Existing law requires a hospital to provide patients with a written notice containing information about the availability of the hospital's discount payment and charity care policies, including information about eligibility and the contact information for a hospital employee or office from which a person may obtain further information about these policies. Existing law defines "charity care" and "discount payment" for these purposes. Existing law requires a hospital to provide to the Department of Health Care Access and Information a copy of its discount payment policy, charity care policy, eligibility procedures for those policies, review process, and the application for charity care or discounted payment programs, among other information. A violation of these provisions results in an administrative penalty, as specified. This bill would, commencing July 1, 2027, require a hospital to screen a patient to determine if they meet specific criteria, including that the patient is enrolled in CalFresh or CalWORKs, and, if they do, presumptively determine that a patient is eligible for participation under the hospital's charity care policy and discount payment policy. The bill would require a hospital to screen a patient for eligibility if the patient meets other specified criteria, including, among others, that the patient is uninsured. The bill would prohibit a hospital from requiring a patient to apply for the federal Medicare program, the Medi-Cal program, or other coverage before the patient is screened for or provided with discounted payment, as specified. The bill would require a hospital to provide patients with the ability to opt out of the screening process through a specified form. The bill would authorize a hospital, at its discretion or as established in its charity care policy or discount payment policy, to make presumptive determinations of eligibility or to conduct screening for patients that do not meet the criteria described above. The bill would authorize certain procedures and tools for screening, including, among others, allowing a hospital to use third-party software tools or services or to contract with a third party under specified conditions. The bill would require a hospital to provide a specified written notice to those patients determined to be eligible, presumptively or otherwise, under these provisions and would prohibit any billing statements from being sent prior to the written notice. The bill would require the billing statements to reflect the adjustments made to the patient's hospital charges under the hospital's charity care policy or discount payment policy.
Existing law, the California Community Care Facilities Act, provides for the licensing and regulation of community care facilities by the State Department of Social Services, including adult day programs and residential facilities. A violation of provisions relating to these facilities is a misdemeanor. This bill would authorize a licensed facility or licensee, as defined, upon receipt of a request from a client, or the authorized representative of a client, who has been diagnosed with seizures, a seizure disorder, or epilepsy and who has been prescribed intranasal emergency antiseizure medication, to allow an administrator or authorized volunteer, as defined, to administer intranasal emergency antiseizure medication to the client during a seizure emergency. The bill would require the department, on or before January 1, 2028, to establish minimum standards for this training, as specified. The bill would prohibit intranasal emergency antiseizure medication from being administered to a client unless the licensee has a seizure action plan for the client that contains specified information, including, among other things, a signed written authorization verifying that a seizure experienced by the client may be responded to at the licensee by a nonmedical professional, including through the administration of emergency antiseizure medication, as specified. The bill would require licensees to maintain with the client's seizure action plan a description of how the licensee will coordinate care for a client in the absence of an administrator or authorized volunteer and what actions will be taken to ensure the continued safety of the client. The bill would require licensed facilities to provide a specified notice to all administrators and authorized volunteers that, among other things, informs them of their right to rescind an offer to volunteer at any time, as specified, and explains the liability protections and indemnification requirements described below. The bill would require any licensee that authorizes administrators or authorized volunteers to ensure that each administrator or authorized volunteer will be provided defense and indemnification for any and all civil liability, as specified. The bill would prohibit an administrator or authorized volunteer who administers intranasal emergency antiseizure medication, any person who provides training to an administrator or authorized volunteer, or any person who otherwise complies with the requirements of the above-described provisions, in good faith and not for compensation, from being subject to professional review, civil liability, or criminal prosecution for their actions or omissions, or the actions or omissions of a volunteer, as specified. By expanding the scope of an existing 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, the Pharmacy Law, establishes the California State Board of Pharmacy for the licensure and regulation of pharmacists and pharmacies. Existing law authorizes a prescriber to dispense a dangerous drug, including a controlled substance, to an emergency room patient if specified requirements are met, including that the dangerous drug is acquired by the hospital pharmacy. This bill would, notwithstanding any other law, authorize a prescriber to dispense an unused portion of a dangerous drug acquired by the hospital pharmacy to an emergency room patient upon discharge if certain conditions are satisfied, including that the dangerous drug is not a controlled substance and that dispensing the unused portion of the dangerous drug is required to continue treatment of the patient. Existing law requires an automated drug delivery system (ADDS) that is installed, leased, owned, or operated in California to be licensed by the board. Existing law exempts an automated unit dose system (AUDS) , a type of ADDS, from licensure if the AUDS is used solely to provide doses administered to patients while in a licensed general acute care hospital facility or a licensed acute psychiatric hospital facility if the licensed hospital pharmacy owns or leases the AUDS and owns the dangerous drugs and dangerous devices in the AUDS. This bill would also exempt from licensure an AUDS that is used to dispense dangerous drugs to emergency room patients in accordance with specified requirements.
Existing law, the Home Care Services Consumer Protection Act, requires a home care organization, as defined, to ensure that an affiliated home care aide completes specified training requirements prior to providing home care services, including annual training related to the aide's clients' rights and safety and how to provide for a client's daily living needs. A violation of the act is a misdemeanor. This bill would, beginning on January 1, 2027, additionally require a home care organization to ensure that a home care aide completes, prior to providing home care and annually thereafter, training related to the special care needs of clients with dementia. Because the bill creates new crimes by expanding the act to include additional requirements for home care organizations, 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 establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services, under fee-for-service or managed care delivery systems. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law establishes, until January 1, 2026, certain time and distance and appointment time standards for specified Medi-Cal managed care covered services, consistent with federal regulations relating to network adequacy standards, to ensure that those services are available and accessible to enrollees of Medi-Cal managed care plans in a timely manner, as specified. This bill would extend the operation of those standards to January 1, 2029. The bill would also require a managed care plan to ensure that each subcontractor network complies with certain appointment time standards unless already required to do so. The bill would require a plan to demonstrate to the department each subcontractor network's compliance with time or distance and appointment time standards, as specified. Existing law permits the department to authorize a managed care plan to use clinically appropriate video synchronous interaction, as defined, as a means of demonstrating compliance with the time or distance standards. Under this bill, the use of telehealth providers to meet time or distance standards would not absolve the managed care plan of responsibility to provide a beneficiary with access, including transportation, to in-person services if the beneficiary prefers. The bill would set forth other related provisions with regard to the use of telehealth. Existing law permits the department, upon request of a managed care plan, to authorize alternative access standards for the time or distance standards under certain conditions. This bill would, effective for contract periods commencing on or after January 1, 2027, require the department to consider the sufficiency of payment rates offered by the Medi-Cal managed care plan to the provider type or for the service type when evaluating requests for the utilization of alternative access standards. The bill would require a Medi-Cal managed care plan that does not meet time or distance standards without the use of an alternative access standards request to submit to the department documentation demonstrating efforts to contract with providers, as specified. The bill would require a Medi-Cal managed care plan, effective no sooner than contract periods commencing on or after January 1, 2026, to inform enrollees of their option to use or not use telehealth, covered transportation services, or out-of-network providers to access covered services if the health care provider is located outside of the time or distance standards. Existing law requires the department to annually evaluate a managed care plan's compliance with the time or distance and appointment time standards and to annually publish a report of its findings, as specified. This bill would require, effective for contract periods commencing on or after January 1, 2029, the evaluation by the department for appointment time standards compliance to be performed using a direct testing method, as specified. The bill would authorize the department to require enhanced time or distance standards that are more stringent than the time or distance standards described above in its contracts with Medi-Cal managed care plans. The bill would require the department to ensure that these enhanced standards are consistent across contracts for similar geographic classifications. The bill would require the department to publish all enhanced time and distance standards adopted by contract with a rationale for the enhanced standards. Under the bill, in alignment with federal regulation that requires the department to conduct analyses when developing or adjusting network adequacy standards, the department would be required to publish on its internet website by January 1, 2027, a specified workplan. The bill would also require the department to convene a stakeholder workgroup and to provide a 30-day public comment period, as specified. Existing law requires the department, to the extent permitted under federal law, to require a Medi-Cal managed care plan that is not licensed by the Department of Managed Health Care to comply with applicable requirements, under specified provisions relating to health equity and quality, for the purpose of serving applicable Medi-Cal beneficiaries. Under this bill, for purposes of implementing specified federal final rules relating to Medicaid, the department would be authorized to enter into contracts, or amend existing contracts, as specified. The bill would make this provision inoperative on January 1, 2029. The bill would authorize the department to implement the above-described provisions, relating to the health equity and quality requirements and to the Medicaid final rules, through all-county letters or similar instructions without taking any further regulatory action.
Existing law, the Robert F. Kennedy Farm Workers Medical Plan, is a nonprofit voluntary employees beneficiary association, organized under federal law, that provides payments for health care and other benefits to its members. Existing law, until January 1, 2031, requires the State Department of Health Care Services to annually reimburse the plan up to $3,000,000 per year for claim payments that exceed $70,000 made by the plan on behalf of an eligible employee or dependent for a single episode of care on or after September 1, 2016. This bill would require the department to annually reimburse the Robert F. Kennedy Farm Workers Medical Plan up to $3,000,000 per year for claim payments that exceed $50,000 made by the plan on behalf of an eligible employee or dependent for a single episode of care.
Existing law grants the State Department of Health Care Services the sole authority in state government to license adult alcoholism or drug abuse recovery or treatment facilities and authorizes the department to issue a license to specified types of facilities if certain criteria are met. Existing law requires an operator of a licensed alcoholism or drug abuse recovery or treatment facility or certified alcohol or other drug program to include on its internet website and intake form paperwork a disclosure that an individual may check the internet website of the department to confirm whether the facility's license or program's certification has been placed in probationary status, been subject to a temporary suspension order, been revoked, or the operator has been given a notice of operation in violation of law. Existing law requires the disclosure to include a link to the department's internet website that contains the Probationary Status, Temporary Suspension Order, Revoked and Notice of Operation in Violation of Law Program List. This bill would require the department to indicate on its internet website containing the above-described list, in a location and font that is easy to see and read, that notices to recovery residences issued for a specified violation are not included in that list. The bill would also require the department to post on its internet website, in a specified manner, an identification and summary of each violation the department has issued for the above-described facilities and programs. The bill would require the department to implement this requirement to protect the public it serves by providing sufficient information regarding those who violate the state laws it administers without posting information that violates privacy rights and protections provided by state or federal law.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and 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 sets forth various provisions for Medi-Cal coverage of community health worker services, enhanced care management, and community supports, subject to any necessary federal approvals. Under existing law, these benefits are designed to, respectively, provide a link between health and social services and the community; address the clinical and nonclinical needs on a whole-person-care basis for certain target populations of Medi-Cal beneficiaries, including individuals experiencing homelessness; and provide housing transition navigation services, among other supports. This bill would set forth provisions regarding field medicine, as defined, under the Medi-Cal program for persons experiencing homelessness, as defined. The bill would state the intent of the Legislature that the field medicine-related provisions coexist with, and not duplicate, other Medi-Cal provisions, including, but not limited to, those regarding community health worker services, enhanced care management, and community supports. The bill would authorize a Medi-Cal managed care plan to elect to offer Medi-Cal covered services through a field medicine provider, as defined. Under the bill, a managed care plan that elects to do so would be required to allow a Medi-Cal member who is experiencing homelessness to receive those services directly from an in-network, contracted field medicine provider, regardless of the member's in-network assignment, as specified. The bill would also require the managed care plan to allow an in-network, contracted field medicine provider enrolled in Medi-Cal to directly refer a member who is experiencing homelessness for covered services within the appropriate network, as specified. The bill would require a managed care plan to have appropriate mechanisms, procedures, or protocols to ensure timely communication between the in-network, contracted field medicine provider, the Medi-Cal member's plan or independent practice association, and the member's primary care provider for purposes of care coordination and to prevent the duplication of services. The bill would require a managed care plan to provide a method for a Medi-Cal member to inform the managed care plan online, in person, or via telephone that the member is experiencing homelessness. The bill would require the department to inform a managed care plan if a member has indicated that they are experiencing homelessness based on information furnished on the Medi-Cal application. In the case of a Medi-Cal beneficiary who is experiencing homelessness and who receives services within the fee-for-service delivery system, the bill would require the department to reimburse a field medicine provider enrolled in Medi-Cal for providing Medi-Cal covered services. The bill would condition implementation of the above-described provisions on receipt of any necessary federal approvals and the availability of federal financial participation. The bill would require, on or before January 1, 2027, that the standard application form for insurance affordability programs include an optional question for an applicant to identify whether they are experiencing homelessness. The bill would make conforming changes to related provisions under existing law regarding the application process. The bill would also remove obsolete references within related provisions. To the extent that the bill would create new duties for counties with regard to data sharing under Medi-Cal, 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, 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 establishes the Health Care Benefits Fund to support the University of California's implementation of the California Health Benefit Review Program. Under the program, the University of California assesses legislation proposing to repeal or mandate a benefit or service requirement on health care insurance plans or health insurers. Under the program, the University of California provides a written analysis that includes, among other data, financial impacts of legislation on publicly funded state health insurance programs, including the Medi-Cal program and the Healthy Families Program. Existing law imposes an annual charge on health care service plans and health insurers for the 2022–23 to 2026–27 fiscal years, inclusive, as specified, to be deposited into the fund. Existing law prohibits the total annual assessment on health care service plans and health insurers from exceeding $2,200,000. Under existing law, the fund and the program become inoperative on July 1, 2027, and are repealed as of January 1, 2028. This bill would extend the operation of the California Health Benefit Review Program and the Health Care Benefits Fund through July 1, 2033, and would authorize the continued assessment of the annual charge on health care service plans and health insurers for that purpose for the 2026–27 to 2032–33 fiscal years, inclusive. The bill would increase the allowable total annual assessment on health care service plans and health insurers to $3,200,000. The bill would remove the Healthy Families Program as an example of the publicly funded state health insurance programs within an analysis of financial impacts of legislation. This bill would make these provisions inoperative on July 1, 2033, and would repeal it as of January 1, 2034. This bill would include a change in state statute that would result in a taxpayer paying a higher tax within the meaning of Section 3 of Article XIIIA of the California Constitution, and thus would require for passage the approval of 23 of the membership of each house of the Legislature.
Existing law, for policy years beginning on or after January 1, 2024, requires student health insurance coverage, as defined, to be considered individual health insurance coverage. Existing law, except as specified, requires a blanket disability insurance policy that meets the definition of student health insurance coverage to comply with insurance provisions that are applicable to nongrandfathered individual health insurance, including, among others, essential health benefits requirements and annual limits on out-of-pocket expenses. Existing law exempts student health insurance coverage from certain requirements otherwise applicable to health insurers and health benefit plans, including the establishment of specified enrollment periods, guaranteed availability and renewability, specified coverage level requirements, and single risk pool rating requirements. Existing law requires a notice to be provided in the student health insurance enrollment materials stating that California requires residents and their dependents to obtain and maintain health coverage, either through student health insurance, or through a different method, including Medi-Cal, Covered California, or, if under 26 years of age, their parent's coverage. This bill would, commencing July 1, 2026, authorize a student certificate holder to request to terminate their student health insurance coverage during the policy year if the student graduates, takes a leave of absence, or is no longer enrolled at the institution of higher education. The bill would require the request to be provided to the institution of higher education at least 30 days before the effective date of termination and would, upon receipt of the request to terminate coverage, require the institution to terminate coverage effective within the same calendar month if feasible, but no later than the last day of the calendar month in which the 30-day period ends. The bill would authorize the student to pay only the premium through the date of the termination, as specified. The bill would require a student or dependent of a student to be notified of premium liability to them, if any, if they choose not to terminate coverage pursuant to these provisions. The bill would, commencing July 1, 2026, if a student requests a waiver from student health insurance coverage, require the waiver to be granted if the student obtains or maintains health coverage that is minimum essential coverage, as specified. The bill would prohibit charging the student a fee or premium if the waiver is granted. Existing law requires a health insurer to file with the Department of Insurance all required rate information for grandfathered individual and specified group health insurance policies at least 120 days before implementing any rate change. This bill would authorize the department to prohibit a requested rate change if the insurer fails to comply with the above-described timelines. This bill would also authorize the Insurance Commissioner to exercise their existing authority to enforce the above-described provisions and prohibits an administrative penalty, if assessed, from exceeding $5,000 for each violation, or $10,000 for a willful violation. The bill would also state the intent of the Legislature to encourage self-funded student health coverage offered by the University of California Student Health Insurance Plan and the University of California Voluntary Dependent Plan to maintain or exceed coverage standards of the federal Patient Protection and Affordable Care Act and to comply with the above described provisions.
