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's requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law sets forth specified coverage requirements for health care service plan contracts and health insurance policies. Existing law requires an individual or small group health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2017, to include, at a minimum, coverage for essential health benefits pursuant to the federal Patient Protection and Affordable Care Act. Existing law requires an essential health benefit to be provided only to the extent that federal law does not require the state to defray the costs of the benefit. This bill would require a health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2027, that provides coverage for the application of fluoride varnish as a pediatric oral care benefit to provide coverage without cost sharing for the application of fluoride varnish as medically necessary regardless of whether the service is billed as a dental benefit or as a medical benefit, except as specified. If this coverage requirement creates an obligation for the state to defray costs for an individual, the bill would not require coverage unless there is an appropriation for this purpose, as specified. Because a willful violation of this provision by a health care service plan would be a crime, the bill would impose a state-mandated local program. Existing law provides for the Medi-Cal program, administered by the State Department of Health Care Services and under which health care services are provided to low-income individuals. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law establishes a schedule of benefits under the Medi-Cal program and provides for various services, including certain dental services, that are rendered by Medi-Cal enrolled providers. Under existing law, silver diamine fluoride treatments are a covered benefit for eligible children 0 to 6 years of age, inclusive, as specified, and application of fluoride or other appropriate fluoride treatment is covered for children 17 years of age and under. This bill would make the application of fluoride or other appropriate fluoride treatment, as defined by the department, a covered benefit under the Medi-Cal program for children under 21 years of age. The bill would require the State Department of Health Care Services, no later than July 1, 2027, to issue billing guidance and make any necessary updates to ensure the coverage policy for Medi-Cal beneficiaries under 21 years of age is consistent with certain federal benefits and would require that policy to allow the application of fluoride varnish, as specified. 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. This bill would incorporate additional changes to Section 14132 of the Welfare and Institutions Code proposed by AB 1949 and SB 944 to be operative only if this bill and either or both AB 1949 and SB 944 are enacted and this bill is enacted last.
Existing law prohibits the Department of Corrections Rehabilitation from allowing any lack of care that would injure or impair the health of an incarcerated person. Existing law prohibits the department from modifying or canceling the medical treatment of an incarcerated person if a physician certifies that the medical treatment is required to prevent certain violations of law or to prevent serious and imminent harm to the health of an incarcerated person, as specified. This bill would prohibit a supervisor, administrator, or employee of the department from interfering with or refusing to implement prescribed health care, as specified, that results in substantial emotional distress or serious bodily injury, as defined.
Existing law, the Physical Therapy Practice Act, establishes the Physical Therapy Board of California within the Department of Consumer Affairs for the licensure, approval, and regulation of physical therapists and physical therapist assistants. Existing law prescribes specified fees for licenses issued by the board. Existing law authorizes the board to decrease or increase the fee amounts, and establishes specified maximum amounts of license fees. Existing law repeals the board and its authority to employ an executive officer on January 1, 2027. This bill would extend the board's authority to enforce and administer the act and to appoint an executive officer until January 1, 2031. The bill would increase specified fees for licenses issued by the board and would increase the maximum amount to which the board may increase the fees, as specified. The bill would also make nonsubstantive changes to those fee provisions. Existing law authorizes a person whose license has been revoked or suspended, or who has been placed on probation, to petition the board for reinstatement or modification of a penalty after a specified period of time has elapsed. Existing law prohibits the board from considering a petition while the petitioner is under sentence for any criminal offense, including any period of court-imposed probation or parole, or while there is an accusation or petition to revoke probation pending against the petitioner. This bill would further prohibit the board from considering a petition if the applicant is required to register as a sex offender, as specified. The bill would except from this prohibition an applicant whose requirement to register as a sex offender is based solely on a misdemeanor conviction. The bill would also prohibit the board from considering a petition if the conduct underlying the petitioner's conviction involved certain sexual misconduct.
Existing law finds and declares that prenatal and postpartum care, among other things, are essential services necessary to ensure maternal health. Existing law establishes the State Department of Public Health, and vests the department with certain duties relating to maternal health, including maintaining a program of maternal and child health, as provided. This bill would require the department to include on its internet website information advising individuals to discuss pelvic floor concerns with their health care provider during their postpartum care visit.
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 authorizes the Director of the Department of Managed Health Care to authorize a pilot program in southern California under which approved providers may undertake risk-bearing arrangements with a voluntary employees' beneficiary association with enrollment of more than 100,000 lives, as specified, beginning no earlier than January 1, 2022, to December 31, 2027, inclusive, if certain criteria are met. Existing law requires the association and each participating health care provider to report to the department information regarding cost savings and clinical patient outcomes compared to a fee-for-service payment model. Existing law requires the department to report those findings to the Legislature after the termination of the pilot program and before January 1, 2027. Existing law repeals these provisions on January 1, 2030. This bill would extend that repeal date to January 1, 2031. The bill would extend the end date of the pilot program to December 31, 2030, but would authorize the department to terminate the pilot program for specified reasons and would require the department to terminate the pilot program prior to the pilot program's end date based on any significant negative findings in any report, including if the department identifies any serious deficiencies that could cause enrollee harm. The bill would, instead of requiring the department to report findings to the Legislature after the termination of the pilot program, require the department to submit an interim report of the findings described above and policy recommendations regarding the continuation of the pilot program to the Legislature before January 1, 2029.
Existing law requires the State Department of Health Care Services to license and regulate adult alcohol or other drug recovery or treatment facilities that provide residential nonmedical services, as specified, and further requires the department to certify and regulate alcohol and other drug programs, as specified. This bill would require an alcohol or other drug treatment facility and an alcohol or other drug program to participate in a public consumer protection platform, as defined, designated or designed by the department in order to be licensed or certified. The bill would specify that participation in the public consumer protection platform pursuant to these provisions is only required if the department determines that sufficient funding has been appropriated or otherwise secured to cover the costs of participation in the platform, as specified. The bill would authorize the department to charge a reasonable fee to alcohol or other drug treatment facilities and alcohol or other drug programs required to enroll in the platform, as specified, and would prohibit the administrator of the public consumer protection platform from accepting payment from the entities subject to these provisions. The bill would authorize the department to verify compliance with participation in the public consumer protection platform as part of the certification or licensing process. The bill would prohibit participation in the consumer protection platform from being used as a criterion in evaluating bids, proposals, network participation, reimbursement, or contract performance for publicly funded substance use disorder treatment services. The bill would require the consumer protection platform, if managed by an entity other than the department, to collect and publicly display information from each participating treatment provider on the provider's adoption of evidence-based practices in substance use disorder care, as specified. The bill would authorize the department to implement, interpret, or make specific those provisions by means of provider bulletins, written guidelines, or similar instructions.
Existing law provides for the licensing and regulation of health facilities by the State Department of Public Health and generally makes a violation of those provisions a crime. 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 generally makes a willful violation of the act a crime. Existing law requires a health facility to provide emergency services and care upon request for any condition in which the person is in danger of loss of life or serious injury or illness. Existing law requires a health care service plan to reimburse providers for emergency services and care. Existing law defines "emergency services and care" for these purposes to mean medical screening, examination, and evaluation by a physician and surgeon, or other appropriate licensed persons under the supervision of a physician and surgeon, to determine if an emergency medical condition or active labor exists and, if it does, the care, treatment, and surgery, if within the scope of that person's license, necessary to relieve or eliminate the emergency medical condition, within the capability of the facility, among other things. This bill would specify that the above-described provisions would not require physician supervision of a licensed nurse-midwife in the labor and delivery unit, obstetric triage, or dedicated emergency obstetric evaluation unit, when the nurse-midwife is providing care to the extent authorized by, and consistent with, specified licensing and certification provisions, or when the nurse-midwife is specifically requested by the treating physician and surgeon to provide obstetric consultation. By changing 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 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 through various delivery systems, including fee-for-service and managed care. The Medi-Cal program is, in part, governed by, and funded pursuant to, federal Medicaid program provisions. Existing law establishes the California Program of All-Inclusive Care for the Elderly (PACE program) to provide community-based, risk-based, and capitated long-term care services as optional services for older individuals under the state's Medi-Cal State Plan and under contracts entered into between the federal Centers for Medicare and Medicaid Services, the department, and PACE organizations. Existing law requires the department to pay capitation rates to health plans participating in the Medi-Cal managed care program using actuarial methods. Existing law requires the department to develop and pay capitation rates to entities contracted pursuant to the PACE program, using actuarial methods consistent with those provisions, with specified exceptions. Existing law requires the department to consult with those contracted entities in developing a rate methodology. This bill would require the department to notify the contracting PACE organization of the proposed rates at least 60 days prior to submission to the federal Centers for Medicare and Medicaid Services (CMS) for approval. The bill would authorize the department to define a reasonable date by which the PACE organization must submit written questions or feedback concerning the proposed rates. The bill would require the department to respond in writing to those questions or feedback by no later than 30 days prior to submitting the rates to CMS.
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 by, and funded pursuant to, federal Medicaid program provisions. Existing law, subject to implementation of the California Advancing and Innovating Medi-Cal (CalAIM) initiative, requires 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. Under existing law, target populations include, among others, high utilizers with frequent hospital admissions, short-term skilled nursing facility stays, or emergency room visits, and individuals experiencing homelessness. This bill would recast the definition of ECM, referring to community-based, high-touch coordination and comprehensive care management services, as specified. The bill would delete certain provisions that designate 2022 or 2023 timelines for commencing ECM coverage, depending on whether or not a Medi-Cal managed care plan operates in a county in which the Whole Person Care pilot program or the Health Home Program was implemented. Existing law, subject to CalAIM implementation, authorizes a Medi-Cal managed care plan to elect to cover community supports. Under existing law, community supports that the department is authorized to approve include, among others, housing transition navigation services and medically supportive food and nutrition services. This bill would require the department to publish and maintain policy guides and all-plan letters on its internet website that define model coverage standards and policy for each community support, to engage stakeholders, to provide ongoing technical assistance, and to establish a standard timeline and process for regular updates to community supports policy guides, as specified. The bill would require a Medi-Cal managed care plan to adopt community supports policies, and to educate its in-network community support providers, as specified. The bill would require the department to publish certain information on ECM and community supports utilization data on the department's internet website on a quarterly basis, to the extent feasible, until January 1, 2032. The bill would require the department, by March 31, 2029, to provide to the legislative committees specified information in writing necessary to inform legislative consideration of transitioning community supports to benefits that are required to be covered under the Medi-Cal program. The bill would make other technical changes to the ECM and community support provisions.
Existing law establishes the Board of Behavioral Sciences within the Department of Consumer Affairs and requires the board to regulate licensees and registrants under the Licensed Marriage and Family Therapist Act (LMFTA) , the Educational Psychologist Practice Act (EPPA) , the Clinical Social Worker Practice Act (CSWPA) , and the Licensed Professional Clinical Counselor Act (LPCCA) . Existing law makes a violation of those acts a crime. The LMFTA, the CSWPA, and the LPCCA each contain varying provisions limiting their application to the practice of certain medical and other behavioral science professionals, attorneys, and certain religious personnel, including priests, rabbis, and ministers of the gospel of any religious denomination. This bill would revise and recast those provisions to, among other things, exempt a religious official of any denomination, including those specified above and imams, when providing faith-based counseling services as part of their regular professional duties for an established and legally recognizable faith-based entity if certain criteria are met. The bill would also exempt attorneys and physicians who provide counseling services as part of their professional practice from the LMFTA and the LPCCA. Existing law establishes examination and experiential requirements under the LMFTA, the EPPA, the CSWPA, and the LPCCA to qualify for licensure or registration under those acts and requires an applicant for licensure or registration to have passed certain examinations or obtain specified experience within a certain timeline for it to be accepted by the board. In this regard, existing law generally requires the applicant to gain the required experience no more than 6 years before the board receives the application. For licensed educational psychologists, the EPPA authorizes the board to accept a passing score on a written examination administered by the board for a period of 7 years from the date the examination was taken. Under the LMFTA, the CSWPA, and the LPCCA, registrants and applicants for licensure, registration, or a subsequent registration number are required to pass a California law and ethics examination. The LMFTA, the CSWPA, and the LPCCA require an applicant for licensure to pass a clinical examination within 7 years from the initial attempt, unless the applicant obtains a passing score on the current version of the California law and ethics examination. This bill, instead, would require applicants for licensure under the LMFTA, the EPPA, the CSWPA, and the LPCCA, to obtain the relevant experience and to pass the relevant examination within 7 years preceding the date on which the board receives the application. The bill would require those applicants and registrants under the LMFTA, the CSWPA, and the LPCCA who submit applications to the board on and after January 1, 2030, to have passed the California law and ethics examination no more than 7 years before the board receives the application, as specified. Existing law authorizes an associate marriage and family therapist registration, an associate clinical social worker registration, or an associate professional clinical counselor registration to be renewed a maximum of 5 times and prohibits a registration from being renewed beyond 6 years from the last day of the month of issuance. Existing law authorizes an applicant to apply for a subsequent registration number when no renewals are possible if certain requirements are met. Existing law prohibits an applicant who is issued a subsequent associate registration number from being employed or volunteering in a private practice. This bill would increase the maximum number of renewals for those registrations to 6 and would extend the renewal deadline to 7 years from the last day of the month of issuance. The bill would authorize an applicant applying for or holding a subsequent associate registration number to request a 2-year hardship extension of the subsequent associate registration number to allow them to be employed or volunteer at one private practice or professional corporation employer, subject to specified conditions and requirements, including signing an application under penalty of perjury. By expanding the crime of perjury, the bill would impose a state-mandated local program. Existing law requires an associate marriage and family therapist or a marriage and family therapist trainee to disclose to a client or patient that they are unlicensed and to provide specified information to the client or patient. Existing law requires a social work applicant or registrant and a clinical counselor trainee, applicant, or associate to inform each client or patient that they are unlicensed and under supervision, as specified. This bill would instead require a marriage and family therapist applicant or registrant, a social work applicant, registrant, intern, or trainee, or a clinical counselor applicant, associate, or trainee, in addition to disclosing to a client or patient that they are unlicensed and under supervision, to provide the name of their employer or the entity for which they volunteer. Existing law establishes a $20 fee for rescoring a written examination under the LMFTA, the EPPA, the CSWPA, and the LPCCA. This bill would delete that fee. This bill would delete obsolete provisions and make other technical and nonsubstantive changes. This bill would incorporate additional changes to Section 4980.41 of the Business and Professions Code proposed by SB 1445 to be operative only if this bill and SB 1445 are enacted and this bill is enacted last. 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.
