Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law requires an individual or small group health care service plan contract or health insurance policy to include, at a minimum, coverage for essential health benefits, as specified. Commencing January 1, 2027, if the United States Department of Health and Human Services approves a new essential health benefits benchmark plan for the state, existing law requires essential health benefits to include an annual hearing exam and one hearing aid per ear every three years. This bill, the Let California Kids Hear Act, would require a large group health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2028, to include coverage for hearing aids, as defined, and related services for enrollees and insureds under 21 years of age, if medically necessary. The bill would authorize a large group health care service plan contract or health insurance policy to limit the dollar coverage for each individual hearing aid device to $3,000, as specified. Because a willful violation of these requirements by a health care service plan would be a crime, the bill would impose a state-mandated local program. The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that no reimbursement is required by this act for a specified reason.
Existing law requires the State Department of Public Health to license and regulate clinics, as defined. A violation of these provisions is a crime. Existing law requires any person, firm, association, partnership, or corporation desiring a license for a clinic to file with the department a verified application containing, among other things, the name and address of the clinic and the class of clinic to be operated. Existing law authorizes a clinic corporation, on behalf of a primary care clinic that has held a valid, unrevoked, and unsuspended license for at least the immediately preceding 5 years, with no demonstrated history of repeated or uncorrected violations of specified provisions that pose immediate jeopardy to a patient, and that has no pending action to suspend or revoke its license, to file an affiliate clinic application to establish a primary care clinic at an additional site or a mobile health care unit, which are referred to as affiliate clinics. Existing law requires the department, upon receipt of the completed affiliate clinic application, to approve the license for the affiliate clinic, without the necessity of first conducting an initial onsite survey if specified conditions are met, including, among other things, the clinic corporation that operates the existing licensed primary care clinic has submitted a completed affiliate clinic application and the associated application fee. Existing law refers to the existing licensed primary care clinic as the parent clinic. Existing law requires the department to issue a clinic license within 30 days of receipt of a completed affiliate clinic application. This bill would authorize a clinic corporation on behalf of at least one primary care clinic to file an affiliate clinic application pursuant to the above-described provisions for any of its primary care clinic locations to establish a new affiliate clinic. The bill would additionally require the affiliate clinic application to be signed by an officer of the clinic corporation's board of directors or the clinic corporation's chief executive officer or executive director. The bill would require the department to approve a license for the affiliate clinic if the conditions described above are met and the parent clinic is not itself an affiliate clinic. This bill would authorize a primary care clinic that has held a valid, unrevoked, and unsuspended license for at least the immediately preceding five years, with no demonstrated history of repeated or uncorrected violations of specified provisions that pose immediate jeopardy to a patient, and that has no pending action to suspend or revoke its license, to apply to the department for a change of location using the affiliate clinic application mentioned above. The bill would authorize the department to approve the application and issue an updated license, consistent with the timeline mentioned above, without the necessity of first conducting an onsite survey. Existing law requires the department to maintain a complete corporate file containing information about each clinic corporation operating one or more affiliate clinics, including, among other things, a copy of the clinic corporation's articles of incorporation and bylaws. Existing law prohibits a clinic corporation from being required to resubmit specified information as part of an affiliate clinic application, unless the information, materials, or documents are necessary to complete the corporate file. This bill would require a clinic corporation, before the closure of a parent clinic, to submit a request to the department to establish another primary care clinic as the parent clinic. The bill would prohibit the department from requiring the clinic corporation to resubmit specified information or materials unless there are any changes to the information in the corporate file maintained by the department. The bill would require the department to approve the request consistent with the timeline mentioned above provided the new parent clinic meets all of the requirements for a parent clinic, as mentioned above. This bill would require any changes to the information provided to the department for a clinic to be filed on forms established and furnished by the department. Because this bill would change the scope of a crime, this bill would impose a state-mandated local program. The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that no reimbursement is required by this act for a specified reason.
Existing law provides for the licensure and regulation of drug testing laboratories and adult alcoholism or drug abuse recovery or treatment facilities and provides for the certification and regulation of adult alcoholism or drug abuse recovery or treatment programs by the State Department of Health Care Services and authorizes the department to enforce those provisions. Existing law authorizes a facility described above to offer transportation services to an individual who is seeking recovery or treatment services only if specified conditions are met, including, among other things, that any air transportation provided to the individual includes a return ticket that may be used by the individual upon discharge and that a return ticket not used by an individual upon discharge is made available to the individual upon request for a period of one year following the individual's discharge. This bill would require a laboratory, facility, or program described above that provides air transportation to provide a ticket for round-trip transportation. The bill would additionally require, as conditions on the provision of transportation services, that the cost of the recovery or treatment services are prohibitive for the individual without assistance from the laboratory, facility, or program, and would require the laboratory, facility, or program to obtain written acknowledgment by the individual that the transportation is not tied to insurance benefits or program participation, to document the purpose and cost of the transportation, to compile information related to the provision of transportation, and to annually publish the compiled information on its internet website. The bill would require a laboratory, facility, or program to retain the information for a minimum of 5 years and to provide that information to the department upon request. Existing law prohibits facilities and programs described above and related persons from giving or receiving remuneration or anything of value for the referral of a person who is seeking alcohol or other drug recovery or treatment services. This bill would additionally apply the prohibition described above to the inducement of a person seeking services and would clarify that the prohibition prohibits specified practices by facilities or programs, including, among others, influencing or inducing an individual to enter or stay in a treatment or recovery program and recruiting individuals for treatment, unless otherwise specified.
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.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care, and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires a pharmacy benefit manager contracting with a health care service plan or health insurer to secure a license from the Department of Managed Health Care on or after January 1, 2027, or the date on which the department has established the licensure process, whichever is later. This bill would require the department to maintain a public internet website displaying specified information for each licensed pharmacy benefit manager, including, among other things, the legal name, license number, and license expiration date.
