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 Former law, repealed as of January 1, 2025, established the Licensed Physicians and Dentists from Mexico Pilot Program, which allowed up to 30 licensed physicians and up to 30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.
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.
Existing law, the Medical Practice Act, establishes the Medical Board of California to license and regulate the practice of medicine. Existing law 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 physicians from Mexico who are licensed, certified, or recertified and in good standing in their medical specialty in Mexico and who meet specified other requirements. This bill would establish the Doctors from El Salvador Program for the purpose of permitting licensed physicians from El Salvador to practice medicine in California for up to 3 years. The bill would require the program to be developed in consultation with representatives from a community health clinic in California that has an established partnership and framework with specified universities in El Salvador and would require the program to, among other things, recruit and vet candidates and assist candidates for the program in El Salvador to meet all program requirements. The bill would require the board to issue a nonrenewable 3-year physician and surgeon's license to a person who is licensed, certified, or recertified, and in good standing in the applicable medical specialty in El Salvador and who meets other requirements of the program. This bill would require a licensee in the program to practice only in the nonprofit community health center that offered the licensee employment and the corresponding hospital. The bill would require a federally qualified health center employing a licensee in the program to take certain actions, including creating and maintaining medical quality assurance protocols for those licensees. The bill would also require the federally qualified health centers to work with a California medical school or residency program to conduct 10 secondary reviews of randomly selected patient encounters with each of those licensees every 6 months, as specified. The bill would also require the faculty from the medical school or residency program and federally qualified health center chief medical officers to jointly develop 2 quality assurance seminars to be attended by the licensees. This bill would require an evaluation of the program to be conducted 12 months after the program has commenced by one of specified universities in El Salvador and an unspecified medical school in southern California, except that if the evaluation does not begin within 18 months of commencement of the program, the bill would require the Director of Consumer Affairs to select an independent consultant to conduct the evaluation. The bill would require progress reports to be provided to the Legislature on achievable time intervals beginning in the 2nd year of implementation of the program. The bill would require the board to coordinate with the community health center, as specified, to ensure that the number of program participants that are issued a license does not exceed a certain number of licensees, based on the year in which the applicant applies. The bill would establish various fees to be deposited in the Contingent Fund of the Medical Board of California or the CURES Fund, as specified. This bill would make legislative findings and declarations as to the necessity of a special statute.
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 requires a health care service plan or health insurer to allow an individual to enroll in or change their health benefit plan as a result of a specified triggering event, including when the individual or the individual's dependent loses minimum essential coverage, as provided. This bill, for purposes of the above, would specify that loss of minimum essential coverage includes loss of coverage due to circumstances in which a joint agreement between health care service plans or health insurers, or between a health care service plan and a health insurer, to provide coverage to an enrollee or insured located in a medically underserved area expires, dissolves, or is otherwise terminated. The bill would require a health care service plan or health insurer to provide a written or electronic notice to enrollees or insureds at least 60 days before the effective date of the expiration, dissolution, or other termination of that joint agreement and would require the notice to additionally indicate that the expiration, dissolution, or other termination of the joint agreement may constitute a loss of minimum essential coverage. 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) The Confidentiality of Medical Information Act (CMIA) prohibits a provider of health care, a health care service plan, a contractor, or a corporation and its subsidiaries and affiliates from intentionally sharing, selling, using for marketing, or otherwise using any medical information, as defined, for any purpose not necessary to provide health care services to a patient, except as provided. Existing law makes a violation of these provisions that results in economic loss or personal injury punishable as a misdemeanor. Existing law deems a business that offers a mental health digital service or reproductive or sexual health digital service to a consumer for the purpose of allowing the individual to manage the individual's information, or for the diagnosis, treatment, or management of a medical condition of the individual, to be a provider of health care subject to the requirements of the CMIA. The bill would additionally deem a business that offers a health care chatbot, as defined, to a consumer for the above-described purposes to be a provider of health care subject to the requirements of the CMIA. Because the bill would expand the scope of a crime, it would impose a state-mandated local program. (2) Existing law requires a health facility, clinic, physician's office, or office of a group practice that uses generative artificial intelligence to generate written or verbal patient communications pertaining to patient clinical information, as defined, to ensure that those communications include both a disclaimer that indicates to the patient that a communication was generated by generative artificial intelligence, as specified, and clear instructions describing how a patient may contact a human health care provider, employee, or other appropriate person, except as specified. This bill would require a health facility, clinic, physician's office, or office of a group practice to take reasonable steps to ensure that a licensed health care professional, acting within their scope of practice, retains the ability to exercise independent professional judgment in their care of a patient whenever that care is informed by the output of a clinical decision support system, as defined. The bill would prohibit a health facility, clinic, physician's office, or office of a group practice from using or deploying a tool, system, or device that includes artificial intelligence to independently perform any clinical function that is required by law to be performed by a person with a professional license. The bill would make a violation of these provisions by a physician subject to the jurisdiction of the Medical Board of California or the Osteopathic Medical Board of California. The bill would also authorize the appropriate professional licensing board to pursue an injunction or restraining order to enforce these provisions to the extent that a violation constitutes the practice of a health care profession without a license. The bill would specify that these provisions do not apply to the use of automated decision systems for documentation and communication that does not involve the application of professional judgment, including automated messages to inform patients of updates to their health records. (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 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 prohibits specified health care service plan contracts and disability insurance policies from excluding persons covered by the plan from receiving benefits if they are diagnosed as having any significant destruction of brain tissue with resultant loss of brain function, including Alzheimer's disease. This bill would require a health care service plan contract or health insurance policy that is issued, amended, or renewed on or after January 1, 2027, to include coverage for all medically necessary treatments or medications, as determined by a health care provider, approved by the United States Food and Drug Administration (FDA) for the treatment of Alzheimer's disease or other medical conditions affecting memory. On and after January 1, 2027, the bill would prohibit a health care service plan or health insurer from imposing step therapy protocols as a prerequisite to authorizing that coverage, except as provided. 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.
Existing law creates the California Health Benefit Exchange (Exchange) , also known as Covered California, to facilitate the enrollment of qualified individuals and qualified small employers in qualified health plans as required under the federal Patient Protection and Affordable Care Act. Existing law requires the Exchange to enroll an individual in the lowest cost silver plan or another plan, as specified, upon receiving the individual's electronic account from an insurance affordability program. Existing law requires enrollment to occur before coverage through the insurance affordability program is terminated and prohibits the premium due date from being sooner than the last day of the first month of enrollment. This bill would, commencing July 1, 2027, additionally authorize the Exchange to enroll an individual in the plan in which other members of the individual's household are enrolled, as specified, or the lowest cost plan available to an Indian who is eligible for specified reduced cost sharing, as determined by the Exchange, and would require the Exchange to enroll an individual in any of the plans described above upon receipt of a complete application for an insurance affordability program submitted through the Statewide Automated Welfare System. The bill would require the Exchange to enroll the individual either before coverage through the insurance affordability program is terminated as described above or upon the receipt of a complete application for an insurance affordability program through the Statewide Automated Welfare System as described above. Existing law requires the Exchange to provide an individual who is enrolled in a plan described above with a notice that includes specified information, including a statement that services received during the first month of enrollment will only be covered by the plan if the premium is paid by the due date. This bill would require the Exchange to provide the notice described above prior to the individual's effective date of coverage, and to provide, instead of the statement described above, instructions on how to effectuate coverage in the selected plan, including by paying the premium on or before the due date, or, if there is no premium due, instructions on how to opt into the selected plan. 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 provide an annual enrollment period for individual health benefit plans offered through the Exchange from November 1 of the preceding calendar year to January 31 of the benefit year, inclusive. Existing law specifies that the effective date of coverage for individual health benefit plans offered outside and through the Exchange be no later than January 1 of the benefit year for plan selection made from November 1 to December 31 of the preceding calendar year, inclusive, and be no later than February 1 of the benefit year for plan selection made from January 1 to January 31 of the benefit year, inclusive. This bill would require a health care service plan or health insurer to provide the annual enrollment period and effective dates of coverage described above, except to the extent that those provisions are inconsistent with federal law, as specified. If inconsistent, the bill would require the plan or insurer to provide the annual enrollment period and effective dates of coverage required by federal law. 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.
