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 sets forth requirements by which a health care service plan or health insurer reimburses a provider for health care services. This bill would require a determination to downcode a claim, which is the unilateral alteration by a payer of the service or procedure code submitted on a claim resulting in a lower payment, to include a documented review of the clinical information supporting the billed service. The bill would set forth requirements for and limitations of downcoding decisions, and, if a claim is downcoded, would require a plan or insurer to provide a billing provider with specified information and a clear and accessible process for disputing downcoded claims. The bill would prohibit a plan or insurer from using downcoding practices in a targeted or discriminatory manner against physicians or other health care providers who routinely treat patients with high acuity, complex, or chronic conditions, and would authorize the departments to take action against a plan or insurer that engages in a pattern or practice of discriminatory downcoding or that otherwise violates these provisions. 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 bill would require the departments to collect data on coding and claims adjustment practices, evaluate the information, and submit a report with specified information to the Legislature. 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 generally provides for the compensation of victims and derivative victims of specified types of crimes by the California Victim Compensation Board from the Restitution Fund, which is continuously appropriated to the board. Existing law authorizes the board to grant for pecuniary loss, when the board determines that it will best aid the person seeking compensation, as specified. Existing law authorizes the board to reimburse, among other things, the amount of medical or medical-related expenses and outpatient psychiatric, psychological, or other mental health counseling-related expenses incurred by the victim or derivative victim, as specified. This bill would also authorize the board to reimburse the expense of tuition at an educational institution, not to exceed $10,000, to a full- or part-time student who is a victim of sexual assault or violence if the victim is unable to continue attendance or suffers an academic setback, as described. The bill would authorize the board to limit compensation to the term the crime occurred and the immediately following term, and would require the calculation of an award based on certain factors, as specified. By expanding the board's authorization for use of moneys in the Restitution Fund, a continuously appropriated fund, this bill would make an appropriation.
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, including dental care, as specified. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. This bill would make behavior management and desensitization services without an accompanying dental procedure covered benefits under the Medi-Cal program, subject to utilization controls, when a patient's physical, behavioral, developmental, or emotional condition requires significant extra time, attention, or personnel, or requires such services preceding a dental visit, respectively, in order to safely deliver dental care. The bill would condition implementation of these provisions on the availability of federal financial participation and any necessary federal approvals having been obtained. The bill would, notwithstanding any other law, authorize the department to implement, interpret, or make specific these provisions by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions without taking any further regulatory action.
Existing law establishes the State Department of Public Health, which, among other things, administers various programs that prevent disease and promote health. This bill would create the California Investigational Peptide and Novel Compound Research and Therapeutic Access Program and would require the department to convene a working group with specified members to study and make recommendations regarding the creation of a state-authorized research and investigational therapeutic framework, as specified. The bill would require the working group to study potential uses of investigational therapeutic compounds and novel peptide compounds, among other things, and to submit a report to the Legislature detailing its findings and recommendations no later than January 1, 2029. The bill would repeal these provisions on January 1, 2030.
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 health care service plan or health insurer that provides prescription drug benefits and maintains one or more drug formularies to meet certain criteria for its formularies and the placement of drugs on formularies. This bill would prohibit a health care service plan or health insurer that provides prescription drug benefits and maintains one or more drug formularies from making changes to a formulary during a plan or policy year, except in specified circumstances. If a plan or insurer implements a formulary change requiring an enrollee or insured to change to a different drug in the same drug class during the plan year, the bill would authorize the individual to remain on the previously covered drug for the rest of the plan year if the drug was previously approved for coverage for the individual's medical condition, is appropriately prescribed, and is considered safe and effective for treating that condition, and would require the plan or insurer to notify the individual and their provider no less than 90 days before the change is implemented. The bill would require a plan or insurer, or its pharmacy benefit manager, to report to the appropriate department any changes made to a formulary during a plan or policy year within 30 days of the change being made. The bill would authorize the departments to investigate and take enforcement action against a plan or insurer for noncompliance with the above-described requirements and to impose, after notice and the opportunity for a hearing, administrative penalties, as specified, for a violation of these provisions. The bill would authorize the departments to conduct audits related to these provisions. Because a willful violation of the bill's provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program. Existing law requires a health care service plan that provides prescription drug benefits to maintain an expeditious process by which prescribing providers may obtain authorization for a medically necessary nonformulary prescription drug. This bill would define "expeditious process" for the above-described purpose to require a plan to approve authorization within 72 hours for nonurgent requests, or within 24 hours if exigent circumstances exist, of a request for approval of a drug prescription. If the plan fails to meet those requirements, the bill would authorize an enrollee to request, and would require the plan to provide, 90 days of transitional coverage to the enrollee for the previously covered drug. The bill would require the Department of Managed Health Care to utilize existing data and its existing authority to collect data from plans and annually publish on its internet website and submit to the Legislature an aggregated report on information related to requests for approval of a nonformulary drug as described above. 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 California Health Facilities Financing Authority Act, establishes the California Health Facilities Financing Authority, which has authority to, among other things, make secured or unsecured loans to, or purchase secured or unsecured loans of, any participating health institution in accordance with an agreement between the authority and the participating health institution to refinance indebtedness incurred by that participating health institution, as specified, in connection with projects undertaken, for health facilities acquired, or for working capital. Existing law also authorizes the authority to award grants to eligible clinics and health facilities, as specified. Existing law establishes the California Health Facilities Financing Authority Fund, a continuously appropriated fund, to carry out the purposes of the act. This bill, the Medical Debt Relief Act of 2026, would establish the medical debt relief program, which would be administered by the authority. The bill would require the authority to enter into an interagency agreement with the Department of Health Care Access and Information to implement the program. The bill would require the authority and department to convene a stakeholder advisory group, as specified, no later than July 1, 2027, to advise on the development, implementation, and administration of the program. The bill would require the stakeholder advisory group, on or before January 1, 2028, to develop recommendations for the authority and department, including, among others, criteria for the ranking and priority of eligible recipients to receive discharge of their medical debt. This bill would authorize the authority, in consultation with the department, to, among other things, contract with a medical debt relief coordinator, as defined, for purposes of acquiring medical debt of eligible recipients either directly from a providing health institution or from a debt buyer, as specified. The bill would require the authority to, among other things, maintain books and records of all the medical debt acquired and canceled. The bill would require the authority to maintain a public internet website for information about the program. This bill would create the California Medical Debt Relief Program Account within the California Health Facilities Financing Authority Fund and would make all moneys in the account available, upon appropriation by the Legislature, to the authority for carrying out the purposes of the Medical Debt Relief Act of 2026. The bill would require the authority, in consultation with the department, to provide a report to the Legislature and Governor by January 1 of each year, starting January 1, 2028. Existing law requires a hospital to report specified financial and utilization data to the Department of Health Care Access and Information, including, among other things, total operating expenses, and deductions from revenue, such as bad debts and charity care. This bill would require a hospital to report to the department outstanding medical debt owed to the hospital, including debt amount, bill adjustments, source of coverage, whether charity care or discount was provided, demographic data, ZIP Code, and whether the debt led to litigation or wage garnishment.
Existing law requires the State Department of Public Health to develop a coordinated state strategy for addressing the health-related needs of women, as specified. This bill, the Rural Farmworker Women's Health Act of 2026, would require the department to, beginning January 1, 2028, and upon appropriation by the Legislature for this purpose, establish a program to work with local nonprofit organizations who have a history of serving farmworker communities to provide free menstrual products in rural or agricultural communities. The bill would require the department to prioritize those communities with the highest rates of poverty.
Existing law requires specified occupied structures that are constructed on or after January 1, 2017, or constructed before that date and subject to subsequent modifications, to have an automated external defibrillator (AED) , as specified. Existing law exempts specified structures from these requirements, including structures that are owned or operated by any local government entity and specified health facilities. Existing law specifies that a structure with an existing AED in the common area of the structure meets the above-described requirement to have an AED without the installation of another AED. Existing law requires a person or entity that acquires an AED to, among other things, notify an agent of the local emergency medical services agency of the existence, location, and type of AED acquired, ensure that the AED is maintained and tested according to the manufacturer's guidelines, and ensure that the AED is tested at least biannually and after each use. Existing law provides that a person or entity that acquires an AED is not liable for civil damages resulting from the act or omission in the rendering of emergency care if certain requirements relating to the operation and maintenance of an AED are met. This bill would additionally require the specified structures described above to have an AED if that structure serves a population of adults 55 years of age or older and has the capacity to serve 50 or more adults 55 years of age or older.
Existing law establishes the Office of Rural Health within the California Health and Human Services Agency to promote a strong working relationship between state government and local and federal agencies, universities, private and public interest groups, rural consumers, health care providers, foundations, and other offices of rural health, as well as to develop health initiatives and maximize the use of existing resources without duplicating existing effort. Existing law requires the office to serve as a key information and referral source to promote coordinated planning for the delivery of health services in rural California. This bill would require the office to develop and administer, upon appropriation by the Legislature, a competitive grant program for the delivery of, or the support, sustenance, or expansion of the delivery of, medical services, as defined, to individuals who reside in rural areas, as defined. The bill would authorize the office upon that appropriation to expend up to $3,000,000 annually and would authorize a qualified provider, as defined, to apply to the office once per year for a grant of up to $10,000 for those purposes. The bill would require the office to establish specified standards and procedures, including criteria and standards for eligibility and the measurement of outcomes achieved, and, on or before January 1, 2028, and annually thereafter, to publish this information on its internet website.
Existing law, the Medi-Cal Act, 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 existing law, early and periodic screening, diagnostic, and treatment (EPSDT) services, including private duty nursing services, are covered under Medi-Cal for an individual under 21 years of age in accordance with certain federal provisions. The Medi-Cal program is in part governed by, and funded pursuant to, federal Medicaid program provisions. This bill would require the department to measure and assess whether private duty nursing services provided as part of the EPSDT benefit are in compliance with federal Medicaid requirements, as specified. The bill would require the assessment to include a comparison of the hours of EPSDT private duty nursing services authorized by the Medi-Cal program to the hours actually provided to eligible beneficiary children and a determination of whether the reimbursement rates for those services are sufficient to ensure that all authorized hours are able to be provided. The bill would require the department to prepare and submit a report to the Legislature on the findings of the assessment by no later than March 1, 2027.
