AB 2353 California Assembly · 2025-2026 Regular Session

Health Mandates Review Program.

Summary

Existing law requests the University of California to establish the California Health Benefit Review Program (CHBRP) to assess legislation proposing to mandate a health care benefit or service or repeal a mandated benefit or service and to prepare a written analysis. Existing law authorizes an appropriate policy or fiscal committee chairperson, the Speaker of the Assembly, or the President pro Tempore of the Senate to request that written analysis. Under existing law, a written analysis is requested to be provided to the Legislature not later than 60 days after a request for analysis is made. Existing law establishes the Health Care Benefits Fund, funded by an annual fee on health care service plans and health insurers, to support the University of California and CHBRP. This bill would require the Department of Health Care Access and Information to seek to partner with the University of California to develop a plan to establish the Center for Health Provider Policy Impact to assess and evaluate the impact of state and federal policies on hospitals. The bill would require the center to evaluate anticipated and actual impacts of proposed policies on health care delivery, access, workforce, and system sustainability and would require the center to create reports, at least annually, as specified. The bill would authorize the Legislature to request that the center review specific legislation or issues. The bill would establish the Health Provider Impact Fund. The bill would require the department to assess a fee for each hospital for the costs required to fund the above-described activities, as specified, thus imposing a tax. The bill would repeal these provisions on January 1, 2033.

Bill status passed 3 of 5 stages cleared

Introduction

Feb 2026

Committee Review

Jul 2026

Assembly Passage

May 2026

Senate Passage

Governor

Introduced Feb 19, 2026 Last action Jul 1, 2026

Maddy AI version diff · 3 comparisons

What changed between versions

02/19/26 - Introduced → 03/16/26 - Amended Assembly · 10 edits · Mar 16, 2026

MAJOR

AB 2353 was substantially expanded from a general findings-and-declarations bill into a detailed operational framework creating two distinct review programs at the University of California: the existing California Health Benefit Review Program (for health insurance mandates) and a new Health Mandates Review Program specifically for legislation mandating services or activities on hospitals. The amendment adds specific triggers, deadlines, analysis requirements, funding mechanisms, and definitions that were entirely absent from the introduced version.

Scope change

The bill's scope expanded dramatically from a general statement of legislative intent about identifying an independent body to estimate costs of provider mandates, into a specific operational framework with two distinct programs, defined triggers, deadlines, funding sources, and analysis requirements. The primary new focus is on hospital-specific mandates, while the existing CHBRP framework for health insurance mandates was also formalized with detailed analysis criteria.

SCOPE

A new Health Mandates Review Program is created at UC to assess legislation proposing to mandate new or additional services or activities for hospitals, beginning no later than January 1, 2028. This is separate from and in addition to the existing California Health Benefit Review Program which covers health insurance mandates.

The legislative findings were restructured from a general statement about 'health care providers' to specifically focus on hospitals. The intent language now references 'hospitals' rather than 'health care providers' throughout, narrowing the bill's primary target while the CHBRP provisions still cover health insurance mandates more broadly.

REQUIREMENT

The appropriate policy or fiscal committee in the legislation's house of origin must request a Health Mandates Review Program analysis if the bill is expected to affect operations of a majority of the state's hospitals, or a majority within a recognized class of hospitals, by requiring: hiring new staff or increasing workforce costs, purchasing or leasing new equipment, making physical alterations to facilities, or providing additional discounted or charitable care.

The Health Mandates Review Program must publish an annual summary by December 31 of each year covering legislation enacted that mandates new hospital services and their cost impacts if analyzed. It must also convene a workgroup of members with expertise in hospital finance or operations to advise on program development.

TIMELINE

The Health Mandates Review Program must deliver its written analysis no later than 72 hours before the legislation is heard in the relevant fiscal committee of the house of origin (or on a mutually agreed timeline). The existing CHBRP has a 60-day deadline.

FISCAL

A new Health Care Mandates Fund is established in the State Treasury to support the Health Mandates Review Program. Starting in the 2027-28 fiscal year, the Department of Health Care Access and Information must transfer an unspecified amount (left blank as $____) from the California Health Data and Planning Fund to this new fund annually by August 1.

The existing Health Care Benefits Fund (supporting CHBRP) is now specified with an annual fee on health care service plans and health insurers capped at $3,200,000 total per year for fiscal years 2026-27 through 2032-33. Fees are assessed by DMHC and CDI in consultation with UC.

DEFINITION

New definitions added: 'Hospital' (health facility under Section 1250(a) or (b)), 'Legislation proposing to mandate a benefit or service' (requiring insurers/plans to cover specific services), 'Legislation proposing to mandate new or additional services or activities' (requiring hospitals to offer previously unrequired services or increasing cost of existing ones), and 'Legislation proposing to repeal a mandated benefit or service.'

ENFORCEMENT

A prohibition is added stating there shall not be an independent review board process by the state for full data access to all claims payer database and hospital discharge data, limiting how the program can obtain financial data.

TECHNICAL

The fiscal committee designation changed from 'no' to 'yes,' indicating the bill now has a fiscal impact requiring fiscal committee review. A coauthor (Assembly Member Petrie-Norris) was added.

03/16/26 - Amended Assembly → 04/28/26 - Amended Assembly · 7 edits · Apr 28, 2026

MODERATE

The April 28 amendment to AB 2353 adds an entirely new chapter (Chapter 7.3) establishing the Center for Health Provider Policy Impact, a new entity that would evaluate the impact of state and federal policies on hospitals and publish annual reports by June 1. It also replaces the previous funding mechanism for the Health Mandates Review Program (a transfer from the California Health Data and Planning Fund) with a new Health Provider Impact Fund financed by an annual fee on hospitals capped at $3 million. The bill now requires a two-thirds vote to pass, up from a simple majority.

SCOPE

New Chapter 7.3 (Sections 127668-127669) establishes the Center for Health Provider Policy Impact, a partnership between DHCAI and UC to be developed by January 1, 2028. The center evaluates anticipated and actual impacts of proposed policies on health care delivery, access, workforce, and system sustainability, and must publish annual reports by June 1 analyzing proposed legislation, regulations, and policy actions affecting hospitals, including disparities across regions and rural/underserved areas.

Two new coauthors were added: Assembly Members Blanca Rubio and Michelle Rodriguez, in addition to the existing coauthor Petrie-Norris.

FISCAL

New Health Provider Impact Fund established in the State Treasury. Each hospital (general acute care, acute psychiatric, and special hospitals) is assessed an annual fee determined by DHCAI through regulation, capped at $3,000,000 total annually. Fees are due by August 1 each year.

The previous mechanism of transferring funds from the California Health Data and Planning Fund to a Health Care Mandates Fund (starting in fiscal year 2027-28) is removed. The Health Mandates Review Program is now funded through the new hospital fee structure in Chapter 7.3.

ENFORCEMENT

The vote requirement changed from a simple majority to a two-thirds supermajority, making passage significantly more difficult. The fiscal committee review designation also changed from 'no' to 'yes.'

TIMELINE

The new Chapter 7.3 provisions sunset on January 1, 2033, after which they are automatically repealed.

DEFINITION

Section 127660 definitions were reorganized from subdivision (d) to subdivision (e), removing redundant cross-references and cleaning up the structure of definitions for 'hospital,' 'legislation proposing to mandate a benefit or service,' 'legislation proposing to mandate new or additional services or activities,' and 'legislation proposing to repeal a mandated benefit or service.'

Floor votes · Assembly May 27, 2026

How they voted

55–1

Passed · 23 other

Total votes 79

May 27, 2026

D Democratic59

38 Yea 21

64% Yea

R Republican20

17 Yea 1 Nay 2

85% Yea

Vote distribution

All Yea All Nay Mixed No data

Full legislative history

Actions timeline

Total actions

Key actions

Committee

Amendments

Jul 1, 2026

Upper · Passed

In committee: Set, first hearing. Hearing canceled at the request of author.

upper

Jun 10, 2026

Committee

Referred to Com. on HEALTH.

upper

May 27, 2026

Lower · Passed

Read third time. Passed. Ordered to the Senate. (Ayes 56. Noes 1.)

lower

May 14, 2026

Lower · Passed

From committee: Do pass. (Ayes 12. Noes 0.) (May 14).

lower

May 13, 2026

Committee

In committee: Set, first hearing. Referred to APPR. suspense file.

lower

Apr 29, 2026

Committee

Re-referred to Com. on APPR.

lower

Apr 28, 2026

Lower · Passed

Read second time and amended.

lower

Apr 27, 2026

Introduced

From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 11. Noes 0.) (April 21).

lower

Mar 17, 2026

Committee

Re-referred to Com. on HEALTH.

lower

Mar 16, 2026

Introduced

From committee chair, with author's amendments: Amend, and re-refer to Com. on HEALTH. Read second time and amended.

lower

Mar 16, 2026

Committee

Referred to Com. on HEALTH.

lower

Feb 20, 2026

Lower · Passed

From printer. May be heard in committee March 22.

lower

1 primary · 3 co-sponsors