20250AB__016498AMD INTRODUCED 2025-01-08 AMENDED_SENATE 2026-06-26 2025 AB AMD Introduced by Committee on Budget (Assembly Members Gabriel (Chair), Addis, Ahrens, Alvarez, Bennett, Bonta, Caloza, Connolly, Fong, Haney, Hart, Jackson, Lee, Ortega, Patel, Petrie-Norris, Quirk-Silva, Ramos, Rogers, Schiavo, Schultz, Sharp-Collins, Solache, Stefani, Ward, and Wilson) LEAD_AUTHOR ASSEMBLY Committee on Budget Assembly Members Gabriel (Chair), Addis, Ahrens, Alvarez, Bennett, Bonta, Caloza, Connolly, Fong, Haney, Hart, Jackson, Lee, Ortega, Patel, Petrie-Norris, Quirk-Silva, Ramos, Rogers, Schiavo, Schultz, Sharp-Collins, Solache, Stefani, Ward, and Wilson <caml:Contribution>LEAD_AUTHOR</caml:Contribution><caml:House>ASSEMBLY</caml:House><caml:Name>Gabriel</caml:Name></caml:Legislator>"?>

An act to amend Sections and 2811.5 of, and to add Sections 2190.4, 2454.7, and 3524.65 to, the Business and Professions Code, to amend

Section 100520.5 of the Government Code, to amend Sections 1254, 1256.05, 1256.06, 1367.03, 1367.04, 1367.626, 1728.1, 1728.3, 1728.7, 1734, 1735, 11832.2, 11832.18, 11834.015, 11834.02, 11834.026, 11834.26, 11834.30, 11834.31, 11834.40, 11834.50, 11839.2, 11839.3, 11839.6.1, 11839.16, 120956, 127630, 127631, 127632, 127633, 127634, 127635, 127638, 130201, and of, to add Sections 1253.4, 1367.252, 1367.253, 1728.75, 1728.9, 1728.95, 127437, and 127631.1 to, to add

Chapter 11 (commencing with

Section 127770) to Part of Division of, and to repeal Sections 11834.29, 130204, 130206, 130208, and of, the Health and Safety Code, to amend

Section 10133.8 of, and to add Sections 10123.861 and 10123.862 to, the Insurance Code, to amend Sections 1602, 1603, and of the Penal Code, to amend

Section 30461.6 of the Revenue and Taxation Code, and to amend Sections 5892, 5963.02, 5963.04, 14005.36, 14005.37, 14007.5, 14007.65, 14007.8, 14016.2, 14019, 14019.6, 14043.26, 14132.100, 14154, 14184.101, 14184.102, 14184.200, 14184.404, 14197.2, and of, to amend, repeal, and add Sections 14005.62 and 14005.11 of, and to add Sections 4360.5, 5892.2, 14005.365, 14005.69, 14007.12, 14132.14, and 14184.900 to, the Welfare and Institutions Code, relating to health, and making an appropriation therefor, to take effect immediately, bill related to the budget. health, and making an appropriation therefor, to take effect immediately, bill related to the budget Health.

(1) 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 federal law, H.R. 1 (Public Law 119-21), enacted in 2025, sets forth various Medicaid eligibility changes for implementation at different stages of a certain timeline, including changes applied to beneficiaries between and years of age, inclusive, with income up to 138% of the federal poverty level, commonly known as Medicaid expansion adults. Federal H.R. 1 generally requires a Medicaid expansion adult to undergo an eligibility redetermination once every months, instead of an annual redetermination.

The federal law generally requires a Medicaid expansion adult to demonstrate community engagement through any of certain methods for the corresponding month, including a minimum of hours of work or community service or a minimum of half-time enrollment in an educational program. The federal law reduces the period of retroactive coverage prior to the date of Medicaid application from months to one month for Medicaid expansion adults and to months for other Medicaid beneficiaries.

The federal law requires the state to provide for a process to regularly obtain beneficiary address information from reliable data sources, and to utilize a system to prevent an individual from being simultaneously enrolled under Medicaid state plans or waivers of multiple states. This bill would make various changes to related state provisions, or would add new provisions, conforming them to the above-described changes under federal H.R. 1. The bill would require a county to accept specified methods of signatures for renewal forms.

Federal H.R. 1 restricts the scope of certain categories of immigrants who qualify for Medicaid eligibility. This bill would make conforming changes to related state provisions. The bill would also modify provisions regarding individuals with certain immigration statuses, so that they would be eligible for the full scope of Medi-Cal state-funded benefits, subject to certain service limitations. Existing law requires an individual without satisfactory immigration status, as specified, who is eligible for full-scope Medi-Cal to enroll in a Medi-Cal managed care plan.

This bill would instead specify that an individual without satisfactory immigration status who is eligible for the Medi-Cal program is eligible for services in the Medi-Cal fee-for-service delivery system. The bill would make conforming changes to related provisions. Existing law requires the department to develop an application for insurance affordability programs, including Medi-Cal, for use by all entities authorized to make an eligibility determination for those programs.

Existing law authorizes the department to develop and require use of supplemental forms to collect additional information needed to determine eligibility. This bill would make various changes to those provisions, relating to user testing, accuracy, readability, and the work or community engagement requirements under federal H.R. 1. The bill would require the department to undertake efforts to conduct outreach regarding the changes made under federal H.R. 1, and to establish a data dashboard.

Under the bill, beneficiary outreach and education would be coordinated across public social services programs to help minimize barriers to administrative disenrollments. The bill would incorporate federal H.R. 1 requirements into county outreach efforts, as specified. By creating new duties for counties regarding Medi-Cal eligibility determinations, procedures, and outreach, the bill would impose a state-mandated local program.

(2) Existing law, beginning no sooner than July 1, 2027, requires certain individuals who do not have satisfactory immigration status to pay a monthly premium of $30 as a condition of eligibility for the full scope of Medi-Cal benefits, subject to certain exceptions. This bill would require, no sooner than May 14, 2027, the Governor’s 2027–28 May Revision to include the level of the monthly premiums, to be set at no less than $30 and no greater than $50 per beneficiary.

Under existing law, no sooner than July 1, 2026, the above-described individuals who are years of age or older are not eligible for dental services under the Medi-Cal program, except as specified. This bill would delay the ineligibility for dental services to a period no sooner than July 1, 2027.

(3) Under existing law, to the extent that federal financial participation is available, federally qualified health center (FQHC) services and rural health clinic (RHC) services are covered Medi-Cal benefits. Under existing law, FQHC and RHC services are reimbursed on a per-visit basis, as defined. Under existing law, commencing on July 1, 2026, that reimbursement is conditioned on the services being eligible for federal financial participation. This bill would instead apply that condition commencing on July 1, 2027.

(4) Existing law, the California Advancing and Innovating Medi-Cal (CalAIM) Act, subject to receipt of any necessary federal approvals, establishes the CalAIM initiative in order to, among other things, improve quality outcomes, reduce health disparities, and transition and transform the Medi-Cal program to a more consistent and seamless system by reducing complexity and increasing flexibility. Under existing law, the CalAIM initiative ends on December 31, 2026.

Existing law appropriates to the department certain amounts of federal financial participation that the department is authorized to claim for expenditures associated with the designated state health programs identified in the CalAIM Terms and Conditions. Existing law appropriates to the Health Care Deposit Fund, a continuously appropriated fund, an amount of General Fund moneys equal to the federal financial participation for use by the department for CalAIM implementation purposes.

Existing law also continuously appropriates moneys from the Medi-Cal County Behavioral Health Fund to the department for purposes of implementing certain behavioral health provisions within CalAIM. This bill, subject to receipt of any necessary federal approvals, would extend the CalAIM initiative to December 31, 2031, thereby making an appropriation.

The bill would require the department to seek federal approval for implementation of Employment Supports and BridgeCare, the latter of which is to provide home- and community-based services and caregiver supports to individuals enrolled in the federal Medicare Program who meet the near dual eligibility criteria, as specified. Existing law requires an individual county, or counties acting jointly, to provide and administer covered behavioral health Medi-Cal benefits under a single Medi-Cal behavioral health delivery system contract, in accordance with the CalAIM Terms and Conditions.

This bill would require the county or counties, if participating in the Drug Medi-Cal organized delivery system, to deliver the behavioral health benefits through a single Prepaid Inpatient Health Plan.

(5) Existing law sets forth various requirements and procedures for the enrollment of providers in the Medi-Cal program. This bill, for the period beginning on July 1, 2026, and ending on June 30, 2027, would prohibit the granting of provisional or preferred provisional enrollment status in the Medi-Cal program to an applicant or provider as a result of the department’s failure to act within any of specified timeframes. Under those circumstances, the bill would require that the application remain pending unless and until the department issues a written determination consistent with all applicable state and federal Medicaid screening requirements.

(6) Existing law prohibits the use of an assets or resources test for individuals whose income eligibility for Medi-Cal is determined based on the application of a modified adjusted gross income (MAGI). Existing federal law authorizes a state to establish a non-MAGI standard for determining the eligibility of certain populations. Existing law, subject to receipt of any necessary federal approvals, implements a disregard of $130,000 in nonexempt property for a case with one member and $65,000 for each additional household member, up to a maximum of members, as specified.

This bill, beginning July 1, 2027, would instead implement a resource limit of $21,000 in nonexempt property for a household with one member, $31,000 for a household with members, and $1,550 for each additional household member, up to a maximum of members, as specified. The bill would make conforming changes to related provisions. By creating new duties for counties relating to the consideration of resources for determining Medi-Cal eligibility, the bill would impose a state-mandated local program.

(7) Existing law requires a Medi-Cal managed care plan to comply with a minimum 85% medical loss ratio consistent with certain federal regulations. Under existing law, after the department returns the requisite federal share amounts associated with any remittance funds collected in any applicable fiscal year to the federal Centers for Medicare and Medicaid Services, the remaining amounts remitted by a Medi-Cal managed care plan under these provisions are transferred to the Medi-Cal Loan Repayment Program Special Fund for purposes of the Medi-Cal Physicians and Dentists Loan Repayment Program.

This bill instead would deposit the remaining amounts remitted by a Medi-Cal managed care plan into the General Fund. The bill would remove an inoperative provision.

(8) Existing law requires the department to establish and maintain a plan, known as the County Administrative Cost Control Plan, whereby costs for county administration of the determination of eligibility for Medi-Cal benefits are effectively controlled within the amounts annually appropriated for that administration. Existing law makes legislative findings that, in order for counties to do the work that is expected of them, it is necessary that they receive adequate funding, including adjustments for reasonable annual cost-of-doing-business increases.

Existing law expresses the intent of the Legislature to not appropriate funds for cost-of-doing-business adjustments for the 2024–25 to 2027–28, inclusive, fiscal years, among certain other previous fiscal years. This bill would remove the 2026–27 and 2027–28 fiscal years from the above-described statement of intent regarding the lack of appropriation of funds for the cost-of-doing-business adjustments.

(9) Existing law provides for the licensure and regulation of health facilities, including general acute care hospitals and skilled nursing facilities, by the State Department of Public Health. A violation of these provisions is generally a crime. Existing law sets forth various provisions relating to distinct parts of acute care hospitals, including those operating skilled nursing facilities. Existing regulations define “distinct part” as an identifiable unit accommodating beds, including, but not limited to, contiguous rooms, a wing, floor, or building that is approved by the department for a specific purpose.

This bill would require a general acute care hospital seeking to provide skilled nursing services in a distinct part, as defined, to submit an application and documentation to the department. If the distinct part meets certain criteria, the bill would authorize the department to approve a hospital’s application for a distinct part on a case-by-case basis. The bill would require a skilled nursing distinct part to meet specified conditions, including, among others, being wholly owned by the hospital and being subject to the bylaws and operating decisions of the hospital’s governing body.

The bill would require a general acute care hospital seeking to add a composite distinct part to its license to submit a proposal to the department, as specified. Under the bill, “composite distinct part” would be defined as a distinct

part consisting of or more noncontiguous components that are not located within the same campus. If the department determines that the composite distinct part may improve access to care and address a specific unmet need in the geographical area served by the hospital, the bill would authorize the hospital to submit an application for approval of a composite distinct part. The bill would require a freestanding component of a composite distinct part to independently meet all of the licensing requirements applicable to a freestanding skilled nursing facility, including staffing requirements and ratios.

The bill would prohibit a hospital from using composite distinct parts to segregate residents by payment source or on a basis other than care needs. The bill would limit the hospital to a maximum of only one licensed skilled nursing distinct part, which may be a composite distinct part, with the hospital and the distinct part or composite distinct part having only one license number. The bill would set forth related identification duties for the department.

Existing law requires the department, upon approval, to issue a separate license for the provision of basic services relating to skilled nursing or intermediate care, whenever these basic services are to be provided by an acute care hospital in a separate freestanding facility, whether or not contiguous to the hospital. Existing law sets forth various exemptions to this requirement, including for beds licensed to an acute care hospital and located within the physical structure in which acute care is provided. This bill would exempt, from the above-described requirement, licensed skilled nursing beds in a distinct

part located on a general acute care hospital’s campus, as specified. Under the bill, a composite distinct part would be exempt only if the hospital’s license has a distinct part on its campus approved for skilled nursing. By creating new requirements for general acute care hospitals, distinct parts, and composite distinct parts, the violation of which would be a crime, the bill would impose a state-mandated local program.

(10) Existing law requires the State Department of Public Health to develop and maintain a statewide comprehensive community-based perinatal services program, as specified, to deliver services in medically underserved areas or areas with demonstrated need. Existing law requires the department, by July 1, 2026, to establish a 10-year pilot project within up to critical access hospitals to allow participating hospitals, on an application basis, to establish standby perinatal services, as defined.

Existing law requires, if qualified, the first hospitals selected to be nonprofit and located in the Counties of Humboldt and Plumas. This bill would require, if qualified, a nonprofit hospital located in the County of Lake to be one of the first hospitals selected. The bill would make various changes to certain criteria, with regard to staff responsibilities and procedures, for a hospital requesting approval to establish a standby perinatal service. Because a violation of these provisions would be a crime, the bill would impose a state-mandated local program.

The bill would make legislative findings and declarations as to the necessity of a special statute for the County of Lake.

(11) Existing law provides for the licensure and regulation of home health agencies by the State Department of Public Health. Existing law generally makes a violation of those provisions a misdemeanor. Existing law prescribes various requirements for the application for a home health agency license, including a provisional license for an applicant that has not been previously licensed.

This bill, except as provided, would require a home health agency to have an administrator, administrator designee, director of patient care services, and director of patient care services designee, and to submit to the department specified information for each individual on an initial application. The bill would require existing agencies to provide this information no later than March 31, 2027. The bill would require the department to verify specified details of home health agency management personnel.

The bill, except as provided, would require an applicant for licensure of a home health agency or a branch office to demonstrate an unmet need for home health services in the agency’s geographic service area. The bill would specify additional grounds by which the department is authorized to deny an application for, or suspend or revoke, a license. Because a violation of these provisions would be a crime, the bill would impose a state-mandated local program. The bill would prohibit the transfer of a license that is issued pursuant to these provisions.

The bill would prohibit the department from approving a change of ownership of a licensed home health agency within years of the date a license was initially issued to the licensee. The bill would authorize the department to make an exception for extenuating circumstances, as specified. The bill, for a specified period of time, would prohibit the department from issuing a new license to operate a home health agency or add a branch office to an existing license.

The bill would authorize the department to grant an exception upon a written finding that an applicant for a new license or with a pending application has demonstrated an unmet need for home health services in the area where the applicant proposes to operate. The bill would require the department to update existing home health agency regulations as necessary and adopt regulations that, among other things, clarify the maximum time and distance that home health agency staff may travel to reach patients, as specified.

(12) Existing law requires the State Department of Health Care Services to license and regulate alcohol or other drug programs that provide recovery, treatment, or detoxification services or medications for addiction treatment. Under existing law, a licensee is required to provide at least one specified nonmedical service.

Existing law requires the department to adopt American Society of Addiction Medicine (ASAM) treatment criteria, or an equivalent evidence-based standard, as the minimum standard of care for licensed facilities, and required the department to adopt regulations to implement the ASAM Criteria by January 1, 2023. The ASAM Criteria, 4th Edition, changes the levels of care for substance use treatment and integrates withdrawal management services, formerly referred to as detoxification services, into other care levels. This bill would recast detoxification as withdrawal management and would make conforming changes.

The bill would require a licensee to provide recovery and treatment services or recovery, treatment, and withdrawal management services. The bill would require a license to provide detoxification-only services to expire on July 1, 2027. The bill would prohibit a licensee from providing detoxification-only services on and after that date and would prohibit the department from issuing or extending a license for detoxification-only services on or after that date.

The bill would require the department to promulgate regulations to implement the ASAM Criteria by January 1, 2030, and in the interim would authorize the department to implement the ASAM Criteria through all-county letters, plan letters, information notices, or similar instructions. On and after July 1, 2027, the bill would require a licensee that provides withdrawal management services to provide those services as required in guidance issued by the department.

(13) Existing law imposes certain fair pricing requirements on hospitals, including, among other things, requiring that hospitals provide patients with a written notice containing information about the availability of the hospital’s discount payment and charity care policies and restricting the sale of patient debts. Existing law requires the Director of the Department of Health Care Access and Information to impose administrative penalties for each violation against a hospital that fails to comply with these provisions, except as specified.

This bill would establish the Hospital Fair Pricing Penalties Fund and would require any moneys collected from the above-described administrative penalties to be deposited into the fund. The bill would, upon appropriation, authorize the department to use moneys from the fund to carry out the above-described fair-pricing provisions.

(14) Existing law requires the Center for Data Insights and Innovation to compile an annual quality of care report card and produce an annual report regarding health care consumer or patient assistance help centers. Existing law establishes the Health Plan Improvement Trust Fund and requires moneys in the fund to be used for these purposes, upon appropriation by the Legislature. Existing law sets forth the shares of funding from the Managed Care Fund and Insurance Fund to be deposited into the Health Plan Improvement Trust Fund.

Existing law makes personal information obtained or maintained by the center confidential and exempt from other disclosure requirements. This bill would repeal and recast the above-described provisions to be administered by the Department of Health Care Access and Information beginning July 1, 2026. The bill would also make conforming changes.

Existing law requires the Department of Health Care Access and Information to establish and implement the California Health and Human Services Data Exchange Framework, which is required to include a single data sharing agreement and common set of policies and procedures that will leverage and advance national standards for information exchange and data content, and that will govern and require the exchange of health information among health care entities and governmental agencies in the state.

Existing law generally requires specified entities to execute the data sharing agreement on or before January 31, 2023, and to exchange health information or provide access to health information pursuant to the framework by July 1, 2026. This bill would delay required compliance with the above-described provisions until July 1, 2027, for specified community clinics, intermittent clinics, and rural health clinics.

(15) Existing law establishes the California Reproductive Health Equity Program within the Department of Health Care Access and Information to ensure abortion and contraception services are affordable for and accessible to all patients and to provide financial support for safety net providers of these services. Existing law authorizes a Medi-Cal enrolled provider to apply to the department for a grant, and a continuation award after the initial grant, to provide abortion and contraception services if specified criteria are met.

Existing law establishes the California Reproductive Health Equity Fund, a continuously appropriated fund, to provide this grant funding. Existing law establishes the Abortion Access Fund, a continuously appropriated fund in the State Treasury, to provide funding for abortion services. This bill would rename the program as the California Reproductive and TGI Health Equity Program, would expand the program’s purposes to ensure affordability and access to gender-affirming care, and would make conforming changes.

The bill would require the department to develop an application form and begin accepting grant applications on or before January 1, 2027. The bill would authorize the department to use the money in the Abortion Access Fund to provide grant funding to safety net providers for abortion services through the program and would expand the purposes of the California Reproductive Health Equity Fund to include grant funding for gender-affirming care services, thus making an appropriation. The bill would make contracts, grants, and related program information confidential and exempt from disclosure to the public.

(16) Existing law, the Medical Practice Act, provides for the licensure and regulation of physicians and surgeons by the Medical Board of California and requires the board to adopt and administer standards for the continuing education of those licensees. Existing law requires the board, in determining its continuing education requirements, to consider including a course in menopausal mental or physical health.

Existing law, the Osteopathic Act, provides for the licensure and regulation of osteopathic physicians and surgeons by the Osteopathic Medical Board of California and requires the board to adopt and administer standards for the continuing education of those licensees. Under this bill, beginning July 1, 2027, a qualifying physician and surgeon or osteopathic physician and surgeon who completes continuing medical education courses in perimenopause, menopause, and postmenopausal care would receive hours of credit for each hour completed of that coursework, as specified.

The bill would make changes to related provisions regarding course hours for nurse practitioners and physician assistants. 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 also provides for the regulation of health insurers by the Department of Insurance.

This bill would require a health care service plan contract or health insurance policy, as specified, to include coverage for certain treatments for menopausal symptoms, as medically necessary. The bill would require these contracts and policies to include a program that meets specified criteria to ensure the individuals have access to current menopause information and covered items and services.

The bill would require a plan or insurer to base a medical necessity determination or utilization review criteria for the treatment of symptoms resulting from menopause on current generally accepted standards of menopause care. Beginning January 1, 2027, the bill would require a plan or insurer conducting utilization review for the treatment of symptoms resulting from menopause to apply certain criteria and guidelines, as specified. 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. Existing law sets forth a

schedule of benefits under the Medi-Cal program. This bill would cover certain treatments for menopausal symptoms under the Medi-Cal program, subject to medical necessity and to the extent that federal financial participation is available. The bill would require the department to establish and maintain a policy to reimburse providers for provision of services related to menopause care.

(17) Existing law establishes the Breast Cancer Fund, which consists of accounts, the Breast Cancer Research Account and the Breast Cancer Control Account. Under existing law, revenues from a specified cigarette tax are deposited into the fund and divided between the accounts, to be allocated upon appropriation by the Legislature. Existing law requires 10% of moneys in the Breast Cancer Research Account to be allocated to the Cancer Surveillance Section, as specified. This bill would correct an erroneous reference within the above provisions.

(18) Existing law creates the California Health Benefit Exchange, also known as Covered California, to facilitate the enrollment of qualified individuals and qualified small employers in qualified health plans as required under the Patient Protection and Affordable Care Act (PPACA). Existing law establishes the Health Care Affordability Reserve Fund to be used, upon appropriation, for health care affordability programs operated by the Exchange, among other things.

Existing law requires the Exchange, upon appropriation, to provide payments equaling the cost of providing coverage of abortion services for which federal funding is prohibited to individuals enrolled in a qualified health plan through the Exchange in the individual market. Existing law prohibits the payments from being less than $1 per enrollee per month. This bill would require that the Health Care Affordability Reserve Fund be utilized, upon appropriation, for the above-described payments.

(19) Existing law, the Mental Health Services Act (MHSA), an initiative measure enacted by the voters as Proposition at the November 2, 2004, statewide general election, creates the Mental Health Service Fund, a continuously appropriated fund, for the purpose of funding a system of county mental health plans for the provision of mental health services. Existing law authorizes the Legislature to clarify procedures and terms of the MHSA by majority vote.

Existing law, the Behavioral Health Services Act (BHSA), a legislative act amending the MHSA that was approved by the voters as Proposition at the March 5, 2024, statewide primary election, recast the MHSA by, among other things, renaming the Mental Health Service Fund as the Behavioral Health Service Fund, expanding the MHSA to include treatment of substance use disorders, changing the county planning process, and expanding services for which counties and the state can use funds.

Existing law requires a county to calculate a maximum amount it establishes as the funding level for its prudent reserve for its Local Behavioral Health Services Fund, not to exceed 20% of the average of the total funds distributed to the county, as specified, and requires a county with a population of less than 200,000 to calculate a maximum amount it establishes as the prudent reserve for its Local Behavioral Health Services Fund, not to exceed 25% of the average of the total funds distributed to the county, as specified.

This bill would, commencing with the 2029–30 fiscal year and every fiscal years thereafter, require a county to calculate the maximum funding level of its prudent reserve, as specified, and include a plan for the expenditure of funds exceeding the maximum amount funding level in the county’s integrated plan.

Existing law requires the Controller, on or before the 15th day of each month, to distribute to each Local Behavioral Health Service Fund established by counties all unexpended and unreserved funds on deposit as of the last day of the prior month in the Behavioral Health Services Fund for the provision of behavioral health programs and other related activities pursuant to a methodology provided by the State Department of Health Care Services.

This bill, commencing July 1, 2028, would require the department to establish a methodology for determining annual minimum expenditure levels for funds distributed to counties, as described above. The bill would, beginning in the 2028–29 fiscal year, set the minimum expenditure level at the average annual amount of distributed funds for a county in the preceding years. The bill would require a county, commencing with the 2029–30 fiscal year and each fiscal year thereafter, to spend an amount of distributed funds that is equal to or greater than the minimum expenditure level for that fiscal year, as specified.

The bill would authorize a county to spend funds from its prudent reserve only during a fiscal year for which the department publishes a revised minimum expenditure level, during any fiscal year in which the amount of distributed funds is less than the minimum expenditure level calculated for that fiscal year, or during a fiscal year in which the county determines that there has been a change in local behavioral health needs or circumstances.

Existing law requires each county to prepare and submit an integrated plan and annual updates to the Behavioral Health Services Oversight and Accountability Commission and the department. Existing law requires the integrated plan and annual update to include a budget that includes the county planned expenditures and reserves for the county distributions from the Behavioral Health Service Fund and any other funds allocated to the county to provide specified services and programs.

Existing law requires all expenditures for county behavioral health programs to be consistent with a currently approved county integrated plan, annual update, or intermittent update. If a county fails to submit certain data and information or fails to allocate funding as specified, existing law authorizes the department to impose a corrective action plan, monetary sanctions, or temporarily withhold payments to the county.

Existing law requires these monetary sanctions to be deposited in the Behavioral Health Services Act Accountability Fund, a continuously appropriated fund, to be allocated and distributed to the county that paid the monetary sanction upon the department’s determination that the county has come into compliance. If a county fails to comply with the minimum expenditure requirements described above, this bill would authorize the department to impose a corrective action plan, monetary sanctions, or temporarily withhold payments to the county.

Because the monetary sanctions would be a new source of moneys for the Behavioral Health Services Act Accountability Fund, a continuously appropriated fund, this bill would make an appropriation. By creating additional duties for counties, the bill would impose a state-mandated local program.

(20) Existing law requires the State Department of State Hospitals to designate a community program director who is responsible for administering community treatment programs for certain committed persons. Existing law establishes the Forensic Conditional Release Program to provide outpatient and community-based treatment to committed persons. Existing law requires the department, until June 30, 2026, to establish a statewide panel of independent evaluators to identify and evaluate state hospital patients who are appropriate for participation in the program.

This bill would rename the independent evaluation panel as the independent placement panel. The bill would make certain changes to the designation process for case reviews and placement recommendations. The bill would extend these provisions indefinitely. Existing law prohibits outpatient status for a person who is charged with and found incompetent on a charge of, convicted of, or found not guilty by reason of insanity of, certain crimes until the person has actually been confined in a state hospital or other treatment facility for at least days.

Existing law permits outpatient status, without a person first being confined in a state hospital or other treatment facility, in the case of other crimes. Existing law requires the court to consider certain criteria before placing those persons on outpatient status. This bill would modify some of those factors that the court would be required to consider. The bill would also make changes to related provisions regarding procedures for the independent placement panel or designee to submit certain recommendations and for the court to give notice of hearing dates to specified entities.

(21) Existing law authorizes the State Public Health Officer, to the extent allowable under federal law, and upon the availability of funds, to expend moneys from the continuously appropriated AIDS Drug Assistance Program (ADAP) Rebate Fund for a program to cover the costs of prescribed ADAP formulary medications for the prevention of HIV infection and other specified costs.

This bill would additionally allow moneys from the ADAP Rebate Fund to be used to cover costs related to state and local public health department disease intervention and investigation activities and services for specified communicable diseases, to the extent that funds are available for these purposes. The bill would also allow moneys from the fund to be used to cover costs related to housing support and other programs or initiatives relating to HIV treatment or overdose prevention and harm reduction.

The bill would, to the extent deemed an allowable use of the fund, authorize the State Department of Public Health to spend up to $134,840,000 in fiscal year 2026–27, $134,490,000 in fiscal year 2027–28, $126,590,000 in fiscal year 2028–29, and $130,090,000 in fiscal year 2029–30, from the fund to implement specified programs. The bill would authorize the department to spend up to $50,000,000 for related purposes, as specified. By adding to the purposes of the ADAP Rebate Fund, the bill would make an appropriation.

(22) 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.

(23) Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest. This bill would make legislative findings to that effect.

(24) This bill would declare that it is to take effect immediately as a bill providing for appropriations related to the Budget Bill. This bill would express the intent of the Legislature to enact statutory changes relating to the Budget Act of 2025.</xhtml:p>"?> MAJORITY YES YES YES YES NO NO NO NO NO YES The people of the State of California do enact as follows:

SECTION

Section 2190.4 is added to the Business and Professions Code , to read: 2190.4. (

a) Beginning July 1, 2027, a qualifying physician and surgeon who completes continuing medical education courses in perimenopause, menopause, and postmenopausal care shall receive two hours of credit for each hour completed of that coursework, for a total earned credit that does not exceed eight course hours, toward the requirement set forth in

Section of Title of the California Code of Regulations. (

b) For purposes of this section, “qualifying physician and surgeon” means a holder of a physician’s and surgeon’s certificate from the board who is certified by a member board of the American Board of Medical Specialties in internal medicine, family medicine, obstetrics and gynecology, neurology, neurological surgery, or psychiatry and whose patient population includes adult women under years of age.

SEC. 2.

Section of the Business and Professions Code is amended to read: 2191. (

a) In determining its continuing education requirements, the board shall consider including a course in human sexuality, defined as the study of a human being as a sexual being and how they function with respect thereto, and nutrition to be taken by those licensees whose practices may require knowledge in those areas. (

b) The board shall consider including a course in child abuse detection and treatment to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with abused or neglected children. (

c) The board shall consider including a course in acupuncture to be taken by those licensees whose practices may require knowledge in the area of acupuncture and whose education has not included instruction in acupuncture. (

d) The board shall encourage every physician and surgeon to take nutrition as part of their continuing education, particularly a physician and surgeon involved in primary care. (

e) The board shall consider including a course in elder abuse detection and treatment to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with abused or neglected persons years of age and older. (

f) In determining its continuing education requirements, the board shall consider including a course in the early detection and treatment of substance abusing pregnant women to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with these women. (

g) In determining its continuing education requirements, the board shall consider including a course in the special care needs of drug-addicted infants to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with these infants. (

h) In determining its continuing education requirements, the board shall consider including a course providing training and guidelines on how to routinely screen for signs exhibited by abused women, particularly for physicians and surgeons in emergency, surgical, primary care, pediatric, prenatal, and mental health settings. In the event the board establishes a requirement for continuing education coursework in spousal or partner abuse detection or treatment, that requirement shall be met by each licensee within no more than four years from the date the requirement is imposed. (

i) In determining its continuing education requirements, the board shall consider including a course in the special care needs of individuals and their families facing end-of-life issues, including, but not limited to, all of the following:

(1) Pain and symptom management.

(2) The psychosocial dynamics of death.

(3) Dying and bereavement.

(4) Hospice care. (

j) In determining its continuing education requirements, the board shall give its highest priority to considering a course on pain management and the risks of addiction associated with the use of

Schedule II drugs. (

k) In determining its continuing education requirements, the board shall consider including a course in geriatric care for emergency room physicians and surgeons. (l)<xhtml:span class="EnSpace"/>In determining its continuing education requirements, the board shall consider including a course in menopausal mental or physical health.</xhtml:p>"?>

SEC.

Section 2454.7 is added to the Business and Professions Code , to read: 2454.7. (

a) Beginning July 1, 2027, a qualifying osteopathic physician and surgeon who completes continuing medical education courses in perimenopause, menopause, and postmenopausal care shall receive two hours of credit for each hour completed of that coursework, for a total earned credit that does not exceed eight course hours, toward the requirement set forth in

Section of Title of the California Code of Regulations. (

b) For purposes of this section, “qualifying osteopathic physician and surgeon” means a holder of a physician’s and surgeon’s certificate who is certified by a member board of the American Board of Medical Specialties or the American Osteopathic Association in internal medicine, family medicine, obstetrics and gynecology, neurology, neurological surgery, or psychiatry and whose patient population is composed of adult women under years of age.

SEC.

Section 2811.5 of the Business and Professions Code is amended to read: 2811.5. (

a) Each person renewing their license under

Section shall submit proof satisfactory to the board that, during the preceding two-year period, they have been informed of the developments in the registered nurse field or in any special area of practice engaged in by the licensee, occurring since the last renewal thereof, either by pursuing a course or courses of continuing education in the registered nurse field or relevant to the practice of the licensee, and approved by the board, or by other means deemed equivalent by the board. (

b) Notwithstanding

Section 10231.5 of the Government Code, the board, in compliance with

Section of the Government Code, shall do the following:

(1) By January 1, 2019, deliver a report to the appropriate legislative policy committees detailing a comprehensive plan for approving and disapproving continuing education opportunities.

(2) By January 1, 2020, report to the appropriate legislative committees on its progress implementing this plan. (

c) For purposes of this section, the board shall, by regulation, establish standards for continuing education. The standards shall be established in a manner to ensure that a variety of alternative forms of continuing education are available to licensees, including, but not limited to, online, academic studies, in-service education, institutes, seminars, lectures, conferences, workshops, extension studies, and home study programs.

The standards shall take cognizance of specialized areas of practice, and content shall be relevant to the practice of nursing and shall be related to the scientific knowledge or technical skills required for the practice of nursing or be related to direct or indirect patient or client care. The continuing education standards established by the board shall not exceed hours of direct participation in a course or courses approved by the board, or its equivalent in the units of measure adopted by the board. (

d) The board shall audit continuing education providers at least once every five years to ensure adherence to regulatory requirements, and shall withhold or rescind approval from any provider that is in violation of the regulatory requirements. (

e) The board shall encourage continuing education in spousal or partner abuse detection and treatment. In the event the board establishes a requirement for continuing education coursework in spousal or partner abuse detection or treatment, that requirement shall be met by each licensee within no more than four years from the date the requirement is imposed. (

f) In establishing standards for continuing education, the board shall consider including a course in the special care needs of individuals and their families, including, but not limited to, all of the following:

(1) Pain and symptom management, including palliative care.

(2) The psychosocial dynamics of death.

(3) Dying and bereavement.

(4) Hospice care. (g)

(1) In establishing standards for continuing education, the board shall consider including a course in menopausal mental or physical health.

(2) In establishing standards for continuing education, the board shall consider including a course in maternal mental health. (

h) This

section shall not apply to licensees during the first two years immediately following their initial licensure in California or any other governmental jurisdiction, except that, beginning January 1, 2023, those licensees shall complete one hour of direct participation in an implicit bias course offered by a continuing education provider approved by the board that meets all the same requirements outlined in paragraph (1) of subdivision (

f) of

Section 2786, including, but not limited to, the identification of the licensees’ previous or current unconscious biases and misinformation and corrective measures to decrease implicit bias at the interpersonal and institutional levels, including ongoing policies and practices for that purpose. (

i) The board may, in accordance with the intent of this section, make exceptions from continuing education requirements for licensees residing in another state or country, or for reasons of health, military service, or other good cause. (

j) For the purpose of fulfilling the requirements of subdivision (a), the following apply:

(1) A nurse practitioner who provides primary care to a patient population of which over percent are years of age or older shall certify that they have completed at least percent of all existing mandatory continuing education hours in a course in the field of gerontology, the special care needs of patients with dementia, or the care of older patients at the time of renewal.

(2) Beginning July 1, 2027, a nurse practitioner who provides care to a patient population composed of adult women under years of age who completes one or more continuing education courses in perimenopause, menopause, or postmenopausal care shall receive two hours for each hour of a completed course, not to exceed six hours, if the following are met: (

A) The course or course provider is accredited by one of the following: (

i) American Nurses Credentialing Center. (ii) American Association of Nurse Practitioners. (iii) Accreditation Council for Continuing Medical Education. (iv) Joint Accreditation for Interprofessional Continuing Education. (

v) The successor organization to an organization specified under this subparagraph. (

B) If the course covers multiple topics, the additional hours are only granted for the hours specified by the course provider as covering perimenopause, menopause, or postmenopausal care.

SEC.

Section 3524.65 is added to the Business and Professions Code , immediately following

Section 3524.6 , to read: 3524.65. Notwithstanding subdivision (

e) of

Section 3524.5, beginning July 1, 2027, a physician assistant who provides care to a patient population composed of adult women under years of age who completes one or more continuing education courses in perimenopause, menopause, or postmenopausal care shall receive two hours towards the requirement in

Section 3524.5 for each hour of a completed course, not to exceed eight hours.

SEC.

Section 100520.5 of the Government Code is amended to read: 100520.5. (

a) The Health Care Affordability Reserve Fund is hereby created in the State Treasury. (

b) Notwithstanding any other law, the Controller may use the funds in the Health Care Affordability Reserve Fund for cashflow loans to the General Fund as provided in Sections and 16381. (

c) Upon the enactment of the Budget Act of 2021, and upon order of the Director of Finance, the Controller shall transfer three hundred thirty-three million four hundred thirty-nine thousand dollars ($333,439,000) from the General Fund to the Health Care Affordability Reserve Fund. (

d) Upon appropriation by the Legislature, the Health Care Affordability Reserve Fund shall be utilized, in addition to any other appropriations made by the Legislature for the same purpose, for the purpose of health care affordability programs, benefit programs pursuant to

Section 100503.6, and payments authorized pursuant to

Section 100503.5, operated by the California Health Benefit Exchange. (e)

(1) The California Health Benefit Exchange shall, in consultation with stakeholders and the Legislature, develop options for providing cost sharing reduction subsidies to reduce cost sharing for low- and middle-income Californians. On or before January 1, 2022, the Exchange shall report those developed options to the Legislature, Governor, and the Healthy California for All Commission, established pursuant to

Section of the Health and Safety Code, for consideration in the 2022–23 budget process.

(2) In developing the options, the Exchange shall do all of the following: (

A) Include options for all Covered California enrollees with income up to percent of the federal poverty level to reduce cost sharing, including copays, deductibles, coinsurance, and maximum out-of-pocket costs. (

B) Include options to provide zero deductibles for all Covered California enrollees with income under percent of the federal poverty level and upgrading those with income between percent and percent, inclusive, of the federal poverty level to gold-tier cost sharing. (

C) Address any operational issues that might impede implementation of enhanced cost-sharing reductions for the calendar year. (

D) Maximize federal funding and address interactions with federal law regarding federal cost-sharing reduction subsidies.

(3) The Exchange shall make the report publicly available on its internet website.

(4) The Exchange shall submit the report in compliance with

Section of the Government Code. (

f) Upon order of the Department of Finance, a loan of six hundred million dollars ($600,000,000) is authorized from the Health Care Affordability Reserve Fund to the General Fund in the 2023–24 fiscal year. The loan shall be repaid in annual installments of two hundred million dollars ($200,000,000) over the 2026–27, 2027–28, and 2028–29 fiscal years.

SEC.

Section 1253.4 is added to the Health and Safety Code , to read: 1253.4. (a)

(1) A general acute care hospital, as defined in subdivision (

a) of

Section 1250, seeking to provide skilled nursing services in a distinct part shall submit an application and documentation to the State Department of Public Health. If the distinct part meets the requirements and criteria specified in this section, the department may approve a hospital’s application for a distinct part on a case-by-case basis consistent with

Section 1254. (2) “Distinct part” means an identifiable unit accommodating beds and related facilities, including, but not limited to, contiguous rooms, a wing, a floor, or a building. A skilled nursing distinct part may comprise one or more buildings or designated parts of buildings. The term “distinct part” includes a “composite distinct part” that is not on the hospital’s campus and that meets the definition, requirements, and other criteria specified in this section. (A) “Composite distinct part” means a distinct

part consisting of two or more noncontiguous components that are not located within the same campus. (B) “Campus” means the physical area immediately adjacent to the hospital’s main buildings or to other areas and structures that are not strictly contiguous to the main buildings. (

C) If the requirements for a “distinct part” and a “composite distinct part” conflict, then the more specific and strict standards shall apply. (

b) A skilled nursing distinct part shall meet and be subject to state licensing statutes and regulations applicable to skilled nursing facilities, unless there is a specific exception or exemption applicable to a distinct part. (c)

(1) A skilled nursing distinct part shall meet all of the following conditions: (

A) Be under the same ownership, control, and governance as the general acute care hospital of which it is a distinct part. (

B) Be wholly owned by the general acute care hospital of which it is a distinct part. (

C) Be subject to the bylaws and operating decisions of the hospital’s governing body.

(2) The general acute care hospital shall have final responsibility for the skilled nursing distinct part’s administrative decisions and personnel policies and procedures. (

d) A general acute care hospital seeking to add a composite distinct part to its license shall submit a proposal to the department demonstrating that a composite distinct part would improve access to care and serve a specific unmet need in the geographical area served by the hospital. If the department determines that the composite distinct part may improve access to care and address a specific unmet need in the geographical area served by the hospital, the general acute care hospital may submit an application with documentation for approval of a composite distinct part. (

e) In deciding whether to approve a general acute care hospital’s application for a composite distinct part, the department may consider the following additional criteria:

(1) Whether the facility is in a rural or underserved area.

(2) The compliance history of the general acute care hospital, the existing distinct part, and the entities and individuals involved with the ownership, administration, operation, and governance of the facilities.

(3) The plan of operation and plan for sharing services with the general acute care hospital and other components of the composite distinct part.

(4) Ability to demonstrate and maintain compliance with the requirements of this

section and the licensing statutes and regulations applicable to skilled nursing facilities.

(5) Whether the general acute care hospital and the components of the composite distinct part are so organizationally or geographically separate that it is not feasible to operate and provide safe, quality, and adequate care as a single licensed entity.

(6) Any additional criteria that the department deems relevant or necessary to protect resident safety or ensure quality of care. (

f) Each composite distinct

part component that is not located on the general acute care hospital’s campus shall have a dedicated nursing home administrator. (

g) The skilled nursing distinct part shall be integrated with the general acute care hospital of which it is a distinct part. The skilled nursing distinct part shall function as an integral and subordinate part of the hospital of which it is a distinct part, which includes, but is not limited to, common resource usage of buildings, equipment, personnel, and services. (

h) A general acute care hospital shall have a maximum of only one licensed skilled nursing distinct part, which may be a composite distinct part.

(1) A general acute care hospital with a distinct part or composite distinct part shall have only one license number.

(2) The department shall identify on the general acute care hospital’s license each distinct part, including the number of beds, location, and address of each distinct part and components of a composite distinct part. (

i) Each freestanding component of a composite distinct part shall independently meet all of the licensing requirements applicable to a freestanding skilled nursing facility, including staffing requirements and ratios. Staffing exceptions for distinct parts, including, but not limited to, the distinct part exception in

Section 1276.65, shall not apply to a freestanding component of a composite distinct part. (

j) The general acute care hospital shall not use composite distinct parts to segregate residents by payment source or on a basis other than care needs. (

k) Existing distinct parts shall meet the requirements of this

section before they are approved as a composite distinct part. In deciding whether to approve a consolidation, change of ownership, or other similar restructuring, the department shall consider whether the composite distinct part meets the requirements and satisfies the criteria described in this section. (

l) Notwithstanding any other law, the department may, without taking any regulatory actions pursuant to

Chapter 3.5 (commencing with

Section 11340) of Part of Division of Title of the Government Code, implement, interpret, or make specific this

section by means of an All Facilities Letter (AFL) or similar instruction.

SEC. 8.

Section of the Health and Safety Code is amended to read: 1254. (

a) Except as provided in subdivisions (

e) and (f), the state department shall inspect and license health facilities. The state department shall license health facilities to provide their respective basic services specified in

Section 1250. Except as provided in

Section 1253, the state department shall inspect and approve a general acute care hospital to provide special services as specified in

Section 1255. The state department shall develop and adopt regulations to implement the provisions contained in this section. (

b) Upon approval, the state department shall issue a separate license for the provision of the basic services enumerated in subdivision (

c) or (

d) of

Section whenever these basic services are to be provided by an acute care hospital, as defined in subdivision (a), (b), or (

f) of that section, where the services enumerated in subdivision (

c) or (

d) of

Section are to be provided in any separate freestanding facility, whether or not the location of the separate freestanding facility is contiguous to the acute care hospital. The same requirement shall apply to any new freestanding facility constructed for the purpose of providing basic services, as defined in subdivision (

c) or (

d) of

Section 1250, by any acute care hospital on or after January 1, 1984. (c)

(1) Those beds licensed to an acute care hospital which, prior to January 1, 1984, were separate freestanding beds and were not part of the physical structure licensed to provide acute care, and which beds were licensed to provide those services enumerated in subdivision (

c) or (

d) of

Section 1250, are exempt from the requirements of subdivision (b). (2) (

A) All beds licensed to an acute care hospital and located within the physical structure in which acute care is provided are exempt from the requirements of subdivision (

b) irrespective of the date of original licensure of the beds, or the licensed category of the beds. (

B) Licensed skilled nursing beds in a distinct

part located on a general acute care hospital’s campus are exempt from subdivision (b). If a general acute care hospital has a distinct part approved for skilled nursing beds on its campus, the state department may approve additional licensed skilled nursing beds in a composite distinct part that meets the applicable definition, requirements, and criteria set forth in

Section 1253.4. A composite distinct

part is exempt from subdivision (

b) only if the general acute care hospital’s license has a distinct part on its campus approved for skilled nursing.

(3) All beds licensed to an acute care hospital owned and operated by the State of California or any other public agency are exempt from the requirements of subdivision (b).

(4) All beds licensed to an acute care hospital in a rural area as defined by

Chapter 1010, of the Statutes of 1982, are exempt from the requirements of subdivision (b), except where there is a freestanding skilled nursing facility or intermediate care facility that has experienced an occupancy rate of percent or less during the past months within a 25-mile radius or that may be reached within minutes using a motor vehicle.

(5) All beds licensed to an acute care hospital that meet the criteria for designation within peer group six or eight, as defined in the report entitled Hospital Peer Grouping for Efficiency Comparison, dated December 20, 1982, and published by the California Health Facilities Commission, and all beds in hospitals that have fewer than licensed acute care beds and that are located in a census designation place of 15,000 or less population, are exempt from the requirements of subdivision (b), except where there is a freestanding skilled nursing facility or intermediate care facility that has experienced an occupancy rate of percent or less during the past months within a 25-mile radius or that may be reached within minutes using a motor vehicle.

(6) All beds licensed to an acute care hospital that has had a certificate of need approved by a health systems agency on or before July 1, 1983, are exempt from the requirements of subdivision (b).

(7) All beds licensed to an acute care hospital are exempt from the requirements of subdivision (b), if reimbursement from the Medi-Cal program for beds licensed for the provision of services enumerated in subdivision (

c) or (

d) of

Section and not otherwise exempt does not exceed the reimbursement that would be received if the beds were in a separately licensed facility. (

d) Except as provided in

Section 1253, the state department shall inspect and approve a general acute care hospital to provide special services as specified in

Section 1255. The state department shall develop and adopt regulations to implement subdivisions (

a) to (d), inclusive, of this section. (

e) The State Department of Health Care Services shall inspect and license psychiatric health facilities. The State Department of Health Care Services shall license psychiatric health facilities to provide their basic services specified in

Section 1250.2. The State Department of Health Care Services shall develop, adopt, or amend regulations to implement this subdivision. (

f) The State Department of Health Care Services shall inspect and license psychiatric residential treatment facilities as defined in

Section 1250.10.

SEC.

Section 1256.05 of the Health and Safety Code is amended to read: 1256.05. (

a) For purposes of this

section and

Section 1256.06, the following

definitions apply: (1) “Critical access hospital” means a hospital designated by the State Department of Public Health as a critical access hospital, and certified as such by the Secretary of the United States Department of Health and Human Services under the federal Medicare Rural Hospital Flexibility Program. (2) “Department” means the State Department of Public Health, unless otherwise specified. (3) “Standardized order sets” means predefined groups of orders that support clinical decisions, including, but not limited to, appropriate treatments, medications, and dosages, for specific conditions or procedures and that are developed using relevant evidence-based guidelines. (4) “Standby perinatal services” means the provision of obstetric and neonatal medical care to patients who are transferred from an alternative birth center, or who present to the hospital’s emergency department with an urgent or emergent obstetric issue, in a specifically designated area of the hospital that is equipped and maintained at all times to receive patients and capable of providing physician, midwifery, and nursing services within a reasonable time not to exceed minutes. (

b) The department shall do all of the following:

(1) By July 1, 2026, establish a 10-year pilot project within up to five critical access hospitals to allow participating hospitals to establish standby perinatal services. If qualified, the first three hospitals selected shall be nonprofit and located in the Counties of Humboldt, Lake, and Plumas. Up to two additional critical access hospitals may be selected at any time if the application includes a signed agreement from the exclusive employee representatives of the workforce that the proposed pilot project site would not adversely impact the workforce or includes an attestation that there is no existing exclusive employee representative.

(2) Within a reasonable time, determine whether hospitals requesting to participate meet applicable statutory requirements, including, but not limited to, maintaining all of the following: (

A) Ability to meet the standards of the standby perinatal service, as described in

Section 1256.06. (

B) Surgery and anesthesia as basic services of the hospital. (

C) Capability for obtaining or performing timely blood gas, pH, and microbiologic analyses. (

D) Ability to maintain premixed infusions. (

E) A basic emergency medical service, comprehensive emergency medical service, or standby emergency medical service licensed as a supplemental service. (F) (

i) A designated room or rooms for the standby perinatal service space. A hospital may designate an existing room or rooms with a licensed general acute care bed as the standby perinatal service space.

If a hospital designates an existing room or rooms for the standby perinatal service space, the hospital may continue to provide general acute care services in that room or rooms when the room or rooms are not in use by the standby perinatal services only if all remaining general acute care beds are occupied or a plan for management of perinatal patients using alternate space is approved by the department. (ii) The operating room may serve as the delivery room in hospitals having a licensed bed capacity of or less, but the operating room shall not serve as the sole standby perinatal service space. (G)</xhtml:p>"?>

(3) In consultation with stakeholders, establish any additional requirements that the department deems necessary to protect patient safety or to ensure quality of care under the pilot project. (3)</xhtml:p>"?> (4) (

A) Develop a template to collect and evaluate data on safety, outcomes, utilization, and populations served under the pilot project using stratified demographic data, to the extent statistically reliable data are available and comply with medical privacy laws and practices. The department may, in consultation with relevant stakeholders, establish additional requirements for participating hospitals to collect and report any additional data under the pilot project that the department deems necessary. (

B) Compile the data collected pursuant to subparagraph (A), prepare and submit an evaluation to the Legislature, and make the evaluation publicly available. The department shall submit the evaluation to the Legislature on or before two years after the completion of the pilot project. Data-collection requests shall be provided in a timely manner to enable the pilot hospital to collect and report the data before the deadline. The evaluation to be submitted to the Legislature pursuant to this subparagraph shall be submitted in compliance with

Section of the Government Code. (4)</xhtml:p>"?>

(5) Consult with relevant state departments and stakeholders on the implementation of the requirements of this subdivision. The department shall invite representatives of hospitals, consumers, the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Nurse-Midwives, health plans, labor, and other health care professionals who provide pediatric and pregnancy-related services, including, but not limited to, registered nurses, certified nurse-midwives, and licensed midwives. (

c) A hospital seeking to participate in the pilot project shall submit an application to the department. (

d) An approved standby perinatal service shall be subject to all relevant licensing enforcement provisions as established under this

chapter and

Chapter 1 (commencing with

Section 70001) of Division of Title of the California Code of Regulations. (

e) If, at any time, a hospital with a standby perinatal service fails to meet the requirements set forth in this

section or

Section 1256.06, or fails to ensure patient health and safety, as determined by the department, the department may suspend or revoke its approval of the hospital’s participation in the pilot project. (f)<xhtml:span class="EnSpace"/>(1)<xhtml:span class="EnSpace"/>Notwithstanding any other law or regulation, a hospital participating in the pilot project may, in consultation with the medical and any other relevant staff, request program flexibility for the statutory requirements of this

section or

Section 1256.06, in order to meet the particular capacities and needs of the hospital and community.</xhtml:p><xhtml:p>(2)<xhtml:span class="EnSpace"/>If the department approves the request described in paragraph (1), the department’s approval shall provide for the terms and conditions under which the program flexibility is granted.</xhtml:p><xhtml:p>(3)<xhtml:span class="EnSpace"/>To request program flexibility for the statutory requirements of this

section or

Section 1256.06, the hospital shall follow existing procedures established by the department for program flexibility requests pursuant to subdivision (

b) of

Section 1276.</xhtml:p>"?> (g)</xhtml:p>"?> (

f) Notwithstanding any other law, the department may, without taking any regulatory actions pursuant to

Chapter 3.5 (commencing with

Section 11340) of Part of Division of Title of the Government Code, implement, interpret, or make specific this

section and

Section 1256.06 by means of an All Facilities Letter (AFL) or similar instruction.

SEC.

Section 1256.06 of the Health and Safety Code is amended to read: 1256.06. A hospital requesting approval to establish a standby perinatal service pursuant to

Section 1256.05 shall implement and maintain all of the following requirements: (a)

(1) Comply with the most recent standards and recommendations for Level I (Basic Care) of the Levels of Maternal Care and Level 1 (Well Newborn Nursery) of the Neonatal Levels of Care, within the Guidelines for Perinatal Care developed by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists.

(2) Have the capacity for operative delivery, including caesarean section, and neonatal resuscitation and stabilization at all times.

(3) Have the ability, equipment, and supplies necessary to provide care for mothers and infants needing emergency or immediate life support measures to sustain life up to hours or to prevent major disability, including, but not limited to, all of the following services: (

A) Administration of intravenous or intramuscular antibiotics. (

B) Administration of intravenous or intramuscular uterotonic drugs, including oxytocin. (

C) Administration of intravenous or intramuscular anticonvulsants. (

D) Administration of antihypertensives. (

E) Manual removal of the placenta. (

F) Removal of retained products of conception. (

G) Basic neonatal resuscitation. (

H) Surgery, including caesarean sections. (

I) Blood transfusions. (

J) Additional services specified by the department, in consultation with relevant stakeholders.

(4) Have capabilities for risk identification and determination of conditions necessitating consultation, referral, and transfer.

(5) Have capabilities, including necessary equipment, for stabilization and the ability to facilitate transfer or transport to a higher level of care at all times. (6) (

A) Have the equipment and supplies specified in

Section of Title of the California Code of Regulations, or its successor. (

B) In addition to the items required under subparagraph (A), have all of the following equipment and supplies: (

i) A fetal heart rate monitor that includes both the ability to monitor multiple gestation pregnancies using internal monitors, including fetal scalp electrodes and intrauterine pressure catheters, and maternal pulse integrated to ensure monitoring of fetal pulse and not maternal pulse. (ii) Provision for oxygen and suction for the mother and infant, including, but not limited to, specialized supplies needed for neonatal resuscitation and breathing support. (iii) A ventilatory assistance bag and infant masks of assorted sizes for infants of different gestational ages. (iv) A postpartum hemorrhage kit, including a uterine tamponade device. (

v) Neonatal resuscitation supplies, including supplies for umbilical access for medications. (vi) Maternal steroid medications available for initial administration in the case of preterm labor while awaiting transport. (vii) A refrigerated medication storage unit in the standby perinatal service for uterotonic medications requiring refrigerated storage to be immediately accessible in emergencies. (viii) A suction device appropriate for neonatal resuscitation. (b)

(1) Define the responsibilities of the medical staff and administration associated with the standby perinatal services. Defined responsibilities shall be consistent with the medical staff bylaws and policies established in consultation with the medical staff. (2) (

A) Ensure that a provider of services subject to this

section meets all applicable requirements set forth in both of the following: (

i) The medical staff bylaws. (ii) Rules, regulations, and policies of that facility. (

B) Nothing in this

section shall be construed to require changes to the medical staff bylaws or policies regarding credentialing or privileges. (c)

(1) Ensure that a physician who is certified, or eligible for certification, by the American Board of Obstetrics and Gynecology, the American Board of Pediatrics, or the American Board of Family Medicine, and who is a member of the medical staff of the facility, has overall responsibility for the standby perinatal services.

(2) The physician described in paragraph (1) shall be responsible for the development of, and the hospital shall be responsible for the implementation of, policies and procedures for all of the following: (

A) Policies and procedures specified in paragraphs (1) to (28), inclusive, of subdivision (

b) of

Section of Title of the California Code of Regulations that align with the standards specified in paragraph (1) of subdivision (a). (

B) Admission policies for infants transferred from an alternative birth center. (

C) Consultations, including, but not limited to, real-time telemedicine services, between the standby perinatal service and health care personnel from an intensive care newborn nursery and from a perinatal service, qualified and available at all times to provide maternal fetal medicine consultation. (

D) Formal arrangements for consultation or transfer of an infant and a mother to a hospital with the necessary services for medical needs beyond the capability of the standby perinatal services. (

E) Current state newborn screening requirements. (

F) Standby perinatal service activation protocols. (

G) Condition-specific management protocols outlining best practices. (

H) Emergency codes. (I)<xhtml:span class="EnSpace"/>Monitoring and checkoff to ensure that equipment stays in the standby perinatal service and does not outdate.</xhtml:p>"?> (J)</xhtml:p>"?> (

I) Documentation standards for antepartum, intrapartum, postpartum, and newborn care. (K)</xhtml:p>"?> (

J) Surgery and anesthesia services readily available at all times. (L)</xhtml:p>"?> (

K) Arrangements for incidents of more than one patient requiring the use of the designated standby perinatal service space. (M)</xhtml:p>"?> (

L) Care management for mothers, fetuses, and neonates in alignment with the standards specified in this section. (N)</xhtml:p>"?> (

M) Development by an appropriate committee of the medical staff of standardized obstetric and newborn nursing procedures and standardized order sets for pregnant patients presenting to the emergency department and for the standby perinatal service, and for neonates. The committee shall annually review the standardized order sets and update them as necessary. (O)</xhtml:p>"?> (

N) Convening of an appropriate obstetric and neonatal or pediatric committee that, at a minimum annually, evaluates the services provided and makes appropriate recommendations to the executive committee of the medical staff and administration. (

d) In consultation with the physician described in subdivision (

c) and with other appropriate health care professionals, do all of the following:

(1) Implement and maintain contracts, and transfer agreements as applicable, and develop and implement policies and procedures for any maternal or neonatal care outside the scope of the standby perinatal service, including, but not limited to, all of the following services: (

A) Transfer of mothers and neonates to appropriate higher levels of care, including a reliable, accurate, and comprehensive communication system between hospitals initiating and hospitals receiving a patient transfer from a standby perinatal service, hospital personnel, and transport teams. (

B) A blood bank, if the facility might need additional blood. (

C) Ambulance transport and rescue services.

(2) Develop a system for ensuring coverage to provide care for both the mother and the neonate, on call hours a day for the standby perinatal service, including, but not limited to, both of the following: (

A) Physician and nursing staff coverage onsite within minutes. (

B) A roster of physicians and certified nurse-midwives who have an agreement or contract with the hospital, and their immediate contact information, who are available to provide emergency perinatal services.

(3) Have a registered nurse immediately available within the hospital to provide nursing care, including emergency maternal fetal triage and infant resuscitation.

(4) Develop a roster of specialty physicians who have an agreement or contract with the hospital, and their immediate contact information, who are available for consultation at all times.

(5) Conduct monitoring and checkoff to ensure that equipment stays in the standby perinatal service and does not outdate, including a process for the medical staff to report equipment and supplies that are out of date or that were not replaced prior to expiration.

(6) Ensure continuing education for the medical staff.

(7) Establish, and document compliance with, continuing education and training program requirements for nursing staff in perinatal nursing and infection control, including, but not limited to, all of the following: (

A) Biennial, week-long rotations at a Level II, III, or IV maternal or neonatal care facility. (

B) Participation in simulation-based training to reinforce response to obstetric emergencies. (

C) All other continuing education and training programs that are necessary to ensure the safe provision of care for both mothers and neonates in the standby perinatal service. (8) (

A) Annually verify and document all nursing competencies, including, but not limited to, maternal care, fetal and newborn care, postdelivery care, and emergency condition competencies. (

B) Maintain evidence of continuing education and training programs for the nursing staff in perinatal nursing and infection control, including all of the following: (

i) Documented current registered nurse license. (ii) Current Basic Life Support (BLS) certification. (iii) Current Advanced Cardiovascular Life Support (ACLS) certification. (iv) Electronic fetal monitoring certification. (

v) S.T.A.B.L.E. neonatal education program certification. (vi) Neonatal resuscitation program certification. (

e) Require a physician, certified nurse-midwife, or registered nurse to attend to patients, within the scope of their licensure, under the effect of anesthesia or regional anesthesia, when in active labor, during delivery, or in the immediate postpartum period. (

f) Initiate and sustain an education program and a quality improvement program that are specific to the standby perinatal services to maximize patient safety, in collaboration with facility partners that provide higher levels of care. (

g) Comply with the existing licensed nurse-to-patient ratios for a combined labor/delivery/postpartum area of perinatal services. This subdivision does not alter or amend the effect of any regulation adopted pursuant to

Section 1276.4. (

h) Report the data required by

Section 1256.05 quarterly and in the manner and method required by the department. (

i) Maintain compliance with federal Medicare obstetrical services conditions of participation, if applicable. (j)

(1) Notwithstanding any other law or regulation, a hospital participating in the pilot project may, in consultation with the medical staff and any relevant personnel, request program flexibility for the statutory requirements of this section, in order to meet the particular capacities and needs of the hospital and community.

(2) If the department approves the request described in paragraph (1), the department’s approval shall provide for the terms and conditions under which the program flexibility is granted.

(3) To request program flexibility for the statutory requirements of this section, the hospital shall follow existing procedures established by the department for program flexibility requests pursuant to subdivision (

b) of

Section 1276.

SEC.

Section 1367.03 of the Health and Safety Code is amended to read: 1367.03. (

a) A health care service plan that provides or arranges for the provision of hospital or physician services, including a specialized mental health plan that provides physician or hospital services, or that provides mental health services pursuant to a contract with a full service plan, shall comply with the following timely access requirements:

(1) A health care service plan shall provide or arrange for the provision of covered health care services in a timely manner appropriate for the nature of the enrollee’s condition consistent with good professional practice. A plan shall establish and maintain networks, policies, procedures, and quality assurance monitoring systems and processes sufficient to ensure compliance with this clinical appropriateness standard. A health care service plan that uses a tiered network shall demonstrate compliance with the standards established by this

section based on providers available at the lowest cost-sharing tier.

(2) A health care service plan shall ensure that all plan and provider processes necessary to obtain covered health care services, including, but not limited to, prior authorization processes, are completed in a manner that assures the provision of covered health care services to an enrollee in a timely manner appropriate for the enrollee’s condition and in compliance with this section.

(3) If it is necessary for a provider or an enrollee to reschedule an appointment, the appointment shall be promptly rescheduled in a manner that is appropriate for the enrollee’s health care needs, and ensures continuity of care consistent with good professional practice, and consistent with this

section and the regulations adopted thereunder.

(4) Interpreter services required by

Section 1367.04 of this code and

Section 1300.67.04 of Title of the California Code of Regulations shall be coordinated with scheduled appointments for health care services in a manner that ensures the provision of interpreter services at the time of the appointment without imposing delay on the scheduling of the appointment. This subdivision does not modify the requirements established in

Section 1300.67.04 of Title of the California Code of Regulations, or approved by the department pursuant to

Section 1300.67.04 of Title of the California Code of Regulations for a plan’s language assistance program.

(5) In addition to ensuring compliance with the clinical appropriateness standard set forth in paragraph (1), a health care service plan shall ensure that its network has adequate capacity and availability of licensed health care providers to offer enrollees appointments that meet the following timeframes: (

A) Urgent care appointments for services that do not require prior authorization: within hours of the request for appointment, except as provided in subparagraph (H). (

B) Urgent care appointments for services that require prior authorization: within hours of the request for appointment, except as provided in subparagraph (H). (

C) Nonurgent appointments for primary care: within business days of the request for appointment, except as provided in subparagraphs (

H) and (I). (

D) Nonurgent appointments with specialist physicians: within business days of the request for appointment, except as provided in subparagraphs (

H) and (I). (

E) Nonurgent appointments with a nonphysician mental health care or substance use disorder provider: within business days of the request for appointment, except as provided in subparagraphs (

H) and (I). (

F) Commencing July 1, 2022, nonurgent followup appointments with a nonphysician mental health care or substance use disorder provider: within business days of the prior appointment for those undergoing a course of treatment for an ongoing mental health or substance use disorder condition, except as provided in subparagraph (H). This subparagraph does not limit coverage for nonurgent followup appointments with a nonphysician mental health care or substance use disorder provider to once every business days. (

G) Nonurgent appointments for ancillary services for the diagnosis or treatment of injury, illness, or other health condition: within business days of the request for appointment, except as provided in subparagraphs (

H) and (I). (

H) The applicable waiting time for a particular appointment may be extended if the referring or treating licensed health care provider, or the health professional providing triage or screening services, as applicable, acting within the scope of their practice and consistent with professionally recognized standards of practice, has determined and noted in the relevant record that a longer waiting time will not have a detrimental impact on the health of the enrollee. (

I) Preventive care services, as defined in subdivision (e), and periodic followup care, including standing referrals to specialists for chronic conditions, periodic office visits to monitor and treat pregnancy, cardiac, mental health, or substance use disorder conditions, and laboratory and radiological monitoring for recurrence of disease, may be scheduled in advance consistent with professionally recognized standards of practice as determined by the treating licensed health care provider acting within the scope of their practice. (

J) A referral to a specialist by a primary care provider or another specialist shall be subject to the relevant time-elapsed standard in subparagraph (A), (B), or (D), unless the requirements in subparagraph (

H) or (

I) are met, and shall be subject to the other provisions of this section. (

K) A plan may demonstrate compliance with the primary care time-elapsed standards established by this subdivision through implementation of standards, processes, and systems providing advanced access to primary care appointments, as defined in subdivision (e).

(6) In addition to ensuring compliance with the clinical appropriateness standard set forth in paragraph (1), each dental plan, and each full service plan offering coverage for dental services, shall ensure that dental networks have adequate capacity and availability of licensed health care providers to offer enrollees appointments for covered dental services in accordance with the following requirements: (

A) Urgent appointments within the dental plan network shall be offered within hours of the time of request for appointment, if consistent with the enrollee’s individual needs and as required by professionally recognized standards of dental practice. (

B) Nonurgent appointments shall be offered within business days of the request for appointment, except as provided in subparagraph (C). (

C) Preventive dental care appointments shall be offered within business days of the request for appointment.

(7) A plan shall ensure it has sufficient numbers of network providers to maintain compliance with the standards established by this section. (

A) This

section does not modify the requirements regarding provider-to-enrollee ratio or geographic accessibility established by

Section 1300.51, 1300.67.2, or 1300.67.2.1 of Title of the California Code of Regulations. (

B) A plan operating in a network service area that has a shortage of one or more types of providers shall ensure timely access to covered health care services as required by this section, including applicable time-elapsed standards, by referring an enrollee to, or, in the case of a preferred provider network, by assisting an enrollee to locate available and accessible network providers in neighboring network service areas consistent with patterns of practice for obtaining health care services in a timely manner appropriate for the enrollee’s health needs. (

C) A plan shall arrange for the provision of covered services from providers outside the plan’s network if unavailable within the network if medically necessary for the enrollee’s condition. A plan shall ensure that enrollee costs for medically necessary referrals to nonnetwork providers shall not exceed applicable in-network copayments, coinsurance, and deductibles. This requirement does not prohibit a plan or its delegated provider group from accommodating an enrollee’s preference to wait for a later appointment from a specific network provider.

If medically necessary treatment of a mental health or substance use disorder is not available in network within the geographic and timely access standards set by law or regulation, a health care service plan shall arrange coverage outside the plan’s network in accordance with subdivision (

d) of

Section 1374.72.

(8) A plan shall provide or arrange for the provision, 24 hours per day, 7 days per week, of triage or screening services by telephone, as defined in subdivision (e). (

A) A plan shall ensure that telephone triage or screening services are provided in a timely manner appropriate for the enrollee’s condition, and that the triage or screening waiting time does not exceed minutes. (

B) A plan may provide or arrange for the provision of telephone triage or screening services through one or more of the following means: plan-operated telephone triage or screening services, telephone medical advice services pursuant to

Section 1348.8, the plan’s primary care and mental health care or substance use disorder network, or another method that provides triage or screening services consistent with this section. (

i) A plan that arranges for the provision of telephone triage or screening services through network primary care, mental health care, and substance use disorder providers shall require those providers to maintain a procedure for triaging or screening enrollee telephone calls, which, at a minimum, shall include the employment, during and after business hours, of a telephone answering machine, an answering service, or office staff, that shall inform the caller of both of the following: (

I) Regarding the length of wait for a return call from the provider. (II) How the caller may obtain urgent or emergency care, including, if applicable, how to contact another provider who has agreed to be on call to triage or screen by phone, or if needed, deliver urgent or emergency care. (ii) A plan that arranges for the provision of triage or screening services through network primary care, mental health care, and substance use disorder providers who are unable to meet the time-elapsed standards established in subparagraph (

A) shall also provide or arrange for the provision of plan-contracted or operated triage or screening services, which shall, at a minimum, be made available to enrollees affected by that portion of the plan’s network. (iii) An unlicensed staff person handling enrollee calls may ask questions on behalf of a licensed staff person to help ascertain the condition of an insured so that the enrollee may be referred to licensed staff.

However, an unlicensed staff person shall not, under any circumstances, use the answers to those questions in an attempt to assess, evaluate, advise, or make a decision regarding the condition of an enrollee or determine when an enrollee needs to be seen by a licensed medical professional.

(9) Dental, vision, chiropractic, and acupuncture plans shall ensure that network providers employ an answering service or a telephone answering machine during nonbusiness hours, which provide instructions regarding how an enrollee may obtain urgent or emergency care, including, if applicable, how to contact another provider who has agreed to be on call to triage or screen by phone, or if needed, deliver urgent or emergency care.

(10) A plan shall ensure that, during normal business hours, the waiting time for an enrollee to speak by telephone with a plan customer service representative knowledgeable and competent regarding the enrollee’s questions and concerns shall not exceed minutes. (

b) With regard to subdivision (a), dental, vision, chiropractic, and acupuncture plans shall comply with paragraphs (1), (3), (4), (7), (9), and (10). (

c) The obligation of a plan to comply with this

section shall not be waived if the plan delegates to its provider groups or other contracting entities any services or activities that the plan is required to perform. A plan’s implementation of this

section shall be consistent with the Health Care Providers’ Bill of Rights, and a material change in the obligations of a plan’s network providers shall be considered a material change to the provider contract, within the meaning of subdivision (

b) and paragraph (2) of subdivision (

h) of

Section 1375.7. (

d) A health care service plan shall incorporate the standards set forth in subdivision (

a) into the health plan’s quality assurance systems and the processes set forth in Sections and of this code and Title of the California Code of Regulations, including Sections 1300.67.2, 1300.67.2.2, 1300.68, and 1300.70. A plan shall not prevent, discourage, or discipline a network provider or employee for informing an enrollee or subscriber about the timely access standards. (

e) For purposes of this section: (1) “Advanced access” means the provision, by a network provider, or by the provider group to which an enrollee is assigned, of appointments with a primary care physician, or other qualified primary care provider such as a nurse practitioner or physician’s assistant, within the same or next business day from the time an appointment is requested, and advance scheduling of appointments at a later date if the enrollee prefers not to accept the appointment offered within the same or the next business day. (2) “Appointment waiting time” means the time from the initial request for health care services by an enrollee or the enrollee’s treating provider to the earliest date offered for the appointment for services inclusive of time for obtaining authorization from the plan or completing any other condition or requirement of the plan or its network providers. (3) “Preventive care” means health care provided for prevention and early detection of disease, illness, injury, or another health condition and, in the case of a full service plan includes all of the basic health care services required by Sections 1345, 1367.002, 1367.3, and 1367.35 of this code and subdivision (

f) of

Section 1300.67 of Title of the California Code of Regulations. (4) “Provider group” has the meaning set forth in subdivision (

g) of

Section 1373.65. (5) “Triage” or “screening” means the assessment of an enrollee’s health concerns and symptoms via communication with a physician, registered nurse, or other qualified health professional acting within their scope of practice and who is trained to screen or triage an enrollee who may need care for the purpose of determining the urgency of the enrollee’s need for care. (6) “Triage or screening waiting time” means the time waiting to speak by telephone with a physician, registered nurse, or other qualified health professional acting within their scope of practice and who is trained to screen or triage an enrollee who may need care. (7) “Urgent care” means health care for a condition that requires prompt attention, consistent with paragraph (2) of subdivision (

h) of

Section 1367.01. (f)

(1) Contracts between health care service plans and health care providers shall ensure compliance with the standards developed under this chapter. These contracts shall require reporting by health care providers to health care service plans and by health care service plans to the department to ensure compliance with the standards.

(2) Health care service plans shall report annually to the department on compliance with the standards in a manner specified by the department. The reported information shall allow consumers to compare the performance of plans and their network providers in complying with the standards, as well as changes in the compliance of plans with these standards.

(3) The department shall develop standardized methodologies for reporting that shall be used by health care service plans to demonstrate compliance with this

section and any regulations adopted pursuant to it, including demonstration of the average waiting time for each class of appointment regulated under this section, except the department may develop methodologies to demonstrate compliance with, and the average appointment wait time for, each class of appointments regulated under paragraph (6) of subdivision (a). The methodologies shall be sufficient to determine compliance with the standards developed under this

section for different networks of providers if a health care service plan uses a different network for Medi-Cal managed care products than for other products or if a health care service plan uses a different network for individual market products than for small group market products. The development and adoption of these methodologies shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with

Section 11340) of Part of Division of Title of the Government Code) until December 31, 2025. The department shall consult with stakeholders in developing standardized methodologies under this paragraph.

(4) Notwithstanding paragraph (3), the department may take compliance or disciplinary action, including assessment of administrative penalties, on the basis of noncompliance with any of the provisions of this section, including, but not limited to, timeframes for appointments and followup appointments.

(5) The department may review and adopt standards, in addition to those specified in this article, concerning the availability of primary care physicians, specialty physicians, hospital care, and other health care, so that consumers have timely access to care. In so doing, the department shall consider the nature of physician practices, including individual and group practices, as well as the nature of the plan network. The department shall also consider various circumstances affecting the delivery of care, including urgent care, care provided on the same day, and requests for specific providers.

If the department finds that health care service plans and health care providers have difficulty meeting these standards, the department may make recommendations to the Assembly Committee on Health and the Senate Committee on Health pursuant to subdivision (i). The development and adoption of standards under this paragraph shall not be subject to the Administrative Procedure Act until December 31, 2028. The department shall consult with stakeholders in developing the standards and methodologies described in this section. (g)

(1) The director may investigate and, by order, take enforcement action against plans, including, but not limited to, assessing administrative penalties subject to appropriate notice of, and the opportunity for, a hearing in accordance with

Section 1397, regarding noncompliance with the requirements of this section. The director shall consider, as an aggravating factor when assessing administrative penalties, if harm to an enrollee, including financial or health impacts to an enrollee or substantial harm as defined in

Section of the Civil Code, has occurred as a result of plan noncompliance. The director has the discretion to determine what harm constitutes harm to an enrollee. The plan may provide to the director, and the director may consider, information regarding the plan’s overall compliance with the requirements of this section. When taking enforcement action against a plan, the director may consider patterns of noncompliance. The administrative penalties shall not be deemed an exclusive remedy available to the director. These penalties shall be paid to the Managed Care Administrative Fines and Penalties Fund and shall be used for the purposes specified in

Section 1341.45. The director shall periodically evaluate grievances to determine if any audit, investigative, or enforcement actions should be undertaken by the department.

(2) The director may, after appropriate notice and opportunity for hearing in accordance with

Section 1397, by order, assess administrative penalties if the director determines that a health care service plan has knowingly committed, or has performed with a frequency that indicates a general business practice, either of the following: (

A) Repeated failure to act promptly and reasonably to assure timely access to care consistent with this chapter. (

B) Repeated failure to act promptly and reasonably to require network providers to assure timely access that the plan is required to perform under this

chapter and that have been delegated by the plan to the network provider when the obligation of the plan to the enrollee or subscriber is reasonably clear. (

C) The administrative penalties available to the director pursuant to this

section are not exclusive, and may be sought and employed in any combination with civil, criminal, and other administrative remedies deemed warranted by the director to enforce this chapter.

(3) The administrative penalties shall be paid to the Managed Care Administrative Fines and Penalties Fund and shall be used for the purposes specified in

Section 1341.45. (

h) The department shall work with the Department of Health Care Access and Information to assure that the quality of care report card incorporates information provided pursuant to subdivision (

f) regarding the degree to which health care service plans and health care providers comply with the requirements for timely access to care. (

i) The department shall annually review information regarding compliance with the standards developed under this

section and shall make recommendations for changes that further protect enrollees. Commencing no later than December 1, 2015, and annually thereafter, the department shall post its final findings from the review on its internet website. (

j) The department shall post on its internet website any waivers or alternative standards that the department approves under this

section on or after January 1, 2015. (

k) This

section applies to a licensed health care service plan that provides services to Medi-Cal beneficiaries. Except for appointment wait time standards set forth in paragraph (5) of subdivision (

a) of this

section and in

Section 1300.67.2.2 of Title of the California Code of Regulations, this

section does not alter the requirements or standards of the State Department of Health Care Services specified in

Section of the Welfare and Institutions Code. (

l) This

section does not prevent the department from developing additional standards to improve timely access to care and network adequacy.

SEC.

Section 1367.04 of the Health and Safety Code is amended to read: 1367.04. (

a) Not later than January 1, 2006, the department shall develop and adopt regulations establishing standards and requirements to provide health care service plan enrollees with appropriate access to language assistance in obtaining health care services. (

b) In developing the regulations, the department shall require every health care service plan and specialized health care service plan to assess the linguistic needs of the enrollee population, excluding Medi-Cal enrollees, and to provide for translation and

interpretation for medical services, as indicated. A health care service plan that participates in the Healthy Families Program may assess the Healthy Families Program enrollee population separately from the remainder of its enrollee population for purposes of subparagraph (

A) of paragraph (1). A health care service plan that chooses to separate its Healthy Families Program enrollment from the remainder of its enrollee population shall treat the Healthy Families Program population separately for purposes of determining whether subparagraph (

A) of paragraph (1) is applicable, and shall also treat the Healthy Families Program population separately for purposes of applying the percentage and numerical thresholds in subparagraph (

A) of paragraph (1). The regulations shall include the following:

(1) Requirements for the translation of vital documents that include the following: (

A) A requirement that all vital documents, as defined pursuant to subparagraph (B), be translated into an indicated language, as follows: (

i) A health care service plan with an enrollment of 1,000,000 or more shall translate vital documents into the top two languages other than English as determined by the needs assessment as required by this subdivision and any additional languages when 0.75 percent or 15,000 of the enrollee population, whichever number is less, excluding Medi-Cal enrollment and treating Healthy Families Program enrollment separately indicates in the needs assessment as required by this subdivision a preference for written materials in that language. (ii) A health care service plan with an enrollment of 300,000 or more but less than 1,000,000 shall translate vital documents into the top one language other than English as determined by the needs assessment as required by this subdivision and any additional languages when percent or 6,000 of the enrollee population, whichever number is less, excluding Medi-Cal enrollment and treating Healthy Families Program enrollment separately indicates in the needs assessment as required by this subdivision a preference for written materials in that language. (iii) A health care service plan with an enrollment of less than 300,000 shall translate vital documents into a language other than English when 3,000 or more or percent of the enrollee population, whichever number is less, excluding Medi-Cal enrollment and treating Healthy Families Program enrollment separately indicates in the needs assessment as required by this subdivision a preference for written materials in that language. (

B) Specification of vital documents produced by the plan that are required to be translated. The specification of vital documents shall not exceed that of the United States Department of Health and Human Services (HHS) Office for Civil Rights (OCR) Policy Guidance (65 Federal Register 52762 (August 30, 2000)), but shall include all of the following: (

i) Applications. (ii) Consent forms. (iii) Letters containing important information regarding eligibility and participation criteria. (iv) Notices pertaining to the denial, reduction, modification, or termination of services and benefits, and the right to file a grievance or appeal. (

v) Notices advising limited-English-proficient persons of the availability of free language assistance and other outreach materials that are provided to enrollees. (vi) Translated documents shall not include a health care service plan’s explanation of benefits or similar claim processing information that is sent to enrollees, unless the document requires a response by the enrollee. (C) (

i) For those documents described in subparagraph (

B) that are not standardized but contain enrollee specific information, health care service plans shall not be required to translate the documents into the threshold languages identified by the needs assessment as required by this subdivision, but rather shall include with the documents a written notice of the availability of

interpretation services in the threshold languages identified by the needs assessment as required by this subdivision. A health care service plan subject to the requirements in

Section 1367.042 shall also include with the documents a written notice of the availability of

interpretation services in the top languages spoken by limited-English-proficient (LEP) individuals in California as determined by the State Department of Health Care Services. (ii) Upon request, the enrollee shall receive a written translation of the documents described in clause (i). The health care service plan shall have up to, but not to exceed, 21 days to comply with the enrollee’s request for a written translation. If an enrollee requests a translated document, all timeframes and deadline requirements related to the document that apply to the health care service plan and enrollees under the provisions of this

chapter and under any regulations adopted pursuant to this

chapter shall begin to run upon the health care service plan’s issuance of the translated document. (iii) For grievances that require expedited plan review and response in accordance with subdivision (

b) of

Section 1368.01, the health care service plan may satisfy this requirement by providing notice of the availability and access to oral

interpretation services. (

D) A requirement that health care service plans advise limited-English-proficient enrollees of the availability of interpreter services.

(2) Standards to ensure the quality and accuracy of the written translations and that a translated document meets the same standards required for the English language version of the document. The English language documents shall determine the rights and obligations of the parties, and the translated documents shall be admissible in evidence only if there is a dispute regarding a substantial difference in the material terms and conditions of the English language document and the translated document.

(3) Requirements for surveying the language preferences and needs assessments of health care service plan enrollees within one year of the effective date of the regulations that permit health care service plans to utilize various survey methods, including, but not limited to, the use of existing enrollment and renewal processes, subscriber newsletters, or other mailings. Health care service plans shall update the needs assessment, demographic profile, and language translation requirements every three years.

(4) Requirements for individual enrollee access to

interpretation services that include the following: (

A) A requirement that an interpreter meets, at a minimum, all of the following qualifications: (

i) Demonstrated proficiency in both English and the target language. (ii) Knowledge in both English and the target language of health care terminology and concepts relevant to health care delivery systems. (iii) Adheres to generally accepted interpreter ethics principles, including client confidentiality. (

B) A requirement that the enrollee with limited English proficiency shall not be required to provide their own interpreter or rely on a staff member who does not meet the qualifications described in subparagraph (

A) to communicate directly with the limited-English-proficient enrollee. (

C) A requirement that the enrollee with limited English proficiency shall not be required to rely on an adult or minor child accompanying the enrollee to interpret or facilitate communication except under either of the following circumstances: (

i) In an emergency, as described in

Section 1317.1, if a qualified interpreter is not immediately available for the enrollee with limited English proficiency. (ii) If the individual with limited English proficiency specifically requests that the accompanying adult interpret or facilitate communication, the accompanying adult agrees to provide that assistance, and reliance on that accompanying adult for that assistance is appropriate under the circumstances.

(5) Standards to ensure the quality and timeliness of oral

interpretation services provided by health care service plans. (

c) In developing the regulations, standards, and requirements, the department shall consider the following:

(1) Publications and standards issued by federal agencies, such as the Culturally and Linguistically Appropriate Services (CLAS) in Health Care issued by the United States Department of Health and Human Services Office of Minority Health in December 2000, and the United States Department of Health and Human Services (HHS) Office for Civil Rights (OCR) Policy Guidance (65 Federal Register 52762 (August 30, 2000)).

(2) Other cultural and linguistic requirements under state programs, such as Medi-Cal Managed Care Policy Letters, cultural and linguistic requirements imposed by the State Department of Health Care Services on health care service plans that contract to provide Medi-Cal managed care services, and cultural and linguistic requirements imposed by the Managed Risk Medical Insurance Board on health care service plans that contract to provide services in the Healthy Families Program.

(3) Standards adopted by other states pertaining to language assistance requirements for health care service plans.

(4) Standards established by California or nationally recognized accrediting, certifying, or licensing organizations and medical and health care interpreter professional associations regarding

interpretation services.

(5) Publications, guidelines, reports, and recommendations issued by state agencies or advisory committees, such as the report to the Legislature from the Task Force on Culturally and Linguistically Competent Physicians and Dentists established by former

Section of the Business and Professions Code.

(6) Examples of best practices relating to language assistance services by health care providers and health care service plans, including existing practices.

(7) Information gathered from complaints to the HMO Helpline and consumer assistance centers regarding language assistance services.

(8) The cost of compliance and the availability of translation and

interpretation services and professionals.

(9) Flexibility to accommodate variations in plan networks and method of service delivery. The department shall allow for health care service plan flexibility in determining compliance with the standards for oral and written

interpretation services. (

d) The department shall work to ensure that the biennial reports required by this section, and the data collected for those reports, are consistent with reports required by government-sponsored programs and do not require duplicative or conflicting data collection or reporting. (

e) The department shall seek public input from a wide range of interested parties through advisory bodies established by the director. (

f) A contract between a health care service plan and a health care provider shall require compliance with the standards developed under this section. In furtherance of this section, the contract shall require providers to cooperate with the plan by providing any information necessary to assess compliance. (

g) The department shall report biennially to the Legislature and advisory bodie