(1) Existing law establishes the Medi-Cal program, administered by the State Department of Health Care Services and under which health care services are provided to qualified low-income persons pursuant to a schedule of benefits, which includes pharmacy benefits, through various health care delivery systems, including fee-for-service and managed care. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law authorizes the department to enter into various types of contracts for the provision of services to beneficiaries, including contracts with a managed care plan. Existing law generally requires Medi-Cal managed care plan contractors to be licensed pursuant to the Knox-Keene Health Care Service Plan Act of 1975. The Knox-Keene Health Care Service Plan Act provides for the licensure and regulation of health care service plans by the Department of Managed Health Care. Under this act, a health care service plan is required to provide an external, independent review process, which meets prescribed standards, to examine the plan's coverage decisions on experimental or investigational therapies for an enrollee who meets specified criteria, including that the enrollee was denied coverage by the plan for a drug, device, procedure, or other therapy recommended or requested. Existing law requires the Department of Managed Health Care to establish the Independent Medical Review System, which generally serves to address grievances involving disputed health care services. By executive order, the Governor directed the department to transition pharmacy services for Medi-Cal managed care to a fee-for-service benefit by January 1, 2021. Existing law requires the department to convene an advisory group to receive feedback on the changes, modifications, and operational timeframes on the implementation of pharmacy benefits offered in the Medi-Cal program, and to provide regular updates on the pharmacy transition, including a description of changes in the division of responsibilities between the department and managed care plans relating to the transition of the outpatient pharmacy benefit to fee-for-service. This bill would require the department to establish the Independent Prescription Drug Medical Review System (IPDMRS) , commencing on January 1, 2021, which generally models the above-described requirements of the Knox-Keene Health Care Service Plan Act. The bill would provide that any Medi-Cal beneficiary grievance involving a disputed health care service is eligible for review under the IPDMRS, and would define "disputed health care service" as any outpatient prescription drug eligible for coverage and payment by the Medi-Cal program that has been denied, modified, or delayed by a decision of the department, or by one of its contracting fiscal intermediaries for the administration of the prescription drug benefit if that entity makes a final decision, in whole or in part, due to a finding that the service is not medically necessary. The bill would require information on the IPDMRS to be included in specified material, including the "my Medi-Cal: How to Get the Health Care You Need" publication, on the department's internet website, and various documents prepared by Medi-Cal managed care plans, including plan member handbooks, beneficiary evidence coverage forms, and letters of denial or notice of adverse benefits. The bill would authorize a beneficiary to apply to the department for an Independent Prescription Drug Medical Review (IPDMR) of a decision involving a disputed health care service within 6 months of receipt of the notice of adverse action, and would prohibit a beneficiary from paying any application or processing fee. The bill would require the department to provide a beneficiary with an application form and an addressed envelope, which the beneficiary may return to initiate an IPDMR, as part of the department's notification to the beneficiary on a disposition of the beneficiary's grievance involving a disputed health care service, and would require the form to include specified information, such as a statement indicating the beneficiary's consent to obtain necessary medical records from the Medi-Cal managed care plan and the beneficiary's providers. Upon notice from the department that the beneficiary has applied for an IPDMR, the bill would require the department and its contracting fiscal intermediaries for the administration of the prescription drug benefit to provide to the IPDMR organization designated by the department specified information, including a copy of any outpatient drugs dispensed to the Medi-Cal beneficiary, for purposes of the IPDMR organization's evaluation of the request. This bill would require the department to contract with one or more IPDMR organizations to conduct IPDMRs, and would require those organizations to be independent of any Medi-Cal managed care plan or the department's contracting fiscal intermediary for the administration of the prescription drug benefit in California. The bill would also authorize the department to enter into an intra-agency agreement with the Department of Managed Health Care to perform some or all of the department's duties, as specified. The bill would impose various requirements on the IPDMR organization, including that the organization is not affiliated or a subsidiary of a pharmaceutical manufacturer and that the organization submit to the department specified information, such as the name of any stockholder and owner of more than 5% of any stock or options, if a publicly held organization. The bill would require the medical professional reviewer or reviewers selected to conduct the IPDMR by the organization to perform specified duties, including reviewing pertinent medical records of the beneficiary. The bill would require the IPDMR organization to complete its review and make a written determination within 30 days of receipt of the application for review and supporting documentation, or less time as prescribed by the director, and to provide specified information, such as the analyses and determinations of the medical professionals reviewing the case, to identified individuals, including the director and the beneficiary. The bill would require the director to immediately adopt the determination of the IPDMR organization, promptly issue a written decision to the parties, and implement that decision. The bill would provide that the director's decision adopting a determination of an IPDMR organization be made publicly available, as prescribed, including in a searchable database on the department's internet website. The bill would require the director to perform an annual audit of IPDMR cases for education and determination of whether any denials, modifications, or delays in the coverage of outpatient prescription drugs necessitate an evaluation of the department's coverage policies. The bill would require the department to establish a reasonable, per-case reimbursement schedule to pay the costs of IPDMR organization review. The bill would require the department to provide an external, independent review process to examine itself and contracting fiscal intermediaries on experimental or investigational outpatient prescription drugs for specified individuals, including a beneficiary who has a life-threatening or seriously debilitating condition, and would provide that a disputed health care service involving experimental or investigational therapies is subject to the above-specified review process, including additional identified criteria. This bill would require the department to permit a Medi-Cal beneficiary to continue use of a drug that was covered by a Medi-Cal managed care plan and is part of a prescribed therapy in effect for the beneficiary immediately before the date of receipt of coverage through the department, irrespective of whether the drug is on the Medi-Cal contract drug list, for a prescribed period of time. (2) Existing law authorizes the department to contract with a vendor for the purposes of surveying drug price information, collecting data from providers, wholesalers, or drug manufacturers, and calculating a proposed actual acquisition cost. Existing law authorizes the department to establish a list of maximum allowable ingredient cost for generically equivalent drugs, and to establish the actual acquisition cost based on 3 specified factors, including the volume weighted actual acquisition cost adjusted by the department to verify that the actual acquisition cost represents the average purchase price paid by retail pharmacies in California, or the proposed actual acquisition cost as calculated by a vendor, as specified. Existing law requires the department to establish a fee schedule for the list of pharmacist services. Existing law specifies the pharmacist services that may be provided to a Medi-Cal beneficiary. This bill would authorize the department to provide a disease management or similar payment to a pharmacy that the department has contracted with to dispense a specialty drug to Medi-Cal beneficiaries in an amount necessary to ensure beneficiary access, as determined by the department based on the results of the survey completed during the 2020 calendar year. (3) Existing law requires the department to prepare and submit assumptions and estimates, as prescribed, relating to the Medi-Cal program to the Department of Finance on a semiannual basis. Existing law requires the department to include in the Governor's proposed budget the fiscal assumptions for the transition of the outpatient pharmacy benefit to a fee-for-service benefit. This bill would require the department to include specified information in the Medi-Cal program assumptions and estimates, such as the percentage of pharmacies actively billing the Medi-Cal program for outpatient prescription drugs and the average expenditure and net expenditure for outpatient prescription drugs per Medi-Cal beneficiary.
Sponsored bills
Existing law, the Medicinal and Adult-Use Cannabis Regulation and Safety Act (MAUCRSA) , which includes the Control, Regulate and Tax Adult Use of Marijuana Act (AUMA) , enacted by the voters at the November 8, 2016, statewide general election, provides for the licensure and regulation of commercial cannabis activity. MAUCRSA prohibits cannabis and cannabis products from being sold unless a representative sample has been tested by a licensed testing laboratory in the final form in which the cannabis or cannabis product will be consumed or used. This bill would specify that for this purpose "final form" means the unpackaged product as it will be consumed and would specify that the cannabis or cannabis product does not have to be delivered to the licensed testing laboratory in the final retail packaging to be considered in its final form. This bill would incorporate additional changes to Section 26100 of the Business and Professions Code proposed by AB 1458 to be operative only if this bill and AB 1458 are enacted and this bill is enacted last.
Existing law, the Nursing Practice Act, provides for the certification and regulation of nurse practitioners by the Board of Registered Nursing. Existing law authorizes the implementation of standardized procedures that authorize a nurse practitioner to perform certain acts that are in addition to other authorized practices, including certifying disability after performing a physical examination and collaboration with a physician and surgeon. A violation of the act is a misdemeanor. This bill would establish the Nurse Practitioner Advisory Committee to advise and give recommendations to the board on matters relating to nurse practitioners. The bill would require the committee to provide recommendations or guidance to the board when the board is considering disciplinary action against a nurse practitioner. The bill would require the board, by regulation, to define minimum standards for a nurse practitioner to transition to practice independently. The bill would authorize a nurse practitioner who meets certain education, experience, and certification requirements to perform, in certain settings or organizations, specified functions without standardized procedures, including ordering, performing, and interpreting diagnostic procedures, certifying disability, and prescribing, administering, dispensing, and furnishing controlled substances. The bill, beginning January 1, 2023, would also authorize a nurse practitioner to perform those functions without standardized procedures outside of specified settings or organizations in accordance with specified conditions and requirements if the nurse practitioner holds an active certification issued by the board. The bill would require the board to issue that certification to a nurse practitioner who meets additional specified education and experience requirements, and would authorize the board to charge a fee for the cost of issuing the certificate. The bill would also require the board to request the department's Office of Professional Examination Services, or an equivalent organization, to perform an occupational analysis of nurse practitioners performing certain functions. The bill would require the occupational analysis to be completed by January 1, 2023. The bill would require the board to take specified measures to identify and assess competencies. The bill would require the board to identify and develop a supplemental examination for licensees if needed based on the assessment, as provided. Existing law makes it unlawful for specified healing arts practitioners, including physicians and surgeons, psychologists, and acupuncturists, to refer a person for certain services, including laboratory, diagnostic nuclear medicine, and physical therapy, if the physician and surgeon or their immediate family has a financial interest with the person or in the entity that receives the referral. A violation of those provisions is a misdemeanor and subject to specified civil penalties and disciplinary action. This bill would make those provisions applicable to a nurse practitioner practicing pursuant to the bill's provisions. Existing law requires certain peer review organizations responsible for reviewing the medical care provided by specified healing arts licentiates to file with the relevant agency an "805 report," which is a report of certain adverse actions taken against a licentiate for a medical disciplinary cause or reason. Existing law exempts a peer review body from the requirement to file an 805 report for an action taken as a result of a revocation or suspension, without stay, of a physician and surgeon's license by the Medical Board of California or a licensing agency of another state. Existing law requires the licensing agency to disclose, among other things, a copy of any 805 report of a licensee upon a request made by specified institutions prior to granting or renewing staff privileges for the licentiate. Existing law specifies certain penalties for failing to file an 805 report, and requires the action or proceeding to be brought by the Medical Board of California if the person who failed to file an 805 report is a licensed physician and surgeon. Existing law defines "licentiate" for those purposes. This bill would include as a licentiate a nurse practitioner practicing pursuant to the bill's provisions, and make conforming changes. The bill would exempt a peer review body from the requirement to file an 805 report for an action taken as a result of a revocation or suspension, without stay, of a nurse practitioner's license by the Board of Registered Nursing or a licensing agency of another state. The bill would require the action or proceeding to be brought by the Board of Registered Nursing if the person who failed to file an 805 report is a licensed nurse practitioner. Because the bill would expand the scope of crimes, the bill would impose a state-mandated local program. This bill would incorporate additional changes to Section 650.01 of the Business and Professions Code proposed by SB 1237 to be operative only if this bill and SB 1237 are enacted and this bill is enacted last. 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 California Safe Drinking Water Act, requires the State Water Resources Control Board to administer provisions relating to the regulation of drinking water to protect public health, including, but not limited to, conducting research, studies, and demonstration projects relating to the provision of a dependable, safe supply of drinking water, enforcing the federal Safe Drinking Water Act, adopting implementing regulations, and conducting studies and investigations to assess the quality of water in private domestic water wells. The act authorizes the state board to delegate, by means of a local primacy delegation agreement, primary responsibility for the act's administration and enforcement within a county to a local health officer, as specified. The act requires that a local primacy delegation remain in effect until specified conditions occur. This bill would authorize the state board to delegate partial responsibility for the act's administration and enforcement by means of a local primacy delegation agreement. The bill would authorize the state board, for a county that has not been delegated primary responsibility as of January 1, 2021, to offer an opportunity for the county to apply for partial or primary responsibility if the state board determines that it needs assistance in performing administrative and enforcement activities, as specified. The bill would authorize the state board to approve the application for delegation if the state board determines that the local health officer is able to sufficiently perform the administrative and enforcement activities and would specify that a local primacy agency has all of the authority over designated public water systems as is granted to the state board by the act. The act establishes the Safe Drinking Water Account, moneys in which are available for use by the state board, upon appropriation by the Legislature, for the administration of the act. The act requires the state board to provide the local primacy agency, to the extent funds are available from the Safe Drinking Water Account, with an annual drinking water surveillance program grant to cover the costs of conducting inspection, monitoring, surveillance, and water quality evaluation activities specified in the local primacy agreement. This bill would eliminate the annual drinking water surveillance program grant. The act requires the state board to evaluate the drinking water program of each local primacy agency at least annually and to prepare a report of the evaluation and list any program improvements needed. The act requires a copy of the report to be provided to the local primacy agency and the county board of supervisors. The act requires a local primacy agency to be granted a reasonable amount of time to make any needed program improvements before the initiation of any local primacy revocation actions. This bill would instead require the state board to evaluate each local primacy agency's oversight program at least annually and the report prepared by the state board to list any deficiencies of each local primacy agency and to be made available on the state board's internet website. The bill would require the reasonable amount of time granted to a local primacy agency to make any needed program improvements to not exceed 2 years. The act requires the state board to adopt a schedule of fees and requires a public water system under the jurisdiction of a local primacy agency to pay these fees to the local primacy agency in lieu of the state board. The act makes it a crime for any person to knowingly commit certain acts, including making a false statement or representation in any record submitted, maintained, or used for the purposes of compliance with the act, possessing a record required to be maintained by the act that has been altered or concealed, and destroying, altering, or concealing any record required to be maintained by the act. This bill would authorize any local primacy agency, with approval of the state board, to elect to participate in a funding stabilization program effective for the 2022–23 fiscal year and fiscal years thereafter, as specified. The bill would require a public water system under the jurisdiction of a local primacy agency participating in the funding stabilization program to pay the fees to the state board, and would require the state board to provide funding to the local primacy agency each year for the reasonable costs incurred for the implementation of activities set forth in the work plan submitted by the local primacy agency to, and approved by, the state board. The bill would prohibit a participating local primacy agency from charging a designated public water system any fee in addition to those fees and would require all fines, penalties, and reimbursement of costs for the local primacy agency's activities to be payable to the state board for deposit in the Safe Drinking Water Account. The bill would require a participating local primacy agency to identify small water systems suitable for consolidation and to report the identified systems to the state board, as specified. The bill would require a participating local primacy agency to establish and maintain accurate accounting records of all costs it incurs and periodically to make these records available to the state board. By requiring new records for the purpose of complying with the act, this bill would expand the scope of a crime and thereby 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 Control, Regulate and Tax Adult Use of Marijuana Act (AUMA) , approved by the voters at the November 8, 2016, statewide general election, regulates the cultivation, distribution, transport, storage, manufacturing, testing, processing, sale, and use of marijuana for nonmedical purposes by people 21 years of age and older. The existing Medicinal and Adult-Use Cannabis Regulation and Safety Act (MAUCRSA) , among other things, consolidates the licensure and regulation of commercial medicinal and adult-use cannabis activities. MAUCRSA prohibits cannabis and cannabis products from being sold unless a representative sample of specified batches has been tested by a licensed testing laboratory. MAUCRSA requires the testing laboratory to issue a certificate of analysis for selected lots of each batch to report specified information, including whether the chemical profile of the sample conforms to the labeled content of compounds. MAUCRSA requires a testing laboratory to follow a standard operating procedure to confirm or refute the original result that falls outside the specifications authorized by law or regulation. This bill, for edible cannabis products, would require the certificate of analysis to report that the milligrams of THC per serving does not exceed 10 milligrams per serving, plus or minus 12% until January 1, 2022, and plus or minus 10% after January 1, 2022. This bill would incorporate additional changes to Section 26100 of the Business and Professions Code proposed by AB 1470 to be operative only if this bill and AB 1470 are enacted and this bill is enacted last.
Existing law establishes the Childhood Lead Poisoning Prevention Program, which is administered by the State Department of Public Health. Existing law requires the department to adopt regulations establishing a standard of care that include the determination of specified risk factors for lead exposure, including a child's time spent in a home, school, or building built before 1978. Existing law requires the department to ensure appropriate case management for children who have been identified with lead poisoning, and authorizes the department to contract with any public or private entity, including any local agency, to perform that duty. This bill would add several risk factors to be considered as part of the standard of care specified in regulations, including a child's residency in or visit to a foreign country. The bill would require the department to update its formula for allocating funds to a local agency that contracts with the department to administer the Childhood Lead Poisoning Prevention Program, and to revise funding allocations before each contract cycle. Existing law provides for 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. Existing law authorizes the department to enter contracts with managed care plans to provide Medi-Cal services, and imposes requirements on the Medi-Cal managed care plans, including network adequacy standards. Under existing law, Medi-Cal covers early and periodic screening, diagnostic, and treatment services for individuals under 21 years of age, consistent with federal law. Existing regulations of the department require a health care provider who performs a periodic health assessment of a child who receives services from a publicly funded program for low-income children, to order the child screened for lead poisoning, as specified, unless a parent or guardian of the child, or other person with legal authority to withhold consent, refuses to consent to the screening or if the risk of screening is a greater risk to the child's health than the risk of lead poisoning. Existing regulations also require the health care provider to provide oral or written guidance to a parent or guardian that includes information relating to the risk of childhood lead poisoning. This bill would require a contract between the department and a Medi-Cal managed care plan to require the Medi-Cal managed care plan, on a quarterly basis, to identify every enrollee who is a child without a record of completing the blood lead screening tests, and to remind the contracting network provider of the requirement to perform the required blood lead screening tests and the requirement to provide the oral or written guidance to a parent or guardian relating to risk of childhood lead poisoning. The bill would require the department to develop and implement procedures to ensure compliance with those requirements would authorize the department to impose sanctions for a violation of those requirements. The bill would authorize the department to implement these provisions by means of plan or county letters, or other similar instructions.
Existing law requires state agencies to take into account the current and future impacts of climate change when planning, designing, building, operating, maintaining, and investing in state infrastructure, as provided. This bill would require state agencies to take into account the economic damages and financial liabilities associated with the above impacts. Existing law requires the Natural Resources Agency to establish a Climate-Safe Infrastructure Working Group for the purpose of examining how to integrate scientific data concerning projected climate change impacts into state infrastructure engineering, including oversight, investment, design, and construction. Existing law requires the working group to work in coordination with other state climate adaption planning efforts, and to consider and build upon existing information produced by the state, as specified. This bill would add a specified 5-year infrastructure plan to the information that the working group is required to consider and build upon. Existing law requires the working group, by July 1, 2018, to make recommendations to the Legislature and the Strategic Growth Council that address specified climate change issues. Existing law makes the provisions governing the working group inoperative on July 1, 2020, and repeals them on January 1, 2021. This bill would delete both the requirement for the working group to make recommendations to the Legislature and the council and the inoperative and repeal dates, thereby extending the above provisions indefinitely beginning January 1, 2021. The bill would also provide that the working group shall only convene and perform its functions to the extent resources are available to fund the support of the working group and its activities.
This measure would designate the interchange at Interstate 880 and State Route 92 in the County of Alameda as the CHP Officer Andrew J. Camilleri Memorial Interchange. The measure would request the Department of Transportation to determine the cost for appropriate signs, which shall include the star of the California Highway Patrol, showing this special designation and, upon receiving donations from nonstate sources covering that cost, to erect those signs.
This measure would designate a specified portion of State Route 50 in the County of El Dorado as the Deputy Sheriff Brian "Ish" Ishmael Memorial Highway. The measure would request that the Department of Transportation determine the cost of appropriate signs showing this special designation and, upon receiving donations from nonstate sources covering that cost, erect those signs.
Existing provisions of the California Constitution establish the University of California as a public trust under the administration of the Regents of the University of California. The California Constitution grants to the regents all the powers necessary or convenient for the effective administration of this public trust. Pursuant to the California Constitution, there are 7 ex officio members of the regents and 18 appointive members appointed by the Governor and approved by the Senate, a majority of the membership concurring. This measure would enact the University of California Equal Employment Opportunity Standards Act, which would, effective January 1, 2021, except as specified, require the regents to ensure that all contract workers, as defined, who are paid to perform support services for students, faculty, patients, or the general public at any campus, dining hall, medical center, clinic, research facility, laboratory, or other university location, are at all times subject to and afforded the same equal employment opportunity standards, as defined, as university employees performing similar services. The measure would authorize the regents, or any campus or other entity of the University of California, to contract for, or otherwise arrange to use, contract labor, as defined, to perform support services only under specified conditions, only if authorized to do so by statute, and only to the extent necessary to address one or more of prescribed needs. The measure would authorize the Legislature to enact statutes to further the purposes of, and to aid the enforcement of, this measure.