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 authorizes health care service plans and health insurers that cover prescription drugs to utilize reasonable medical management practices, including prior authorization and step therapy, consistent with applicable law. This bill would prohibit a health care service plan contract or a health insurance policy that is issued, amended, or renewed on or after January 1, 2027, from imposing step therapy as a prerequisite to authorizing coverage of any prescription drug used for the treatment of a serious mental illness or substance use disorder, as those terms are defined, except as specified. The bill would specify that the prohibition on step therapy does not apply when the United States Food and Drug Administration-labeled indications and usage of a drug indicate that some prior medication must be taken. 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. 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 each county to provide aid, commonly known as a general assistance program, to the county's indigent residents who are not supported by other means and are ineligible for the Medi-Cal program, as specified. Existing law sets forth various provisions relating to county-based health care services for indigent individuals and to reporting systems for those services. This bill would require the State Department of Health Care Services, by July 1, 2027, to establish an internet website where the public can access information on safety-net health care services in the state. The bill would require that the website include certain information and resources, including, among other items, information about each county that provides health care to low-income county residents who are uninsured or underinsured, including eligibility requirements, the cost structure for applicants, and other specified elements. The bill would require the department, in consultation with certain entities, to review the information and resources on the website, as specified. The bill would require each county to submit any changes to the above-described elements to the department within 120 calendar days, as specified. By creating new data-reporting duties for counties, 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.
(1) Existing law provides for the licensing and regulation of health facilities, including, but not limited to, long-term health care facilities, as defined, by the State Department of Health Care Services. Existing law requires a contract for admission to a long-term care facility to state that a resident shall not be involuntarily transferred within, or discharged from, a long-term health care facility unless the resident is given reasonable notice in writing, and transfer or discharge planning, as specified. Willful or repeated violations of the provisions relating to long-term health care facilities is a misdemeanor. This bill would require long-term health care facilities to provide residents with a notice of a facility-initiated transfer or discharge at least 30 days before a resident is transferred or discharged, unless an exception applies. The bill would require the notice of transfer or discharge to be acknowledged by the signature of the resident or, if applicable, the resident's representative. The bill would make a violation of these provisions a class "B" violation and would make knowingly making a false verification regarding the delivery of a notice of transfer or discharge a willful violation for purposes of the criminal provision described above. The bill would require a notice of discharge or transfer to be provided to a resident and, if applicable, the resident's representative in a translated or accessible format at the same time as the written notice in English if the resident's primary language is not English or if the resident is vision impaired or blind, as specified. The bill would also require the translated or accessible-format notices to be made available to the local long-term care ombudsman upon request. The bill would require the translator to attest, under penalty of perjury, to the accuracy of the translation, thereby expanding the crime of perjury. The bill would require a resident's primary language or sensory impairments to be included in the minimum dataset maintained by the facility. The bill would make a violation of these provisions a class "B" violation. Existing law requires that a copy of the notice of transfer or discharge be sent to the local long-term care ombudsman at the same time notice is provided to the resident or the resident's representative by facsimile machine, email, or first-class mail, as specified. Existing law requires, if a resident is subject to a facility-initiated transfer to a general acute care hospital on an emergency basis, the notice to be provided to the local long-term care ombudsman as soon as practicable. This bill would instead require the notices described above to be sent to the long-term care ombudsman by facsimile, email, or other electronic means. For emergency transfer notices, the bill would require a copy of the notice to be provided to the local long-term care ombudsman as soon as practicable, but in no event later than 24 hours after the transfer. Because a willful or repeated violation of long-term care facilities provisions is a crime and because the crime of perjury is expanded, the bill would impose a state-mandated local program. (2) Existing law requires the State Department of Public Health to establish an inspection and reporting system to ensure that long-term health care facilities are in compliance with state statutes and regulations. Existing law, the Medi-Cal Long-Term Care Reimbursement Act, requires, among other things, that long-term health care facilities timely comply with hearing decisions issued by the department's Office of Administrative Hearings and Appeals for improperly transferring, discharging, or refusing to readmit a resident. Existing law authorizes the department to assess a penalty of $750 for each calendar day a facility fails to comply with the hearing decision and caps aggregate penalties for each individual hearing decision at $75,000. The bill would authorize the State Department of Public Health to prohibit the admission of new residents to a long-term health care facility upon notification that a facility has failed to timely comply with a hearing decision. The bill would require the prohibition to remain in effect until the facility has achieved compliance, the maximum aggregate of penalties have been collected, or the facility has formally sought judicial review of the hearing decision. The bill would increase the daily penalty described above to $1,000 for each calendar day and increase the maximum aggregate penalty amount to $100,000. (3) 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 Children and Youth Behavioral Health Initiative, administered by the California Health and Human Services Agency and its departments, as applicable. Under existing law, the purpose of the initiative is to transform the state's behavioral health system into an innovative ecosystem in which all children and youth 25 years of age and younger, regardless of payer, are screened, supported, and served for emerging and existing behavioral health needs. Existing law requires, as a part of the initiative, the State Department of Health Care Services to develop and maintain a school-linked statewide fee schedule for outpatient mental health or substance use disorder treatment provided to a student who is 25 years of age or younger at a schoolsite. Existing law requires providers of medically necessary schoolsite services to be reimbursed by health care service plans, insurers, and Medi-Cal managed care plans, at a minimum, at the fee schedule rate or rates, regardless of network provider status. This bill would establish the Fee Schedule Intensive Technical Support for Onboarding Program. The bill would require the State Department of Education, upon appropriation and subject to the terms of the appropriation, to select through a competitive process, and, no later than July 1 of the year after an appropriation is made to fund the program, allocate funding to, a local educational agency that will serve as the lead entity that will administer the program over a 3-year period, as provided. The bill would require the lead entity, in coordination with the State Department of Education and the State Department of Health Care Services, to, no later than November 1 of the year after an appropriation is made to fund the program, select up to 25 entities to participate in the program and prioritize certain applicants, including, among others, applicants who will increase the number and amount of statewide fee schedule reimbursements. The bill would require that an entity meet specified criteria in order to be eligible to participate in the program, including, among other things, that the entity has past experience in serving children and youth that are of the age that the entity intends to serve. The bill would require a participating entity, as a condition of participation, to commit to increasing, among other things, the number of transition-age youth 16 to 25 years of age receiving behavioral health services. The bill would require the lead entity, starting on or before December 1 of the year after an appropriation is made to fund the program, and ending no earlier than 3 years after the program begins, to provide intensive technical assistance and support with regard to specified activities to the participating entities. The bill would require the lead entity to submit a progress report on or before September 1 of the year that is 3 years after an appropriation is made to fund the program, and submit a summative report by January 1 of the year that is 4 years after an appropriation is made to fund the program, regarding the program to the appropriate policy and fiscal committees of the Legislature.
Existing law requires the governing board of a school district to give diligent care to the health and physical development of pupils and authorizes the governing board of a school district to employ properly certified persons for this purpose. Existing law requires a school of a school district or county office of education and a charter school to notify pupils and parents or guardians of pupils no less than twice during the school year on how to initiate access to available pupil mental health services on campus or in the community, or both, as provided. This bill would require, on or before July 1, 2027, the State Department of Education to enter into a contract with one or more local educational agencies with capacity and established expertise, as provided, to serve as lead entities in providing support for the implementation of integrated, universal social-emotional learning, behavioral health, and restorative practices for pupils in kindergarten and grades 1 to 12, inclusive. The bill would require, on or before January 1, 2028, the lead entities, selected pursuant to a competitive process, to make available guidance, resources, and technical assistance to local educational agencies to expand the statewide implementation of integrated, universal social-emotional learning, behavioral health, and restorative practices, as provided. The bill would make the implementation of these provisions contingent upon an appropriation, as provided.
Existing law requires that, as a condition of parole, a prisoner who has a severe mental health disorder, as specified, be treated by the State Department of State Hospitals, if the prisoner meets certain requirements, including, among others, that the person in charge of treating the prisoner and a practicing psychiatrist or psychologist from the State Department of State Hospitals have evaluated the prisoner and that a chief psychiatrist of the Department of Corrections and Rehabilitation certify to the Board of Parole Hearings that by reason of the prisoner's severe mental health disorder, the prisoner represents a substantial danger of physical harm to others. This bill would require that certain factors be considered in determining whether an offender poses a substantial danger of physical harm to others, including, but not limited to, a history of violent behavior and prior history of state hospital commitment. Existing law allows a prisoner to request a hearing before the Board of Parole Hearings for the purpose of proving that the prisoner meets the criteria to be treated by the State Department of State Hospitals. Existing law allows a prisoner who disagrees with the determination of the Board of Parole Hearings to file a petition in court for a hearing on whether they met the criteria and, if the court reverses the determination of the Board of Parole Hearings, existing law authorizes the court to require the parties to return to court to ensure that the entities involved in the release of the prisoner have coordinated an exit plan for the prisoner. This bill would require that an exit plan include the submission of an application for Medi-Cal benefits and a recommendation, as appropriate, to the supervising county's behavioral health department by a licensed behavioral health professional, as specified, supervising the treatment of, or treating, the prisoner for a mental health disorder for certain resources and programs, including substance use disorder treatment, assisted outpatient treatment, and early psychosis intervention services. Existing law, the Mental Health Services Act (MHSA) , an initiative measure enacted by the voters as Proposition 63 at the November 2, 2004, statewide general election, funds a system of county mental health plans for the provision of mental health services, as specified. The MHSA establishes the Mental Health Services Fund, a continuously appropriated fund, which is administered by the State Department of Health Care Services (department) , to fund specified county mental health programs. Existing law, the Behavioral Health Services Act (BHSA) , a legislative act amending the MHSA that was approved by the voters as Proposition 1 at the March 5, 2024, statewide primary election, recast the MHSA by, among other things, renaming the fund to the Behavioral Health Services Fund and reallocating how moneys from that fund may be spent. The BHSA requires each county to establish and administer a full-service partnership program that includes, among other things, outpatient behavioral health services, as specified, and housing interventions. Existing law establishes criteria for an individual with a serious mental illness to be presumptively eligible for a full-service partnership, including, among other things, the person is transitioning to the community after 6 months or more in the state prison or county jail. This bill would add to the criteria for presumptively eligibility for a full-service partnership an individual transitioning to the community after 6 months or more in a state hospital. 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, the California Advancing and Innovating Medi-Cal (CalAIM) Act, supports the 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. Existing law makes a qualifying inmate of a public institution eligible, commencing no sooner than January 1, 2023, to receive targeted Medi-Cal services, limited to those services approved in the CalAIM Terms and Conditions for 90 days, as specified. This bill would also make a qualifying inmate of a state hospital eligible to receive targeted Medi-Cal services, as described. By expanding the population receiving benefits under the BHSA and to the extent that the bill would create new duties for counties relating to Medi-Cal eligibility determinations, 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, 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, except as provided and under certain circumstances, prohibits a person who manufactures a prescription drug from offering a discount, repayment, product voucher, or other reduction in an individual's out-of-pocket expenses associated with their health insurance or health care service plan. Existing law generally imposes specified cost sharing limits on covered prescription drugs. This bill would require a health care service plan or health insurer, when calculating an enrollee's or insured's overall contribution to an out-of-pocket maximum or cost sharing requirement under the plan contract or insurance policy, to count any amount paid by the enrollee or insured or on behalf of the enrollee or insured for a covered drug toward the enrollee's or insured's cost sharing, except as provided. The bill would prescribe an administrative penalty for each violation by a health insurer that is enforceable by the Insurance Commissioner after appropriate notice and opportunity for hearing. Because a willful violation of these provisions 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, the Community Assistance, Recovery, and Empowerment (CARE) Act (CARE Act) , authorizes specified persons, including a person with whom the respondent resides, family members, and first responders, among others, to petition a civil court to create a voluntary CARE agreement or a court-ordered CARE plan and implement services, to be provided by county behavioral health agencies, to provide behavioral health care, including stabilization medication, housing, and other enumerated services, to adults who are currently experiencing a severe mental illness and have a diagnosis identified in the disorder class schizophrenia and other psychotic disorders, or bipolar I disorder with psychotic features, and who meet other specified criteria. Existing law requires the Judicial Council to develop a mandatory form for use to file a CARE process petition with the court and any other forms necessary for the CARE process, to be signed under the penalty of perjury, and requires the form to contain certain information, including either a specified affidavit of a licensed behavioral health professional or evidence the respondent was detained for a minimum of two intensive treatments pursuant to specified provisions of law. Existing law, the Lanterman-Petris-Short Act (LPS Act) , generally provides for the evaluation, treatment, and civil commitment of persons with mental health disorders and other specified persons. Existing law authorizes, under a superior court order, an evaluation of a person alleged, as a result of mental disorder, to be a danger to themselves or others or to be gravely disabled, and provides the forms to use for these evaluations. The CARE Act authorizes a court to terminate a respondent's participation in the CARE process if the court determines that the respondent is not participating in the CARE process or is not adhering to their CARE plan, as specified, and authorizes the court to order the court-ordered evaluation under the LPS Act. If the court finds the petitioner has made a prima facie showing that the respondent is, or may be, a person eligible for the CARE program, the court is required to order the county behavioral health agency, or their designee, as specified, to submit a written report to the court with specified information, including, but not limited to, a determination whether the respondent meets, or is likely to meet, the criteria for the CARE process and conclusions and recommendations about the respondent's ability to voluntarily engage in services. Existing law requires the court to, within 5 days of receiving the report, take one of several actions, including dismissing the petition if the court determines that voluntary engagement with the respondent is effective and the individual has enrolled, or is likely to enroll, in behavioral health treatment. This bill would require the written report to include conclusions about whether the respondent is likely to need a higher level of care than is available under the CARE Act and, if so, recommendations about the appropriate level of care and the necessary steps to obtain that level of care for the respondent and remove the authorization for a court to dismiss the petition if the respondent is only likely to enroll in behavioral health treatment. If the court intends to dismiss a petition because the respondent needs a higher level of services, the bill would authorize the court to order the county to conduct a prepetition screening and hold the CARE petition open until the screening is complete. The bill would also make other technical and conforming changes. By requiring a higher level of service on the county, this bill would impose a state-mandated local program. Existing law requires all hearings regarding these provisions to occur in person unless the court, in its discretion, allows a party or witness to appear remotely. This bill would require the court to allow the hearings to be held remotely, unless otherwise ordered by the court or demanded by the respondent. 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 with regard to certain mandates no reimbursement is required by this act for a specified reason. With regard to any other mandates, this bill would provide that, if the Commission on State Mandates determines that the bill contains costs so mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.
Existing law that governs the labor relations of public employees and employers, including, among others, the Meyers-Milias-Brown Act, the Ralph C. Dills Act, provisions relating to public schools, and provisions relating to higher education prohibits employers from taking certain actions relating to employee organization, including imposing or threatening to impose reprisals on employees, discriminating or threatening to discriminate against employees, or otherwise interfering with, restraining, or coercing employees because of their exercise of their guaranteed rights. Those provisions of existing law further prohibit denying to employee organizations the rights guaranteed to them by existing law. This bill would prohibit a public employer from questioning a public employee, a representative of a recognized employee organization, or an exclusive representative regarding communications made in confidence between an employee and an employee representative in connection with representation relating to any matter within the scope of the recognized employee organization's representation. The bill would also prohibit a public employer from compelling a public employee, a representative of a recognized employee organization, or an exclusive representative to disclose those confidential communications to a third party. The bill would not apply to a criminal investigation or when a public safety officer is under investigation and certain circumstances exist.
Existing law establishes the California Community Colleges, administered by the Board of Governors of the California Community Colleges, as one of the segments of public postsecondary education in the state. Existing law requires the board to appoint a chief executive officer, known as the Chancellor of the California Community Colleges. Existing law establishes community college districts throughout the state, under the administration of community college district governing boards, and authorizes these districts to provide instruction at the community college campuses they operate. Existing law establishes the Part-Time Community College Faculty Health Insurance Program, which authorizes the governing board of a community college district to provide a program of health insurance for part-time faculty, multidistrict part-time faculty, and their dependents. Existing law requires the chancellor, by June 15 of each year, to apportion to each community college that establishes a program an amount that equals up to12 of the total cost of the individual premiums required to be paid for the health insurance coverage of participating part-time faculty, multidistrict part-time faculty, and their dependents, and to apportion any remaining funds to each community college district that establishes a program and meets certain criteria, up to the total cost of the individual premiums required to be paid for the health insurance coverage of the participants, as provided. If funds appropriated for purposes of the program remain after those apportionments, existing law requires that the balance revert to the General Fund annually, as specified. This bill would instead require that the balance be deposited into the Part-Time Community College Faculty Health Insurance Program Fund, which the bill would create. The bill would continuously appropriate the moneys in the fund to the chancellor for purposes of the above-described apportionments, as specified. This bill would state the intent of the Legislature that, by January 1, 2030, each community college district commence negotiations with the exclusive representatives for part-time community college faculty to offer health insurance benefits to part-time and multidistrict part-time community college faculty and their eligible dependents.
