AB 184

Bill Subjects

Abstract

(1) Existing federal law, the Patient Protection and Affordable Care Act (PPACA) , enacts various health care market reforms. Existing state law creates the California Health Benefit Exchange (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, until January 1, 2023, requires the Exchange to administer a program of health care coverage financial assistance to help low-income and middle-income Californians. Existing law exempted the program design of financial assistance and a related regulation, standard, criterion, procedure, determination, rule, notice, guideline, or any other guidance established or issued by the Exchange or Franchise Tax Board from the Administrative Procedure Act until January 1, 2022. This bill would indefinitely extend the above-described financial assistance program and Administrative Procedure Act exemptions. (2) Existing law generally requires the State Department of Public Health to license, inspect, and regulate health facilities, including hospitals. Existing law requires health facilities to meet specified cost and disclosure requirements, including maintaining an understandable written policy regarding discount payments and charity. Existing law establishes the Department of Health Care Access and Information (HCAI) to oversee various aspects of the health care market, including oversight of hospital facilities and community benefit plans. Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care, and makes a willful violation of the act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law requires each department to develop and adopt regulations to ensure that enrollees and insureds have access to needed health care services in a timely manner. Existing law requires that health care service plans and health insurers submit rates to their regulating entity for review. This bill would establish, within HCAI, the Office of Health Care Affordability to analyze the health care market for cost trends and drivers of spending, develop data-informed policies for lowering health care costs for consumers and purchasers, set and enforce cost targets, and create a state strategy for controlling the cost of health care and ensuring affordability for consumers and purchasers. The bill would also establish the Health Care Affordability Board , composed of 8 members, appointed as prescribed, and the Health Care Affordability Advisory Committee. The bill would require the board to establish statewide health care cost targets for per capita total health care expenditures by the 2025 calendar year and specific targets for each health care sector it defines, including fully integrated delivery system systems, geographic regions, and individual health care entities, as appropriate. The bill, commencing in 2026, would require the office to take progressive actions against health care entities for failing to meet the cost targets, including performance improvement plans and escalating administrative penalties. The bill would establish the Health Care Affordability Fund for the purpose of receiving and, upon appropriation by the Legislature, expending revenues collected pursuant to the provisions of the bill. The bill would require the office to set standards for various health care metrics, including health care quality and equity , alternative payment models , primary care and behavioral health investments , and health care workforce stability. The bill would require the office to gather data and present a report on baseline health care spending trends and underlying factors on or before June 1, 2025. On or before June 1, 2027, the bill would require the office to prepare and publish annual reports concerning health care spending trends and underlying factors, along with policy recommendations to control costs and the other stated metrics. The bill would require the office to present the report's findings to the board and the broader public at a public meeting of the board and would provide for public comment and feedback on the report, as specified. The bill would require the office to monitor cost trends in the health care market and to examine health care mergers, acquisitions, corporate affiliations, or other transactions that entail material changes to ownership, operations, or governance of health care service plans, insurers, hospitals or hospital systems, physician organizations, providers, pharmacy benefit managers, and other health care entities. The bill would require the health care entities to provide the office with written notice, as specified, of agreements and transactions that would sell, transfer, lease, exchange, option, encumber, convey, or otherwise dispose of a material amount of assets, or that would transfer control, responsibility, or governance of a material amount of the assets or operations to one or more entities. The bill would require the office to conduct a cost and market impact review, as specified, if it finds that the change is likely to have a risk of a significant impact on market competition, the state's ability to meet cost targets, or costs for purchasers and consumers. The bill would prohibit an agreement or transaction for which a cost and market impact review proceeds to be implemented without a written waiver from the office or until 60 days after the office issues its final report. The bill would require the health care entity to pay specified costs associated with that review and completing the report. The bill would require health care service plans and health insurers, in submitting rates for review, to demonstrate the impact of any changes in the rate of growth of health care costs resulting from the health care cost targets. 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. (3) Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. 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 law, after the Director of the State Department of Health Care Services has communicated the determination to the Department of Finance that systems have been programmed for the implementation of these purposes, but no sooner than May 1, 2022, extends Medi-Cal eligibility for the full scope of Medi-Cal benefits to an individual who is 50 years of age or older, and who does not have satisfactory immigrant status or is unable to establish satisfactory immigration status, as specified, if they are otherwise eligible for those benefits. Existing law makes the effective date of enrollment for those individuals the same day that systems are operational to begin processing new applications pursuant to the director's determination. Existing law provides that a person enrolled in the Medi-Cal program under these provisions is not required to file a new application for the Medi-Cal program, requires the enrollment to be conducted pursuant to a prescribed eligibility and enrollment plan, and requires the department to provide monthly updates to the Legislature, as specified. This bill would extend Medi-Cal eligibility for the full scope of Medi-Cal benefits to an individual who is 26 to 49 years of age, inclusive, and who does not have satisfactory immigrant status if they are otherwise eligible for those benefits. The bill would make the expansion after the director has determined and communicated the determination to the Department of Finance, that systems have been programmed for the implementation of these purposes, but no later than January 1, 2024. The bill would, as described above, make the effective date of enrollment the same day that systems are operational, would not require a new application, and would require the department to include these individuals in monthly updates to the Legislature. Because counties are required to make Medi-Cal eligibility determinations and this bill would expand Medi-Cal eligibility to specified individuals who are 26 to 49 years of age, inclusive, the bill would impose a state-mandated local program. This bill would require the eligibility and enrollment plan to enable, to the maximum extent possible, as determined by the department, an individual to maintain their primary care provider or medical home. The bill would require the department to work with counties, Medi-Cal managed care health plans, health care providers, and consumer advocations, among others, to identify and maintain such linkage. (4) Existing law, to the extent federal financial participation is available, requires the State Department of Health Care Services to exercise its option under federal law to implement a program for individuals who are 65 years of age or older or are disabled , without a share of cost, if they meet certain financial eligibility criteria, including not exceeding 138% of the federal poverty level in their countable income or as specified. Under existing law, certain medically needy persons with higher incomes qualify for Medi-Cal with a share of cost, if they meet specified criteria. Under existing law, the share of cost for those persons is generally the total after deducting an amount for maintenance from the person's monthly income. Existing law requires the department to establish income levels for maintenance at the lowest levels that reasonably permit a medically needy person to meet their basic needs for food, clothing, and shelter, and for which federal financial participation will still be provided under applicable federal law. Under existing law, for a single individual, the amount of the income level for maintenance per month is based on a calculation of 80% of the highest amount that would ordinarily be paid to a family of 2 persons, without any income or resources, under specified cash assistance provisions, multiplied by the federal financial participation rate, adjusted as specified. This bill, to the extent that any necessary federal authorization is obtained, would increase the above-described income level for maintenance per month to be equal to the income limit for Medi-Cal without a share of cost for individuals who are 65 years of age or older or are disabled, generally totaling 138% of the federal poverty level. The bill would make these provisions operative on January 1, 2025, or the date certified by the department, whichever is later. The bill would repeal related provisions as part of conforming changes. (5) Existing law requires the State Department of Health Care Services ,to the extent federal financial participation is available, to exercise a federal option to extend continuous eligibility to children 19 years of age and younger until the earlier of either the end of a 12-month period following the eligibility determination or the date the child exceeds 19 years of age. Under this bill, a child under 5 years of age would be continuously eligible for Medi-Cal, including without regard to income, until the child reaches 5 years of age. The bill would prohibit the redetermination of Medi-Cal eligibility before the child reaches 5 years of age, unless the department or county possesses facts indicating that the family has requested the child's voluntary disenrollment, the child is deceased, the child is no longer a state resident, or the child's original enrollment was based on a state or county error or on fraud, abuse, or perjury, as specified. The bill would require the department to implement those provisions on January 1, 2025, or a date specified by the direction, whichever is later. (6) Under existing law, a pregnant woman is eligible for Medi-Cal benefits if her income is less than or equal to 109% of the federal poverty level, as specified, and meets all other eligibility requirements, subject to receipt of any necessary federal approvals and the availability of federal financial participation. This bill would instead make a pregnant individual eligible for full-scope Medi-Cal benefits if their income, effective January 1, 2022, is less than or equal to 208% of the federal poverty level before the application of the 5% income disregard, as specified. The bill would delete certain reporting provisions and would make conforming changes to related provisions. To the extent that the bill would create new duties for counties relating to Medi-Cal eligibility determinations, the bill would impose a state-mandated local program. Existing law requires the department to seek any state plan amendments or federal waivers necessary to provide full-scope Medi-Cal benefits without a share of cost to pregnant women during their pregnancy and for 60 days thereafter if their income is over 109% of, and is up to and including 138% of, the federal poverty level, as specified. This bill would repeal those provisions. (7) Existing law requires that Medi-Cal benefits be provided to optional targeted low-income children based on a certain income eligibility threshold. Existing law establishes the Medi-Cal Access Program , which provides health care services to a woman who is pregnant or in her postpartum period and whose household income is between certain thresholds, and to a child under 2 years of age who is delivered by a mother enrolled in the program, as specified. Existing law requires a subscriber to provide income information at the end of 12 months of coverage under the Medi-Cal Access Program, and requires that the infant be disenrolled from the program if the annual household income exceeds 317% of the federal poverty level or if the infant is eligible for full-scope Medi-Cal with no share of cost. Existing law also establishes a program under which certain employed persons with disabilities are eligible for Medi-Cal benefits based on income and other criteria. Existing law creates the County Health Initiative Matching Fund in the State Treasury, administered by the State Department of Health Care Services for the purpose of providing matching state funds and local funds received by the fund through intergovernmental transfers to a county agency, a local initiative, or a county organized health system in order to provide health insurance coverage to certain children and adults in low-income households who do not qualify for health care benefits through the Healthy Families Program or Medi-Cal. Existing law requires the department to exercise the option , available to the state under federal law, to impose specified monthly premiums, based on income level, for the above-described children and employed persons with disabilities. Existing law requires the department to determine schedules for subscriber contribution amounts for persons enrolled in the Medi-Cal Access Program. This bill would authorize the department, to the extent allowable under federal law, to elect not to impose premiums on specified individuals whose family income has been determined to be above 160% and up to and including 261% of the federal poverty level for the above-described programs. The bill would require the department to specify that election or reinstatement of premiums in the published Medi-Cal Local Assistance Estimate for the impacted state fiscal year or years, subject to appropriation in the annual Budget Act. Beginning January 1, 2025, or the date certified by the State Department of Health Care Services, as specified, this bill would remove the requirement for providing income information at the end of the 12 months of enrollment in the Medi-Cal Access Program, and would instead require that the infant remain continuously eligible for the Medi-Cal program until they are 5 years of age, as specified. The bill would also make conforming changes. (8) Existing law requires the State Department of Health Care Services to administer the Child Health and Disability Prevention (CHDP) Program. Under the CHDP Program , certain health and disability prevention treatment services are provided to eligible children. Existing law requires the governing board of a county to establish a community CHDP program for the purpose of providing early and periodic assessments of the health status of children in the county. Under this bill, all qualified providers enrolled in the CHDP Program as of June 30, 2024, instead, would be automatically enrolled as providers under the Children's Presumptive Eligibility Program on July 1, 2024. The bill would require the department, before July 1, 2024, to take various steps, including developing a transition plan to transition the CHDP Program, conducting a stakeholder engagement process to inform the department in the development and implementation of the transition plan, and requiring the department to seek federal approval to implement the transition plan. The bill would make the CHDP Program inoperative on July 1, 2024, or on the date that the department certifies that all the steps have been taken to implement the transition plan, whichever date is later. (9) Existing law created the Healthy Families Program for the provision of health, vision, and dental benefits to eligible children pursuant to the federal Children's Health Insurance Program. Existing law requires the department and the former Managed Risk Medical Insurance Board to implement a program for preenrollment of children into the Medi-Cal program and the former Healthy Families Program. Existing law requires that subscribers continue to be eligible for the Healthy Families Program for a period of 12 months from the month eligibility is established. Existing law requires the State Department of Health Care Services to develop an electronic application to serve as the application into these programs and the CHDP Program, and authorizes the department to designate CHDP Program providers as qualified entities who are authorized to determine eligibility for the CHDP Program and for preenrollment into the Medi-Cal program and the former Healthy Families Program. This bill, beginning January 1, 2025, or on a date certified by the State Department of Health Care Services, as specified, would require that a child be continuously eligible for the Healthy Families Program at up to five years of age. The bill would delete obsolete provisions relating to the former Healthy Families Program and the former Managed Risk Medical Insurance Board, and would make technical, nonsubstantive changes. (10) Existing law generally requires a county to redetermine a Medi-Cal beneficiary's eligibility to receive Medi-Cal benefits every 12 months and whenever the county receives information about changes in a beneficiary's circumstances that may affect their eligibility for Medi-Cal benefits. Existing law conditions implementation of the redetermination provisions on the availability of federal financial participation and receipt of any necessary federal approvals. In response to a change in circumstances, if a county cannot obtain sufficient information to redetermine eligibility, existing law requires the county to send to the beneficiary a form developed by the department that is prepopulated with the information that the county has obtained and that states the information needed to renew eligibility. If the individual will provide the form by mail or in person, existing law requires them to sign the form. If, within 90 days of termination of a Medi-Cal beneficiary's eligibility or a change in eligibility status, the beneficiary submits the form or needed information to the county, existing law requires the county to redetermine eligibility. If the beneficiary is found eligible, or the beneficiary's eligibility status has not changed, whichever applies, existing law requires the termination to be rescinded as though the form were submitted in a timely manner. This bill would remove the requirement on the county to prepopulate the form with the obtained information to redetermine eligibility in response to a change in circumstances. Under the bill, the beneficiary would not be required to sign and return the form. The bill would require the department to develop future revisions to the form. The bill would require that the eligibility redetermination be performed in a timely manner without requiring a new application. The bill would remove the requirement of rescinding the preceding termination as though the form were submitted in a timely manner. To the extent that the bill would modify county duties relating to the redetermination of Medi-Cal eligibility, the bill would impose a state-mandated local program. (11) Existing law provides that routine health care costs related to the treatment of a beneficiary who is diagnosed with cancer and accepted in a clinical trial are covered under the Medi-Cal program, if certain requirements are met. Under existing federal law, medical assistance covered by the Medicaid program includes, among other services, routine patient costs for items and services furnished in connection with participation in a qualifying clinical trial, which is defined as a clinical trial, in any clinical phase of development, that is conducted in relation to the prevention, detection, or treatment of any serious or life-threatening disease, as specified. This bill, effective July 1, 2022, would expand the coverage requirements for qualifying clinical trials for purposes of the Medi-Cal program, to conform with the Medicaid definition of a qualifying clinical trial. (12) Under existing law, face-to-face contact between a health care provider and a patient is not required under the Medi-Cal program for health care services provided by the modality of asynchronous store and forward, as defined, to the extent that federal financial participation is available. This bill would also provide that face-to-face contact is not required when covered health care services are provided by video synchronous interaction, audio-only synchronous interaction, remote patient monitoring, or other permissible virtual communication modalities, when those services and settings meet certain criteria. The bill would require a provider furnishing services through video synchronous interaction or audio-only synchronous interaction to also offer those services through in-person face-to-face contact or arrange for a referral to in-person care, except as specified. The bill would authorize a provider to establish a new patient relationship with a Medi-Cal beneficiary through video synchronous interaction, as specified, and would prohibit a provider from doing so through the other modalities, except as specified. The bill would set forth other requirements on the State Department of Health Care Services or a Medi-Cal provider relating to the use of those telehealth modalities, including requirements concerning fee schedules and minimum reimbursement limits, services in border communities, as defined, consent standards, privacy and security compliance, informational notices, and a research and evaluation plan. (13) Under existing law, federally qualified health center (FQHC) services and rural health clinic (RHC) services are covered benefits under the Medi-Cal program, to be reimbursed, to the extent that federal financial participation is available, to providers on a per-visit basis. "Visit " is defined as a face-to-face encounter between an FQHC or RHC patient and any of specified health care professionals. This bill would expand "visit" to include an encounter between an FQHC or RHC patient and any of specified health care professionals using video synchronous interaction, audio-only synchronous interaction, or asynchronous store and forward modality when the applicable standard of care and other conditions are met. The bill would set forth other requirements on an FQHC or RHC relating to the use of those telehealth modalities, including requirements concerning reimbursement rates, consent standards, privacy and security compliance, the establishment of new patient relationships, and in-person services or referrals. (14) Existing law establishes, until January 1, 2023, certain time and distance and appointment time standards for specified services to ensure that Medi-Cal managed care covered services are available and accessible to enrollees of Medi-Cal managed care plans in a timely manner. This bill would extend those provisions to January 1, 2026. Existing law authorizes the State Department of Health Care Services to allow a Medi-Cal managed care plan to use clinically appropriate telecommunications technology as a means of determining annual compliance with the time and distance standards or to approve alternative access to care, including telehealth, e-visits, or other evolving and innovative technological solutions that are used to provide care from a distance. This bill would delete those provisions and would instead authorize the department to allow a Medi-Cal managed care plan to use clinically appropriate video synchronous interaction as a means of demonstrating compliance with the time or distance standards, and as part of an alternative access standard request. The bill would authorize the department to develop policies for granting credit, as specified. If a Medi-Cal managed care plan cannot meet the time and distance standards, existing law requires the plan to submit a request for alternative access standards to the department, as specified. This bill would make changes to the frequency of those request submissions. The bill would also require the plan to close out any corrective action plan deficiencies in a timely manner to ensure beneficiary access is adequate and to continually work to improve access in its provider network. (15) Existing law requires a Medi-Cal managed care plan to comply with a minimum 85% medical loss ratio (MLR) consistent with specified federal regulations. Existing law excludes certain health care service plans and dental managed care plans from those provisions. This bill would remove those exclusions commencing on specified dates. The bill would also require the department to post on its internet website certain MLR-related and remittance-related information regarding subcontractor plans or other delegated entities. (16) Existing federal law authorizes a state plan to provide for payment in any fiscal year to an FQHC for specified services in an amount that is determined under an alternative payment methodology (APM) if it is agreed to by the state and the FQHC and results in a payment to the FQHC of an amount that is at least equal to the amount otherwise required to be paid to the FQHC. Existing state law requires the department to authorize an APM pilot project for FQHCs that agree to participate, for implementation with respect to a county for a period of up to 3 years. This bill would make various changes to the APM methodology for FQHCs, with implementation of the new provisions under the APM project to begin no sooner than January 1, 2024, subject to any necessary federal approvals, and no longer limited to a period of up to 3 years. Existing law requires the department to establish a risk corridor structure for principal health plans, as defined, and to construct the risk sharing of the costs, as specified, and requires that certain responsibility-sharing terms apply and be incorporated into the contracts of each affected principal health plan. This bill would remove those responsibility-sharing terms and would instead require the department to develop and specify the terms of the risk corridor in a form and manner specified by the department through all-plan letters or other technical guidance that would be incorporated into the contracts between each affected principal health plan and the department. Existing law requires the department to establish a payment adjustment structure for the duration of the APM pilot project. Under existing law, an adjustment to payments in the case of higher than expected utilization is triggered when utilization exceeds projections by specified percentages, through which a participating FQHC site receives an aggregate payment adjustment from the principal health plan or applicable subcontracting payer that is based upon certain formulas involving the actualization utilization and projected utilization. This bill would remove those formulas and would instead specify that, if an adjustment is required in a given year, the participating FQHC site would receive an aggregate payment adjustment from the principal health plan or applicable subcontracting payer that is based upon the difference between its actual utilization for the year and the projected utilization for the year. The bill would make conforming changes to related provisions. Under existing law, participating FQHCs have the flexibility to experience a lower than expected visit utilization of up to 30% of projected utilization. If an FQHC site's actual utilization is at a level above that threshold, existing law requires the department to conduct a review and determine whether to allow the participating FQHC site to retain all or a portion of the payments, as specified. This bill would remove those provisions relating to the determination when the threshold is exceeded, and would require the department to develop objective criteria to ensure minimum standards for access and quality. If an FQHC site does not meet those standards, the bill would require the participating FQHC to return a portion of revenue based on a formula developed by the department, as specified. Existing law authorizes the department to modify any methodology, process, or provision specified above to the extent necessary to comply with federal law or to obtain any necessary federal approvals. This bill would condition the modification on not violating the spirit, purposes, and intent of the APM provisions, and would require the department to notify affected FQHCs, principal health plans, and certain legislative committees within 10 business days of the modification. Existing law authorizes the department to make payment adjustments in response to an epidemic or similar catastrophic occurrence, as specified. Existing law requires the department to contract with an independent entity to perform an evaluation of the APM pilot project, and requires that certain reports be submitted to the Legislature. This bill would repeal those provisions. The bill would also make conforming changes to other APM-related provisions concerning FQHCs. (17) Existing law, the Children and Youth Behavioral Health Initiative , requires the State Department of Health Care Services to develop and select evidence-based interventions and community-defined promising practices, with a competitive grant process , to improve outcomes for children and youth with, or at high risk for, behavioral health conditions. Existing law establishes the California Advancing and Innovating Medi-Cal (CalAIM) initiative to, among other things, improve quality outcomes, reduce health disparities, and increase flexibility. Existing law requires the department, subject to an appropriation, to establish the Behavioral Health Quality Improvement Program to provide grants to qualified Medi-Cal behavioral health delivery systems for purposes of implementing CalAIM behavioral health components and the Children and Youth Behavioral Health Initiative, as specified. This bill would instead specify that those grants be provided for purposes of implementing CalAIM behavioral health components and for other purposes related to Medi-Cal behavioral health delivery systems, as specified. The bill would make conforming changes to related provisions. (18) Existing law sets forth coverage for certain nonspecialty mental health services by Medi-Cal managed care plans or the Medi-Cal fee-for-service delivery system, and coverage for specialty mental health services by county mental health plans, as specified. Existing law requires the State Department of Health Care Services to continue to implement the Specialty Mental Health Services Program as a component of CalAIM. This bill would authorize the department, as a component of the Specialty Mental Health Program, to seek federal approval for a demonstration project to receive federal financial participation for services furnished to Medi-Cal beneficiaries during short-term stays for acute care in psychiatric hospitals or residential treatment settings that qualify as institutions for mental diseases, as defined. (19) Under the Medi-Cal program, qualified low-income individuals receive health care services pursuant to a schedule of benefits. Existing law requires the State Department of Health Care Services to standardize those applicable covered Medi-Cal benefits provided by Medi-Cal managed care plans under comprehensive risk contracts with the department on a statewide basis and across all models of Medi-Cal managed care in accordance with specified requirements and the CalAIM Terms and Conditions. Existing law, commencing January 1, 2023, subject to CalAIM implementation, requires the department to include, or continue to include, institutional long-term care services as capitated benefits in the comprehensive risk contract with each Medi-Cal managed care plan. This bill would instead require the department, commencing July 1, 2023, and subject to CalAIM implementation, to include or continue to include institutional long-term care services not described in the above-described provision, as capitated benefits in the comprehensive risk contract with each Medi-Cal managed care plan, as specified. (20) Existing law, subject to CalAIM implementation, authorizes a Medi-Cal managed care plan to cover those services or settings approved by the department as cost effective and medically appropriate in a comprehensive risk contract that are in lieu of applicable Medi-Cal state plan services, including, among others, housing transition navigation services or recuperative care. Existing law requires the department, beginning no later than January 1, 2024, to conduct an independent evaluation of the effectiveness of in lieu of services. This bill would rename in lieu of services or settings as community supports. The bill would remove the above-described deadline and would instead require the department to conduct the evaluation in accordance with the parameters and timeframes specified in the CalAIM Terms and Conditions. (21) Existing federal law provides for the suspension of Medi-Cal benefits to an inmate of a public institution and provides that the suspension ends, as specified, for an individual who is defined as a Juvenile under federal law. Under existing state law, the suspension of Medi-Cal benefits to an inmate of a public institution ends, for someone who is not a juvenile, on the date the individual is no longer an inmate of a public institution or one year from the date the individual becomes an inmate of a public institution, whichever is sooner, and ends, for a juvenile, as defined, as specified in federal law or one year from the date the individual becomes an inmate of a public institution, whichever is sooner. This bill would instead provide, commencing January 1, 2023, for the suspensions of those benefits on the day the person becomes an inmate of a public institution, except as specified for an individual who is a juvenile or for a person who is not a juvenile to the extent permissible under federal law. Existing law makes a qualifying inmate of a public institution eligible, commencing no sooner than January 1, 2023, to receive targeted Medi-Cal services for 90 days, or the number of days approved in the CalAIM Terms and Conditions if fewer than 90 days, before the date they are released from a public institution, as specified. This bill would change the duration of eligibility for targeted Medi-Cal services to 90 days or the number of days approved in the CalAIM Terms and Conditions with respect to an eligible population of qualifying inmates if different than 90 days, before the date they are released from a public institution. To the extent that the bill would create new duties for counties relating to Medi-Cal eligibility determinations, the bill would impose a state-mandated local program. (22) Existing regulation requires facilities that provide specialty mental health services and community mental health services to maintain a written record of a voluntarily admitted patient's consent to receive antipsychotic medications, including the patient's signature. This bill would delete the requirement that a facility's written record include the patient's signature. (23) Existing law, the Hospital Presumptive Eligibility program, provides Medi-Cal benefits to certain individuals who have been determined eligible on the basis of preliminary information by a qualified hospital, as specified. This bill would authorize qualified hospitals to make presumptive eligibility determinations for individuals who are 65 years of age or older, blind, or disabled, who meet certain income criteria. (24) Existing law authorizes the State Department of Health Care Services to provide health care services to beneficiaries through various models of managed care, including geographic managed care and prepaid health plans, and requires the department to implement a dental managed care program. Dental services are provided under geographic managed care in the County of Sacramento and prepaid health plans in the County of Los Angeles. Existing law requires the department to extend dental managed care contracts to December 31, 2022, and to secure the extensions on a sole source basis, as specified. This bill would require the department to conduct a competitive bid and procurement process to award new dental managed care contracts, commencing January 1, 2024, as specified. The bill would extend the above-described existing dental managed care contracts through December 31, 2023, or through the calendar day immediately preceding the effective date for the new contracts to the extent that effective date is later than January 1, 2024. The bill would condition implementation of these provisions on receipt of any necessary federal approvals. The bill would require the department, if new dental managed care contracts have not taken effect on or before July 1, 2024, to provide an update to the Legislature detailing the specific circumstances that contributed to the delay and an expected commencement date for the new contracts. This bill would require that covered dental benefits and accompanying criteria be identified in the Medi-Cal Dental Manual of Criteria, and would require the State Department of Health Care Services to evaluate all covered dental benefits for evidence-based practices consistent with the American Academy of Pediatric Dentistry and the American Dental Association guidelines. Existing law sets forth different dental services as covered benefits based on whether the beneficiary is under 21 years of age or is older. Under existing law, for persons 21 years of age or older, laboratory-processed crowns on posterior teeth are not a covered benefit except when a posterior tooth is necessary as an abutment for any fixed or removable prosthesis. This bill would, for those persons, instead cover laboratory-processed crowns on posterior teeth when medically necessary to restore a posterior tooth back to normal function based on the criteria specified in the Medi-Cal Dental Manual of Criteria. Existing law requires the department to reduce the rate of subgingival curettage and root planing by 41% for all beneficiaries except those residing in a skilled nursing facility or an intermediate care facility for the developmentally disabled, as specified. This bill would repeal that provision relating to the rate reduction. (25) Existing law requires the State Department of Health Care Services to audit amounts paid for services provided to Medi-Cal beneficiaries, as specified. Existing law requires every primary supplier of pharmaceuticals, medical equipment, or supplies to maintain specified accounting records for 3 years subject to audit by the department. This bill would instead require every primary supplier of pharmaceuticals, medical equipment, or supplies to maintain those accounting records for 10 years. (26) Existing law requires the Medi-Cal reimbursement rate for intermediate care facilities for the developmentally disabled or facilities providing continuous skilled nursing care to developmentally disabled individuals, for dates of service on or after August 1, 2021, to July 31, 2022, inclusive, to be the greater of the rate published by the State Department of Health Care Services or the rate, including Proposition 56 supplemental payments, if available, or the approved Medi–Cal State Plan reimbursement rate, inclusive of the temporary increased Medicaid payments associated with the COVID–19 Public Health Emergency, plus the Proposition 56 supplemental payment amount, in effect for that facility, as specified. This bill would require the Medi-Cal reimbursement rate for the above-described facilities and services, for dates of service on or after August 1, 2021, to be the greater of the rate published by the department or the rate, including Proposition 56 supplemental payments, if available, or the approved Medi–Cal State Plan reimbursement rate, inclusive of the temporary increased Medicaid payments associated with the COVID-19 Public Health Emergency, plus the Proposition 56 supplemental payment amount, in effect for that facility, on the last day of the COVID-19 Public Health Emergency. (27) Existing law requires that Medi-Cal provider payments and payments for specified non-Medi-Cal programs be reduced by 10% for dates of service on and after June 1, 2011, and conditions implementation of those payment reductions on receipt of any necessary federal approvals. Existing law exempts certain services, facilities, and payments from those payment reductions. This bill would make additional exemptions, for dates of service on and after July 1, 2022, or the effective date of any necessary federal approvals, whichever is later, for specified services and providers, and would exempt podiatrists and prosthetists for dates of service on and after January 1, 2023, or the effective date of any necessary federal approvals, whichever is later. The bill would condition implementation of these provisions on receipt of federal approval. The bill would make other conforming changes. The bill would, for the above-described dates, authorize the maintenance of the reimbursement rates or payments for specified services and providers, using General Fund or other state funds appropriated to the department as the state share, at the payment levels in effect on December 31, 2021, as specified, under the California Healthcare, Research and Prevention Tobacco Tax Act of 2016 that were implemented with funds from the Healthcare Treatment Fund. The bill would condition implementation of the maintenance provision on receipt of any necessary federal approvals and the availability of federal financial participation. The bill would authorize the department to implement the provision through provider bulletins or similar instructions. The bill would require the department to develop the eligibility criteria, methodologies, and parameters for the payments and rate increases maintained, and would authorize revisions, as specified. (28) Existing law requires the State Department of Health Care Services to establish a list of covered services and maximum allowable reimbursement rates for durable medical equipment, as defined. Existing law requires reimbursement for oxygen delivery systems and oxygen contents to utilize certain national codes, and to be the lesser of specified amounts. This bill would, effective July 1, 2022, require that reimbursement for oxygen and respiratory equipment, as determined by the department, not to exceed 100% of the lowest maximum allowance for California established by the federal Medicare Program for the same or similar item or service. (29) Under the Medi-Cal program, existing law prohibits the allowable markup payable for the dispensing of medical supplies, generally, by assistive device and sickroom supply dealers and pharmacies, from exceeding 23% of the estimated acquisition cost of the item dispensed, as defined by the State Department of Health Care Services. Existing law requires that payment for diabetic testing supplies not exceed the estimated acquisition cost of the item dispensed, as defined by the department, plus a fee, as specified. This bill would clarify that, beginning July 1, 2022, the allowable markup described above applies to diabetic testing supplies dispensed by assistive device and sickroom supply dealers and pharmacies except for diabetic test strips, lancets, and insulin syringes. (30) Existing law, for the duration of the COVID-19 emergency period, requires the department to implement any federal Medicaid program waiver or flexibility approved by the federal Centers for Medicare and Medicaid Services related to that emergency and to exercise its option under prescribed law to extend medical assistance to uninsured individuals, as specified, for the duration of that emergency period. This bill would require the department to reimburse the administration of a COVID-19 vaccine at 100% of the Medicare national equivalent rate in effect at the time of administration without geographic adjustment. (31) Existing law establishes the Drug Medi-Cal Treatment Program (Drug Medi-Cal) , under which the State Department of Health Care Services is authorized to enter into contracts with each county, or enter into contracts directly with certified providers, for the provision of various alcohol and drug use treatment services to Medi-Cal beneficiaries. Existing law requires, to the extent federal financial participation is available and any necessary federal approvals have been obtained, that a Drug Medi-Cal certified provider receive reimbursement for individual counseling services provided through telehealth by a licensed practitioner of the healing arts or a registered or certified alcohol or other drug counselor, when medically necessary and in accordance with the Medicaid state plan. This bill would expand reimbursement for other medically necessary Drug Medi-Cal services and to other authorized individuals, as specified, when those services are delivered through video synchronous interaction or audio-only synchronous interaction. The bill would similarly set forth certain requirements relating to privacy and security compliance and the establishment of new patient relationships through telehealth modalities. The bill would require the department to adopt regulations by July 1, 2024, to implement these provisions. (32) Existing law charges the State Department of Health Care Services with administering prevention, treatment, and recovery services for alcohol and drug abuse. Existing law authorizes the department to conduct various activities to alleviate problems related to alcohol and other drug use, including providing funds to counties for the implementation of local programs, reviewing and certifying alcohol and other drug programs, and licensing and regulating adult alcoholism or drug abuse recovery or treatment facilities. This bill would require alcohol and other drug programs and alcoholism or drug abuse recovery or treatment facilities to either offer medications for addiction treatment (MAT) directly to clients, or have an effective referral process in place with narcotic treatment programs, community health centers, or other MAT providers. The bill would require these programs and facilities to implement and maintain a MAT policy approved by the department, as specified. Existing law requires the department to license narcotic treatment programs to use narcotic replacement therapy and medication-assisted treatment in the treatment of addicted persons. This bill would require the department to establish a program for the operation and regulation of mobile narcotic treatment programs. The bill would require those programs to meet specified requirements, including that they operate under the license of a primary narcotic treatment program and receive approval from the department before operating a mobile narcotic treatment program. (33) Existing federal law authorizes a state to provide medical assistance for qualifying community-based mobile crisis intervention services during a specified 5-year period ending on March 31, 2027. This bill would require the State Department of Health Care Services to seek all necessary federal approvals to provide qualifying community-based mobile crisis intervention services to eligible Medi-Cal beneficiaries experiencing a mental health or substance use disorder crisis. Under the bill, these services would be available exclusively through a Medi-Cal behavioral health delivery system. The bill would require the department to establish requirements for the receipt of the services by eligible Medi-Cal beneficiaries and for authorized service providers, and to oversee and enforce the requirements and guidelines. The bill would authorize the department to enter into exclusive or nonexclusive contracts, or to amend existing contracts, for purposes of implementing these provisions, as specified. Under the bill, these provisions would be implemented no sooner than January 1, 2023, up to the end of the 5-year period specified under federal law. (34) Existing law prohibits a person from being tried or adjudged to punishment while that person is mentally incompetent. Existing law establishes a process by which a defendant's mental competency is evaluated. Existing law requires the court to appoint a psychiatrist or licensed psychologist to examine the defendant, and requires the psychiatrist or licensed psychologist to inform the court of their opinion regarding the defendant's ability to understand the proceedings and to assist counsel in their defense, and their opinion regarding the suitability of antipsychotic medication to treat the defendant, as specified. Existing law requires a court, before ordering a defendant to be committed to the State Department of State Hospitals or other treatment facility, to hear and determine whether the defendant lacks the capacity to make decisions regarding the administration of antipsychotic medication, as specified. This bill would revise the respective roles of a licensed psychologist or psychiatrist in this process, and would revise the requirements for the hearing regarding the defendant's capacity and administration of antipsychotic medication. Existing law requires a court, when ordering commitment to the State Department of State Hospitals or other treatment facility, to provide copies of certain documents to the facility, including a commitment order. Existing law requires a court to order a mentally incompetent defendant to be delivered to a State Department of State Hospitals facility or to any other available public or private treatment facility, as specified. This bill would require additional documentation to be provided when ordering commitment. The bill would, commencing on July 1, 2023, require that a defendant first be considered for placement in an outpatient treatment program, a community treatment program, or a diversion program, if available, unless the court finds that the clinical needs of the defendant or the risk to community safety, warrant placement in a State Department of State Hospitals facility, as specified. Existing law authorizes the State Department of State Hospitals to conduct reevaluations of defendants who have been found mentally incompetent to stand trial and have been awaiting admission to the department for 60 days or more. This bill would instead authorize the department to conduct reevaluations of those defendants awaiting admission any time after commitment has been ordered. The bill would authorize a court to order the involuntary administration of antipsychotic medication based upon a reevaluation, as specified. The bill would also require local county jails to cooperate with evaluators, as specified. This bill would, subject to an appropriation, authorize the State Department of State Hospitals to contract for medical, evaluation, and other services for felony defendants in county jail deemed incompetent to stand trial. Existing law defines a treatment facility to include a county jail, as specified, and authorizes the administration of antipsychotic medications in a county jail, subject to specified limitations. This bill would repeal this provision and make conforming changes. Existing law requires each county, acting singly or in combination with other counties, to contract with the State Department of State Hospitals for the number and types of state hospital beds that the department will make available to the county or counties during the year. This bill would require the department to implement a cap for the number of mentally incompetent persons committed in each county per year and would assess a penalty rate for commitments exceeding that cap. The bill would create the Mental Health Diversion Fund, a continuously appropriated fund, and would require the penalty funds to be collected by the department and deposited into the fund. The bill would require the penalty funds to be dispersed to each county in amounts equal to the penalty payments made for the purpose of supporting county mental health services and activities, as specified. By requiring counties to utilize county funds for specified purposes, this bill would impose a state-mandated local program. By creating a continuously appropriated fund, the bill would make an appropriation. Existing law establishes the Forensic Conditional Release Program to provide outpatient and community-based treatment to persons committed to the State Department of State Hospitals. This bill would, until June 30, 2026, establish a statewide panel of independent evaluators, as specified, to identify and evaluate state hospital patients that are appropriate for participation in the Forensic Conditional Release Program. Under existing law, patient records of the State Department of State Hospitals are confidential. This bill would authorize disclosure of these records to parties in specified judicial and administrative proceedings and to district attorneys in commitment, recommitment, or petition for release proceedings. (35) Existing law, the Investment in Mental Health Wellness Act of 2013, provides that funds appropriated by the Legislature to the California Health Facilities Financing Authority for the purposes of the act be made available to selected counties or counties acting jointly, except as otherwise provided, and used to increase capacity for client assistance and services in crisis intervention, crisis stabilization, crisis residential treatment, rehabilitative mental health services, and mobile crisis support teams. The act, through appropriations in the annual Budget Act, authorizes the authority and the Mental Health Services Oversight and Accountability Commission to administer competitive selection processes for capital capacity and program expansion to increase capacity for mobile crisis support, crisis intervention, crisis stabilization services, crisis residential treatment, and specified personnel resources. This bill would authorize the authority and the commission to use a sole-source contracting processes to increase capacity for those services. The act requires funds allocated to the commission to be allocated selected counties, counties acting jointly, or city mental health departments for triage personnel to provide intensive case management and linkage services for individuals with mental health disorders at various points of access. Existing law requires the commission to distribute these funds through a competitive selection process. This bill, instead, would require funds appropriated to the commission to be allocated to various entities, including community-based organizations or local government entities, to support crisis prevention, crisis early intervention, and crisis response strategies. The bill would authorize the commission to utilize a sole-source process to allocate funds when it determines, during a public hearing, that it is in the public interest to do so and would address barriers to participation for local government agencies and community-based organizations, as specified. (36) Existing law requires the State Department of Public Health to develop and review plans and participate in a program for the prevention and control of venereal disease. Existing law requires the department to allocate funds to local health jurisdictions for sexually transmitted disease prevention and control activities. In awarding these funds, existing law requires the department to authorize local health jurisdictions to include innovative and impactful prevention and control activities, including, among other things, community-based testing and disease investigation. This bill would expand these activities to include, among other things, integrated services for sexually transmitted infections (STIs) , viral hepatitis, human immunodeficiency virus infection, and drug overdose to the extent they improve health outcomes for people living with, or at risk for, STIs. Existing law requires, if funds are explicitly appropriated in the annual Budget Act for these purposes, the State Department of Public Health to allocate funds to local health jurisdictions to provide hepatitis C virus (HCV) activities, including monitoring, prevention, testing, and linkage to and retention in care activities for the most vulnerable and underserved individuals living with, or at high risk for, HCV infection. Existing law requires no less than 50% of the funds allocated to local health jurisdictions to be provided to community-based organizations if the community-based organizations are able to provide these activities and demonstrate expertise, history, and credibility working successfully in engaging the most vulnerable and underserved individuals living with, or at high risk for, HCV infection. This bill would, contingent on funding, expand the activities that the department may allocate funding for including, among other things, integrated services for human immunodeficiency virus (HIV) infection and sexually transmitted infections. The bill would authorize local health jurisdictions and community-based organizations to use funds to provide material support, including, among other things, sleeping bags and clothing items. The bill would also authorize the department to use funds to support capacity building assistance, including, among other things, integrated services for HIV and sexually transmitted infections, to the extent they improve health outcomes for the most vulnerable and underserved individuals living with, or at high risk for, HCV infection. (37) Existing law, the California Uniform Controlled Substances Act, classifies opioids as Schedule II controlled substances and imposes various restrictions on the prescription of those drugs. Existing law requires the State Department of Public Health, subject to an appropriation in the Budget Act of 2016, to award grant funding for naloxone, or another approved opioid antagonist, to local health departments, local government agencies, or other specified entities to reduce the rate of fatal overdose from opioid drugs. Existing law establishes the Litigation Deposits Fund , under the control of the Department of Justice and consisting of moneys received as litigation deposits where the state is a party to the litigation, as specified. The State of California is a party to certain opioid-related settlements, through which the state receives funds for opioid remediation. This bill would create the Opioid Settlements Fund (OSF) , to be administered by the State Department of Health Care Services. The bill would, upon appropriation by the Legislature, require the moneys in the OSF to be used for opioid remediation in accordance with the terms of the judgment or settlement from which the funds were received. The bill would funds certain opioid settlements and funds from any future judgments or settlements that are not deposited in the Litigation Deposits Fund to be transferred to the OSF. The bill would require the State Department of Health Care Services to oversee those activities funded by the OSF, including preparing periodic written reports. The bill would authorize the department to implement these provisions through information notices or other similar instructions, and to enter into exclusive or nonexclusive contracts, or amend existing contracts, on a bid or negotiated basis for purposes of implementing those activities funded by the OSF, as specified. (38) Existing law establishes the State Department of State Hospitals within the California Health and Human Services Agency, and provides the department with jurisdiction over specified facilities for the care and treatment of persons with mental health disorders. Existing law authorizes the Director of State Hospitals to reduce, cancel, or remit the amount to be paid by the estate liable for the care and treatment of a person at the state hospital who is an alcoholic or who has a mental health disorder and who is a patient at a state hospital, on satisfactory proof that the estate is unable to pay the cost of that care and treatment or that the amount is uncollectible. This bill would, among other things, additionally authorize the director's designee to reduce, cancel, or remit the amount to be paid by the estate, and would no longer include under that provision the care and treatment of a person who is an alcoholic. The bill would require the department to develop and implement a financial assistance program that may reduce or cancel the amount that a patient owes for the cost of care and treatment at a state hospital, as specified, and would require the department to make its financial assistance program policy available to the public on the department's internet website. The bill would also authorize the department to develop reasonable payment plans suitable to the patient's ability to pay. Existing law, if at any time there is not sufficient money on hand in the estate of a committed person to pay the claim of a state mental hospital for their care, support, maintenance, and expenses therein, authorizes the court to make an order directing the guardian or conservator to sell as much of the other personal or real property, or both, of the person as is necessary to pay for the care, support, maintenance, and expenses of the person at the state hospital, and use those proceeds to pay the amount due. Under existing law, if a person who lacks legal capacity to make decisions, who has no guardian or conservator of the estate, and who has been admitted or committed to the department for placement in a state hospital, is the owner of any property, the department may apply to the superior court of the proper county for its appointment as guardian or conservator of the person's estate. Existing law also authorizes the department to invest funds held as executor, administrator, or conservator of estates, or trustee, in specified bonds or obligations, and to establish one or more common trusts for investment of those funds. Existing law authorizes the department, upon the death of a person under its jurisdiction, to make proper disposition of the remains and pay for the disposition of the remains, as specified. This bill would delete the above-described provisions. (39) Existing law establishes the California Health Workforce Education and Training Council to help coordinate California's health workforce education and training in order to develop a health workforce that meets the state's health care needs. Existing law establishes the membership of the council. This bill would revise and recast those provisions, and additionally include the Secretary of Labor and Workforce Development on the council. (40) Under existing law, HCAI is responsible for, among other things, administering various health professions training and development programs. Existing law, the Song-Brown Health Care Workforce Training Act, establishes a state medical contract program with accredited medical schools, hospitals, and other programs and institutions to increase the number of students and residents receiving quality education and training in specified primary care specialties and maximize the delivery of primary care and family physician services to underserved areas of the state. Existing law requires the director of HCAI to take specified actions regarding this program, including, among others, developing application and contract criteria based on health care workforce needs and the priorities of the council. This bill would instead require the director of HCAI to develop application and contract criteria based on health care workforce needs and priorities. The bill would add programs that train midwives to the list of programs eligible to contract with the state under the Song-Brown Health Care Workforce Training Act, and would add midwifery to the list of specified primary care specialties under that act. The bill would make conforming changes. The bill would establish the Abortion Practical Support Fund, a continuously appropriated fund, and would require HCAI to administer the fund for the purpose of providing grants to nonprofit organizations that either specialize in assisting pregnant people who are low income, or who face other financial barriers, with direct practical support services to access and obtain an abortion or that provide abortion services to those persons. By creating a continuously appropriated fund, the bill would make an appropriation. This bill would require HCAI, on or before July 1, 2023, to develop and approve statewide requirements for community health worker certificate programs and to approve the curriculum required for programs to certify community health workers. The bill would require HCAI, on or before July 1, 2023, to review, approve, or renew evidence-based curricula and community-defined curricula for core competencies, specialized programs, and training. The bill would require an organization that seeks approval or renewal of a community health worker certificate program to submit a community health worker certificate program plan, submit to periodic reviews, and submit annual community health worker certificate program reports, as specified. The bill would authorize HCAI, in consultation with stakeholders, to request that an individual who is either enrolled in, or who has completed, a community health worker certificate program submit specified workforce data. This bill would require the State Department of Health Care Services, subject to appropriation by the Legislature, to provide funding to specified employers for retention payments to their eligible employees or physicians for the public purpose of promoting stability and retention in California's health care workforce. The bill would define a qualifying work period as a 91-day period identified by the department beginning no later than 30 days after the enactment of the bill and would require employers to submit to the department information related to its eligible employees and their hours of compensated work during that period, among other information. The bill would authorize the department to provide funding to the employers up to $1,500 per employee, subject to pro rata reductions based on the aggregate appropriation. The bill would require employers to provide the funding to their employees within 60 days, to attest to the department that the payments were made within that time period, to return any unspent funds to the department, and to report to the department within 90 days the payments made to the employees, as specified. Because the bill would require the employer to attest to the payments being made under penalty of perjury, the bill would establish a new crime and would create a state-mandated local program. (41) Existing law recognizes the Legislature's intent to further the provision of necessary public health services by granting financial assistance to local health departments and enabling them to meet present and future health needs in an efficient and effective manner. This bill would require the State Department of Public Health to develop and implement a program to fund and support vital public health activities and services provided by local health jurisdictions. The bill would condition funding on a local health jurisdiction's submission of a public health plan, as specified. The bill would specify how funds under this program are to be allocated and would require the funds to be used to supplement, rather than supplant, existing levels of services provided by qualifying local health jurisdictions. The bill would provide, for the 2022–23 fiscal year, that each local health jurisdiction may use the funds to develop the required public health plans. This bill would require the State Public Health Officer, on or before February 1 of every other year, to submit a report to the Governor and Legislature on the state of public health in California. The bill would require the report to include, among other things, data on the prevalence of morbidity and mortality related to mental illness and substance abuse. The bill would also require, as condition of the funding, local health jurisdictions to present annual updates on the public health status to the city council or board of supervisors, including an update on the progress addressing these issues through the strategies and programs identified by the local health jurisdiction. (42) Existing law requires the State Department of Social Services to establish a program of public health nursing in the child welfare services program, and requires counties to use the services of the foster care public health nurse under this program. Existing law requires the foster care public health nurse to work with the appropriate child welfare services workers to coordinate health care services and to serve as a liaison with health care professionals, and requires the foster care public health nurse to have access to the child's medical, dental, and mental health care information to fulfill these duties. Existing law limits the implementation of those provisions to the extent that the State Department of Social Services determines that federal financial participation is available. This bill would limit the implementation of those provisions to the extent that the State Department of Health Care Services determines that federal financial participation is available. The bill would require the State Department of Social Services, the State Department of Health Care Services, and counties and cities, to maximize the use of federal funds in implementing those provisions. The bill would, among other things, authorize the State Department of Health Care Services to enter into contracts, or amend existing contracts, with a California county, city, or city and county to facilitate local administration of those provisions, as specified. (43) Existing law, the California Affordable Drug Manufacturing Act of 2020, requires the California Health and Human Services Agency (CHHSA) to enter into partnerships, in consultation with other state departments as necessary, to increase patient access to affordable drugs, among other things. Existing law requires CHHSA to report to the Legislature on or before July 1, 2022, with a description of the status of the drugs targeted for manufacture and an analysis of how CHHSA's activities have impacted competition, access, and costs for those drugs, and also requires CHHSA, upon appropriation by the Legislature, to submit a report to the Legislature on or before July 1, 2023, that assesses the feasibility and advantages of directly manufacturing generic prescription drugs and selling generic prescription drugs at a fair price. Existing law exempts all nonpublic information and documents obtained under this program from disclosure under the California Public Records Act. For purposes of implementing the California Affordable Drug Manufacturing Act of 2020, this bill would authorize CHHSA or its departments to enter into to enter into exclusive or nonexclusive contracts on a bid or negotiated basis and would exempt these contracts from review or approval by the Department of General Services until December 31, 2027, as specified. The bill would extend the deadline for the report describing the status of the drugs targeted for manufacture and the related impacts until December 31, 2022, and would extend the deadline for the report assessing the feasibility of directly manufacturing generic prescription drugs until December 31, 2023. The bill would additionally exempt all nonpublic information and documents prepared under the California Affordable Drug Manufacturing Act of 2020 from disclosure under the California Public Records Act. (44) Existing law, the Personal Income Tax Law, authorizes an individual to contribute amounts in excess of their personal income tax liability for the support of specified funds. Existing law establishes the Suicide Prevention Voluntary Tax Contribution Fund in the State Treasury, as a continuously appropriated fund, and requires the Franchise Tax Board to revise the tax return to include a space for this fund when another voluntary contribution designation is removed or space becomes available. Existing law requires moneys contributed to the fund on the tax return to be allocated to the Franchise Tax Board, the Controller, and the Mental Health Services Oversight and Accountability Commission for administrative costs and to the commission for disbursement to crisis centers located in the state that are active members of the National Suicide Prevention Lifeline. Existing law requires 50% of the funds disbursed to crisis centers to be awarded through a project-specific grant process to fund programs that are designed to provide suicide prevention services to rural and desert communities. Existing law requires the other 50% of those funds to be disbursed to crisis centers for the sole purpose of providing suicide prevention services and requires those funds to be disbursed to each crisis center in an amount proportional to the proportion that the annual number of calls the crisis center answers bears to the annual number of calls answered by all crisis centers located in the state, as specified. Existing law requires the commission to report on its internet website information regarding the award of funds and the administrative costs of the program. This bill would require the State Department of Health Care Services, instead of the commission, to administer the funds disbursed to crisis centers. The bill would eliminate the requirement that 50% of those funds be awarded as grants to provide suicide prevention services to rural and desert communities and that 50% of the funds be disbursed on a proportional basis to crisis centers based on the number of calls answered by the crisis centers. The bill would instead require the money to be disbursed to crisis centers located in the state that are active members of the National Suicide Prevention Lifeline, with priority given to those crisis centers located in rural and desert communities. By changing the purposes for which the moneys in a continuously appropriated fund may be expended, the bill would make an appropriation. This bill would eliminate the commission's reporting requirement and would prohibit money in the fund from being used to supplant administrative funding for other specified mental health programs. The bill would authorize the department, in administering the funds, to enter into exclusive or nonexclusive contracts, or amend existing contracts. The bill would make other conforming changes. (45) The California Health Facilities Financing Authority Act authorizes the California Health Facilities Financing Authority to, among other things, make loans from the continuously appropriated California Health Facilities Financing Authority Fund to participating health institutions for financing or refinancing the acquisition, construction, or remodeling of health facilities. Under existing law, participating health institutions are specified entities authorized by state law to provide or operate a health facility and undertake the financing or refinancing of the construction or acquisition of a project or of working capital, as defined. Existing law defines "working capital" as moneys to be used by or on behalf of a participating health institution for specified expenses in connection with the ownership or operation of a health facility, including interest not to exceed one year on any loan for working capital made pursuant to these provisions. Existing law requires a participating health institution that is a private nonprofit corporation or association and that borrows money to finance working capital to repay and discharge the loan within 15 months of the loan date. This bill would change the definition of "working capital" to include 2 years' worth of interest on any loan for working capital. The bill would also extend the time for a participating health institution that is a private nonprofit corporation or association to repay and discharge a loan for working capital to 24 months. (46) 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. (47) 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. (48) This bill would declare that it is to take effect immediately as a bill providing for appropriations related to the Budget Bill.