Existing law provides for the regulation of health insurers by the Department of Insurance. Existing federal law, the Patient Protection and Affordable Care Act (PPACA) , enacts various health care market reforms. Existing law requires an individual or small group health insurance policy issued, amended, or renewed on or after January 1, 2017, to cover essential health benefits as prescribed, and provides that these provisions shall be implemented only to the extent essential health benefits are required pursuant to PPACA. This bill would delete the provision that conditions the implementation of that provision only to the extent essential health benefits are required pursuant to PPACA, and would make technical, nonsubstantive changes to that provision. Existing law prohibits a nongrandfathered health benefit plan for individual coverage from imposing a preexisting condition provision or waivered condition provision upon a person, and makes this provision inoperative if prescribed federal law on minimum essential coverage is repealed or amended. This bill would delete the conditional operation of that provision. Among other things, PPACA requires each health insurance issuer that offers health insurance coverage in the individual or group market in a state to accept every employer and individual in the state that applies for coverage, and prohibits discriminatory premium rates, as specified. PPACA also requires applicable individuals to maintain minimum essential coverage, and imposes a shared responsibility penalty on an applicable individual who does not maintain minimum essential coverage. This provision is referred to as the individual mandate. Existing law requires a carrier to fairly and affirmatively offer, market, and sell all of the carrier's health benefit plans that are sold to, offered through, or sponsored by, small employers or associations that include small employers for plan years on or after January 1, 2014, to all small employers in each geographic region in which the carrier makes coverage available or provides benefits. Existing law provides that the premium rate for a small employer health benefit plan issued, amended, or renewed on or after January 1, 2014, shall vary with respect to the particular coverage involved only by age, geographic region, and whether the contract covers an individual or family, as specified. Under existing law, these provisions would become inoperative 12 months after the repeal of the federal coverage guarantee and premium rate regulation provisions, as prescribed. This bill would delete the conditional operation of the above-described provisions based on the continued operation of the federal coverage guarantee and premium rate regulation provisions in the small employer market. For policy years on or after January 1, 2014, existing law requires a health insurer to fairly and affirmatively offer, market, and sell all of its health benefit plans that are sold in the individual market to all individuals and dependents in each service area in which the insurer provides or arranges for the provision of health care services, and prohibits an individual health benefit plan issued, amended, or renewed on or after January 1, 2014, from imposing a preexisting condition provision upon an individual. Existing law requires a health insurer to use only age, geographic region, and whether the contract covers an individual or family in setting premium rates for nongrandfathered small employer and individual health benefit plans issued, amended, or renewed on or after January 1, 2014. Under existing law, these provisions would become inoperative 12 months after the repeal of the federal individual mandate or its amendment to no longer apply to the individual market. This bill would delete the conditional operation of the above-described provisions based on the continued operation of the federal individual mandate and its applicability to the individual market.
Sponsored bills
This measure would commemorate October 24, 2021, as the 150th Anniversary of the Chinese Massacre of 1871 to foster awareness about this incident in an effort to promote inclusiveness, tolerance, and unity, while recognizing and appreciating the contributions individuals from all backgrounds, including immigrants, make to the United States and California.
This measure would proclaim May 15, 2021 as Áo Dài Day in California.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed by, and funded pursuant to, federal Medicaid program provisions. Under existing law, health care services are provided under the Medi-Cal program pursuant to a schedule of benefits, and those benefits are provided to beneficiaries through various health care delivery systems, including fee-for-service and managed care. Existing law authorizes the department to enter into various types of contracts for the provision of services to beneficiaries, including contracts with a Medi-Cal managed care plan. Existing law imposes various requirements on Medi-Cal managed care plan contractors, and requires the department to pay capitations rates to health plans participating in the Medi-Cal managed care program using actuarial methods. Existing law authorizes the department to establish, and requires the department to utilize, health-plan- and county-specific rates for specified Medi-Cal managed care plan contracts, and requires those developed rates to include identified information, such as health-plan-specific encounter and claims data. Existing law, the Medi-Cal 2020 Demonstration Project Act, requires the department to implement specified components of a Medi-Cal demonstration project, including the Global Payment Program, the Whole Person Care pilot program, and the Dental Transformation Initiative, consistent with the Special Terms and Conditions approved by the federal Centers for Medicare and Medicaid Services. Pursuant to existing law, the department has created a multiyear initiative, the California Advancing and Innovating Medi-Cal (CalAIM) initiative, for purposes of building upon the outcomes of various Medi-Cal pilots and demonstration projects, including the Medi-Cal 2020 demonstration project. Existing federal law authorizes specified managed care entities that participate in a state's Medicaid program to cover, for enrollees, services or settings that are in lieu of services and settings otherwise covered under a state plan. This bill would establish the CalAIM initiative, and would require the implementation of CalAIM to support stated goals of identifying and managing the risk and needs of Medi-Cal beneficiaries, transitioning and transforming the Medi-Cal program to a more consistent and seamless system, and improving quality outcomes. The bill would require the department to seek federal approval for the CalAIM initiative, and would condition its implementation on receipt of any necessary federal approvals and availability of federal financial participation. To implement the CalAIM initiative, the bill would authorize the department to enter into exclusive or nonexclusive contracts, or amend existing contracts, and to implement these provisions by various means, including provider bulletins. For purposes of the CalAIM initiative, this bill would additionally authorize the department to standardize those populations that are subject to mandatory enrollment in a Medi-Cal managed care plan across aid code groups and Medi-Cal managed care models. Commencing January 1, 2023, the bill would require the department to implement the Population Health Management Program under the Medi-Cal managed care delivery system to improve health outcomes, care coordination, and efficiency through application of standardized health management requirements. The bill would require the department to require each Medi-Cal managed care plan to develop and maintain a beneficiary-centered population health management program that meets specified standards, including identifying and mitigating social determinants of health and reducing health disparities or inequities. The bill would require the department to consult with specified stakeholders, including the State Department of Public Health, to establish requirements for the population health management program, as specified, and, beginning January 1, 2024, would require the department to annually develop and issue a public report, which includes prescribed information, on this program. Under the CalAIM initiative, this bill would require the department to implement an enhanced care management (ECM) benefit designed to address the clinical and nonclinical needs on a whole-person-care basis for certain target populations of Medi-Cal beneficiaries enrolled in Medi-Cal managed care plans, as specified. The bill would require Medi-Cal managed care plans to consult and collaborate with county mental health plans for the delivery of ECM services for beneficiaries with certain health conditions, including serious mental illness, to maximize federal reimbursement and minimize duplication of services. The bill would require the department to require those plans to report specified information related to the ECM benefit and would require the department to annually publicly report on the utilization of ECM in a manner that allows for an analysis of demographic populations, as specified. As part of the CalAIM initiative, and commencing January 1, 2022, this bill would require the department to authorize Medi-Cal managed care plans to elect to cover those services or settings approved by the department as cost effective and medically appropriate in the comprehensive risk contract that are in lieu of applicable Medi-Cal state plan services. The bill would provide that in lieu of services include specified services, such as housing transition navigation services, recuperative care, and asthma remediation. The bill would require the department to establish metrics for, and conduct an annual evaluation of, the utilization and effectiveness of in lieu of services, and to publicly report, as prescribed, the evaluation and conduct the evaluation in a specified manner. Commencing January 1, 2022, this bill would require the department, subject to appropriation, to make incentive payments available to qualifying Medi-Cal managed care plans that meet predefined milestones and metrics associated with implementation of applicable components of the CalAIM initiative, and to consult with specified entities, including Medi-Cal managed care plans, to establish the methodology pursuant to prescribed standards. This bill would authorize the department to establish capitation rates to contracted health plans on a regional basis in lieu of health plan and county-specific rates, and would require the department to consult with affected entities and individuals, including consumer representatives. Before the implementation of a regional-based capitation rate, the bill would require the department to report to the Legislature on specified matters, including how these rates are to be established. This bill would make its provisions severable and would make other legislative findings and declarations.
(1) Existing law establishes the College Readiness Block Grant to provide California's high school pupils, particularly unduplicated pupils, additional supports to increase the number of pupils who enroll at institutions of higher education and complete an undergraduate degree within 4 years. Existing law requires the Superintendent of Public Instruction to allocate funds under the program to certain local educational agencies during the 2015–16 fiscal year to be available for expenditure or encumbrance through the 2018–19 fiscal year. This bill would repeal provisions establishing the College Readiness Block Grant. The bill would establish the A–G Completion Improvement Grant Program, contingent upon an appropriation by the Legislature, to provide additional supports to local educational agencies to help increase the number of California high school pupils, particularly unduplicated pupils, who graduate high school meeting the A–G subject matter requirements for admission to the University of California and the California State University. If sufficient funds have been appropriated for the program, the bill would require the Superintendent to allocate $200,000,000 for the 2021–22 fiscal year under the program, as A–G Access Grants and A–G Success Grants, to school districts, county offices of education, and charter schools meeting certain requirements to be available for expenditure or encumbrance through the 2025–26 fiscal year. The bill would require those funds to be used for activities that directly support pupil access to, and successful completion of, the A–G subject matter requirements, as prescribed. The bill would require the Superintendent to annually post on the State Department of Education's internet website in an easily accessible location a list of each local educational agency's and each individual high school's A–G completion rate, as defined. (2) Existing law requires each school district maintaining any of grades 7 to 12, inclusive, to offer to all otherwise qualified pupils in those grades a course of study that fulfills the requirements and prerequisites for admission to the California public institutions of postsecondary education. This bill would impose that requirement on each county office of education or charter school maintaining any of grades 7 to 12, inclusive, commencing with the 2026–27 school year, and would expressly include the A–G subject matter requirements for admission to the California State University and the University of California in that requirement. By imposing additional duties on county offices of education and charter schools, the bill would impose a state-mandated local program. (3) Existing law requires a school district offering any of grades 9 to 12, inclusive, to provide the parent or guardian of each minor pupil enrolled in any of those grades in the school district with written notification containing certain information relating to A–G subject matter requirements and career technical education. This bill would impose that requirement on each county office of education or charter school maintaining any of grades 9 to 12, inclusive, and would require additional information to be included in the notification, including the A–G completion rate, as defined, for each high school within the local educational agency. The bill would require a local educational agency offering grade 8 to provide the parent or guardian of each minor pupil enrolled in grade 8 in the local educational agency with written notification of certain information relating to A–G subject matter requirements. By imposing additional duties on local educational agencies, the bill would impose a state-mandated local program. (4) 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.
This measure would proclaim April 21, 2021, as King Hùng Vương Commemorative Day and would recognize it as a day of cultural festivals commemorating the roots of Vietnamese Americans in California.
This measure would declare that the Legislature recognizes the week of May 9, 2021, to May 15, 2021, inclusive, as Hospital Week, and would recognize the life-saving contributions of hospitals in this state during the unprecedented coronavirus pandemic.
This measure would proclaim the month of March 2021 as Bleeding Disorders Awareness Month in the State of California.