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, the Medi-Cal Long-Term Care Reimbursement Act, requires the department, subject to any necessary federal approvals, for managed care rating periods that begin between January 1, 2023, and December 31, 2026, inclusive, to establish and implement the Workforce and Quality Incentive Program. Under that program, a network provider furnishing skilled nursing facility services to a Medi-Cal managed care enrollee is authorized to earn performance-based directed payments from the Medi-Cal managed care plan with which they contract, as specified, in addition to other certain payments. This bill would remove from the above-described provision the qualification that the provider be within the network. The bill would make conforming changes to related provisions. Under the bill, pursuant to conditions of eligibility for directed payments under certain federal regulations, payments made under the Workforce and Quality Incentive Program would be retroactively calculated and paid based on the total number of days, effective July 9, 2024, during which the facility provided services to Medi-Cal beneficiaries, regardless of whether the facility was a network provider.
Existing law allows a person who was arrested or convicted of a nonviolent offense while they were a victim of human trafficking, intimate partner violence, or sexual violence, to petition the court, under penalty of perjury, for vacatur relief. Existing law requires, to receive that relief, that the crime for which the person was arrested or convicted was a nonviolent offense and that the person establish, by clear and convincing evidence, that the arrest or conviction was the direct result of being a victim of human trafficking, intimate partner violence, or sexual violence. Existing law authorizes the court to vacate the conviction if it concludes that the petitioner was a victim of one of those crimes at the time of the alleged commission of the offense, the arrest was a direct result of being a victim of that offense, and the vacatur is in the best interest of justice. This bill would allow that relief for a person arrested or convicted of any offense, except murder, as specified. Because this bill would authorize more petitions to be filed under penalty of perjury, by expanding the scope of the crime of perjury, this bill would impose a state-mandated local program. If a court issues an order for a person who was arrested or convicted of an offense while they were a victim of intimate partner violence or sexual violence, existing law requires the court to order the law enforcement agency having jurisdiction over the offense, the Department of Justice, and any law enforcement agency that arrested the petitioner or participated in the arrest of the petitioner to seal their records of the arrest and the court order to seal and destroy the records within 3 years from the date of the arrest, or within one year after the court order is granted, whichever occurs later, and thereafter to destroy their records of the arrest and the court order to seal and destroy those records. This bill would require the court to also order any law enforcement agency that has taken action or maintains records related to or because of the offense, including, but not limited to, departments of probation, rehabilitation, corrections, and parole, to seal and destroy their records. The bill would require those agencies to seal their records of arrest, conviction, or adjudication and the court order to seal and destroy the records within one year from the date of arrest, or within 90 days after the court order is granted, whichever occurs later. The bill would require the agencies to destroy these records within one year of the date of the court order. By increasing duties on local law enforcement, this bill would impose a state-mandated local program. The bill would also require the Department of Justice to notify the petitioner and the petitioner's counsel that the department has complied with the order to seal the arrest records by the applicable deadline. Existing law creates an affirmative defense against a charge of a crime that the person was coerced to commit the offense as a direct result of being a victim of human trafficking, intimate partner violence, or sexual violence at the time of the offense and when the person had reasonable fear of harm. Existing law prohibits this defense from being used with respect to a violent felony, as defined. This bill would allow that defense to be used with respect to a violent felony, except for murder, as specified. 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 with regard to certain mandates no reimbursement is required by this act for a specified reason. With regard to any other mandates, this bill would provide that, if the Commission on State Mandates determines that the bill contains costs so mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.
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. Under existing law, community health worker (CHW) services are a covered Medi-Cal benefit subject to any necessary federal approvals. CHW is defined as a liaison, link, or intermediary between health and social services and the community to facilitate access to services and to improve the access and cultural competence of service delivery. Existing law requires a Medi-Cal managed care plan to engage in outreach and education efforts to enrollees with regard to the CHW services benefit, as specified. Existing law requires the department to inform stakeholders about implementation of the benefit. This bill would require the department to annually conduct an analysis of the CHW services benefit, submit the analysis to the Legislature, and publish the analysis on the department's internet website, with the first analysis due July 1, 2027. The bill would require the analysis to include, at a minimum, an assessment of the above-described outreach and education efforts conducted by each Medi-Cal managed care plan, an assessment of the CHW benefit utilization and services, a demographic disaggregation of CHWs providing the CHW benefit and the Medi-Cal beneficiaries receiving services, and data on Medi-Cal reimbursements for CHW services billed to the department, as specified.
Existing federal law provides for the Medicare Program, which is a public health insurance program for persons 65 years of age and older and specified persons with disabilities who are under 65 years of age. Existing federal law specifies parts of Medicare that cover specific services, such as Medicare Part B, which generally covers medically necessary services and supplies and preventive services. 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 federal law additionally provides for the issuance of Medicare supplement policies or certificates, also known as Medigap coverage, which are advertised, marketed, or designed primarily as a supplement to reimbursements under the Medicare Program for the hospital, medical, or surgical expenses of persons eligible for the Medicare Program, including coverage of Medicare deductible, copayment, or coinsurance amounts, as specified. Existing law, among other provisions, requires supplement benefit plans to be uniform in structure, language, designation, and format with the standard benefit plans, as prescribed. Existing law prohibits an issuer from denying or conditioning the offering or effectiveness of any Medicare supplement contract, policy, or certificate available for sale in this state, or discriminating in the pricing of a contract, policy, or certificate because of the health status, claims experience, receipt of health care, or medical condition of an applicant in the case of an application that is submitted prior to or during the 6-month period beginning with the first day of the first month in which an individual is both 65 years of age or older and is enrolled for benefits under Medicare Part B. Existing law requires an issuer to make available specified Medicare supplement benefit plans to a qualifying applicant under those circumstances who is 64 years of age or younger who does not have end stage renal disease. This bill would delete the exclusion of otherwise qualified applicants who have end stage renal disease, thereby making the specified Medicare supplement benefit plans available to those individuals. The bill, on and after January 1, 2027, would prohibit an issuer of Medicare supplement coverage in this state from denying or conditioning the issuance or effectiveness of any Medicare supplement coverage available for sale in the state, or discriminate in the pricing of that coverage because of the health status, claims experience, receipt of health care, medical condition, or age of an applicant, except as specified, if an application for coverage is submitted during an open enrollment period, as specified in the bill. The bill would entitle an individual enrolled in Medicare Part B to a 90-day annual open enrollment period beginning on January 1 of each year, as specified, during which period the bill would require applications to be accepted for any Medicare supplement coverage available from an issuer, as specified. The bill would require the open enrollment period to be a guaranteed issue period. The bill would authorize premium rates offered to applicants during the open enrollment period to vary based on the applicants' age at the time of issue, as specified, but would prohibit the premiums from varying based on age after the contract is issued. 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 requires the adopted course of study for grades 1 to 6, inclusive, to include certain areas of study, including, among others, health. Existing law requires the adopted course of study for grades 7 to 12, inclusive, to offer courses in specified areas of study, including, among others, English, social sciences, and mathematics. This bill, with respect to the adopted course of study for grades 1 to 6, inclusive, would require the health area of study to also include mental health education, as provided. The bill, with respect to the adopted course of study for grades 7 to 12, inclusive, would add mental health education, as provided, to the adopted course of study. To the extent this bill would impose additional duties on local educational agencies or local officials, 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 Health and Human Services Agency, which includes departments charged with the administration of health, social, and other human services. Under existing law, the Legislature finds that state government has an affirmative role in alleviating problems related to the inappropriate use of alcoholic beverages and other drug use and that its major objective is protection of the public health and safety, particularly where problems related to inappropriate alcohol use and other drug use are likely to cause harm to individuals, families, and the community. The agency convened the Behavioral Health Task Force to inform its work on behavioral health issues across the state. This bill, the California Overdose Death and Addiction Reduction Act of 2025, would require the California Health and Human Services Agency, on or before January 1, 2028, to direct the task force, or a successor group, to create a set of recommendations to support an implementation plan for reducing alcohol- and drug-related addiction deaths by 50% on or before 5 years from the date the task force provides the recommendations to the agency, but no later than January 1, 2033. The bill would authorize the task force to include additional members as deemed appropriate by the agency, including representatives from specified entities, experts, and providers, among others. The bill would require the agency to adopt the recommendations provided by the task force and require the agency to consider specified information, including quality and performance measures to establish minimum standards for effective delivery of services. The bill would require the agency, on or before July 1, 2033, to provide the Governor and the Legislature a report of the findings and recommendations related to the extent that the 2033 goal was met and how effective the recommendations of the task force were, and recommendations for beyond 2033 that will continue to reduce overdose deaths and addiction. The bill would also make related findings and declarations.
Existing law, the Nevaeh Youth Sports Safety Act, requires a youth sports organization to ensure, by January 1, 2028, that its athletes have access to an automated external defibrillator (AED) during any official practice or match. Existing law requires a youth sports organization, commencing January 1, 2028, to ensure that its AED is maintained and tested according to specified operation and maintenance guidelines. This bill would require, commencing January 1, 2028, a public or private local facility with a permanent sports infrastructure, as defined, to ensure that the youth sports organization has access to an AED procured and maintained by the facility during an official practice or match permitted by the facility, except as specified with respect to local educational agencies. The bill would require the youth sports organization, commencing January 1, 2028, to ensure there is access to an operational AED if an AED is not available at a public or private local facility where an official practice or match is taking place. The bill would additionally require a public or private local facility, commencing January 1, 2028, to ensure that its AED is maintained and tested according to specified operation and maintenance guidelines. The bill would require a public or private local facility to work in collaboration with the youth sports organization to ensure that any AED that is installed be accessible to youth sports organizations at the time of official practices or matches permitted by the facility. The bill would require a public or private local facility that has installed an AED to work with the youth sports organization to identify means to share the financial costs associated with ensuring the AED is maintained and accessible at the facility, or to identify means to share the financial costs associated with installing an AED at the facility.
This measure would urge the United States Congress to avoid any cuts to the Supplemental Nutrition Assistance Program (SNAP) , which could harm the state's children, older adults, and families, and impact the state's economic well-being.
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 establishes the Independent Medical Review System within each department, under which an enrollee or insured may seek review if a health care service has been denied, modified, or delayed by a health care service plan or health insurer and the enrollee or insured has previously filed a grievance that remains unresolved after 30 days. This bill would require a health care service plan or health insurer to annually report to the appropriate department the total number of claims processed by the health care service plan or health insurer for the prior year and its number of treatment denials or modifications, separated and disaggregated as specified, commencing on or before June 1, 2026. The bill would require the departments to compare the number of a health care service plan's or health insurer's treatment denials and modifications to (1) the number of successful independent medical review overturns of the plan's or insurer's treatment denials or modifications and (2) the number of treatment denials or modifications reversed by a plan or insurer after an independent medical review for the denial or modification is requested, filed, or applied for. For a health care service plan or health insurer with 10 or more independent medical reviews in a given year, the bill would make the health care service plan or health insurer liable for an administrative penalty, as specified, if more than 50% of the independent medical reviews filed with a health care service plan or health insurer result in an overturning or reversal of a treatment denial or modification in any one individual category of specified general types of care. The bill would make a health care service plan or health insurer liable for additional administrative penalties for each independent medical review resulting in an additional overturned or reversed denial or modification in excess of that threshold. The bill would require the departments to annually include data, analysis, and conclusions relating to these provisions in specified reports. 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. Existing law creates the Managed Care Administrative Fines and Penalties Fund in the State Treasury for the deposit of fines and administrative penalties collected pursuant to provisions licensing and regulating health care service plans. This bill would create the Managed Care Independent Medical Review Administrative Penalties Subaccount in the Managed Care Administrative Fines and Penalties Fund for the receipt and deposit of moneys generated from the administrative penalties described above with respect to health care service plans. The bill would create the Health Insurance Independent Medical Review Administrative Penalties Fund in the State Treasury for the receipt and deposit of moneys generated from the administrative penalties described above with respect to health insurers. The bill would authorize the moneys in the Managed Care Independent Medical Review Administrative Penalties Subaccount and Health Insurance Independent Medical Review Administrative Penalties Fund to be expended, as specified, upon appropriation by the Legislature. This bill would declare that its provisions are severable. 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 and funded by federal Medicaid program provisions. Existing law, subject to implementation of the California Advancing and Innovating Medi-Cal (CalAIM) initiative, requires the department to implement an enhanced care management (ECM) benefit designed to address the clinical and nonclinical needs on a whole-person-care basis for certain target populations of Medi-Cal beneficiaries enrolled in Medi-Cal managed care plans. Under existing law, target populations include, among others, high utilizers with frequent hospital admissions, short-term skilled nursing facility stays, or emergency room visits, and individuals experiencing homelessness. Existing law, subject to CalAIM implementation, authorizes a Medi-Cal managed care plan to elect to cover community supports, as specified. Under existing law, community supports that the department is authorized to approve include, among others, housing transition navigation services and medically supportive food and nutrition services. This bill would require a Medi-Cal managed care plan, for purposes of covering the ECM benefit, or if it elects to cover a community support, to contract with community providers, as defined, that can demonstrate that they are capable of providing access and meeting quality requirements in accordance with Medi-Cal guidelines. In determining which community providers to contract with, the bill would authorize Medi-Cal managed care plans to take into consideration whether those providers are available in the respective county and have experience in providing the applicable ECM or community support. The bill would require the department, for purposes of enforcing these provisions, to require Medi-Cal managed care plans to set goals every other year for the level of contracting and utilization of community providers and local entities, as defined. The bill would require these goals to be established in consultation with the department, as specified. If a community provider contracted to provide ECM services or community supports submits a referral or authorization request for the applicable service on behalf of an eligible member, the bill would require a Medi-Cal managed care plan to assign the member to the contracted referring provider if the plan determines that the provider can appropriately meet the needs of the member. The bill would prohibit the above-described provisions from being construed to limit the department's authority to grant eligibility for presumptive authorization for categories of ECM providers that have extensive experience and expertise in serving certain ECM populations of focus. Existing law requires the department to develop, in consultation with Medi-Cal managed care plans and other appropriate stakeholders, a monitoring plan and reporting template for the implementation of ECM or community supports. Existing law requires the department to annually publish a public report on reported ECM or community support utilization data, populations served, and demographic data, stratified by age, sex, race, ethnicity, and languages spoken, to the extent that statistically reliant data are available. This bill would expressly include providers of ECM or community supports within the consultation process. The bill would require the department to publish the public report on a quarterly basis instead and would require additional demographic data. The bill would also require the department to develop standardized and streamlined templates to be used by Medi-Cal managed care plans or their contracted providers, as specified, and to develop guidance to allow community providers to act as a primary subcontractor with Medi-Cal managed care plans and to subcontract with other community providers as a 3rd-tier subcontractor, as specified.
