Asm. Joaquin Arambula

Existing law, the Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene) , 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 authorizes a health insurer to require step therapy if there is more than one drug that is appropriate for the treatment of a medical condition, and authorizes a health care service plan to utilize step therapy consistent with Knox-Keene. Under existing law, if a health care service plan, health insurer, or contracted physician group fails to respond to a completed prior authorization request from a prescribing provider within a specified timeframe, the prior authorization request is deemed to have been granted. This bill would clarify that a health care service plan that provides coverage for prescription drugs may require step therapy, as defined, if there is more than one drug that is clinically appropriate for the treatment of a medical condition. The bill would require a health care service plan or health insurer to expeditiously grant a step therapy exception request if the health care provider submits justification and supporting clinical documentation, as specified, supporting the provider's determination that the required prescription drug is inconsistent with good professional practice for provision of medically necessary covered services to the enrollee or insured, based on specified criteria. The bill would authorize a health care provider or prescribing provider to appeal a denial of an exception request for coverage of a nonformulary drug, prior authorization request, or step therapy exception request consistent with the health care service plan's or health insurer's current utilization management processes. The bill would authorize an enrollee or insured, or their designee or guardian, to appeal a denial of an exception request for coverage of a nonformulary drug, prior authorization request, or step therapy exception request, as specified. The bill would require a prior authorization or step therapy exception request to be deemed approved for the duration of the prescription, including refills, if a health care service plan, health insurer, or contracted physician group fails to send an approval or denial within a specified timeframe. Commencing January 1, 2022, the bill would require a contract between a health care service plan or health insurer and a utilization review organization that performs utilization review or utilization management functions on behalf of health care service plans or health insurers, or between a health care service plan and another contracted entity, to include terms that require the utilization review organization or other contracted entity to comply with specified provisions relating to step therapy determinations and procedures. 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. 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. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law requires each department to develop and adopt regulations to ensure that enrollees and insureds have access to needed health care services in a timely manner. Under existing law, a Medi-Cal managed care plan is required to comply with timely access standards developed by the department. Existing regulations require a health care service plan or an insurer to ensure that their contracted provider networks have adequate capacity and availability of licensed health care providers to offer enrollees and insureds appointments that meet specified timeframes. Existing regulations require a health care service plan or an insurer to ensure that for an enrollee requesting a nonurgent appointment with a nonphysician mental health care provider, or an insured requesting a nonurgent appointment with a nonphysician mental health care or substance use disorder provider, appointments are offered within 10 business days of the request for an appointment. Existing regulations also authorize appointments for preventive care services and periodic followup care, including periodic office visits to monitor and treat mental health or substance use disorder conditions, as specified, to be scheduled in advance consistent with professionally recognized standards of practice as determined by the treating licensed health care provider acting within the provider's scope of practice. These regulations of the Department of Managed Health Care are limited in application to mental health care providers, while those regulations of the Department of Insurance are applicable to both mental health care and substance use disorder providers. This bill would codify the regulations adopted by the Department of Managed Health Care and the Department of Insurance to provide timely access standards for health care service plans and insurers for nonemergency health care services. The bill would require both a health care service plan and a health insurer, including a Medi-Cal Managed Care Plan, to ensure that appointments with nonphysician mental health and substance use disorder providers are subject to the timely access requirements, as specified. The bill would additionally require, commencing July 1, 2022, a health care service plan and a health insurer, including a Medi-Cal Managed Care Plan, to ensure that an enrollee or insured that is undergoing a course of treatment for an ongoing mental health or substance use disorder condition is able to get a followup appointment with a nonphysician mental health care or substance use disorder provider within 10 business days of the prior appointment. The bill would require that a referral to a specialist by another provider meet the timely access standards. If a health care service plan is operating in a service area that has a shortage of providers and the plan is not able to meet the geographic and timely access standards for providing mental health or substance use disorder services with an in-network provider, the bill would require the plan, including a Medi-Cal Managed Care Plan, to arrange coverage outside the plan's contracted network. By imposing new requirements on health care service plans, the willful violation of which 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 Digital Infrastructure and Video Competition Act of 2006, establishes a procedure for the issuance of state franchises for the provision of video service, defined to include cable service and open-video systems, administered by the Public Utilities Commission. The act provides that the holder of a state franchise is not a public utility as a result of providing video service and does not provide the commission with authority to regulate the rates, terms, and conditions of video service except as explicitly set forth in the act. The act requires a franchise holder to annually report to the commission regarding the availability of and subscriptions to broadband and video service, as specified. This bill would repeal the requirement that franchise holders annually report regarding the availability of and subscriptions to broadband and video service. The bill would instead require the commission to collect granular data on the actual locations served by franchise holders, adopt customer service requirements for franchise holders, and adjudicate any customer complaints. The bill would prohibit the commission from publicly disclosing any personally identifiable information collected pursuant to these requirements. Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest. This bill would make legislative findings to that effect.

(1) Under existing law, the Public Utilities Commission has regulatory authority over public utilities, including telephone corporations. Existing law requires the commission to develop, implement, and administer the California Advanced Services Fund (CASF) to encourage deployment of high-quality advanced communications services to all Californians that will promote economic growth, job creation, and the substantial social benefits of advanced information and communications technologies. Existing law authorizes the commission to impose a surcharge to collect $330,000,000 for deposit into the CASF beginning January 1, 2018, and continuing through the 2022 calendar year. Existing law specifies the amount of surcharge revenues to be deposited into each account within the CASF, subject to appropriation by the Legislature. This bill would authorize the commission to impose the surcharge to fund the CASF until December 31, 2032, as specified. Existing law requires the commission, until April 1, 2023, to annually report specified information to the Legislature, including the remaining unserved areas in the state, the status of the CASF balance, and the projected amount to be collected in each year. This bill would require the commission to report that information in perpetuity. This bill would authorize the commission to require each internet service provider, as defined, to report specified information regarding each free, low-cost, income-qualified, or affordable internet service plan advertised by the provider. (2) Existing law requires the commission to require interconnected Voice over Internet Protocol service providers to collect and remit surcharges on their California intrastate revenues in support of specified public purpose program funds. Existing law authorizes those providers to use certain methodologies to identify their intrastate revenues subject to the surcharge. This bill would repeal that authorization to use those methodologies. (3) Existing law establishes the deaf and disabled telecommunications program and requires the commission to establish a rate recovery mechanism through a surcharge not to exceed 12 of 1% uniformly applied to a subscriber's intrastate telephone service, other than one-way radio paging service and universal telephone service, until January 1, 2025, to allow providers of equipment and service pursuant to that program to recover their costs as they are incurred. This bill would revise those requirements to instead require the commission to administer a surcharge to collect revenues of up to $100,000,000 per year until January 1, 2025, subject to annual appropriation of moneys by the Legislature, to allow providers of equipment and service pursuant to the deaf and disabled telecommunications program to recover their costs as they are incurred. (4) Under existing law, a violation of the Public Utilities Act or any order, decision, rule, direction, demand, or requirement of the commission is a crime. Because certain of the above provisions would be part of the act and a violation of a commission action implementing this bill's requirements 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. (5) This bill would become effective only if SB 4 of the 2021–22 Regular Session is enacted and takes effect on or before January 1, 2022. (6) This bill would declare that it is to take effect immediately as an urgency statute.

(1) Existing law requires a pupil to complete designated coursework while in grades 9 to 12, inclusive, in order to receive a diploma of graduation from high school. These graduation requirements include, among others, the completion of 3 years of courses in English and 3 years of courses in social studies, including one-year courses in United States history and geography and world history, culture, and geography, a one-semester course in American government and civics, and a one-semester course in economics. Existing law requires the Instructional Quality Commission to develop, and the State Board of Education to adopt, modify, or revise, a model curriculum in ethnic studies. Existing law also encourages each school district and charter school that maintains any of grades 9 to 12, inclusive, and that does not otherwise offer a standards-based ethnic studies curriculum to offer, beginning in the school year following the adoption of the model curriculum, a course of study in ethnic studies based on the model curriculum. This bill would add the completion of a one-semester course in ethnic studies, meeting specified requirements, to the graduation requirements commencing with pupils graduating in the 2029–30 school year, including for pupils enrolled in a charter school. The bill would expressly authorize local educational agencies, including charter schools, to require a full-year course in ethnic studies at their discretion. The bill would require local educational agencies, including charter schools, to offer an ethnic studies course commencing with the 2025–26 school year, as specified. The bill would authorize, subject to the course offerings of a local educational agency, including a charter school, a pupil to satisfy the ethnic studies course requirement by completing either (A) a course based on the model curriculum in ethnic studies developed by the commission, (B) an existing ethnic studies course, (C) an ethnic studies course taught as part of a course that has been approved as meeting the A–G requirements of the University of California and the California State University, or (D) a locally developed ethnic studies course approved by the governing board of the school district or the governing body of the charter school. The bill would prohibit a course that does not use ethnic studies content as the primary content through which the subject is taught from being used to satisfy the ethnic studies course requirement. The bill would require a pupil who completes a course described above to also accrue credit for coursework in the subject that the course is offered, including, if applicable, credit towards satisfying a course required for a diploma of graduation from high school. These provisions would become operative only upon an appropriation of funds by the Legislature for these purposes in the annual Budget Act or another statute. Because the bill would add new duties to local educational agencies, it would constitute a state-mandated local program. (2) The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.

(1) Existing law defines rape as an act of sexual intercourse accomplished with a person not the spouse of the perpetrator under certain circumstances, including where the victim is incapable of giving legal consent because of a mental disorder or developmental or physical disability, where the victim is not aware of the essential characteristics of the act due to the perpetrator's fraudulent representation that the act serves a professional purpose, and where the victim submits to the act under the belief that the perpetrator is someone known to the victim other than the perpetrator, and the perpetrator intentionally and fraudulently induces that belief. Existing law separately defines rape of a spouse as an act of sexual intercourse accomplished with the spouse of the perpetrator under similar circumstances as nonspousal rape, except that spousal rape does not include acts of sexual intercourse accomplished under the specific circumstances described above. This bill would repeal the provisions relating to spousal rape and make conforming changes, thereby making an act of sexual intercourse accomplished with a spouse punishable as rape if the act otherwise meets the definition of rape, except that sexual intercourse with a person who is incapable of giving legal consent because of mental disorder or developmental or physical disability would not be rape if the 2 people are married. By changing the definition of a crime, this bill would impose a state-mandated local program. (2) Existing law authorizes an employer to request from the Department of Justice records of all convictions or any arrest pending adjudication for specified offenses for a person who applies for a license, employment, or volunteer position, in which the person would have supervisory or disciplinary power over a minor and requires the employer to notify the parent or guardian of a child if a person with specified convictions will have supervisory or disciplinary power over that child. Existing law exempts certain convictions, including spousal rape, from that notification requirement. This bill would remove the exemption for spousal rape or any other felony conviction and would instead exempt only misdemeanor convictions from that notification. The bill would make numerous conforming changes. (3) This bill would incorporate additional changes to Section 1103 of the Evidence Code proposed by AB 939 to be operative only if this bill and AB 939 are enacted and this bill is enacted last. (4) This bill would incorporate additional changes to Section 3044 of the Family Code proposed by SB 320 and AB 1579 to be operative only if this bill and SB 320, AB 1579, or both, are enacted and this bill is enacted last. (5) This bill would incorporate additional changes to Section 13956 of the Government Code proposed by SB 299 to be operative only if this bill and SB 299 are enacted and this bill is enacted last. (6) 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 protection, care, and assistance for the people of the state, and the promotion of the welfare and happiness of all people in the state by providing appropriate aid and services to the needy and distressed. Under existing law, counties are responsible for administering the various public social services programs and related services, including, but not limited to, CalFresh and general assistance benefits. Existing law establishes the California Community Colleges, under the administration of the Board of Governors of the California Community Colleges, the California State University, under the administration of the Trustees of the California State University, and the University of California, under the administration of the Regents of the University of California, as segments of public postsecondary education in this state. Existing law establishes community college districts, locations of the California State University, and campuses of the University of California throughout the state. This bill would require a county human services agency to designate at least one employee as a staff liaison to serve as a point of contact for academic counselors and other professional staff at a campus of an institution of public higher education located within the county. The bill would require any disclosure or sharing of personal information under the bill to be made in compliance with applicable state and federal confidentiality laws. The bill would require a county human services agency, with input from the public institutions of higher learning in the county, to develop protocols for engagement between the staff liaison and a campus of an institution of public higher education located within the county and would encourage those entities to consult with specified stakeholders in the development of those protocols. The bill would authorize the State Department of Social Services to implement its provisions by all-county letters or similar instructions. By requiring counties to perform new duties, the bill would impose a state-mandated local program. This bill would also require the Office of the Chancellor of the California State University and the Office of the Chancellor of the California Community Colleges, and request the Office of the President of the University of California, in collaboration with county human services agencies, to conduct a survey to determine the effectiveness of the county liaison position and submit, on or before January 1, 2025, a report with the results of the survey to specified legislative committees and the State Department of Social Services. The bill would repeal these provisions on January 1, 2026. The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.

Existing law authorizes the State Public Defender to represent any person financially unable to employ counsel in specified matters. The State Public Defender is authorized to employ deputies and other employees, and establish and operate offices, as they may need for the proper performance of their duties, and to contract with county public defenders, private attorneys, and nonprofit corporations for participation in the representation of eligible persons. This bill would, subject to an appropriation by the Legislature, require the State Public Defender, in consultation with the California Public Defenders Association and other subject matter experts, to undertake a study to assess appropriate workloads for public defenders and indigent defense attorneys and submit a report with their findings and recommendations to the Legislature no later than January 1, 2024.

(1) Existing law establishes the Department of Health Care Access and Information and requires the department to maintain a Health Professions Career Opportunity Program to, among other things, implement programs at colleges and universities selected by the department and include in those programs pipeline programs that provide comprehensive academic enrichment, career development, mentorship, and advising in order to support students from underrepresented regions and backgrounds to pursue health careers. Existing law requires, in accordance with the compliance schedule approved by the department, but in any case no later than January 1, 2030, owners of all acute care inpatient hospitals to either demolish, replace, or change to nonacute care use all hospital buildings not in substantial compliance with certain regulations and standards developed by the department related to seismic safety or to seismically retrofit all acute care inpatient hospital buildings so that they are in substantial compliance with those regulations and standards. This bill would authorize the department to enter into contracts, to meet the requirements of the Health Professions Career Opportunity Program, with nonprofit entities headquartered in California that have previous experience with administering statewide workforce programs aimed at building a diverse provider workforce. This bill would establish the Small and Rural Hospital Relief Program under the administration of the department for the purpose of funding seismic safety compliance with respect to small hospitals, rural hospitals, and critical access hospitals in the state. The bill would require the department to provide grants to small, rural, and critical access hospital applicants that meet certain criteria, including that seismic safety compliance, as defined, imposes a financial burden on the applicant that may result in hospital closure. The bill would also create the Small and Rural Hospital Relief Fund and would continuously appropriate the moneys in the fund for the purposes of administering and funding the grant program. (2) The Cigarette and Tobacco Products Tax Law imposes a tax on distributors of cigarettes at the rate of $2.87 per package of 20 cigarettes and a tax on distributors of tobacco products, based on wholesale cost, at a rate determined annually that is equivalent to the combined rate of all taxes imposed on cigarettes plus an additional rate equivalent to $0.50 per package of 20 cigarettes. These taxes are inclusive of the taxes imposed under the Tobacco Tax and Health Protection Act of 1988, the California Families and Children Act of 1998, and the California Healthcare, Research and Prevention Tobacco Tax Act of 2016. The California Healthcare, Research and Prevention Tobacco Tax Act of 2016 (Proposition 56) , an initiative measure approved at the November 8, 2016, statewide general election, revised the definition of tobacco products to include electronic cigarettes, thereby extending the taxes on distributors of tobacco products to distributors of electronic cigarettes, which is based on the wholesale cost of these products. Proposition 56 requires the California Department of Tax and Fee Administration to adopt regulations providing for the implementation of the equivalent tax on electronic cigarettes and the methods for collection of the tax. This bill would, beginning July 1, 2022, require a purchaser of electronic cigarettes, as defined, at retail to pay a tax on the purchase for use in this state of an electronic cigarette from a retailer of 12.5% of the sales price from the sale of an electronic cigarette. The bill would require a retailer to collect the tax from the purchaser at the time of the retail sale of an electronic cigarette. The bill would require all revenues, interest, and penalties, less refunds, collected from the tax described above to be deposited into the California Electronic Cigarette Excise Tax Fund, a continuously appropriated fund created by the bill, and would require all amounts in the fund to be distributed to the Health Education Account in the Cigarette and Tobacco Products Surtax Fund, the California Children and Families Trust Fund, to fund the Proposition 56 Medi-Cal Physicians and Dentists Loan Repayment Act, the University of California, to support the joint program in medical education between the University of California, Merced and the University of California, San Francisco at Fresno, the Small and Rural Hospital Relief Fund created by this bill, and to the Department of Health Care Access and Information to fund the Health Professions Career Opportunity Program described above, as specified. By creating a continuously appropriated fund and allocating additional moneys to continuously appropriated funds, this bill would make an appropriation. The bill would provide for the administration and collection of this tax pursuant to procedures set forth in the Fee Collection Procedures Law. By expanding the application of the Fee Collection Procedures Law, the violation of which is a crime, this bill would impose a state-mandated local program. (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.

(1) Existing law, the Nursing Practice Act, establishes the Board of Registered Nursing within the Department of Consumer Affairs for the licensure and regulation of the practice of nursing, and requires the board to issue a certificate to practice nurse-midwifery to a person who, among other qualifications, meets educational standards established by the board or the equivalent of those educational standards. Existing law, the Licensed Midwifery Practice Act of 1993, provides for the licensure of midwives by the Medical Board of California. Existing law, the Song-Brown Health Care Workforce Training Act, provides for specified training programs for certain health care workers, including family physicians, registered nurses, nurse practitioners, and physician assistants. Existing law establishes a state medical contract program with accredited medical schools, hospitals, and other programs and institutions to increase the number of students and residents receiving quality education and training in specified primary care specialties and maximize the delivery of primary care and family physician services to underserved areas of the state. This bill would enact the Midwifery Workforce Training Act, under which the Office of Statewide Health Planning and Development would, upon appropriation by the Legislature, contract with programs that train certified nurse-midwives and programs that train licensed midwives to increase the number of students receiving quality education and training as a certified nurse-midwife or a licensed midwife, as specified. The bill would require the office to contract only with programs that include, or intend to include, a component of training designed for medically underserved multicultural communities, lower socioeconomic neighborhoods, or rural communities, and that are organized to prepare program graduates for service in those neighborhoods and communities. (2) Existing law requires the State Department of Public Health to track data on pregnancy-related deaths, including specified health conditions, indirect obstetric deaths, and other maternal disorders predominantly related to pregnancy and complications predominantly related to the puerperium, and requires this data to be published at least once every 3 years. Existing law also requires the department to develop a plan to identify causes of infant mortality and morbidity in California and to study recommendations on the reduction of infant mortality and morbidity in California. This bill would, commencing August 1, 2022, establish the California Pregnancy-Associated Review Committee, and would require the committee to, among other things, identify and review all pregnancy-related deaths and severe maternal morbidity. The bill would require the committee to be composed of a minimum of 13 members, as specified, and would authorize the committee to request from any state department, commission, local health department, or coroner, among others, specified information, including death records, medical records, and autopsy reports. The bill would make all proceedings, activities, and opinions of the committee confidential. This bill would require each county to annually report infant deaths to its respective local health department. The bill would require local health departments, upon appropriation by the Legislature, to establish a Fetal and Infant Mortality Review committee to investigate infant deaths to prevent fetal and infant death under specified circumstances, and would require those local health departments that participate in the Fetal and Infant Mortality Review process to annually investigate, track, and review cases of term infants, as defined, who were born following labor with the outcome of intrapartum stillbirth, early neonatal death, or postneonatal death. The bill would require counties, hospitals, birthing centers, and state entities to provide to local health departments death records, medical records, and autopsy reports, among other information, that will help the local health department conduct the fetal and infant mortality review. By imposing duties on local officials, this bill would impose a state-mandated local program. (3) 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 pursuant to a schedule of benefits. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. This bill would require the department to convene a workgroup to examine the implementation of the Medi-Cal doula benefit, as specified. No later than July 1, 2024, the bill would require the department to publish a report that addresses the number of Medi-Cal recipients utilizing doula services and identifies barriers that impede access to doula services, among other things, and would require the department to post that report on its internet website. (4) Existing law provides for the California Work Opportunity and Responsibility to Kids (CalWORKs) program under which, through a combination of state and county funds and federal funds, each county provides cash assistance and other benefits to qualified low-income families. Existing law requires a recipient of CalWORKs to participate in welfare-to-work activities as a condition of eligibility, but provides an exemption to a woman who is pregnant and for whom it has been medically verified that the pregnancy impairs their ability to be regularly employed or participate in welfare-to-work activities or the county has determined that, at that time, participation will not readily lead to employment or that a training activity is not appropriate. This bill would remove the medical verification and county determination requirements, and would instead provide an exemption to any recipient who is pregnant. Because the bill would result in an increase in CalWORKs eligibility, thus increasing the duties of counties administering the CalWORKs program, the bill would impose a state-mandated local program. Existing law continuously appropriates moneys from the General Fund to defray a portion of county costs under the CalWORKs program. This bill would, instead, provide that the continuous appropriation would not be made for purposes of implementing the bill. (5) Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest. This bill would make legislative findings to that effect. (6) The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.