Healthcare

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 to provide coverage for behavioral health treatment for pervasive developmental disorder or autism. This bill would prohibit a health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2026, from requiring an enrollee or insured previously diagnosed with pervasive developmental disorder or autism to receive a rediagnosis to maintain coverage for behavioral health treatment for their condition. The bill would require a treatment plan to be made available to the plan or insurer upon request. 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 within the Department of Consumer Affairs and charges it with administrative and enforcement duties related to the provision of medical services under the act. The act makes unprofessional conduct subject to discipline by the board the regular practice of medicine in a specified hospital having 5 or more physicians and surgeons on the medical staff without rules established by the board of directors to govern the operation of the hospital. The act requires the rules to include a provision for the organization of physicians and surgeons into a formal medical staff with staff appointments on an annual or biennial basis. This bill would revise that provision to instead require staff reappointments at least every 3 years. Existing law requires that physician and surgeon staff require members of the staff to demonstrate their ability to perform surgical and other procedures competently and to the satisfaction of an appropriate committee or committees of the staff at the time of original application for appointment to the staff and at least every 2 years thereafter. This bill would instead require physician and surgeon staff to require members of the staff to demonstrate their ability at least every 3 years thereafter. Existing law provides for the licensure and inspection of health facilities, including general acute care hospitals and acute psychiatric hospitals, by the State Department of Public Health and makes a violation of those provisions a crime. This bill would require the governing body of a general acute care hospital or an acute psychiatric hospital to require that medical staff establish controls that are designed to ensure the achievement and maintenance of high standards of professional ethical practices, including a requirement that all members of the medical staff be required to demonstrate their ability to perform surgical or other procedures competently and to the satisfaction of an appropriate medical staff committee or committees at the time of original application for appointment to the medical staff and every 3 years thereafter. The bill would prohibit the department from requiring an acute care hospital or acute psychiatric hospital to undertake routine reappointments more frequently than every 3 years. Because a violation of this requirement 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 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, including federally qualified health center (FQHC) services as described by federal law. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. This bill would require each FQHC to have an annual mission spend ratio, as defined, of no less than 90% and would provide a methodology for calculation of that ratio, as specified, until the State Department of Public Health (department) has adopted a methodology for this purpose, with a goal of implementation of the latter methodology by January 1, 2028. By June 30, 2027, and annually thereafter by June 30, the bill would require each FQHC or its parent corporation to report to the department total revenues collected in a form to be determined by the department. The bill would require each report to include, among other things, one of certain Internal Revenue Service (IRS) forms. The bill would require each FQHC to submit an annual registration fee in an amount to be determined by the department and adjusted as necessary to fund these provisions. The bill would require the department to calculate and prepare a report of each FQHC's mission spend ratio no later than 90 days after the deadline for receipt of each FQHC's submission. The bill would require the department to conduct an audit of the financial information reported by FQHCs every 3 years, as specified. This bill would impose penalties for failure of an FQHC to comply with the above-described reporting and mission spend ratio requirements, including an administrative fine of $5,000 for a first violation and $10,000 for each subsequent month that an FQHC fails to submit an annual report. The bill would require those penalties to be deposited into the Mission Spend Ratio Penalty Account, which would be subject to appropriation by the Legislature, within the Special Deposit Fund. This bill would require an FQHC to abate the violation within 2 years after the department imposes an administrative penalty. The bill would prohibit the FQHC from being required to pay the penalty if it meets specified requirements within the abatement period, including reaching an agreement with the department on a plan to spend the total amount of the administrative penalty on mission-directed expenses within 2 years. The bill would require the department to conduct annual audits of any FQHC that has reached an agreement with the department. If the department determines that an FQHC is not in substantial compliance with the agreed-upon plan, the bill would require the FQHC to pay the imposed administrative penalty within 2 working days and to pay other costs, as specified. The bill would provide that appeals run concurrently with the abatement period. This bill would authorize an FQHC to apply to the department for a waiver providing a temporary pause of the above-described reporting and mission spend ratio requirements or for an alternative mission spend ratio requirement on the basis of unexpected or exceptional circumstances or the FQHC's economic condition. The bill would provide that a waiver or alternative mission spend ratio is for a term of one calendar year. The bill would prescribe various types of information to be reported by an FQHC to obtain a waiver or alternative mission spend ratio. The bill would authorize the department to provide an alternative mission spend ratio to an FQHC to adjust, exclude, or otherwise account for imminently planned capital improvement, as specified, if the assessed penalty will result in the inability for the planned capital improvement to move forward during the next calendar year. The bill would authorize an FQHC to apply to renew a waiver or alternative mission spend ratio at any time no fewer than 180 days before the expiration of the existing waiver or alternative mission spend ratio. This bill would make its provisions inapplicable to an FQHC or FQHC look-alike that is owned or operated by a political subdivision of the state or by a tribe or tribal organization or urban Indian organization receiving certain federal funding, as specified, or to an FQHC or FQHC look-alike participating in a bona fide labor-management cooperation committee. The bill would require the department to adopt all regulations necessary to implement these provisions and would authorize the department to implement, interpret, or make specific these provisions, in whole or in part, by means of information notices, all-county letters, or other similar instructions without taking regulatory action. The bill would make its provisions severable. The bill would define various terms for purposes of these provisions.

AJR 13 is a non-binding resolution from the California State Assembly that would formally censure members of California's delegation to the U.S. House of Representatives who support federal cuts to social safety net programs. It directly targets those California representatives who vote in favor of reducing funding for programs like food assistance, housing support, or healthcare subsidies. The resolution expresses the Assembly's disapproval through a formal written reprimand but does not change any laws or affect the representatives' voting power.

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's requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law sets forth specified coverage requirements for health care service plan contracts and health insurance policies. Existing law requires an individual or small group health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2017, to include, at a minimum, coverage for essential health benefits pursuant to the federal Patient Protection and Affordable Care Act. Existing law requires an essential health benefit to be provided only to the extent that federal law does not require the state to defray the costs of the benefit. This bill would require a health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2027, that provides coverage for the application of fluoride varnish as a pediatric oral care benefit to provide coverage without cost sharing for the application of fluoride varnish as medically necessary regardless of whether the service is billed as a dental benefit or as a medical benefit, except as specified. If this coverage requirement creates an obligation for the state to defray costs for an individual, the bill would not require coverage unless there is an appropriation for this purpose, as specified. 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. 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. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law establishes a schedule of benefits under the Medi-Cal program and provides for various services, including certain dental services, that are rendered by Medi-Cal enrolled providers. Under existing law, silver diamine fluoride treatments are a covered benefit for eligible children 0 to 6 years of age, inclusive, as specified, and application of fluoride or other appropriate fluoride treatment is covered for children 17 years of age and under. This bill would make the application of fluoride or other appropriate fluoride treatment, as defined by the department, a covered benefit under the Medi-Cal program for children under 21 years of age. The bill would require the State Department of Health Care Services, no later than July 1, 2027, to issue billing guidance and make any necessary updates to ensure the coverage policy for Medi-Cal beneficiaries under 21 years of age is consistent with certain federal benefits and would require that policy to allow the application of fluoride varnish, 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 no reimbursement is required by this act for a specified reason. This bill would incorporate additional changes to Section 14132 of the Welfare and Institutions Code proposed by AB 1949 and SB 944 to be operative only if this bill and either or both AB 1949 and SB 944 are enacted and this bill is enacted last.

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 requires a licensed health care practitioner who provides prenatal, postpartum, or interpregnancy care for a patient to offer to screen or appropriately screen a mother for maternal mental health conditions. For purposes of that requirement, existing law defines "maternal mental health condition" to mean a mental health condition that occurs during pregnancy, the postpartum period, or interpregnancy, as specified. This bill would limit the definition of "maternal mental health condition" to a mental health condition that occurs during the pregnancy or the postpartum period, as specified. The bill would authorize a licensed health care practitioner to satisfy the above-described requirement for maternal mental health screening by referring the patient or client to another licensed health care practitioner who is authorized to screen, evaluate, diagnose, and treat the patient or client for a maternal mental health condition. The bill would require a licensed health care practitioner who provides prenatal, postpartum, or perinatal care for a patient or client who screens positive for a maternal mental health condition to ensure that the patient or client receives appropriate clinical evaluation, and, if the practitioner diagnoses a patient or client with a maternal mental health condition, offer or provide treatment to the patient or client, consistent with the provider's scope of practice. 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 develop a maternal mental health program designed to promote quality and cost-effective outcomes. Existing law requires the program to, among other things, conduct specified maternal mental health screenings during pregnancy and the postpartum period. Existing law requires the program guidelines and criteria to be provided to relevant medical providers, including all contracting obstetric providers. Existing law encourages health care service plans and health insurers to, among other things, improve screening, treatment, and referral to maternal mental health services. For purposes of these provisions, existing law defines "maternal mental health" to mean a mental health condition that occurs during pregnancy or during the postpartum period, as specified. This bill would modify the term to "maternal mental health condition" and define it as a mental health condition that occurs during the pregnancy or the postpartum period, as defined by the most recent clinical guidelines adopted by the American College of Obstetricians, as specified. The bill would instead require the above-described maternal mental health program to include maternal mental health screening to be conducted during pregnancy and one or more mental health screenings to be conducted during the postpartum period in accordance with applicable clinical guidelines and the standards of care appropriate to the provider's scope of practice, as specified. The bill would require program guidelines and criteria to be provided to relevant licensed health care practitioners, as defined, including all contracting obstetric providers. The bill would require a health care service plan or health insurer to provide case management or care coordination for an enrollee or insured who screens positive for a maternal mental health condition in accordance with the plan's or insurer's existing case management and care coordination programs. The bill would encourage health care service plans and health insurers to improve treatment, including through the use of outpatient prescription drugs approved for maternal mental health by the United States Food and Drug Administration. 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.

This measure would urge the administration of President Donald J. Trump and the Congress of the United States to rescind the National Institutes of Health funding cuts. This measure also affirms the Legislature's commitment to postsecondary educational institutions.

Senate Resolution 53 designates September 2025 as Childhood Cancer Awareness Month in California, encouraging residents, businesses, and organizations to host events that raise awareness about childhood cancer and support affected families year-round. The resolution also expresses the state's commitment to advancing research for cures and less toxic treatments, while honoring children battling cancer and thanking healthcare providers and parents who support patients. This procedural resolution does not create new laws but formally recognizes and promotes statewide engagement with childhood cancer issues.

Existing law establishes 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. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Under existing law, in-person, face-to-face contact is not required under the Medi-Cal program when covered health care services are provided by video synchronous interaction, asynchronous store and forward, audio-only synchronous interaction, remote patient monitoring, or other permissible virtual communication modalities, when those services and settings meet certain criteria. Existing law required the department, on or before January 1, 2023, to develop a research and evaluation plan that, among other things, proposes strategies to analyze the relationship between telehealth and access to care, quality of care, and Medi-Cal program costs, utilization, and program integrity. The department created that plan in December of 2022 and published the Biennial Telehealth Utilization Report in April of 2024. This bill, the Telehealth for All Act of 2025, would require the department, commencing in 2028 and every 2 years thereafter, to use Medi-Cal data and other data sources available to the department to produce analyses in a publicly available Medi-Cal telehealth utilization report. The bill would authorize the department to include those analyses in each of the department's Biennial Telehealth Utilization Reports, as specified. The bill would require the analyses to address telehealth access and utilization data, including various metrics on telehealth visits and claims, disaggregated by geographic, demographic, and social determinants of health categories to identify disparities. The bill would require the department to identify additional data elements for inclusion in future reports to help to identify and address access-to-care issues or provide greater insight into utilization of telehealth modalities.