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.
(1) Under existing law, a licensed health care provider who is authorized by law to prescribe an opioid antagonist may issue standing orders for the distribution of an opioid antagonist to a person at risk of an opioid-related overdose or to a family member, friend, or other person in a position to assist a person at risk of an opioid-related overdose. Existing law exempts a health care provider who acts with reasonable care in issuing a prescription or order for an opioid antagonist from professional review, civil action, or criminal prosecution, under certain circumstances. Existing law requires that a person who receives an opioid antagonist pursuant to a standing order or otherwise possesses an opioid antagonist receive training, as specified. Existing law provides that a person who is trained in the use of an opioid antagonist and acts with reasonable care and in good faith is not subject to professional review, liable in a civil action, or subject to criminal prosecution. This bill would expand the above-described authorizations to those who are at risk of or any person who may be in a position to assist a person experiencing any overdose and would strike the requirement that those who receive and possess opioid antagonists receive training. The bill would authorize a person in a position to assist a person at risk of an overdose to possess an opioid antagonist and subsequently dispense or distribute an opioid antagonist to a person at risk of an overdose or another person in a position to assist a person at risk of an overdose. The bill would instead exempt a person who administers an opioid antagonist in good faith, whether or not they were trained, from liability for civil damages, as specified, and would instead exempt a health care provider who acts with reasonable care from liability in a civil action for any injuries or damages relating to or resulting from the acts or omissions of any person who administers the opioid antagonist in good faith, as specified. (2) Existing law imposes a drug program fee for each separate controlled substance offense, as specified, to be deposited by the county treasurer in a drug program fund. Existing law requires that a portion of the fund be allocated to primary prevention programs in the community. This bill would state that primary prevention programs may include those activities aligned with evidence-based best practices, as specified. (3) Existing law requires the State Department of Health Care Services to license and regulate facilities that provide residential nonmedical services to adults who are recovering from problems related to alcohol, drug, or alcohol and drug misuse or abuse, and who need alcohol, drug, or alcohol and drug recovery treatment or detoxification services. Existing law authorizes a licensed alcohol or other drug recovery or treatment facility to permit incidental medical services, as defined, to be provided to a resident at the facility premises by a licensed physician and surgeon or other health care practitioner under specified limited circumstances, including that the resident has signed an admission agreement. Existing law requires a licensee to develop a plan to address when a resident relapses, including when a resident is on the licensed premises after consuming alcohol or using illicit drugs. This bill would require the department, on or before January 1, 2027, to offer a combined application for entities seeking licensure as an alcohol or other drug recovery or treatment facility and to provide incidental medical services, as defined. The bill would prohibit the department from requiring an admission agreement to require a person to be abstinent and not intoxicated in order to be admitted to care or continue treatment. The bill would require a licensee to prioritize the individual maintaining some level of connection to treatment, following a relapse. (4) Existing law defines "drug- or alcohol-related program" as any program designed to reduce the unlawful use of, or assist those who engage in the unlawful use of, drugs or alcohol, through various means, such as intervention, treatment, and enforcement, among others. Existing law prohibits the encumbrance of state funds for a drug- or alcohol-related program unless it contains a component that explains that there is no unlawful use of drugs or alcohol and requires all aspects of a drug- or alcohol-related program receiving state funds to be consistent with the "no lawful use" message. This bill would redefine that term to mean any program designed to assist persons with substance use disorders and would strike enforcement from the specified means. The bill would repeal the above-described provisions related to the "no lawful use" message.
Existing law provides for the regulation of health care service plans by the Department of Managed Health Care and health insurers by the Department of Insurance. Existing law requires a health care service plan contract or disability insurance policy to provide coverage for medically necessary treatment of mental health and substance use disorders, as defined, under the same terms and conditions applied to other medical conditions. 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 medically necessary health care services, including specified mental health and substance use disorder services, pursuant to a schedule of benefits. Existing law provides for the regulation of community care facilities that provide nonmedical care, including residential facilities, short-term residential therapeutic programs, and group homes by the State Department of Social Services. Existing law requires the care and supervision provided by a short-term residential therapeutic program or group home to be nonmedical, except as otherwise permitted by law. This bill would require the Department of Managed Health Care, the Department of Insurance, and the State Department of Health Care Services to prepare and send one letter to each chief financial officer of a health care service plan, health insurer, or Medi-Cal managed care plan that provides coverage, including out-of-network benefits, in California for substance use disorder in residential facilities, as defined. The bill would require the letter to include, among other things, a statement informing the plan or insurer that substance use disorder treatment in licensed or unlicensed residential facilities is almost exclusively nonmedical, with rare exceptions. The bill would authorize the Department of Managed Health Care, the Department of Insurance, and the State Department of Health Care Services to consult with each other, and would require those departments to consult with the State Department of Social Services, when preparing the contents of the letter. The bill would require the letters to be sent on or before October 1, 2026. The bill would repeal these provisions on January 1, 2027.
Existing law, the California Affordable Drug Manufacturing Act of 2020, requires the California Health and Human Services Agency (CHHSA) or its departments to enter into partnerships, in consultation with other state departments as necessary, to increase competition, lower prices, and address shortages in the market for generic prescription drugs, to reduce the cost of prescription drugs for public and private purchasers, taxpayers, and consumers, and to increase patient access to affordable drugs. For purposes of implementing these provisions, existing law authorizes CHHSA and its departments, including the Department of Health Care Access and Information, to enter into exclusive or nonexclusive contracts on a bid or negotiated bases. Existing law exempts these contracts entered into by CHHSA and its departments from the review or approval of any division of the Department of General Services as well as from provisions pertaining to bidding and awarding of state contracts. This bill would prohibit a state agency from awarding a contract, pursuant to the above provisions, on a noncompetitive basis for the purchase or acquisition of an opioid antagonist, as defined, with a contractor that has entered into a multistate settlement agreement for its role in contributing to the opioid epidemic. The bill would make a contract void and unenforceable for a violation of this provision and apply those provisions retroactively to contracts entered into before January 1, 2026.
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 generally authorizes a health care service plan or health insurer to use prior authorization and other utilization management functions, under which a licensed physician or a licensed health care professional who is competent to evaluate specific clinical issues may approve, modify, delay, or deny requests for health care services based on medical necessity. Existing law requires health care service plan contracts and health insurance policies that provide hospital, medical, or surgical coverage and are issued, amended, or renewed on or after January 1, 2021, to provide coverage for medically necessary treatment of mental health and substance use disorders under the same terms and conditions applied to other medical conditions, as specified. On and after January 1, 2027, this bill would prohibit concurrent or retrospective review of medical necessity of in-network health care services and benefits (1) for the first 28 days of a treatment plan for inpatient or residential substance use disorder stay at a specified licensed facility during each plan or policy year or (2) for outpatient services provided by specified certified programs for substance use disorder visits, except as specified. The bill would authorize, after the 29th day, in-network health care services and benefits for inpatient or residential substance use disorder care to be subject to concurrent review. On and after January 1, 2027, the bill would prohibit retrospective review of medical necessity for the first 28 days of intensive outpatient or partial hospitalization services for substance use disorder, but would authorize concurrent or retrospective review for day 29 and days thereafter of that stay or service. With respect to health care service plans, the bill would specify that its provisions do not apply to Medi-Cal behavioral health delivery systems or Medi-Cal managed care plan contracts. Because a willful 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.
