Existing law requires a health facility to provide emergency services and care upon request for any condition in which the person is in danger of loss of life or serious injury or illness. Existing law requires a health care service plan to reimburse providers for emergency services and care. Existing law defines "emergency services and care" for these purposes to mean medical screening, examination, and evaluation by a physician and surgeon, or other appropriate licensed persons under the supervision of a physician and surgeon, to determine if an emergency medical condition or active labor exists and, if it does, the care, treatment, and surgery, if within the scope of that person's license, necessary to relieve or eliminate the emergency medical condition, within the capability of the facility, among other things. This bill would specify that the above-described provisions would not require physician supervision of a licensed nurse-midwife in the labor and delivery unit, obstetric triage, or dedicated emergency obstetric evaluation unit, when the nurse-midwife is providing care to the extent authorized by, and consistent with, specified licensing and certification provisions, or when the nurse-midwife is specifically requested by the treating physician and surgeon to provide obstetric consultation. By changing the scope of 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, 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 generally prohibits a health care service plan or health insurer from subjecting antiretroviral drugs that are medically necessary for the prevention of HIV/AIDS to prior authorization or step therapy. This bill would prohibit a health care service plan and health insurer from subjecting direct-acting antiviral drugs that are medically necessary for the treatment of hepatitis C to prior authorization. The bill would specify that these provisions do not require a health care service plan or health insurer to cover all therapeutically equivalent versions without prior authorization, as specified. Because a 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, 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 or health insurer to reimburse a complete claim or a portion thereof within 30 calendar days after receipt of the claim, or, if a claim or portion thereof does not meet the criteria for a complete claim or the criteria for coverage under the plan or insurance contract, to notify the claimant in writing that the claim or portion thereof is contested or denied as soon as practicable, but no later than 30 calendar days after receipt of the claim by the plan or insurer. This bill would, commencing May 26, 2028, require a plan or insurer to accept electronic medical records and supporting documentation necessary to process a claim through a standard electronic submission method, as specified, and would prohibit a plan or insurer from denying, pending, or delaying a claim solely because the plan's or insurer's systems are unable to accept documentation that otherwise meets the plan's or insurer's requirements. The bill would specify that if a state or federal standard is adopted that is specific to file size, number, or other capacity requirements for claims-related supporting documentation submissions, that standard would apply. Because a willful violation of these provisions 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.
(1) Existing law provides for the licensing and regulation of health facilities, including, but not limited to, long-term health care facilities, as defined, by the State Department of Health Care Services. Existing law requires a contract for admission to a long-term care facility to state that a resident shall not be involuntarily transferred within, or discharged from, a long-term health care facility unless the resident is given reasonable notice in writing, and transfer or discharge planning, as specified. Willful or repeated violations of the provisions relating to long-term health care facilities is a misdemeanor. This bill would require long-term health care facilities to provide residents with a notice of a facility-initiated transfer or discharge at least 30 days before a resident is transferred or discharged, unless an exception applies. The bill would require the notice of transfer or discharge to be acknowledged by the signature of the resident or, if applicable, the resident's representative. The bill would make a violation of these provisions a class "B" violation and would make knowingly making a false verification regarding the delivery of a notice of transfer or discharge a willful violation for purposes of the criminal provision described above. The bill would require a notice of discharge or transfer to be provided to a resident and, if applicable, the resident's representative in a translated or accessible format at the same time as the written notice in English if the resident's primary language is not English or if the resident is vision impaired or blind, as specified. The bill would also require the translated or accessible-format notices to be made available to the local long-term care ombudsman upon request. The bill would require the translator to attest, under penalty of perjury, to the accuracy of the translation, thereby expanding the crime of perjury. The bill would require a resident's primary language or sensory impairments to be included in the minimum dataset maintained by the facility. The bill would make a violation of these provisions a class "B" violation. Existing law requires that a copy of the notice of transfer or discharge be sent to the local long-term care ombudsman at the same time notice is provided to the resident or the resident's representative by facsimile machine, email, or first-class mail, as specified. Existing law requires, if a resident is subject to a facility-initiated transfer to a general acute care hospital on an emergency basis, the notice to be provided to the local long-term care ombudsman as soon as practicable. This bill would instead require the notices described above to be sent to the long-term care ombudsman by facsimile, email, or other electronic means. For emergency transfer notices, the bill would require a copy of the notice to be provided to the local long-term care ombudsman as soon as practicable, but in no event later than 24 hours after the transfer. Because a willful or repeated violation of long-term care facilities provisions is a crime and because the crime of perjury is expanded, the bill would impose a state-mandated local program. (2) Existing law requires the State Department of Public Health to establish an inspection and reporting system to ensure that long-term health care facilities are in compliance with state statutes and regulations. Existing law, the Medi-Cal Long-Term Care Reimbursement Act, requires, among other things, that long-term health care facilities timely comply with hearing decisions issued by the department's Office of Administrative Hearings and Appeals for improperly transferring, discharging, or refusing to readmit a resident. Existing law authorizes the department to assess a penalty of $750 for each calendar day a facility fails to comply with the hearing decision and caps aggregate penalties for each individual hearing decision at $75,000. The bill would authorize the State Department of Public Health to prohibit the admission of new residents to a long-term health care facility upon notification that a facility has failed to timely comply with a hearing decision. The bill would require the prohibition to remain in effect until the facility has achieved compliance, the maximum aggregate of penalties have been collected, or the facility has formally sought judicial review of the hearing decision. The bill would increase the daily penalty described above to $1,000 for each calendar day and increase the maximum aggregate penalty amount to $100,000. (3) 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 Sherman Food, Drug, and Cosmetic Law, provides for the regulation of various subjects relating to the manufacturing, processing, labeling, advertising, and sale of food, drugs, and cosmetics, under the administration and enforcement of the State Department of Public Health. A violation of these provisions is punishable as a misdemeanor. This bill would require a manufacturer of infant formula for sale or distribution in this state to test its final infant formula product for arsenic, cadmium, lead, and mercury at least once per month. The bill also would, commencing on January 1, 2028, require a brand owner, as defined, to provide information to consumers on its internet website or package label regarding specific information about its infant formula that includes, among other things, certain test results for arsenic, cadmium, lead, and mercury. The bill would specifically prohibit a person from selling in the state or manufacturing, delivering, holding, or offering for sale in the state any infant formula that does not comply with these requirements. The bill would require the manufacturer and brand owner to provide test results to the department upon request, as specified. By expanding the requirements relating to infant formula under the Sherman Food, Drug, and Cosmetic Law, the violation of which 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.
