20250SB__014498AMD INTRODUCED 2025-01-23 AMENDED_ASSEMBLY 2025-09-09 2025 SB AMD Introduced by Committee on Budget and Fiscal Review LEAD_AUTHOR SENATE Committee on Budget and Fiscal Review

An act to amend Sections 1246, 1300, 1300.1, 1625.6, 2473, 3041, and 3041.5 of, and to add Sections and 4052.05 to, the Business and Professions Code, to amend

Section 48980.4 of the Education Code, to amend

Section 100520.5 of, and add

Section 100503.6 to, the Government Code, to amend Sections 1206, 1261.3, 1342.2, 1342.3, 1347.8, 1367.002, 1367.3, 1367.35, 100425, 100450, 104151, 120372, 120372.05, 120392.2, 120392.3, 120392.6, 120392.9, 120393, 124981, and of, to amend, repeal, and add Sections 120336, 120390.6, and of, to add Sections 1797.11 and to, to add and repeal

Chapter 6.1 (commencing with

Section 127640) of Part of Division of, and to repeal

Section 11756.8 of, the Health and Safety Code, to amend Sections 10110.7, 10110.75, 10112.2, 10123.5, and 10123.55 of the Insurance Code, to amend

Section 30461.6 of the Revenue and Taxation Code, to amend Sections 5961.4, 11265.8, 14005.27, 14005.62, 14007.5, 14007.8, 14012.5, 14105.47, 14105.475, 14124.11, 14146, 14146.5, and of, to add

Section 14132.995 to, and to repeal Sections 14007.95 and 14100.95 of, the Welfare and Institutions Code, to amend

Section of

Chapter of the Statutes of 2025, and to repeal

Section of

Chapter of the Statutes of 2005, and

Section of

Chapter of the Statutes of 2008, 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 provides for the licensure and regulation of various healing arts practitioners by boards within the Department of Consumer Affairs. Existing law provides an exemption from these requirements for a health care practitioner licensed in another state who offers or provides health care for which the practitioner is licensed during a state of emergency, as defined, and upon request of the Director of the Emergency Medical Services Authority, as specified.

This bill would exempt health care practitioners licensed in another state, territory, or country from certain healing arts licensure, certification, or registration requirements, as described above, while providing professional services at Olympic and Paralympic activities, as defined, if the health care practitioner has been invited by the Los Angeles Organizing Committee for the Olympic and Paralympic Games to provide those services and the committee provides specified information to the Director of Consumer Affairs.

The bill would specify that the exemption applies while the health care practitioner is providing professional services at the invitation of the committee and only during the time sanctioned by the committee. This bill would authorize the official team representative who is responsible for any member participating in Olympic and Paralympic activities to give consent to the furnishing of professional services to a team member who, due to age, disability, or injury, is not able to personally consent in the event the consent of a parent, guardian, or legal representative of a team member cannot be obtained.

The bill would specify that in the case of emergency, the consent of the parent, guardian, or legal representative of the team member would not be necessary in order to authorize the performance of professional services.

(2) Existing law sets forth various powers and responsibilities for the State Department of Public Health concerning communicable disease prevention and control, in relation to persons, animals, and places, as necessary to protect or preserve the public health.

This bill would require that the list of immunizations, items, and services that were recommended by the United States Preventive Services Task Force (USPSTF), the federal Advisory Committee on Immunization Practices (ACIP), and the federal Health Resources and Services Administration (HRSA) that were in effect on January 1, 2025, serve as a baseline of recommendations and would authorize the State Department of Public Health, notwithstanding the rulemaking provisions of the Administrative Procedure Act, to modify or supplement those baseline recommendations, as specified.

The bill would require the department to publish recommendations and any updates, modifications, or supplements.

(3) Existing law authorizes various healing arts licensees, including dentists, doctors of podiatric medicine, optometrists, and pharmacists, to independently prescribe, initiate, or administer specified immunizations approved or authorized by the United States Food and Drug Administration in compliance with specified recommendations, including those by the ACIP. This bill would instead authorize those licensees to prescribe, initiate, or administer specified immunizations in a manner consistent with a recommendation made by the State Department of Public Health, as specified.

(4) Existing law provides for the licensure, registration, and regulation of clinical laboratories and various clinical laboratory personnel by the State Department of Public Health. Existing law requires the fees or charges accompanying an application for the issuance or renewal of these licenses, among others, to be adjusted annually by the percentage change printed in the Budget Act and determined by dividing the General Fund appropriation to Laboratory Field Services in the current state fiscal year by the General Fund appropriation to Laboratory Field Services in the preceding state fiscal year.

Commencing January 1, 1995, upon establishment of the Clinical Laboratory Improvement Fund, existing law requires this annual adjustment to be determined by dividing the current fiscal year appropriation to the Clinical Laboratory Improvement Fund by the General Fund appropriation to Laboratory Field Services of the department in the preceding fiscal year.

Existing law also requires these fees and charges to be adjusted annually by a percentage determined by dividing the total amount of federal funds available for all programs in Laboratory Field Services of the department during the federal fiscal year ending on September of the year immediately preceding the effective date of the change in fees, as specified. This bill would delete the above provisions pertaining to the annual adjustment of fees or charges and replace them with a requirement that the annual adjustment be done by the department to cover the estimated licensing program costs.

Existing law requires a tissue bank, as defined, to have a current and valid tissue bank license. Under existing law, the application and annual renewal fee for a tissue bank license is $950, adjusted annually by a percentage listed in the Budget Act. This bill would adjust the fees or charges for a tissue bank license annually pursuant to the provision above requiring the annual adjustment be done by the department to cover the estimated licensing program costs. This bill would additionally revise the application, registration, and license fees for clinical laboratories and clinical laboratory personnel.

(5) Existing federal law, the Patient Protection and Affordable Care Act (PPACA), requires each state to establish an American Health Benefit Exchange to facilitate the purchase of qualified health benefit plans by qualified individuals and qualified small employers. PPACA defines a “qualified health plan” as a plan that, among other requirements, provides an essential health benefits package.

Existing state 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 PPACA. Existing law establishes the Health Care Affordability Reserve Fund to be used, upon appropriation by the Legislature, for health care affordability programs operated by the Exchange.

If a qualified health plan is required to cover state-mandated gender-affirming care benefits determined to be in addition to essential health benefits, this bill would require the Exchange to provide payments to issuers of qualified health plans to defray the costs of offering those benefits for plan years beginning on or after January 1, 2026, subject to an appropriation by the Legislature. The bill would authorize the Health Care Affordability Reserve Fund to be used, upon appropriation by the Legislature, for these payments.

(6) Existing law establishes the State Department of Public Health and sets forth its powers and duties, including, but not limited to, duties relating to the licensing and regulation of various entities, including clinics. Existing law exempts specified clinics from these licensure requirements, including, among others, certain federal clinics, clinics maintained as outpatient departments of hospitals, and student health centers operated by public institutions of higher education.

This bill would exempt from the above-described licensure requirements a clinic approved by, and that provides health care services at locations designated or sanctioned by, the Los Angeles Organizing Committee for the Olympic and Paralympic Games from May 15, 2028, to September 15, 2028, inclusive.

(7) Existing law, the Emergency Medical Services System and the Prehospital Emergency Medical Care Personnel Act, establishes the Emergency Medical Services Authority, which is responsible for the coordination of various state activities concerning emergency medical services (EMS), including, among others, establishing minimum standards and promulgating regulations for the training and scope of practice for an Emergency Medical Technician I and II (EMT-I and EMT-II) and Emergency Medical Technician-Paramedic (EMT-P).

Existing law requires the authority to have a chief medical officer who is required to provide clinical leadership and oversight concerning treatment, education, and other matters involving medical decisionmaking and delivery of patient care.

This bill, notwithstanding any other law, would exempt from the EMS licensure, certification, or accreditation requirements of this state an EMT-I, EMT-II, EMT-P, or similar EMS provider, as defined, licensed or certified in another state or territory of the United States, who provides EMS for which they are licensed, if they are authorized by the chief medical officer of the authority to provide EMS at sites in this state sanctioned by the Los Angeles Organizing Committee for the Olympic and Paralympic Games and associated with the Olympic and Paralympic Games.

The bill would require the chief medical officer to authorize those EMS personnel based on system needs and informed by committee needs, qualifications of the emergency medical services personnel, and public safety considerations. The bill would prohibit EMS providers authorized by the chief medical officer from being liable for any act or omission taken in good faith while providing authorized services. The bill would require authorization pursuant to these provisions to be valid from May 15, 2028, to September 15, 2028, inclusive, or until authorization is otherwise withdrawn by the chief medical officer.

(8) Existing law requires the State Department of Health Care Services (DHCS) to annually report to certain legislative committees, and publicly post, a

summary of outcome and expenditure data with regard to outcome measures for alcohol and drug program services, as specified. This bill would repeal the above-described reporting and publication provisions.

(9) Existing law requires DHCS to provide certain legislative committees with biannual updates on caseload, estimated expenditures, and related program monitoring data for the Every Woman Counts (EWC) Program, as specified. Existing law requires that expenditures for the EWC Program included in the department’s budget for services provided on or after July 1, 2017, be charged against the appropriation for the fiscal year in which the billing is paid. This bill would delete the above-described requirements relating to the EWC Program.

(10) Existing law establishes the public policy of the state that pupils are advised to adhere to current immunization guidelines, as recommended by, among other entities, the ACIP. Existing law prohibits the governing authority of a school or other institution from unconditionally admitting any person as a pupil unless, before the person’s admission to that institution, the person has been fully immunized against various diseases, including any disease deemed appropriate by the State Department of Public Health, taking into consideration recommendations of various entities, including the ACIP.

Existing law requires a medical exemption form and the appeal process for revocation of a medical exemption to be consistent with specified guidelines, including those by the ACIP. This bill would delete certain references to the ACIP and replace other references to the ACIP with the State Department of Public Health. Some of these provisions would be operative beginning July 1, 2026. To the extent that this bill imposes new duties on a local education agency, the bill would impose a state-mandated local program.

(11) Existing law, from October to the following April 1, inclusive, of each year, requires specified health facilities to offer immunizations for influenza and pneumococcal disease to residents or inpatients years of age or older who are receiving services at the facility, based upon the latest recommendations of specified entities, including the ACIP. This bill would replace those references to ACIP with the State Department of Public Health.

Existing law requires the State Department of Public Health to post on its internet website educational information regarding influenza in accordance with the latest recommendations of the ACIP. This bill would replace the reference to ACIP with the State Department of Public Health.

(12) Existing law, the Hereditary Disorders Act, requires the State Department of Public Health to license genetic counselors and temporary genetic counselors who meet specified requirements. Existing law prohibits the license fee from exceeding $200 for an original license, license renewal, or temporary license. Existing law requires all moneys collected by the department under the act to be deposited in the Genetic Disease Testing Fund, which is continuously appropriated to the department to carry out the purposes of the act.

This bill would instead set the fee for an original license, license renewal, and temporary license at $300. The bill would authorize the department to adjust those fees to an amount not to exceed $500. The bill would require the department to solicit input from affected stakeholders before raising these fees. By authorizing additional moneys to be deposited into a continuously appropriated fund, the bill would make an appropriation.

(13) Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care, and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance.

Existing law requires specified health care service plan contracts, or specified disability or health insurance policies, to cover an evidence-based item, service, or immunization that has in effect a specified rating in the recommendations of the USPSTF or an immunization that has in effect a recommendation from specified entities, including the ACIP.

Existing law also requires specified health care service plans or disability insurers to offer benefits for the comprehensive prevention care of children consistent with the most current version of the Recommended Childhood Immunization Schedule/United States, jointly adopted by various entities, including the ACIP. This bill would require those health care service plan contracts or disability or health insurance policies to cover an evidence-based item, service, or immunization that had in effect on January 1, 2025, a specified rating in the recommendations of USPSTF.

The bill would replace references to the ACIP with the State Department of Public Health. 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.

(14) Existing federal law, the Patient Protection and Affordable Care Act (PPACA), requires each state to establish an American Health Benefit Exchange to facilitate the purchase of qualified health benefit plans by qualified individuals and qualified small employers. Existing state law creates the California Health Benefit Exchange (Exchange), also known as Covered California, for this purpose.

PPACA generally prohibits the use of federal funds for abortion services, but if a qualified health plan provides abortion coverage, PPACA requires the issuer of the plan to collect specified amounts from each enrollee and deposit those funds into a segregated account to be used to pay for abortion services. Under state law, the Exchange makes those payments to qualified health plans on behalf of enrollees.

Existing state law requires a health care service plan that provides a qualified health plan through the Exchange to report to the Director of the Department of Managed Health Care the total amount of funds maintained in a segregated account. This bill would establish the Abortion Access Fund, a continuously appropriated fund, to provide funding for abortion services, including for abortion services funded through grants to provide abortion access. The bill would authorize the Department of Health Care Access and Information to distribute moneys in the fund through grants and contracts.

Under the bill, contracts, grants, and related information would be exempt from public disclosure. From the 2025–26 fiscal year to the 2028–29 fiscal year, inclusive, the bill would require the Director of the Department of Managed Health Care to order a health care service plan that provides a qualified health plan through the Exchange to transfer to the Abortion Access Fund up to the total amount previously funded by the Exchange, not to exceed a specified percentage of the ending balance in its segregated account, and would require a plan to complete the transfer.

Because a willful violation of the bill’s requirements relative to health care service plans would be a crime, the bill would impose a state-mandated local program.

(15) Under existing law, the Breast Cancer Fund consists of 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 equally between the accounts, to be allocated upon appropriation. Existing law requires any entity funded by the Breast Cancer Control Program to collect data and maintain records that are determined by the State Department of Public Health to be necessary to facilitate the department’s ability to monitor and evaluate the effectiveness of the entities and the program.

Existing law requires the department to submit an annual report to the Legislature and any other appropriate entity. This bill would switch the jurisdiction from the State Department of Public Health to DHCS for purposes of the above-described and other related provisions. The bill would make certain changes to the required contents of the report.

Existing law requires the State Department of Public Health to provide for breast cancer screening services at the level of funding budgeted from state and other resources during the fiscal year in which the Legislature has appropriated funds to the department for this purpose, with administrative or indirect costs not exceeding certain limits. This bill would delete those provisions.

(16) Existing law establishes the Children and Youth Behavioral Health Initiative, administered by the California Health and Human Services Agency and its departments, as applicable. Under existing law, the purpose of the initiative is to transform the state’s behavioral health system into an innovative ecosystem in which all children and youth years of age and younger, regardless of payer, are screened, supported, and served for emerging and existing behavioral health needs.

Existing law requires DHCS, or a contracted vendor, to provide competitive grants to qualified entities to build partnerships, capacity, and infrastructure supporting ongoing school-linked behavioral health services, among other purposes, for children and youth years of age and younger. For these purposes, existing law requires the department to develop and maintain a school-linked statewide fee

schedule for outpatient mental health or substance use disorder treatment provided to a student who is years of age or younger at a schoolsite. Existing law requires the department to develop and maintain a school-linked statewide provider network of schoolsite behavioral health counselors. Existing law authorizes the department to contract with an entity to administer the school-linked statewide behavioral health provider network. Existing law requires that administrator to, among other things, create and administer a process for the submission and reimbursement of eligible claims.

This bill would require the department to convene a working group twice each year of specified stakeholders, including, among others, behavioral health providers and local educational agencies, to discuss the status of, and receive feedback regarding, the implementation of the fee schedule. The bill would require a contracted administrator to automate the matching of student records with health plan enrollment information and to reimburse claims pursuant to claim payment deadlines, as specified.

The bill would require the California Health and Human Service Agency to publish a manual to assist a local educational agency with navigating certain federal laws.

(17) Existing law, the California Work Opportunity and Responsibility to Kids (CalWORKs) program, requires all applicants for or recipients of CalWORKs to ensure and provide documentation that each child in the assistance unit who is not required to be enrolled in school has received all age-appropriate immunizations. Existing law requires all applicants and recipients to be given notice of that obligation and for the notice to include specified recommended childhood immunization schedules, as approved by various entities, including the ACIP. This bill would remove the reference to the ACIP and replace it with the State Department of Public Health, as specified.

(18) Existing law establishes the Medi-Cal program, which is administered by DHCS and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law sets a

schedule of benefits that are covered by the Medi-Cal program. This bill would require that vaccines and immunizations are covered in accordance with a recommendation from ACIP, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, and any modification or supplement to a recommendation adopted by the State Department of Public Health. The bill would make the implementation of this provision contingent to the extent that federal financial participation is available and any necessary federal approvals are obtained.

(19) 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 law prohibits, until January 1, 2026, the use of resources to determine Medi-Cal eligibility for applicants or beneficiaries whose eligibility is not determined using the MAGI-based financial methods, subject to receipt of any necessary federal approvals.

Under existing law, operative on January 1, 2026, for those applicants or beneficiaries whose eligibility is not determined using the MAGI-based financial methods, DHCS is required to seek federal approval to implement 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. Existing law requires that provision to be implemented only after the Director of Health Care Services determines that systems have been programmed for the disregards and they communicate that determination in writing to the Department of Finance.

This bill would additionally specify that the above-described implementation condition occur no sooner than January 1, 2026.

(20) Existing law sets forth provisions for the transition of certain children from the former Healthy Families Program to the Medi-Cal program. Existing law requires DHCS to provide monthly status reports to certain legislative committees on the transition, with a final comprehensive report provided within days after completion of the last phase of transition. This bill would delete the above-described reporting requirement.

(21) Existing law establishes a program, known as the 250% Working Disabled Program (250% WDP), under which certain working persons with disabilities are eligible for Medi-Cal benefits based on a net countable income of less than 250% of the federal poverty level and other specified criteria. Existing law requires DHCS to report to the Governor and the Legislature any information that DHCS gathers that may explain the low participation rates in 250% WDP and any recommendations on increasing participation, as specified. This bill would repeal the above-described reporting provision.

(22) The federal Medicaid program prohibits payment to a state for medical assistance furnished to an alien who is not lawfully admitted for permanent residence or otherwise permanently residing in the United States under color of law. Existing state law extends Medi-Cal eligibility for the full scope of Medi-Cal benefits to individuals who do not have satisfactory immigration status if they are otherwise eligible for those benefits, with the exception of specified dental benefits for individuals who are years of age or older.

Existing law makes an individual who is years of age or older, who does not have satisfactory immigration status, and who applies for Medi-Cal on or after January 1, 2026, eligible only for pregnancy-related services and emergency medical treatment. Existing law, beginning no sooner than July 1, 2026, or July 1, 2027, as specified, requires individuals who do not have satisfactory immigration status, who are not pregnant, and who are to years of age, inclusive, to pay a monthly premium of $30, subject to certain exceptions.

This bill would make certain nonminor dependents and foster youths exempt from the service limitations and monthly premium provisions described above. The bill would require the monthly premium payments described above to begin no sooner than July 1, 2027, and make other technical and conforming changes.

(23) Existing law requires DHCS to implement a process that allows applicants and beneficiaries of certain Medi-Cal programs to self-certify the amount and nature of assets and income without the need to submit income or asset documentation. Existing law requires DHCS to implement the process in phases, with the first phase in counties and the 2nd phase statewide, with each county agreeing to meet all federal requirements for income, resource, and other verifications and to perform determinations and verifications in a timely manner.

Existing law requires DHCS to promptly provide certain legislative committees with an evaluation of the process and its impact on the Medi-Cal program. This bill would delete certain provisions relating to the phases, including the evaluation requirement.

(24) Existing law, under Medi-Cal provisions, requires DHCS to enter into demonstration contracts with manufacturers of medical supplies for items of its own selection of medical supplies existing on the pharmacy claims processing system, for the purpose of establishing rebates or other cost-saving mechanisms and demonstrating cost savings in the purchase of these medical supplies. This bill would repeal those and related provisions. The bill would make conforming changes to other provisions.

(25) Existing law requires DHCS to establish a 2-year pilot program to utilize the federal Public Assistance Reporting Information System (PARIS) to identify veterans and their dependents or survivors who are enrolled in the Medi-Cal program and assist them in obtaining federal veteran health care benefits. Existing law requires DHCS to monitor the pilot program, evaluate the outcomes and savings, and provide the fiscal committees of the Legislature with a report on the findings and recommendations. This bill would delete the above-described monitoring, evaluation, and reporting requirements.

(26) Existing law, operative until July 1, 2025, requires DHCS to work with stakeholders to conduct a study to identify current requirements for medical

interpretation services and make recommendations on strategies that may be employed regarding the provision of medical

interpretation services for Medi-Cal beneficiaries who are limited English proficient (LEP). Existing law requires the department to establish a pilot project to evaluate certain factors, including whether disparities in care are reduced, with respect to LEP Medi-Cal beneficiaries compared with Medi-Cal beneficiaries who are proficient in English. Existing law requires the department to expend up to $5,000,000 for the pilot project pursuant to an appropriation made in the Budget Act of 2019, and makes those funds available for that purpose until June 30, 2025.

This bill would extend the operation of these provisions until July 1, 2026, and make those funds available for expenditure, encumbrance, and liquidation until June 30, 2026. By extending the period of time in which previously appropriated funds are available for expenditure, encumbrance, and liquidation, the bill would make an appropriation.

(27) Existing law requires the Office of Family Planning within DHCS to submit a biennial report to the Legislature on specified subjects relating to family planning services. This bill would instead require the office to post annual reports on its internet website.

(28) Existing law requires the former State Department of Health Services, whose functions were transferred to other departments, to provide certain legislative committees with quarterly updates regarding core activities to improve the Medi‑Cal managed care program and county expansion, as specified. This bill would repeal those reporting provisions.

(29) Existing law requires the former State Department of Mental Health, whose functions were transferred to other departments, to provide certain legislative committees with semiannual updates regarding key results and funding for the capital costs associated with development, acquisition, construction, and rehabilitation of permanent supportive housing for individuals with mental illness, as specified. This bill would repeal those reporting provisions.

(30) 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. Existing law authorizes the State Department of Public Health to spend up to $75,000,000 from the ADAP Rebate Fund to support current or eligible HIV services and programs, as specified.

Existing law prescribes the allocation of those funds, including by authorizing up to $65,000,000 of that $75,000,000 to be spent to supplement or fund services, programs, or initiatives for which federal funding has been reduced or eliminated and making $9,000,000 available to fund state and local disease intervention specialists. This bill would make up to $18,000,000 of the above-described $65,000,000 available for state operations and would make up to $1,640,000 of the above-described $9,000,000 available for state operations.

By adding to the purposes for which the ADAP Rebate Fund may be spent, the bill would make an appropriation.

(31) 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.

(32) 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.

(33) 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 1.

Section is added to the Business and Professions Code , to read: 901. (

a) For purposes of this section, the following

definitions shall apply: (1) “Committee” means the Los Angeles Organizing Committee for the Olympic and Paralympic Games. (2) “Health care practitioner” means any person who engages in acts that are the subject of licensure or regulation under this division or under any initiative act referred to in this division and who maintains an active license in good standing to provide the same or substantially similar services in another state, territory, or country. (3) “Olympic and Paralympic activities” means any competition, non competition, athlete village, training, or support sites in this state sanctioned by the committee. (

b) Notwithstanding any other law, any licensure, certification, or registration requirements of this division shall not apply to a health care practitioner licensed in another state, territory, or country while providing professional services for which a license would otherwise be required in this state if both of the following conditions are met:

(1) The health care practitioner has been invited by the committee to provide professional services at Olympic and Paralympic activities.

(2) The committee provides to the Director of Consumer Affairs, to forward to the applicable licensing entity within the department that corresponds to the licensing entity in the state, territory, or country where the health care practitioner is licensed before the provision of professional services by a health care practitioner, all of the following information: (

A) The name of the health care practitioner. (

B) The state, territory, or country of the health care practitioner’s licensure and the licensing entity from which the health care practitioner holds a license. (

C) The dates for which the health care practitioner has been invited to provide professional services. (

D) The scope of practice the committee requires for that practitioner at Olympic and Paralympic activities. (

c) The exemption granted under this

section shall be limited to only those professional services required by or on behalf of the committee. Those professional services shall be within the scope of the health care practitioner’s existing licensure, certification, or registration and shall only be provided at Olympic and Paralympic activities. (

d) A health care practitioner shall cease to be exempted under this

section upon a request made by the department to the committee on behalf of an applicable licensing entity. (

e) The exemption provided in this

section shall remain in force while the health care practitioner is providing professional services at the invitation of the committee and only during the time sanctioned by the committee. (f)

(1) Notwithstanding any other law, in the event the consent of the parent, guardian, or legal representative of a team member cannot be obtained, the official team representative who is responsible for any member participating in Olympic and Paralympic activities may give consent to the furnishing of professional services to a team member who, due to age, disability, or injury, is not able to personally consent.

(2) Consent given pursuant to paragraph (1) shall not be subject to disaffirmance or invalidation due to the individual’s age, disability, or injury.

(3) In the case of an emergency, the consent of the parent, guardian, or legal representative of the team member shall not be necessary in order to authorize the performance of professional services. (

g) This

section does not apply to persons who engage in acts that are subject to licensure or regulation pursuant to

Chapter 9 (commencing with

Section 4000) or

Chapter 9.5 (commencing with

Section 4430).

SEC. 2.

Section of the Business and Professions Code is amended to read: 1246. (a)

(1) On and after the effective date of the regulations specified in paragraph (2), any unlicensed person employed by a clinical laboratory performing the duties described in this

section shall possess a valid and current certification as a certified phlebotomy technician issued by the department.

(2) The department shall adopt regulations for certification by January 1, 2001, as a certified phlebotomy technician that shall include all of the following: (

A) The applicant shall hold a valid, current certification as a phlebotomist issued by a national accreditation agency approved by the department, and shall submit proof of that certification when applying for certification pursuant to this section. (

B) An applicant with fewer than 1,040 hours of work experience shall complete education, training, and experience requirements as specified by regulations that shall include, but not be limited to, the following: (

i) At least hours of didactic instruction. (ii) At least hours of practical instruction. (iii) At least successful venipunctures. (

C) An applicant who has at least 1,040 hours of work experience that includes at least successful venipunctures shall complete at least hours of didactic instruction, as specified in regulations adopted by the department. (

D) Each certified phlebotomy technician shall complete at least three hours per year or six hours every two years of continuing education or training. The department shall consider a variety of programs in determining the programs that meet the continuing education or training requirement. (

E) The applicant has been found to be competent in phlebotomy by a licensed physician and surgeon or person licensed pursuant to this chapter. (

F) The applicant works under the supervision of a licensed physician and surgeon, licensed registered nurse, or person licensed under this chapter, or the designee of a licensed physician and surgeon or the designee of a person licensed under this chapter.

(3) A certified phlebotomy technician may collect blood through a peripheral venous catheter if all of the following are met: (

A) The blood collection procedure is performed in a facility licensed under Division 2 (commencing with

Section 1200) of the Health and Safety Code. (

B) The blood collection procedures or protocols are developed and approved by the facility’s supervising physician and surgeon or licensed clinical laboratory director and approved by the licensed facility. (

C) The certified phlebotomy technician has received a minimum of three hours of training by the supervising physician and surgeon or their delegate in the proper procedures to be employed when collecting blood through a peripheral venous catheter. (

i) Training in the blood collection procedure through a peripheral venous catheter shall be conducted according to standardized training procedures developed and approved by the facility’s supervising physician and surgeon or licensed clinical laboratory director. The facility shall make these standardized procedures available to the department upon request. (ii) The instructor shall document the certified phlebotomy technician’s successful completion of training. The facility shall maintain and make available to the department, upon request, documentation of training completed by a certified phlebotomy technician pursuant to this paragraph. (

D) The certified phlebotomy technician performs the blood collection procedure under the supervision of a physician and surgeon licensed under

Chapter 5 (commencing with

Section 2000). Notwithstanding subdivision (b), the physician and surgeon may only delegate the supervision duties in this subparagraph to a registered nurse. A physician and surgeon or a registered nurse may restrict or limit a certified phlebotomy technician’s ability to collect blood from a patient’s peripheral venous catheter. (

E) The certified phlebotomy technician performs the blood collection procedure using a device or devices approved by the licensed facility and the United States Food and Drug Administration. (

F) This paragraph does not authorize the certified phlebotomy technician to manage, stop, or restart a patient’s active intravenous infusion or insert or remove a peripheral intravenous catheter. (4) Paragraph (3) does not authorize a certified phlebotomy technician to withdraw blood through a peripherally inserted central catheter or central venous catheter.

(5) The department shall adopt regulations establishing standards for approving training programs designed to prepare applicants for certification pursuant to this section. The standards shall ensure that these programs meet the state’s minimum education and training requirements for comparable programs.

(6) The department shall adopt regulations establishing standards for approving national accreditation agencies to administer certification examinations and tests pursuant to this section.

(7) The department shall charge fees for application for and renewal of the certificate authorized by this

section pursuant to subdivision (

f) of

Section 1300. (b) (1) (

A) A certified phlebotomy technician may perform venipuncture or skin puncture to obtain a specimen for nondiagnostic tests assessing the health of an individual, for insurance purposes, provided that the technician works under the general supervision of a physician and surgeon licensed under

Chapter 5 (commencing with

Section 2000). The physician and surgeon may delegate the general supervision duties to a registered nurse or a person licensed under this chapter, but shall remain responsible for ensuring that all those duties and responsibilities are properly performed. The physician and surgeon shall make available to the department, upon request, records maintained documenting when a certified phlebotomy technician has performed venipuncture or skin puncture pursuant to this paragraph. (

B) As used in this paragraph, general supervision requires the supervisor of the technician to determine that the technician is competent to perform venipuncture or skin puncture, or to collect blood, before the technician’s first blood withdrawal, and on an annual basis thereafter. The supervisor is also required to determine, on a monthly basis, that the technician complies with appropriate venipuncture, skin puncture, and blood collection policies and procedures approved by the medical director and required by state regulations.

The supervisor, or another designated licensed physician and surgeon, registered nurse, or person licensed under this chapter, shall be available for consultation with the technician, either in person or through telephonic or electronic means, at the time of blood withdrawal. (2) (

A) Notwithstanding any other law, a person who has been issued a certified phlebotomy technician certificate pursuant to this

section may draw blood following policies and procedures approved by a physician and surgeon licensed under

Chapter 5 (commencing with

Section 2000), appropriate to the location where the blood is being drawn and in accordance with state regulations. The blood collection shall be done at the request and in the presence of a peace officer for forensic purposes in a jail, law enforcement facility, or medical facility, with general supervision. (

B) As used in this paragraph, “general supervision” means that the supervisor of the technician is licensed under this code as a physician and surgeon, physician assistant, clinical laboratory bioanalyst, registered nurse, or clinical laboratory scientist, and reviews the competency of the technician before the technician may perform blood withdrawals without direct supervision, and on an annual basis thereafter. The supervisor is also required to review the work of the technician at least once a month to ensure compliance with venipuncture policies, procedures, and regulations.

The supervisor, or another person licensed under this code as a physician and surgeon, physician assistant, clinical laboratory bioanalyst, registered nurse, or clinical laboratory scientist, shall be accessible to the location where the technician is working to provide onsite, telephone, or electronic consultation, within minutes when needed. (

c) The department may adopt regulations providing for the issuance of a certificate to an unlicensed person employed by a clinical laboratory authorizing only the performance of skin punctures for test purposes.

SEC. 3.

Section of the Business and Professions Code is amended to read: 1300. The amount of application, registration, certification, and license fees under this

chapter shall be as follows: (

a) The application fee for a histocompatibility laboratory director’s, clinical laboratory bioanalyst’s, clinical chemist’s, clinical microbiologist’s, clinical laboratory toxicologist’s, clinical genetic molecular biologist’s, clinical cytogeneticist’s, clinical laboratory geneticist’s, or clinical reproductive biologist’s license, or license for another specialty or subspecialty specified by regulation adopted by the department, is five hundred seventy dollars ($570). (

b) The annual renewal fee for a license listed in subdivision (

a) is five hundred seventy dollars ($570). (

c) The application fee for a clinical laboratory scientist’s or limited clinical laboratory scientist’s license is three hundred dollars ($300). (

d) The application and annual renewal fee for a cytotechnologist’s license is two hundred sixty dollars ($260). (

e) The annual renewal fee for a clinical laboratory scientist’s or limited clinical laboratory scientist’s license is three hundred dollars ($300). (

f) The application and annual renewal fee for a phlebotomist’s certification is one hundred fifty dollars ($150). (f)</xhtml:p>"?> (

g) A clinical laboratory applying for a license to perform tests or examinations classified as of moderate or of high complexity under CLIA and a clinical laboratory applying for certification under subdivision (

c) of

Section shall pay an application fee for that license or certification based on the number of tests it performs or expects to perform in a year, as follows:

(1) Less than 2,001 tests: three hundred thirty-five dollars ($335).

(2) Between 2,001 and 10,000, inclusive, tests: one thousand one hundred dollars ($1,100).

(3) Between 10,001 and 25,000, inclusive, tests: one thousand eight hundred dollars ($1,800).

(4) Between 25,001 and 50,000, inclusive, tests: two thousand two hundred dollars ($2,200).

(5) Between 50,001 and 75,000, inclusive, tests: two thousand seven hundred dollars ($2,700).

(6) Between 75,001 and 100,000, inclusive, tests: three thousand three hundred dollars ($3,300).

(7) Between 100,001 and 500,000, inclusive, tests: four thousand dollars ($4,000).

(8) Between 500,001 and 1,000,000, inclusive, tests: seven thousand two hundred dollars ($7,200).

(9) More than 1,000,000 tests: eight thousand six hundred thirty dollars ($8,630) plus four hundred twenty dollars ($420) for every 500,000 tests over 1,000,000, up to a maximum of 15,000,000 tests. (g)</xhtml:p>"?> (

h) A clinical laboratory performing tests or examinations classified as of moderate or of high complexity under CLIA and a clinical laboratory with a certificate issued under subdivision (

c) of

Section shall pay an annual renewal fee based on the number of tests it performed in the preceding calendar year, as follows:

(1) Less than 2,001 tests: three hundred thirty-five dollars ($335).

(2) Between 2,001 and 10,000, inclusive, tests: one thousand one hundred dollars ($1,100).

(3) Between 10,001 and 25,000, inclusive, tests: one thousand eight hundred dollars ($1,800).

(4) Between 25,001 and 50,000, inclusive, tests: two thousand two hundred dollars ($2,200).

(5) Between 50,001 and 75,000, inclusive, tests: two thousand seven hundred dollars ($2,700).

(6) Between 75,001 and 100,000, inclusive, tests: three hundred three hundred dollars ($3,300).

(7) Between 100,001 and 500,000, inclusive, tests: four thousand dollars ($4,000).

(8) Between 500,001 and 1,000,000, inclusive, tests: seven thousand two hundred dollars ($7,200).

(9) More than 1,000,000 tests per year: eight thousand six hundred thirty dollars ($8,630) plus four hundred twenty dollars ($420) for every 500,000 tests over 1,000,000, up to a maximum of 15,000,000 tests. (h)</xhtml:p>"?> (

i) The application fee for a trainee’s license is forty-five dollars ($45). (i)</xhtml:p>"?> (

j) The annual renewal fee for a trainee’s license is forty-five dollars ($45). (j)</xhtml:p>"?> (

k) The application fee for a duplicate license is five dollars ($5). (k)</xhtml:p>"?> (

l) The personnel licensing delinquency fee is equal to the annual renewal fee. (l)</xhtml:p>"?> (

m) The director may establish a fee for examinations required under this chapter. The fee shall not exceed the total cost to the department in conducting the examination. (m)</xhtml:p>"?> (

n) A clinical laboratory subject to registration under paragraph (2) of subdivision (

a) of

Section and performing only those clinical laboratory tests or examinations considered waived under CLIA shall pay an annual fee of one hundred fifty-five dollars ($155). A clinical laboratory subject to registration under paragraph (2) of subdivision (

a) of

Section and performing only provider-performed microscopy, as defined under CLIA, shall pay an annual fee of two hundred thirty-five dollars ($235). A clinical laboratory performing both waived and provider-performed microscopy shall pay an annual registration fee of two hundred thirty-five dollars ($235). (n)</xhtml:p>"?> (

o) The costs of the department in conducting a complaint investigation, imposing sanctions, or conducting a hearing under this

chapter shall be paid by the clinical laboratory. The fee shall be no greater than the fee the laboratory would pay under CLIA for the same type of activities and shall not be payable if the clinical laboratory would not be required to pay those fees under CLIA. (o)</xhtml:p>"?> (

p) The state, a district, city, county, city and county, or other political subdivision, or any public officer or body shall be subject to the payment of fees established pursuant to this

chapter or regulations adopted thereunder. (p)</xhtml:p>"?> (

q) In addition to the payment of registration or licensure fees, a clinical laboratory located outside the State of California shall reimburse the department for travel and per diem to perform any necessary onsite inspections at the clinical laboratory in order to ensure compliance with this chapter. (q)</xhtml:p>"?> (

r) The department shall establish an application fee and a renewal fee for a medical laboratory technician license, the total fees collected not to exceed the costs of the department for the implementation and operation of the program licensing and regulating medical laboratory technicians pursuant to

Section 1260.3. (r)</xhtml:p>"?> (

s) The costs of the department to conduct any reinspections to ensure compliance of a laboratory applying for initial licensure shall be paid by the laboratory. This additional cost for each visit shall be equal to the initial application fee and shall be paid by the laboratory prior to issuance of a license. The department shall not charge a reinspection fee if the reinspection is due to error or omission on the part of the department. (s)</xhtml:p>"?> (

t) A fee of twenty-eight dollars ($28) shall be assessed for approval of each additional location authorized by paragraph (2) of subdivision (

d) of

Section 1265. (t)</xhtml:p>"?> (

u) On or before July 1, 2013, the department shall report to the Legislature during the annual legislative budget hearing process the extent to which the state oversight program meets or exceeds federal oversight standards and the extent to which the federal Department of Health and Human Services is accepting exemption applications and the potential cost to the state for an exemption.

SEC.

Section 1300.1 of the Business and Professions Code is amended to read: 1300.1. (

a) The application, registration, certification, and license fees specified in

Section shall be adjusted annually in the manner specified in

Section of the Health and Safety Code. The adjustments shall be rounded off to the nearest whole dollar amount. (

b) This

section shall become operative on January 1, 2020.

SEC.

Section 1625.6 of the Business and Professions Code is amended to read: 1625.6. (

a) In addition to the actions authorized under

Section 1625, a dentist may independently prescribe and administer influenza and COVID-19 vaccines, consistent with recommendations adopted pursuant to

Section of the Health and Safety Code, to persons years of age or older. (

b) In order to prescribe and administer a vaccine described in subdivision (a), a dentist shall do all of the following:

(1) Complete an immunization training program biennially that is either offered by the CDC or taken through a registered provider approved by the board that, at a minimum, includes vaccine administration, prevention and management of adverse reactions, and maintenance of vaccine records.

(2) Comply with all state and federal recordkeeping and reporting requirements, including providing documentation to the patient’s primary care provider, if applicable, and entering in the information in the appropriate immunization registry designated by the Immunization Branch of the State Department of Public Health. (

c) The board may adopt regulations to implement this section. The adoption, amendment, repeal, or readoption of a regulation authorized by this

section is deemed to address an emergency, for purposes of Sections 11346.1 and 11349.6 of the Government Code, and the board is hereby exempted for this purpose from the requirements of subdivision (

b) of

Section 11346.1 of the Government Code. For purposes of subdivision (

e) of

Section 11346.1 of the Government Code, the 180-day period, as applicable to the effective period of an emergency regulatory action and submission of specified materials to the Office of Administrative Law, is hereby extended to days.

SEC. 6.

Section of the Business and Professions Code is amended to read: 2473. (

a) A doctor of podiatric medicine may independently prescribe and administer influenza and COVID-19 vaccines, consistent with recommendations adopted pursuant to

Section of the Health and Safety Code, to persons three years of age or older. (

b) In order to prescribe and administer a vaccine described in subdivision (a), a doctor of podiatric medicine shall do all of the following:

(1) Complete an immunization training program biennially that is either offered by the CDC or taken through a registered provider approved by the board that, at a minimum, includes vaccine administration, prevention and management of adverse reactions, and maintenance of vaccine records.

(2) Comply with all state and federal recordkeeping and reporting requirements, including providing documentation to the patient’s primary care provider, if applicable, and entering in the information in the appropriate immunization registry designated by the Immunization Branch of the State Department of Public Health. (

c) The board may adopt regulations to implement this section. The adoption, amendment, repeal, or readoption of a regulation authorized by this

section is deemed to address an emergency, for purposes of Sections 11346.1 and 11349.6 of the Government Code, and the board is hereby exempted for this purpose from the requirements of subdivision (

b) of

Section 11346.1 of the Government Code. For purposes of subdivision (

e) of

Section 11346.1 of the Government Code, the 180-day period, as applicable to the effective period of an emergency regulatory action and submission of specified materials to the Office of Administrative Law, is hereby extended to days.

SEC. 7.

Section of the Business and Professions Code is amended to read: 3041. (

a) The practice of optometry includes the diagnosis, prevention, treatment, and management of disorders and dysfunctions of the visual system, as authorized by this chapter, as well as the provision of habilitative or rehabilitative optometric services, and is the doing of any or all of the following:

(1) The examination of the human eyes and their adnexa, including through the use of all topical and oral diagnostic pharmaceutical agents that are not controlled substances, and the analysis of the human vision system, either subjectively or objectively.

(2) The determination of the powers or range of human vision and the accommodative and refractive states of the human eyes, including the scope of their functions and general condition.

(3) The prescribing, using, or directing the use of any optical device in connection with ocular exercises, visual training, vision training, or orthoptics.

(4) The prescribing, fitting, or adaptation of contact and spectacle lenses to, the human eyes, including lenses that may be classified as drugs or devices by any law of the United States or of this state, and diagnostic or therapeutic contact lenses that incorporate a medication or therapy the optometrist is certified to prescribe or provide.

(5) For an optometrist certified pursuant to

Section 3041.3, diagnosing and preventing conditions and diseases of the human eyes and their adnexa, and treating nonmalignant conditions and diseases of the anterior segment of the human eyes and their adnexa, including ametropia and presbyopia: (

A) Using or prescribing, including for rational off-label purposes, topical and oral prescription and nonprescription therapeutic pharmaceutical agents that are not controlled substances and are not antiglaucoma agents or limited or excluded by subdivision (b). For purposes of this section, “controlled substance” has the same meaning as used in the California Uniform Controlled Substances Act (Division 10 (commencing with

Section 11000) of the Health and Safety Code) and the United States Uniform Controlled Substances Act (21 U.S.C.

Sec. 801 et seq.). (

B) Prescribing the oral analgesic controlled substance codeine with compounds, hydrocodone with compounds, and tramadol as listed in the California Uniform Controlled Substances Act (Division 10 (commencing with

Section 11000) of the Health and Safety Code) and the United States Uniform Controlled Substances Act (21 U.S.C.

Sec. 801 et seq.), limited to three days, with referral to an ophthalmologist if the pain persists. (

C) If also certified under subdivision (c), using or prescribing topical and oral antiglaucoma agents for the medical treatment of all primary open-angle, exfoliation, pigmentary, and steroid-induced glaucomas in persons years of age or over. In the case of steroid-induced glaucoma, the prescriber of the steroid medication shall be promptly notified if the prescriber did not refer the patient to the optometrist for treatment. (

D) If also certified under subdivision (d), independent initiation and administration of immunizations for influenza, herpes zoster virus, pneumococcus, and SARS-CoV-2 in compliance with recommendations adopted pursuant to

Section of the Health and Safety Code in persons years of age or older. (

E) Utilizing the following techniques and instrumentation necessary for the diagnosis of conditions and diseases of the eye and adnexa: (

i) Laboratory tests or examinations ordered from an outside facility. (ii) Laboratory tests or examinations performed in a laboratory with a certificate of waiver under the federal Clinical Laboratory Improvement Amendments of 1988 (CLIA) (42 U.S.C.

Sec. 263a; Public Law 100-578), which shall also be allowed for: (

I) Detecting indicators of possible systemic disease that manifests in the eye for the purpose of facilitating appropriate referral to or consultation with a physician and surgeon. (II) Detecting the presence of SARS-CoV-2 virus. (iii) Skin testing performed in an office to diagnose ocular allergies, limited to the superficial layer of the skin. (iv) X-rays ordered from an outside facility. (

v) Other imaging studies ordered from an outside facility subject to prior consultation with an appropriate physician and surgeon. (vi) Other imaging studies performed in an office, including those that utilize laser or ultrasound technology, but excluding those that utilize radiation. (

F) Performing the following procedures, which are excluded from restrictions imposed on the performance of surgery by paragraph (6) of subdivision (b), unless explicitly indicated: (

i) Corneal scraping with cultures. (ii) Debridement of corneal epithelium not associated with band keratopathy. (iii) Mechanical epilation. (iv) Collection of blood by skin puncture or venipuncture for laboratory testing authorized by this subdivision. (

v) Suture removal subject to comanagement requirements in paragraph (7) of subdivision (b). (vi) Treatment or removal of sebaceous cysts by expression. (vii) Lacrimal punctal occlusion using plugs, or placement of a stent or similar device in a lacrimal canaliculus intended to deliver a medication the optometrist is certified to prescribe or provide. (viii) Foreign body and staining removal from the cornea, eyelid, and conjunctiva with any appropriate instrument.

Removal of corneal foreign bodies and any related stain shall, as relevant, be limited to that which is nonperforating, no deeper than the midstroma, and not reasonably anticipated to require surgical repair. (ix) Lacrimal irrigation and dilation in patients years of age or over, excluding probing of the nasolacrimal tract. The board shall certify any optometrist who graduated from an accredited school of optometry before May 1, 2000, to perform this procedure after submitting proof of satisfactory completion of procedures under the supervision of an ophthalmologist as confirmed by the ophthalmologist.

Any optometrist who graduated from an accredited school of optometry on or after May 1, 2000, shall be exempt from the certification requirement contained in this paragraph. (

x) Administration of oral fluorescein for the purpose of ocular angiography. (xi) Intravenous injection for the purpose of performing ocular angiography at the direction of an ophthalmologist as part of an active treatment plan in a setting where a physician and surgeon is immediately available. (xii) Use of noninvasive devices delivering intense pulsed light therapy or low-level light therapy that do not rely on laser technology, limited to treatment of conditions and diseases of the adnexa. (xiii) Use of an intranasal stimulator in conjunction with treatment of dry eye syndrome. (

G) Using additional noninvasive medical devices or technology that: (

i) Have received a United States Food and Drug Administration approved indication for the diagnosis or treatment of a condition or disease authorized by this chapter. A licensee shall successfully complete any clinical training imposed by a related manufacturer prior to using any of those noninvasive medical devices or technologies. (ii) Have been approved by the board through regulation for the rational treatment of a condition or disease authorized by this chapter.

Any regulation under this paragraph shall require a licensee to successfully complete an appropriate amount of clinical training to qualify to use each noninvasive medical device or technology approved by the board pursuant to this paragraph. (

b) Exceptions or limitations to the provisions of subdivision (

a) are as follows:

(1) Treatment of the following is excluded from the practice of optometry in a patient under years of age, unless explicitly allowed otherwise: (

A) Anterior segment inflammation, which shall not exclude treatment of: (

i) The conjunctiva. (ii) Nonmalignant ocular surface disease, including dry eye syndrome. (iii) Contact lens-related inflammation of the cornea. (iv) An infection of the cornea. (

B) Conditions or diseases of the sclera.

(2) Use of any oral prescription steroid anti-inflammatory medication for a patient under years of age shall be done pursuant to a documented, timely consultation with an appropriate physician and surgeon.

(3) Use of any nonantibiotic oral prescription medication for a patient under five years of age shall be done pursuant to a documented, prior consultation with an appropriate physician and surgeon.

(4) The following classes of agents are excluded from the practice of optometry unless they have an explicit United States Food and Drug Administration-approved indication for treatment of a condition or disease authorized under this section: (

A) Antiamoebics. (

B) Antineoplastics. (

C) Coagulation modulators. (

D) Hormone modulators. (

E) Immunomodulators.

(5) The following are excluded from authorization under subparagraph (

G) of paragraph (5) of subdivision (a): (

A) A laboratory test or imaging study. (

B) Any noninvasive device or technology that constitutes surgery under paragraph (6).

(6) Performing surgery is excluded from the practice of optometry. “Surgery” means any act in which human tissue is cut, altered, or otherwise infiltrated by any means. It does not mean

an act that solely involves the administration or prescribing of a topical or oral therapeutic pharmaceutical. (7) (

A) Treatment with topical and oral medications authorized in subdivision (

a) related to an ocular surgery shall be comanaged with the ophthalmologist that performed the surgery, or another ophthalmologist designated by that surgeon, during the customary preoperative and postoperative period for the procedure. For purposes of this subparagraph, this may involve treatment of ocular inflammation in a patient under years of age. (

B) Where published, the postoperative period shall be the “global” period established by the federal Centers for Medicare and Medicaid Services, or, if not published, a reasonable period not to exceed days. (

C) Such comanaged treatment may include addressing agreed-upon complications of the surgical procedure occurring in any ocular or adnexal structure with topical and oral medications authorized in subdivision (a). For patients under years of age, this subparagraph shall not apply unless the patient’s primary care provider agrees to allowing comanagement of complications. (

c) An optometrist certified pursuant to

Section 3041.3 shall be certified to medically treat authorized glaucomas under this

chapter after meeting the following requirements:

(1) For licensees who graduated from an accredited school of optometry on or after May 1, 2008, submission of proof of graduation from that institution.

(2) For licensees who were certified to treat glaucoma under this

section before January 1, 2009, submission of proof of completion of that certification program.

(3) For licensees who completed a didactic course of not less than hours in the diagnosis, pharmacological, and other treatment and management of glaucoma, submission of proof of satisfactory completion of the case management requirements for certification established by the board.

(4) For licensees who graduated from an accredited school of optometry on or before May 1, 2008, and who are not described in paragraph (2) or (3), submission of proof of satisfactory completion of the requirements for certification established by the board under

Chapter of the Statutes of 2008. (

d) An optometrist certified pursuant to

Section 3041.3 shall be certified to administer authorized immunizations, as described in subparagraph (

D) of paragraph (5) of subdivision (a), after the optometrist meets all of the following requirements:

(1) Completes an immunization training program endorsed by the federal Centers for Disease Control and Prevention (CDC) or the Accreditation Council for Pharmacy Education that, at a minimum, includes hands-on injection technique, clinical evaluation of indications and contraindications of vaccines, and the recognition and treatment of emergency reactions to vaccines, and maintains that training.

(2) Is certified in basic life support.

(3) Complies with all state and federal recordkeeping and reporting requirements, including providing documentation to the patient’s primary care provider and entering information in the appropriate immunization registry designated by the immunization branch of the State Department of Public Health.

(4) Applies for an immunization certificate in accordance with

Section 3041.5. (

e) Other than for prescription ophthalmic devices described in subdivision (

b) of

Section 2541, any dispensing of a therapeutic pharmaceutical agent by an optometrist shall be without charge. (

f) An optometrist licensed under this

chapter is subject to the provisions of

Section 2290.5 for purposes of practicing telehealth. (

g) For the purposes of this chapter, all of the following

definitions shall apply: (1) “Adnexa” means the eyelids and muscles within the eyelids, the lacrimal system, and the skin extending from the eyebrows inferiorly, bounded by the medial, lateral, and inferior orbital rims, excluding the intraorbital extraocular muscles and orbital contents. (2) “Anterior segment” means the portion of the eye anterior to the vitreous humor, including its overlying soft tissue coats. (3) “Ophthalmologist” means a physician and surgeon, licensed under

Chapter 5 (commencing with

Section 2000) of Division of the Business and Professions Code, specializing in treating eye disease. (4) “Physician and surgeon” means a physician and surgeon licensed under

Chapter 5 (commencing with

Section 2000) of Division of the Business and Professions Code. (5) “Prevention” means use or prescription of an agent or noninvasive device or technology for the purpose of inhibiting the development of an authorized condition or disease. (6) “Treatment” means use of or prescription of an agent or noninvasive device or technology to alter the course of an authorized condition or disease once it is present. (

h) In an emergency, an optometrist shall stabilize, if possible, and immediately refer any patient who has an acute attack of angle closure to an ophthalmologist.

SEC.

Section 3041.5 of the Business and Professions Code is amended to read: 3041.5. (

a) A person requesting to be certified to administer immunizations pursuant to

Section shall apply for a certificate from the board pursuant to an application that shall be in substantially the following form: “Application for Optometrists to Administer Immunizations Per California Business and Professions Code §3041(g), you must have a current California Optometrist License and have a Therapeutic Pharmaceutical Agents (TPA) license type to be eligible for a certificate to administer immunizations. “Immunization” means the administration of immunizations for influenza, herpes zoster virus, pneumococcus, and SARS-CoV-2, consistent with recommendations adopted pursuant to

Section of the Health and Safety Code, for persons years of age or older. If eligible, you must also meet and maintain the following requirements for an immunization certificate: 1. Complete an immunization training program endorsed by the CDC or the Accreditation Council for Pharmacy Education that, at a minimum, includes hands-on injection technique, clinical evaluation of indications and contraindications of vaccines, and the recognition and treatment of emergency reactions to vaccines, and maintain that training. 2. Be certified in basic life support. 3.

Comply with all state and federal recordkeeping and reporting requirements, including providing documentation to the patient’s primary care provider and entering information in the appropriate immunization registry designated by the immunization branch of the California State Department of Public Health. To apply for an immunization certificate, provide documentation for items #1 and #2 above with your application. All documentation must be provided, or the application will be rejected.

First, Middle, and Last Name:_________________________ Email address:________________________________________ License No.:__________________________________________ 1. I declare under penalty of perjury under the laws of the State of California that the information provided on this form and the attached documents or other requested proof of completion is true and accurate. I understand and agree that any misstatements of material facts may be cause for denial of the Application for Optometrists to Administer Immunizations and disciplinary action by the California State Board of Optometry. AND 2.

I declare under penalty of perjury under the laws of the State of California that I will comply with all state and federal recordkeeping and reporting requirements, including providing documentation to the patient’s primary care provider and entering information in the appropriate immunization registry designated by the immunization branch of the California State Department of Public Health. Optometrist Signature: _________________________________ Date:___________________________________________________” (

b) The application for an immunization certificate set forth in subdivision (

a) shall be accompanied by an application fee of fifty dollars ($50), or a fee in an amount as determined by the board, not to exceed the reasonable cost of administering this section. (

c) After the effective date of this section, the board may modify the Application for Optometrists to Administer Immunizations set forth in subdivision (

a) by regulation in accordance with

Section 3025.

SEC.

Section 4052.05 is added to the Business and Professions Code , to read: 4052.05. A pharmacist may independently initiate and administer an immunization that, on January 1, 2025, had in effect a recommendation from the Advisory Committee on Immunization Practices of the federal Centers for Disease Control and Prevention, regardless of whether the immunization is recommended for routine use, or as modified or supplemented by the State Department of Public Health pursuant to

Section of the Health and Safety Code, to individuals three years of age or older.

SEC.

Section 48980.4 of the Education Code is amended to read: 48980.4. (a)

(1) Until June 30, 2026, the notification required pursuant to

Section for pupils admitted to, or advancing to, grade shall include a notification to the pupil’s parent or guardian containing a statement about the state’s public policy described in subdivision (

a) of

Section of the Health and Safety Code, advising that the pupil adhere to current immunization guidelines, as recommended by the Advisory Committee on Immunization Practices of the federal Centers for Disease Control and Prevention as of January 1, 2025, the American Academy of Pediatrics, and the American Academy of Family Physicians, regarding full human papillomavirus (HPV) immunization before admission or advancement to the grade 8.

(2) Beginning July 1, 2026, the notification required pursuant to

Section for pupils admitted to, or advancing to, grade shall include a notification to the pupil’s parent or guardian containing a statement about the state’s public policy described in subdivision (

a) of

Section of the Health and Safety Code, advising that the pupil adhere to current immunization guidelines, as recommended by the State Department of Public Health, in accordance with

Section of the Health and Safety Code, regarding full human papillomavirus (HPV) immunization before admission or advancement to the grade 8. (

b) The notification sent pursuant to subdivision (

a) shall conform to the notification requirements outlined in this article. (

c) The notification sent pursuant to subdivision (

a) shall also include the statement specified in subdivision (

c) of

Section of the Health and Safety Code.

SEC.

Section 100503.6 is added to the Government Code , to read: 100503.6. (

a) If a qualified health plan is required to cover state-mandated gender-affirming care benefits determined to be in addition to essential health benefits pursuant to

Section 18031(d)(3)(

B) of Title of the United States Code, the Exchange shall provide payments to issuers of qualified health plans offered through the Exchange to defray the costs of offering those benefits to qualified health plan enrollees. (

b) In accordance with

Section 155.170 of Title of the Code of Federal Regulations, the payments required by subdivision (

a) shall equal the cost of the additional required benefits reported to the Exchange. (

c) The payments required under subdivision (

a) shall only be made upon appropriation by the Legislature. The payments shall not be made from the California Health Trust Fund established by

Section 100520. (

d) Subject to an appropriation by the Legislature, the payments shall be made for plan years beginning on or after January 1, 2026. (

e) This

section does not create an entitlement program of any kind, appropriate any funds, require the Legislature to appropriate any funds, or increase or decrease taxes owed by a taxpayer. (

f) The Director of the Department of Managed Health Care may issue guidance regarding gender-affirming care benefits subject to this section. This guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with

Section 11340) of Part of Division of Title 2).

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, and benefit programs pursuant to

Section 100503.6, 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. 13.

Section of the Health and Safety Code is amended to read: 1206. This

chapter does not apply to the following: (

a) Except with respect to the option provided with regard to surgical clinics in paragraph (1) of subdivision (

b) of

Section and, further, with respect to specialty clinics specified in paragraph (2) of subdivision (

b) of

Section 1204, any place or establishment owned or leased and operated as a clinic or office by one or more licensed health care practitioners and used as an office for the practice of their profession, within the scope of their license, regardless of the name used publicly to identify the place or establishment. (

b) Any clinic directly conducted, maintained, or operated by the United States or by any of its departments, officers, or agencies, and any primary care clinic specified in subdivision (

a) of

Section that is directly conducted, maintained, or operated by this state or by any of its political subdivisions or districts, or by any city. This subdivision does not preclude the department from adopting regulations that utilize clinic licensing standards as eligibility criteria for participation in programs funded wholly or partially under Title XVIII or XIX of the federal Social Security Act. (c)

(1) Any clinic conducted, maintained, or operated by a federally recognized Indian tribe or tribal organization, as defined in

Section or of Title of the United States Code, that is located on land recognized as tribal land by the federal government.

(2) Any clinic conducted, maintained, or operated by a federally recognized Indian tribe or tribal organization, as defined in

Section or of Title of the United States Code, under a contract with the United States pursuant to the Indian Self-Determination and Education Assistance Act (Public Law 93-638), regardless of the location of the clinic, except that if the clinic chooses to apply to the State Department of Public Health for a state facility license, then the State Department of Public Health will retain authority to regulate that clinic as a primary care clinic as defined by subdivision (

a) of

Section 1204. (

d) A clinic conducted, operated, or maintained as outpatient departments of hospitals. (

e) Any facility licensed as a health facility under

Chapter 2 (commencing with

Section 1250). (

f) Any freestanding clinical or pathological laboratory licensed under

Chapter 3 (commencing with

Section 1200) of Division of the Business and Professions Code. (

g) A clinic operated by, or affiliated with, any institution of learning that teaches a recognized healing art and is approved by the state board or commission vested with responsibility for regulation of the practice of that healing art. (

h) A clinic that is operated by a primary care community or free clinic and that is operated on separate premises from the licensed clinic and is only open for limited services of no more than hours a week. An intermittent clinic as described in this subdivision shall, however, meet all other requirements of law, including administrative regulations and requirements, pertaining to fire and life safety. (

i) The offices of physicians in group practice who provide a preponderance of their services to members of a comprehensive group practice prepayment health care service plan subject to

Chapter 2.2 (commencing with

Section 1340). (

j) Student health centers operated by public institutions of higher education. (

k) Nonprofit speech and hearing centers, as defined in

Section 1201.5. Any nonprofit speech and hearing clinic desiring an exemption under this subdivision shall make application therefor to the director, who shall grant the exemption to any facility meeting the criteria of

Section 1201.5. Notwithstanding the licensure exemption contained in this subdivision, a nonprofit speech and hearing center shall be an organized outpatient clinic for purposes of qualifying for reimbursement as a rehabilitation center under the Medi-Cal Act (Chapter 7 (commencing with

Section 14000) of Part of Division of the Welfare and Institutions Code). (

l) A clinic operated by a nonprofit corporation exempt from federal income taxation under paragraph (3) of subsection (

c) of

Section of the Internal Revenue Code of 1954, as amended, or a statutory successor thereof, that conducts medical research and health education and provides health care to its patients through a group of or more physicians and surgeons, who are independent contractors representing not less than board-certified specialties, and not less than two-thirds of whom practice on a full-time basis at the clinic. (

m) Any clinic, limited to in vivo diagnostic services by magnetic resonance imaging functions or radiological services under the direct and immediate supervision of a physician and surgeon who is licensed to practice in California. This shall not be construed to permit cardiac catheterization or any treatment modality in these clinics. (

n) A clinic operated by an employer or jointly by two or more employers for their employees only, or by a group of employees, or jointly by employees and employers, without profit to the operators thereof or to any other person, for the prevention and treatment of accidental injuries to, and the care of the health of, the employees comprising the group. (

o) A community mental health center, as defined in

Section of the Welfare and Institutions Code. (p)

(1) A clinic operated by a nonprofit corporation exempt from federal income taxation under paragraph (3) of subsection (

c) of

Section of the Internal Revenue Code of 1954, as amended, or a statutory successor thereof, as an entity organized and operated exclusively for scientific and charitable purposes and that satisfied all of the following requirements on or before January 1, 2005: (

A) Commenced conducting medical research on or before January 1, 1982, and continues to conduct medical research. (

B) Conducted research in, among other areas, prostatic cancer, cardiovascular disease, electronic neural prosthetic devices, biological effects and medical uses of lasers, and human magnetic resonance imaging and spectroscopy. (

C) Sponsored publication of at least medical research articles in peer-reviewed publications. (

D) Received grants and contracts from the National Institutes of Health. (

E) Held and licensed patents on medical technology. (

F) Received charitable contributions and bequests totaling at least five million dollars ($5,000,000). (

G) Provides health care services to patients only: (

i) In conjunction with research being conducted on procedures or applications not approved or only partially approved for payment (

I) under the Medicare program pursuant to

Section 1359y(a)(1)(

A) of Title of the United States Code, or (II) by a health care service plan registered under

Chapter 2.2 (commencing with

Section 1340), or a disability insurer regulated under

Chapter 1 (commencing with

Section 10110) of Part of Division of the Insurance Code; provided that services may be provided by the clinic for an additional period of up to three years following the approvals, but only to the extent necessary to maintain clinical expertise in the procedure or application for purposes of actively providing training in the procedure or application for physicians and surgeons unrelated to the clinic. (ii) Through physicians and surgeons who, in the aggregate, devote no more than percent of their professional time for the entity operating the clinic, on an annual basis, to direct patient care activities for which charges for professional services are paid. (

H) Makes available to the public the general results of its research activities on at least an annual basis, subject to good faith protection of proprietary rights in its intellectual property. (

I) Is a freestanding clinic, whose operations under this subdivision are not conducted in conjunction with any affiliated or associated health clinic or facility defined under this division, except a clinic exempt from licensure under subdivision (m). For purposes of this subparagraph, a freestanding clinic is defined as “affiliated” only if it directly, or indirectly through one or more intermediaries, controls, or is controlled by, or is under common control with, a clinic or health facility defined under this division, except a clinic exempt from licensure under subdivision (m).

For purposes of this subparagraph, a freestanding clinic is defined as “associated” only if more than percent of the directors or trustees of the clinic are also the directors or trustees of any individual clinic or health facility defined under this division, except a clinic exempt from licensure under subdivision (m). Any activity by a clinic under this subdivision in connection with an affiliated or associated entity shall fully comply with the requirements of this subdivision. This subparagraph does not apply to agreements between a clinic and any entity for purposes of coordinating medical research.

(2) By January 1, 2007, and every five years thereafter, the Legislature shall receive a report from each clinic meeting the criteria of this subdivision and any other interested party concerning the operation of the clinic’s activities. The report shall include, but not be limited to, an evaluation of how the clinic impacted competition in the relevant health care market, and a detailed description of the clinic’s research results and the level of acceptance by the payer community of the procedures performed at the clinic.

The report shall also include a description of procedures performed both in clinics governed by this subdivision and those performed in other settings. The cost of preparing the reports shall be borne by the clinics that are required to submit them to the Legislature pursuant to this paragraph. (

q) A primary care clinic operated as part of a Program of All-Inclusive Care for the Elderly (PACE) organization, as defined in

Section 460.6 of Title of the Code of Federal Regulations and approved by the State Department of Health Care Services pursuant to

Section of the Welfare and Institutions Code, that exclusively serves PACE participants, as defined in

Section 460.6 of Title of the Code of Federal Regulations.

(1) A primary care clinic approved by the State Department of Health Care Services pursuant to

Section of the Welfare and Institutions Code to operate exclusively as part of a PACE organization may provide services to individuals who are being assessed for eligibility to enroll in the PACE program for not more than calendar days after an individual submits an application for enrollment.

(2) If the State Department of Health Care Services determines that a primary care clinic approved to operate exclusively as part of a PACE organization has provided services to individuals other than those enrolled in the PACE program, or who are being assessed for eligibility pursuant to paragraph (1), the clinic shall apply for licensure with the State Department of Public Health.

A clinic required to obtain licensure from the State Department of Public Health pursuant to this paragraph shall apply for the license not later than calendar days following the determination by the State Department of Health Care Services described in this paragraph. The clinic shall not accept any new participants in the PACE program until licensure is obtained.

(3) This subdivision shall become operative only if the Director of Health Care Services determines, and communicates that determination in writing to the State Department of Public Health, that operating standards compliance programs consistent with subdivisions (

d) and (

e) of

Section of the Welfare and Institutions Code have been established. A primary care clinic described in subdivision (

c) of

Section of the Welfare and Institutions Code shall remain under the oversight and regulatory authority of the State Department of Public Health until the Director of Health Care Services communicates their written determination to the State Department of Public Health. (r)

(1) A clinic, including any location thereof, operated by a nonprofit corporation exempt from federal income taxation under paragraph (3) of subsection (

c) of

Section of the Internal Revenue Code of 1954, as amended, or a statutory successor thereof, as an entity organized and operated exclusively to provide health care services and health education services within the Los Angeles County Service Planning Area 6, is located in a Clinic Service Area, as defined in paragraph (3), and satisfies all of the following requirements: (

A) Provides health care services and health education services solely within a Clinic Service Area, as defined in paragraph (3). (

B) Provides health care services to patients through an independent agreement with a multispecialty medical group of or more physicians and surgeons who represent not less than board-certified specialties, and not less than two-thirds of whom practice on a full-time basis at the clinic by July 1, 2021. (

C) Serves substantial beneficiaries of a “federal health care program,” as that term is defined in subsection (

f) of

Section 1320a-7b of Title of the United States Code and indigent and uninsured individuals pursuant to an authorized and adopted charity care policy. (

D) Participates in a graduate medical education program that is administered by the Martin Luther King, Jr. Community Hospital, as described in

Section 14165.50 of the Welfare and Institutions Code, in furtherance of its charitable mission to reduce health care disparities in a Clinic Service Area, as defined in paragraph (3), through the training and retention of physicians and surgeons by 2022. (2) (

A) By July 1, 2022, and every five years thereafter, a clinic that is exempt from licensing provisions pursuant to this subdivision shall provide the Legislature with a report that includes all of the following: (

i) A copy of the current Community Health Needs Assessment, developed by the Martin Luther King, Jr. Community Hospital. (ii) A community needs assessment for physicians and surgeons, including an analysis of the clinic’s role in physician and surgeon recruitment and retention, and meeting the community needs for a physician and surgeon workforce. (iii) A copy of the Martin Luther King, Jr. Community Hospital’s most recent Internal Revenue Service Form 990,

Schedule H, including a description of the federally-funded payer mix, and identification of the clinic as a component of the Martin Luther King, Jr. Community Hospital’s community benefit activities. (iv) The clinic’s role in the hospital-sponsored graduate medical education program. (

v) An analysis of how the clinic impacted physicians and surgeons practicing or providing services in the Clinic Service Area prior to January 1, 2020. (

B) A report to be submitted pursuant to subparagraph (

A) of paragraph (2) shall be submitted in compliance with

Section of the Government Code.

(3) For purposes of this subdivision, “Clinic Service Area” means the geographic area within any ZIP Code that is located within six miles of the physical location of the Martin Luther King, Jr. Community Hospital, as described in

Section 14165.50 of the Welfare and Institutions Code. (s)

(1) From May 15, 2028, to September 15, 2028, inclusive, a clinic that meets all of the following requirements: (

A) Approved by the Los Angeles Organizing Committee for the Olympic and Paralympic Games. (

B) Is either of the following: (

i) Conducted, operated, or maintained by a California licensed health care practitioner acting within the scope of their license. (ii) Operated by or affiliated with a health facility, as defined in subdivision (

a) or (

b) of

Section 1250. (

C) Provides health care services at either of the following: (

i) A competition, noncompetition, athlete village, training, or support site designated by the committee. (ii) An event in this state sanctioned by the committee.

(2) This subdivision exempts a clinic from this

chapter only for health care services provided at the locations described in subparagraph (

C) of paragraph (1).

(3) For purposes of this subdivision, “committee” means the Los Angeles Organizing Committee for the Olympic and Paralympic Games.

SEC.

Section 1261.3 of the Health and Safety Code is amended to read: 1261.3. (

a) Notwithstanding any other provision of law, for a patient aged years or older, a registered nurse or licensed pharmacist may administer in a skilled nursing facility, as defined in subdivision (

c) of

Section 1250, influenza and pneumococcal immunizations pursuant to standing orders and without patient-specific orders if all of the following criteria are met:

(1) The skilled nursing facility medical director, as defined in

Section of Title of the California Code of Regulations, has approved the immunization standing orders established by the facility.

(2) The standing orders meet the recommendations adopted by the State Department of Public Health pursuant to

Section 120164. (

b) Nothing in this

section amends, alters, or restricts the scope of registered nurse practice including, but not limited to, the scope of practice set forth in

Article 2 (commencing with

Section 2725) of

Chapter of Division of the Business and Professions Code, the implementing regulations, and interpretative bulletins or practice advisories issued by the Board of Registered Nursing.

SEC.

Section 1342.2 of the Health and Safety Code is amended to read: 1342.2. (

a) Notwithstanding any other law, a health care service plan contract that covers medical, surgical, and hospital benefits, excluding a specialized health care service plan contract, shall cover the costs for COVID-19 diagnostic and screening testing and health care services related to diagnostic and screening testing approved or granted emergency use authorization by the federal Food and Drug Administration for COVID-19, regardless of whether the services are provided by an in-network or out-of-network provider. Coverage required by this

section shall not be subject to copayment, coinsurance, deductible, or any other form of cost sharing. Services related to COVID-19 diagnostic and screening testing include, but are not limited to, hospital or health care provider office visits for the purposes of receiving testing, products related to testing, the administration of testing, and items and services furnished to an enrollee as part of testing. Services related to COVID-19 diagnostic and screening testing do not include bonus payments for the use of specialized equipment or expedited processing.

(1) To the extent a health care provider would have been entitled to receive cost sharing but for this section, the health care service plan shall reimburse the health care provider the amount of that lost cost sharing.

(2) A health care service plan contract shall not impose prior authorization or any other utilization management requirements on COVID-19 diagnostic and screening testing.

(3) With respect to an enrollee, a health care service plan shall reimburse the provider of the testing according to either of the following: (

A) If the health plan has a specifically negotiated rate for COVID-19 diagnostic and screening testing with such provider in effect before the public health emergency declared under

Section of the Public Health Service Act (42 U.S.C.

Sec. 247d), such negotiated rate shall apply throughout the period of such declaration. (

B) If the health plan does not have a specifically negotiated rate for COVID-19 diagnostic and screening testing with such provider, the plan may negotiate a rate with such provider.

(4) For an out-of-network provider with whom a health care service plan does not have a specifically negotiated rate for COVID-19 diagnostic and screening testing and health care services related to testing, a plan shall reimburse the provider for all testing items or services in an amount that is reasonable, as determined in comparison to prevailing market rates for testing items or services in the geographic region where the item or service is rendered.

An out-of-network provider shall accept this payment as payment in full, shall not seek additional remuneration from an enrollee for services related to testing, and shall not report adverse information to a consumer credit reporting agency or commence civil action against the enrollee.

(5) Beginning six months after the federal public health emergency expires, a health care service plan shall no longer be required to cover the cost sharing for COVID-19 diagnostic and screening testing and health care services related to testing when delivered by an out-of-network provider, except as otherwise required by law. All other requirements of this subdivision shall remain in effect after the federal public health emergency expires.

(6) Changes to a contract between a health care service plan and a provider delegating financial risk for diagnostic and screening testing related to a declared public health emergency shall be considered a material change to the parties’ contract. A health care service plan shall not delegate the financial risk to a contracted provider for the cost of enrollee services provided under this

section unless the parties have negotiated and agreed upon a new provision of the parties’ contract pursuant to

Section 1375.7. (b)

(1) A health care service plan contract that covers medical, surgical, and hospital benefits shall cover without cost sharing any item, service, or immunization that is intended to prevent or mitigate COVID-19 and that is either of the following with respect to the individual enrollee: (

A) An evidence-based item or service that had in effect on January 1, 2025, a rating of “A” or “B” in the recommendations of the United States Preventive Services Task Force or any modification or supplement to that recommendation adopted pursuant to

Section 120164. (

B) An immunization that had in effect on January 1, 2025 a recommendation from the Advisory Committee on Immunization Practices of the federal Centers for Disease Control and Prevention or any modification or supplement to that recommendation adopted pursuant to

Section 120164, regardless of whether the immunization is recommended for routine use.

(2) The item, service, or immunization covered pursuant to paragraph (1) shall be covered upon operation of the act that amended this subdivision.

(3) Any modification or supplement to the recommendations described in paragraph (1) shall be covered or removed from coverage no later than business days after the date on which the State Department of Public Health publishes the updated recommendations pursuant to

Section 120164. (3)</xhtml:p>"?> (4) (

A) A health care service plan subject to this subdivision shall not impose any cost-sharing requirements, including a copayment, coinsurance, or deductible, for any item, service, or immunization described in paragraph (1), regardless of whether such service is delivered by an in-network or out-of-network provider. (

B) To the extent a health care provider would have been entitled to receive cost sharing but for this section, the health care service plan shall reimburse the health care provider the amount of that lost cost sharing. (

C) With respect to an enrollee, a health care service plan shall reimburse the provider of the immunization according to either of the following: (

i) If the health plan has a negotiated rate with such provider in effect before the public health emergency declared under

Section of the Public Health Service Act (42 U.S.C.

Sec. 247d), such negotiated rate shall apply throughout the period of such declaration. (ii) If the health plan does not have a negotiated rate with such provider, the plan may negotiate a rate with such provider. (

D) A health care service plan shall not impose cost sharing for any items or services that are necessary for the furnishing of an item, service, or immunization described in paragraph (1), including, but not limited to, provider office visits and vaccine administration, regardless of whether the service is delivered by an in-network or out-of-network provider. (E) (

i) For an out-of-network provider with whom a health care service plan does not have a negotiated rate for an item, service, or immunization described in paragraph (1), a health care service plan shall reimburse the provider for all related items or services, including any items or services that are necessary for the furnishing of an item, service, or immunization described in paragraph (1), in an amount that is reasonable, as determined in comparison to prevailing market rates for such items or services in the geographic region in which the item or service is rendered.

An out-of-network provider shall accept this payment as payment in full, shall not seek additional remuneration from an enrollee, and shall not report adverse information to a consumer credit reporting agency or commence civil action against the enrollee for items, services, and immunizations described in subdivision (b), including any items or services that are necessary for the furnishing of an item, service, or immunization described in paragraph (1). (ii) Beginning six months after the federal public health emergency expires, a health care service plan shall no longer be required to cover the cost sharing for any item, service, or immunization described in paragraph (1) and to cover items or services that are necessary for the furnishing of the items, services, or immunizations described in paragraph (1) when delivered by an out-of-network provider, except as otherwise required by law.

All other requirements of this

section shall remain in effect after the federal public health emergency expires. (4)</xhtml:p>"?>

(5) A health care service plan subject to this subdivision shall not impose prior authorization or any other utilization management requirements on any item, service, or immunization described in paragraph (1) or to items or services that are necessary for the furnishing of the items, services, or immunizations described in subparagraph (

D) of paragraph (3). (5)</xhtml:p>"?> ( 6) Changes to a contract between a health care service plan and a provider delegating financial risk for immunization related to a declared public health emergency, shall be considered a material change to the parties’ contract. A health plan shall not delegate the financial risk to a contracted provider for the cost of enrollee services provided under this

section unless the parties have negotiated and agreed upon a new provision of the parties’ contract pursuant to

Section 1375.7. (

c) The director may issue guidance to health care service plans regarding compliance with this section. This guidance 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). The department shall consult with the Department of Insurance in issuing the guidance specified in this subdivision. (

d) This section, excluding subdivision (h), shall apply retroactively beginning from the Governor’s declared State of Emergency related to the SARS-CoV-2 (COVID-19) pandemic on March 4, 2020. Notwithstanding

Section 1390, this subdivision does not create criminal liability for transactions that occurred before January 1, 2022. (

e) For purposes of this section: (1) “Diagnostic testing” means all of the following: (

A) Testing intended to identify current or past infection and performed when a person has signs or symptoms consistent with COVID-19, or when a person is asymptomatic but has recent known or suspected exposure to SARS-CoV-2. (

B) Testing a person with symptoms consistent with COVID-19. (

C) Testing a person as a result of contact tracing efforts. (

D) Testing a person who indicates that they were exposed to someone with a confirmed or suspected case of COVID-19. (

E) Testing a person after an individualized clinical assessment by a licensed health care provider. (2) “Screening testing” means tests that are intended to identify people with COVID-19 who are asymptomatic and do not have known, suspected, or reported exposure to SARS-CoV-2. Screening testing helps to identify unknown cases so that measures can be taken to prevent further transmission. Screening testing includes all of the following: (

A) Workers in a workplace setting. (

B) Pupils, faculty, and staff in a school setting. (

C) A person before or after travel. (

D) At home for someone who does not have symptoms associated with COVID-19 and does not have a known exposure to someone with COVID-19. (

f) This

section does not relieve a health care service plan from continuing to cover testing as required by federal law and guidance. (

g) The department shall hold health care service plans accountable for timely access to services required under this

section and coverage requirements established under federal law, regulations, or guidelines. (h)

(1) This subdivision applies to a health care service plan contract issued, amended, or renewed on or after the operative date of this subdivision that covers medical, surgical, and hospital benefits, excluding a specialized health care service plan contract, with respect to therapeutics for COVID-19 covered under the contract, which shall include therapeutics approved or granted emergency use authorization by the federal Food and Drug Administration for treatment of COVID-19 when prescribed or furnished by a licensed health care provider acting within their scope of practice and the standard of care.

(2) A health care service plan shall reimburse a provider for the therapeutics described in paragraph (1) at the specifically negotiated rate for those therapeutics, if the plan and provider have negotiated a rate. If the plan does not have a negotiated rate with a provider, the plan may negotiate a rate with the provider.

(3) For an out-of-network provider with whom a health care service plan does not have a negotiated rate for the therapeutics described in paragraph (1), a health care service plan shall reimburse the provider for the therapeutics in an amount that is reasonable, as determined in comparison to prevailing market rates for the therapeutics in the geographic region in which the therapeutic was delivered.

An out-of-network provider shall accept this payment as payment in full, shall not seek additional remuneration from an enrollee, and shall not report adverse information to a consumer credit reporting agency or commence civil action against the enrollee for therapeutics described in this subdivision.

(4) A health care service plan shall cover COVID-19 therapeutics without cost sharing, regardless of whether the therapeutics are provided by an in-network or out-of-network provider, and without utilization management. If a provider would have been entitled to receive cost sharing but for this section, the health care service plan shall reimburse the provider for the amount of that lost cost sharing. A provider shall accept this payment as payment in full, shall not seek additional remuneration from an enrollee, and shall not report adverse information to a consumer credit reporting agency or commence civil action against the enrollee for therapeutics pursuant to this subdivision.

(5) Beginning six months after the federal public health emergency expires, a health care service plan shall no longer be required to cover the cost sharing for COVID-19 therapeutics delivered by an out-of-network provider, unless otherwise required by law. All other requirements of this subdivision shall remain in effect after the federal public health emergency expires.

(6) This

section does not apply to a Medi-Cal managed care plan that contracts with the State Department of Health Care Services pursuant to

Chapter 7 (commencing with

Section 14000) and

Chapter 8 (commencing with

Section 14200) of Part of Division of the Welfare and Institutions Code.

SEC.

Section 1342.3 of the Health and Safety Code is amended to read: 1342.3. (

a) A health care service plan contract that covers medical, surgical, and hospital benefits, excluding a specialized health care service plan contract, shall cover, without cost sharing and without prior authorization or other utilization management, the costs of the following health care services to prevent or mitigate a disease when the Governor of the State of California has declared a public health emergency due to that disease:

(1) An evidence-based item, service, or immunization that is intended to prevent or mitigate a disease and that is either of the following: (

A) An item or service that, as of January 1, 2025, had in effect a rating of “A” or “B” in the recommendations of the United States Preventive Services Task Force, or any modification or supplement to that recommendation adopted pursuant to

Section 120164. (

B) An immunization that, as of January 1, 2025, had in effect a recommendation of the Advisory Committee on Immunization Practices of the federal Centers for Disease Control and Prevention, or any modification or supplement to that recommendation adopted pursuant to

Section 120164.

(2) A health care service or product related to diagnostic and screening testing for the disease that is approved or granted emergency use authorization by the federal Food and Drug Administration, or is recommended by the State Department of Public Health or the federal Centers for Disease Control and Prevention.

(3) Therapeutics approved or granted emergency use authorization by the federal Food and Drug Administration for the disease. (b)

(1) The item, service, or immunization covered pursuant to paragraph (1) of subdivision (

a) shall be covered upon operation of the act that added this paragraph.

(2) Any modification or supplement to the recommendations described in subparagraphs (

A) or (

B) of paragraph (1) of subdivision (

a) shall be covered or removed from coverage no later than business days after the date on which the State Department of Public Health publishes the updated recommendations pursuant to

Section 120164. (

c) For purposes of this section, “health care service plan” includes a Medi-Cal managed care plan that contracts with the State Department of Health Care Services pursuant to

Chapter 7 (commencing with

Section 14000) and

Chapter 8 (commencing with

Section 14200) of Part of Division of the Welfare and Institutions Code. The State Department of Health Care Services shall seek any federal approvals it deems necessary to implement this section. This

section applies to a Medi-Cal managed care plan contract only to the extent that the State Department of Health Care Services obtains any necessary federal approvals, and federal financial participation under the Medi-Cal program is available and not otherwise jeopardized.

SEC.

Section 1347.8 of the Health and Safety Code is amended to read: 1347.8. (a)

(1) Beginning on July 1, 2023, and annually thereafter, a health care service plan providing a qualified health plan through the Exchange shall report to the director the total amount of funds maintained in a segregated account pursuant to subsection (

b) of

Section of the federal Patient Protection and Affordable Care Act (Public Law 111-148).

(2) This annual report shall contain the ending balance of the account and the total dollar amount of claims paid during the reporting year. This report shall also include any related documentation required by the director. (

b) For purposes of this section: (1) “Exchange” means the California Health Benefit Exchange established pursuant to Title 22 (commencing with

Section 100500) of the Government Code. (2) “Qualified health plan” has the same meaning as defined in

Section of the federal Patient Protection and Affordable Care Act (Public Law 111-148). (

c) Annually from the 2025–26 fiscal year to the 2028–29 fiscal year, inclusive, and upon receipt of the required annual report, the director shall order the transfer of funds from each qualified health plan’s segregated account with a positive balance, and each qualified health plan shall complete the transfer, to the Abortion Access Fund established in

Section 127641, as follows:

(1) On or before October 30, 2025, up to the total amount provided by the California Health Benefit Exchange to qualified health plans pursuant to

Section 100503.5 of the Government Code as of July 1, 2025, not to exceed percent of the amount of the ending balance of the qualified health plan’s segregated account as of July 1, 2025.

(2) On or before September 1, 2026, and each year thereafter through the 2028–29 fiscal year, up to the total amount provided by the California Health Benefit Exchange to qualified health plans pursuant to

Section 100503.5 of the Government Code as of July of that year, not to exceed percent of the amount of the ending balance of a qualified health plan’s segregated account that exceeds claims paid in the prior plan year.

SEC.

Section 1367.002 of the Health and Safety Code is amended to read: 1367.002. (

a) A group or individual nongrandfathered health care service plan contract shall, at a minimum, provide coverage for and shall not impose any cost-sharing requirements for any of the following:

(1) Evidence-based items or services that had in effect on January 1, 2025, a rating of “A” or “B” in the recommendations of the United States Preventive Services Task Force or any modification or supplement to that recommendation adopted pursuant to

Section 120164.

(2) Immunizations that had in effect