Existing law provides for the licensure and regulation by the State Department of Public Health of health facilities, including general acute care hospitals, as defined. Existing law requires a health facility to allow a patient's domestic partner, the children of the patient's domestic partner, and the domestic partner of the patient's parent or child to visit unless no visitors are allowed, the facility reasonably determines that the presence of a particular visitor would endanger the health or safety of a patient, a member of the health facility staff, or other visitor to the health facility, or would significantly disrupt the operations of a facility, or the patient has indicated to the health facility staff that the patient does not want this person to visit. A violation of this provision is a misdemeanor. This bill would require a general acute care hospital to allow a patient with physical, intellectual, or developmental disabilities, a patient with cognitive impairment, including dementia, and a patient with another disability, as specified, to have a family or friend caregiver with them as needed, including outside standard visiting hours, unless specified conditions are met, including, but not limited to, that the hospital reasonably determines that the presence of a particular visitor would endanger the health or safety of the visitor, a patient, a member of the staff, or other visitor to the hospital, or would significantly disrupt the operations of the hospital. The bill would not prohibit a hospital from otherwise establishing reasonable restrictions upon visitation. The bill would authorize the hospital to impose legitimate health and safety requirements on visitors, as specified. The bill would specify that its provisions do not prohibit restrictions to patient visitation policies implemented during a state of emergency declared by the Governor, a health emergency declared by the State Public Health Officer, or a local health emergency declared by a local health officer, as specified. The bill would specify that its provisions do not create any new civil or criminal liability, including, but not limited to, liability for any illness, infection, or injury experienced by a patient or visitor on the part of a hospital that complies with its requirements. By expanding 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.
(1) 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, established the Mental Health Services Oversight and Accountability Commission to oversee the implementation of the MHSA. Existing law specifies the composition of the 16-member commission, including the Attorney General or their designee, the Superintendent of Public Instruction or their designee, specified members of the Legislature, and 12 members appointed by the Governor, as prescribed. Existing law, the Behavioral Health Services Act (BHSA) , an initiative measure enacted by the voters as Proposition 1 at the March 5, 2024, statewide primary election, recast the MHSA by, among other things, renaming the commission to the Behavioral Health Services Oversight and Accountability Commission and changing its composition and duties. This bill would make technical changes to reflect the correct name of the commission. (2) Existing law provides for the licensure and regulation of health facilities by the State Department of Public Health. Existing law requires a health facility to develop, implement, and comply with a patient safety plan to improve the health and safety of patients and to reduce preventable patient safety events. Existing law requires a patient safety plan to contain specified elements, including, but not limited to, a reporting system for patient safety events that allows anyone involved to make a report of a patient safety event to the health facility and a process for a team of facility staff to conduct analyses related to root causes of patient safety events. Existing law, commencing January 1, 2026, and biannually thereafter, requires a health facility to submit a patient safety plan to the department. A violation of these provisions is a crime. This bill would instead require a health facility to submit a patient safety plan to the department biennially. The bill would also make technical corrections to those provisions. (3) Existing law establishes the State Department of Public Health and sets forth its powers and duties to license and administer health facilities, as defined, including skilled nursing facilities and intermediate care facilities. Existing law requires the department to prepare and maintain a list of approved training programs for nurse assistant certification, which are required to include a precertification training program consisting of at least 60 classroom hours of training on basic nursing skills, patient safety and rights, the social and psychological problems of patients, and elder abuse recognition and reporting and at least 100 hours of supervised and on-the-job training clinical practice. Existing law requires at least 2 hours of the 60 hours of classroom training and at least 4 hours of the 100 hours of the supervised clinical training to address the special needs of persons with developmental and mental disorders, including intellectual disability, Alzheimer's disease, cerebral palsy, epilepsy, dementia, Parkinson's disease, and mental illness. A violation of these provisions is a crime. This bill would require that at least 2 of the 60 hours of classroom training address the special needs of persons with Alzheimer's disease and related dementias. By changing the definition of a crime, this bill would impose a state-mandated local program. (4) Existing law requires a hospital, as defined, to maintain an understandable written policy regarding discount payments for financially qualified patients as well as a written charity care policy, and requires a hospital to negotiate the terms of a discount payment plan with an eligible patient, as specified. Existing law requires each hospital to provide patients with written notice, provided at the time of service, about the availability of the hospital's discount payment and charity care policies, and other additional information. This bill would authorize, with the exception of emergency room visits, a hospital to provide the written notice in either hard copy or, if the patient has previously consented to receive electronic communications, using the patient's preferred electronic notification method. The bill would require the written notice related to an emergency room visit to be provided in hard copy. The bill would require, if the notice is provided electronically, the notice to be sent separately from any other electronic communications and to prominently indicate in the subject line that the notice is related to the hospital's discount and charity care policies. (5) Existing law authorizes the State Department of Public Health to develop and administer a syndromic surveillance program and, subject to an appropriation, to either designate an existing system or to create a new system that would be required, at a minimum, to provide public health practitioners access to an electronic health system to rapidly collect, evaluate, share, and store syndromic surveillance data, as specified. This bill would make technical corrections to related provisions. (6) Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires a large group disability insurance policy and a small group disability insurance policy, except as specified, issued, amended, or renewed on or after January 1, 2026, to provide coverage for the diagnosis and treatment of infertility and fertility services, as specified. This bill would instead require a large group health insurance policy and a small group health insurance policy, except as specified, to offer the above-described services. (7) Existing law requires an insurer to provide an insured with an annual written or electronic notice regarding the benefits of a behavioral health and wellness screening, as defined, for children and adolescents 8 to 18 years of age. This bill would make technical changes to those provisions. (8) 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 requires, commencing January 1, 2022, that Community-Based Adult Services (CBAS) continue to be available as a capitated benefit for a qualified Medi-Cal beneficiary under a comprehensive risk contract with an applicable Medi-Cal managed care plan. This bill would make a technical correction to this provision. (9) Existing law, subject to any necessary federal approvals, sets forth various Medi-Cal provisions relating to complex rehabilitation technology (CRT) , which is a form of durable medical equipment, including, but not limited to, complex rehabilitation manual and power wheelchairs. Existing law requires a CRT provider to comply with certain standards, including requiring a qualified rehabilitation technology professional to be physically present for the evaluation. This bill would make a technical correction to this provision. (10) Existing law, the Sherman Food, Drug, and Cosmetic Law, provides for the regulation of various subjects relating to the manufacturing, processing, labeling, advertising, and sale of food, drugs, and cosmetics under the administration and enforcement of the State Department of Public Health. Existing law requires a manufacturer of baby food, as defined, for sale or distribution in this state to test a representative sample of each production aggregate of the manufacturer's final baby food product, at a proficient laboratory meeting certain criteria, for toxic elements, as specified. Existing law defines baby food as food packaged in jars, pouches, tubs, and boxes represented or purported to be specifically for babies and young children less than 2 years of age and excludes infant formula. This bill would clarify that baby food does not include dietary supplements, as defined. (11) 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.
Under existing law, the State Department of Health Care Services is responsible for administering prevention, treatment, and recovery services for alcohol and drug abuse. Existing law also provides for the certification and regulation of adult alcoholism or drug abuse recovery and treatment programs by the department and authorizes the department to enforce those provisions. Existing law requires the department's death investigation policy to be designed to ensure that a resident's death is addressed and investigated by the department in a timely manner, and requires specified procedures if a death occurs in a licensed facility, including requiring a written report related to the death that includes a description of the followup action that is planned to prevent a future death. Existing law requires that report to be submitted to the department within 7 calendar days of the event or incident. This bill, John's Law, would additionally require a facility to submit to the department, within 30 days of the initial incident, any relevant information that was not known at the time of the initial incident. If the department identifies any violations of specified licensing provisions during its investigation of a resident's death, the bill would require the department to issue a written notice of deficiency to the facility. The bill would authorize the department to implement, interpret, or make specific these provisions through the use of all-county letters, provider bulletins, or similar instructions without taking any further regulatory action.
Existing law establishes the California Children's Services (CCS) Program, administered by the State Department of Health Care Services and counties, to provide medically necessary services, based on financial eligibility, for persons under 21 years of age who have any of specified medical conditions, including, among others, cystic fibrosis or hemophilia. Existing law requires the board of supervisors of each county to designate the county department of public health or the county department of social welfare as the designated agency to administer the program. Existing law authorizes counties with a total population under 200,000 persons to administer the county program independently or jointly with the department. Existing law requires counties with a total population in excess of 200,000 persons to administer the county program independently. This bill would authorize counties with a total population under 2,000 persons to designate another county to administer the program, if the other county agrees to the designation and otherwise meets certain CCS standards established by the Director of Health Care Services and if neither county is a Whole Child Model county under certain provisions of the Medi-Cal program. The bill would require the department to adopt regulations necessary to implement these provisions.
(1) Existing law, the Pharmacy Law, requires the California State Board of Pharmacy within the Department of Consumer Affairs to license and regulate the practice of pharmacy, including pharmacists, pharmacy technicians, and pharmacies. Existing law authorizes the board, with the approval of the Director of Consumer Affairs, to appoint an executive officer to exercise certain powers and to perform certain duties delegated by the board, as specified. Existing law repeals the provisions establishing the board and authorizing the appointment of an executive officer on January 1, 2026, rendering the board subject to review by the appropriate policy committees of the Legislature. This bill would provide that the board has exclusive authority to administer and enforce the Pharmacy Law related to the practice of pharmacy and the licensing of pharmacists and pharmacies, and would specify that its provisions do not prohibit the board from evaluating or acting regarding unlicensed activity, as provided. The bill would extend the repeal date of the above-described provisions to January 1, 2030. The bill would additionally require the board to establish a Pharmacy Technician Advisory Committee to advise and make recommendations to the board, as specified. Existing law specifies the fees for issuance or renewal of licenses issued pursuant to the Pharmacy Law, including, among others, pharmacy licenses. This bill would require the board to waive the application fee for a pharmacy operating a physical location in a medically underserved area, as defined, and would authorize the board to waive the fee for the annual renewal of a license if the licensee provides the board with certification of continued operation in the medically underserved area. (2) Existing law authorizes a pharmacist to perform various procedures and functions, including those related to dispensing or furnishing drugs or devices, as specified. Existing law generally requires a pharmacist's dispensing or furnishing drugs to be done pursuant to a valid prescription, except as provided in specified circumstances. Those exceptions include furnishing an FDA-approved opioid antagonist, emergency contraception drug therapy, self-administered hormonal contraceptives, nicotine replacement products, certain medications for individuals traveling outside of the United States, and certain HIV medications, as specified. Existing law requires certain conditions to be met for a pharmacist to authorize the initiation of a prescription under certain of those exceptions or to otherwise provide clinical advice, services, information, or patient consultation. This bill would revise and recast the above-described provisions to authorize a pharmacist to, among other things, furnish dangerous devices, to furnish FDA-approved or authorized medications as part of preventative health care services that do not require a diagnosis, as specified, and to complete missing information on a prescription for a noncontrolled medication if there is evidence to support the change. The bill would require that a pharmacist provide those and other specified services or activities consistent with the accepted standard of care, defined to mean the degree of care a prudent and reasonable pharmacist licensed under the Pharmacy Law, with similar education, training, experience, resources, and setting, would use in a similar situation. The bill would make nonsubstantive, conforming changes. Existing law requires the clinical advice, services, information, or patient consultation that a pharmacist provides to be provided to a health care professional or to a patient. This bill would authorize a pharmacist to provide the clinical advice, services, information, or patient consultation to a patient's agent. Existing law, until January 1, 2026, authorizes a pharmacist to furnish COVID-19 oral therapeutics, as defined, following a positive test for SARS-CoV-2, the virus that causes COVID-19, in accordance with specified requirements. This bill would delete the January 1, 2026, repeal date, thereby extending this authorization indefinitely. Existing law prohibits a dangerous drug from being refilled without the authorization of the prescriber, except under specified circumstances. Under those circumstances, existing law requires a pharmacist to make every reasonable effort to contact the prescriber. This bill would remove the above-described requirement that the pharmacist make every reasonable effort to contact the prescriber. Existing law authorizes a pharmacist to dispense not more than a 90-day supply of a dangerous drug other than a controlled substance pursuant to a valid prescription that specifies an initial quantity of less than a 90-day supply followed by periodic refills of that amount if certain requirements are met. Existing law prohibits a pharmacist from dispensing a greater supply pursuant to that provision if the prescriber indicates that there is to be no change to the quantity of the refill, as specified. This bill would remove that prohibition. Existing law authorizes a pharmacy to dispense epinephrine auto-injectors to a prehospital emergency medical care person or lay rescuer for the purpose of rendering emergency care, as specified. This bill would remove the above-described authorization. (3) Existing law authorizes a licensed pharmacist to perform additional functions if the licensee is recognized by the board as "an advanced practice pharmacist" by meeting certain requirements. Those additional functions include, among others, performing patient assessments, ordering and interpreting drug therapy-related tests, and initiating, adjusting, or discontinuing drug therapy, as specified. The requirements for recognition as an advanced practice pharmacist include having completed a combination of specified certifications, postgraduate residencies, or experience under a collaborative practice agreement or protocol with a physician. Existing law also requires an advanced practice pharmacist to complete 10 hours of continuing education in addition to the continuing education otherwise required at the time of a second or subsequent license renewal. This bill would revise those and other related provisions to refer to those licensees as "advanced pharmacist practitioners," instead of as "advanced practice pharmacists." (4) Existing law prohibits any person from furnishing or dispensing any dangerous drug or device on the internet for delivery to any person in California without a prescription issued pursuant to a "good faith prior examination," as provided. This bill would instead refer to that examination as an "appropriate prior examination." (5) Existing law authorizes the board to issue citations containing fines and orders of abatement for violations of specified law, as provided. Existing law authorizes the board to bring an action against a chain community pharmacy under common ownership or management for fines for a violation of the Pharmacy Law that was expressly encouraged by the common owner or manager, as provided. This bill would instead apply those fines for a violation that was expressly encouraged by any owner or manager of the chain community pharmacy. Existing law authorizes the board to bring an action for fines for repeated violations of materially similar provisions of the Pharmacy Law within 5 years by 3 or more pharmacies operating under common ownership or management within a chain community pharmacy, as specified. Existing law provides a pharmacy with a defense if it establishes that the violation was contrary to a written policy that was communicated by the common owner or manager to all employees where the violation occurred. Existing law also provides a defense if the pharmacy establishes that, within 6 months after the violation, the common owner or manager corrected all unlawful policies, communicated the change in policies, and provided the board with proof of abatement of the violation, as specified. This bill would, for the defense that the violation was contrary to a written policy, also require the entity to establish that it has complied with the policy. The bill would revise the above-described corrective-actions defense by allowing those actions to be undertaken by any owner or manager of the pharmacy. The bill would additionally authorize the board to bring an action for fines for repeated violations of materially similar provisions of the Pharmacy Law against a mail order pharmacy, defined as a nonresident pharmacy that dispenses medications and ships them to patients via the postal service or other mail delivery method, as provided. The bill would require the board, in determining the amount of the fine, to consider mitigating and aggregating factors, as specified. (6) Existing law prohibits the board from issuing a pharmacy license to a person who has a shared community or financial interest with a person authorized to prescribe or write a prescription, as provided. This bill would establish an exception to the above-described prohibition under which the applicant and the prescriber would be required to provide statements that the prescriber disavows any community or financial interest in the license and to transmute any interest in the license that is shared community property into the separate property of the applicant, as provided. The bill would prohibit a pharmacy granted a license pursuant to this exception from filling any prescriptions issued or prescribed by a person who shares a community or other financial interest with the licensee or a prescriber at the same place of business as that person if the prescriber owns an interest greater than 10% in the practice issuing the prescription. Existing law authorizes the board to issue a retired license to a licensed pharmacist, as specified. Existing law authorizes the holder of a retired license to restore their license to active status by passing the examination that is required for initial licensure with the board. This bill would instead authorize the holder of a retired license to request to restore their license to active status within 3 years of issuance of the retired license by paying a renewal fee and successfully completing certain continuing education within the 2 years preceding the request, as specified. If more than 3 years have elapsed since the issuance of the retired license, the bill would require the holder of the retired license to reapply for licensure as a pharmacist, as specified. Existing law authorizes the board to deny a license application if the applicant has been convicted of a crime or subjected to formal discipline that would be grounds for denial of a federal registration to distribute controlled substances. This bill would also authorize the board to deny a license application if the applicant has been convicted of a crime involving fraud in violation of state or federal laws related to health care or involving financial identity theft. Existing law requires certain licensed facilities to perform a self-assessment evaluating compliance with specified provisions of the Pharmacy Law, as provided. This bill would require all licensed facilities to complete a self-assessment every odd-numbered year and within 30 days of certain changes to the license, management personnel, and location, as provided. The bill would require this self-assessment to be signed under penalty of perjury, thereby imposing a state-mandated local program by expanding the crime of perjury. (7) Existing law requires a pharmacy to designate a pharmacist-in-charge and notify the board within 30 days of that designation, as specified. Existing law authorizes the pharmacist-in-charge to, among other things, make staffing decisions and notify store management of dangerous conditions, as specified. This bill would require the pharmacist-in-charge to determine the appropriate pharmacist-to-technician ratio, within prescribed limits, and prohibit anyone else from interfering with the exercise of the pharmacist-in-charge's independent professional judgment in setting this ratio. The bill would additionally require the pharmacist-in-charge to notify the owner or hospital administrator of dangerous conditions, as specified. Existing law provides for the licensing of nonresident pharmacies, as specified. Existing law prohibits a pharmacist at a nonresident pharmacy whose license has been revoked from prescribing a dangerous drug or providing other pharmacy-related services, as specified. This bill would, beginning July 1, 2026, require a nonresident pharmacy, as a prerequisite to registering with the board and ongoing licensure, to identify a California-licensed pharmacist employed and working at the nonresident pharmacy to be proposed to serve as the pharmacist-in-charge. The bill would also require the nonresident pharmacy, within 90 days of designating a pharmacist-in-charge, to notify the board of the identity and license number of that pharmacist and the date they were designated, as specified. The bill would require the nonresident pharmacy, within 90 days, to notify the board of a pharmacist-in-charge ceasing to act as the pharmacist-in-charge and to propose another pharmacist to take over as the pharmacist-in-charge. The bill would additionally, beginning July 1, 2026, prohibit a nonresident pharmacy from permitting a pharmacist-in-charge who is not licensed in California from working at a nonresident pharmacy. The bill would authorize the board to inspect a nonresident pharmacy. The bill would require a nonresident pharmacy to deposit a reasonable amount, as determined by the board, necessary to cover the board's estimated reasonable costs of performing the inspection, as specified. (8) Existing law limits a pharmacy with only one pharmacist to one pharmacy technician performing packaging, manipulative, repetitive, or other nondiscretionary tasks. This bill would increase this limit to 3 pharmacy technicians performing those tasks. (9) Existing law requires a pharmacy to preserve certain records, as provided. This bill would require a pharmacy to additionally maintain records related to prescribed policies and procedures in a readily retrievable format. The bill would also impose requirements related to electronically maintained records. (10) This bill would incorporate additional changes to Section 4064.5 of the Business and Professions Code proposed by SB 418 to be operative only if this bill and SB 418 is enacted and this bill is enacted last. This bill would incorporate additional changes to Section 4076 of the Business and Professions Code proposed by AB 260 to be operative only if this bill and AB 260 are enacted and this bill is enacted last. (11) Because a violation of these provisions 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 Pharmacy Law, establishes in the Department of Consumer Affairs the California State Board of Pharmacy to license and regulate the practice of pharmacy. Exiting law requires a pharmacist, when furnishing self-administered hormonal contraceptives, to follow specified standardized procedures or protocols developed and approved by both the board and the Medical Board of California in consultation with the American Congress of Obstetricians and Gynecologists, the California Pharmacists Association, and other appropriate entities. Existing law requires those standardized procedures or protocols to require that the patient use a self-screening tool that will identify related patient risk factors and that require the pharmacist to refer the patient for appropriate followup care, as specified. Existing law requires the pharmacist to provide the recipient of the drug with a standardized factsheet that includes the indications and contraindications for use of the drug, the appropriate method for using the drug, the need for medical followup, and other appropriate information. Existing law authorizes a pharmacist furnishing an FDA-approved, self-administered hormonal contraceptive pursuant to the above-described protocols to furnish, at the patient's request, up to a 12-month supply at one time. This bill would limit the application of those requirements to self-administered hormonal contraceptives that are prescription-only, and would authorize a pharmacist to furnish over-the-counter contraceptives without following those standardized procedures or protocols. The bill would additionally authorize a pharmacist to furnish up to a 12-month supply at one time of over-the-counter contraceptives at the patient's request. The bill would make related conforming changes. This bill would declare that it is to take effect immediately as an urgency statute.
This measure would recognize May 2025 as Head Start Month and call on the Congress and the President of the United States to protect and increase funding for Head Start.
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, 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 authorizes the provision of Medi-Cal benefits by a contracted managed care plan and requires that benefits provided by a managed care plan are subject to specified time and distance standards. 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 or arranges for the provision of hospital or physician services to comply with specified timely access to care requirements, including ensuring that its network has adequate capacity and availability of licensed health care providers to offer enrollees and insureds appointments that meet specified timeframes. Existing law authorizes the department director to take enforcement action against health care plans that fail to comply with these provisions, including assessing administrative penalties. This bill would require, on or before July 1, 2027, the Department of Managed Health Care, the Department of Insurance, and the State Department of Health Care Services to consult together and with stakeholders develop and adopt standards for the geographic accessibility of perinatal units to ensure timely access for enrollees and insureds, as specified. The bill's provisions would become inoperative on July 1, 2033, and would be repealed on January 1, 2034. Because a violation by a health care service plan of a standard adopted by the Department of Managed Health Care 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.
(1) Existing law establishes the State Department of Public Health to, among other things, implement and administer various programs relating to public health. Existing law, the Valley Fever Education, Early Diagnosis, and Treatment Act, states the intent of the Legislature to raise awareness of the symptoms, tests, and treatments for valley fever among the general public, primary health care providers, and health care providers who care for persons at higher risk for getting valley fever. This bill, the Valley Fever Screening and Prevention Act of 2025, would require the department, in consultation with subject matter experts, to the extent feasible and using available data and resources, including public health surveillance data, to annually analyze and identify regions with elevated rates of valley fever. The bill would require the department to publish its first list of high-incidence regions for valley fever on or before March 1, 2027. The bill would require the department to provide local health departments in high-incidence regions with detailed infection data and standardized screening protocols that align with the current national clinical practice recommendations for valley fever. The bill would require the department, on or before January 1, 2030, and every 2 years thereafter, to evaluate the effectiveness of the valley fever screening and prevention program and report its findings to the Legislature. This bill would require local health departments in high-incidence areas to conduct outreach to health care providers and the general public to raise awareness of valley fever risks, symptoms, and prevention strategies. The bill would require local health departments to annually report the number of confirmed cases of valley fever to the department, as specified. By imposing duties on local health departments, this bill would impose a state-mandated local program. (2) Existing law provides for the licensure and regulation of health facilities and clinics by the State Department of Public Health. A violation of these provisions is a crime. This bill, commencing January 1, 2028, would require an adult patient receiving primary care services in a facility, clinic, unlicensed clinic, center, office, or other setting, and in a high-incidence region for valley fever, to be screened for valley fever, to the extent the services are covered under the patient's health insurance, unless specified circumstances exist. If the results of a screening suggest that testing should be considered, the bill would require the health care provider to offer the patient diagnostic testing. If the test result is positive, the health care provider shall offer care, as specified, for valley fever management. The bill would prohibit a health care provider who, based on their professional judgment, determines it is not appropriate to screen, offer to screen, or consider or offer a patient testing for valley fever from being subject to any disciplinary action related to their licensure, certification, or privileges in relation to that determination. The bill would also prohibit a violation of these provisions from being the basis of civil or criminal liability. By expanding the scope of a crime applicable to the health care settings described above, this bill would impose a state-mandated local program. (3) 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. This bill would prohibit a health care service plan contract or health insurance policy, except as specified, from imposing a deductible, coinsurance, copayment, or other requirement on a valley fever screening or test, as specified, in high-incidence regions for valley fever. Because a violation of this requirement relative to health care service plans would be a crime, the bill would impose a state-mandated local program. (4) 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 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, 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. Existing law, subject to CalAIM implementation, authorizes a Medi-Cal managed care plan to elect to cover community supports, as specified. 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 a Medi-Cal managed care plan, for purposes of covering the ECM benefit, or if it elects to cover a community support, to contract with community providers, as defined, that can demonstrate that they are capable of providing access and meeting quality requirements in accordance with Medi-Cal guidelines. In determining which community providers to contract with, the bill would authorize Medi-Cal managed care plans to take into consideration whether those providers are available in the respective county and have experience in providing the applicable ECM or community support. The bill would require the department, for purposes of enforcing these provisions, to require Medi-Cal managed care plans to set goals every other year for the level of contracting and utilization of community providers and local entities, as defined. The bill would require these goals to be established in consultation with the department, as specified. If a community provider contracted to provide ECM services or community supports submits a referral or authorization request for the applicable service on behalf of an eligible member, the bill would require a Medi-Cal managed care plan to assign the member to the contracted referring provider if the plan determines that the provider can appropriately meet the needs of the member. The bill would prohibit the above-described provisions from being construed to limit the department's authority to grant eligibility for presumptive authorization for categories of ECM providers that have extensive experience and expertise in serving certain ECM populations of focus. Existing law requires the department to develop, in consultation with Medi-Cal managed care plans and other appropriate stakeholders, a monitoring plan and reporting template for the implementation of ECM or community supports. Existing law requires the department to annually publish a public report on reported ECM or community support utilization data, populations served, and demographic data, stratified by age, sex, race, ethnicity, and languages spoken, to the extent that statistically reliant data are available. This bill would expressly include providers of ECM or community supports within the consultation process. The bill would require the department to publish the public report on a quarterly basis instead and would require additional demographic data. The bill would also require the department to develop standardized and streamlined templates to be used by Medi-Cal managed care plans or their contracted providers, as specified, and to develop guidance to allow community providers to act as a primary subcontractor with Medi-Cal managed care plans and to subcontract with other community providers as a 3rd-tier subcontractor, as specified.
