AB 118

Bill Subjects

Abstract

(1) 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 requires a health care service plan to provide disclosures regarding the benefits, services, and terms of the plan contract, as specified, to provide the public, subscribers, and enrollees with a full and fair disclosure of the provisions of the plan. This bill would require the department to develop standard templates for the disclosure form and evidence of coverage, to include, among other things, standard definitions, benefit descriptions, and any other information that the director determines, consistent with the goals of providing fair disclosures of the provisions of a health care service plan. The bill would require the department to consult with the Department of Insurance and interested stakeholders in developing the standard templates. The bill would require health care service plans, beginning January 1, 2025, to use the standard templates for any disclosure form or evidence of coverage published or distributed, except as specified. Because a willful violation of these requirements is a crime, the bill would impose a state-mandated local program. This bill would authorize the department to develop standard templates for a schedule of benefits, an explanation of benefits, a cost-sharing summary, or any similar document. The bill would authorize the department to require health care service plans to use the standard templates, except as specified, and would authorize the director to require health care service plans to submit forms the health care service plan created based on the department's templates for the purpose of compliance review. The bill would additionally specify that the department may implement these provisions by issuing and modifying templates and all-plan letters or similar instructions, without taking regulatory action. The bill would also update cross-references in various provisions. (2) Existing law requires a health care service plan contract or disability insurance policy to cover mental health and substance use disorder treatment, including medically necessary treatment of a mental health or substance use disorder provided by an in-network or out-of-network 988 center or mobile crisis team. Existing law prohibits a health care service plan or insurer from requiring prior authorization for medically necessary treatment of a mental health or substance use disorder provided by a 988 center or mobile crisis team. This bill would instead specify that mental health and substance use disorder treatment includes behavioral health crisis services that are provided by a 988 center, mobile crisis team or other provider of behavioral health crisis services. The bill would prohibit a health care service plan or health insurer from requiring prior authorization for behavioral health crisis stabilization services and care, but would authorize prior authorization for medically necessary mental health or substance use disorder services following stabilization from a behavioral health crisis addressed by services provided through the 988 system. This bill would require a health care service plan or health insurer that is contacted by a 988 center, mobile crisis team, or other provider of behavioral health crisis services to, within 30 minutes of initial contact, either authorize poststabilization care or inform the provider that it will arrange for the prompt transfer of the enrollee's care to another provider. The bill would require the plan or insurer to reimburse a provider for poststabilization care in specified circumstances, including if the plan or insurer did not respond within 30 minutes to authorize care or arrange for transfer. The bill would require a plan or insurer to prominently display on its internet website its authorization telephone number for noncontracting providers, and would require the Department of Managed Health Care to post the telephone number on its internet website. 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. (3) 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 generally requires an individual, and any dependents of the individual, to maintain minimum essential coverage. 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 imposes the Individual Shared Responsibility Penalty for the failure to maintain minimum essential coverage, and requires the moneys collected to be deposited into the General Fund. Existing law requires the Exchange to administer a financial assistance program to help low-income and middle-income Californians access affordable health care coverage through the Exchange. Existing law creates the Health Care Affordability Reserve Fund and requires moneys in the fund to be used, upon appropriation by the Legislature, for health care affordability programs operated by the Exchange. This bill would require moneys collected from the Individual Shared Responsibility Penalty to be deposited into the Health Care Affordability Reserve Fund beginning July 1, 2023, and on every July 1 thereafter. The bill would authorize a loan from the Health Care Affordability Reserve Fund to the General Fund upon order of the Department of Finance. (4) Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. Existing law requires that the Medi-Cal program covers specified health care services, including inpatient intensive rehabilitation hospital services, and requires those services consist of programs for, among other services, strengthening and training of selected muscle groups. Existing law requires those programs to provide for an initial evaluation for assessment of medical condition, functional limitations, possible need for surgery, attitude toward rehabilitation, functional goals and plans for discharge. This bill would eliminate the requirement for the above-described initial evaluation, and would also make technical, nonsubstantive changes. (5) This bill would, for dates of service no sooner than January 1, 2024, or on the effective date of any necessary federal approvals, whichever is later, require the reimbursement rates for primary care services, obstetric care services, doula services, and certain outpatient mental health services to be the greater of 87.5% of the lowest maximum allowance established by the federal Medicare Program for the same or similar services or the level of reimbursement, as specified. The bill would require the department to annually review and revise the reimbursement rates, and to develop and implement a methodology for establishing rates or payments for the services. The bill would require each Medi-Cal managed care plan to reimburse a network provider furnishing those services at least the amount the network provider would be paid for those services in the Medi-Cal fee-for-service delivery system, as specified. The bill would condition implementation of these provisions on receipt of any necessary federal approvals and the availability of federal financial participation. The bill would require the department to submit to the Legislature, as part of the 2024–25 Governor's Budget, a plan for targeted increases to Medi-Cal payments or other investments, in relation to certain domains. Under the bill, the above-described payments would be supported by the managed care organization provider tax revenue, as specified, or other state funds appropriated to the department as the state share for this purpose, including, but not limited to, funds transferred to the Medi-Cal Provider Payment Reserve Fund, as described below, and to the Healthcare Treatment Fund under the California Healthcare, Research and Prevention Tobacco Tax Act of 2016, as specified. The bill would create the Medi-Cal Provider Payment Reserve Fund. The bill would require the department, subject to an appropriation, to use the moneys transferred to the fund pursuant to other specified provisions for purposes of funding targeted increases to Medi-Cal payments or other investments that advance access, quality, and equity for Medi-Cal beneficiaries and promote provider participation in the Medi-Cal program. The bill would require the department to provide an annual report to all health plans accounting for the funds deposited in, and expended from, the fund. The bill would require those expenditures to include increased costs as a result of the above-described reimbursement requirements, transfers to the Distressed Hospital Loan Program Fund, certain transfers or appropriations to the University of California to expand graduate medical education programs, as specified, and, effective no sooner than January 1, 2025, increased costs for targeted increases to Medi-Cal payments or other investments pursuant to the above-described plan. 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 an additional exemption, for dates of service on and after July 1, 2022, or the effective date of any necessary federal approvals, whichever is later, for Community-Based Adult Services, as specified. The bill would make additional exemptions, for dates of service on and after January 1, 2024, or the effective date of specified payments, whichever is later. Existing law establishes the Distressed Hospital Loan Program, administered by the Department of Health Care Access and Information, in order to provide interest-free cashflow loans to not-for-profit hospitals and public hospitals in significant financial distress or to governmental entities representing a closed hospital, except as otherwise provided, to prevent the closure of, or facilitate the reopening of, those hospitals. Existing law establishes the Distressed Hospital Loan Program Fund, with moneys in the fund being continuously appropriated for the department and the California Health Facilities Financing Authority to implement the program. This bill would authorize the Department of Finance to transfer up to $150,000,000 from the Medi-Cal Provider Payment Reserve Fund to the Distressed Hospital Loan Program Fund in state fiscal year 2023–24 to implement the program, as specified, and would make a conforming change. (6) Existing law requires Medi-Cal benefits to be provided to individuals eligible for services pursuant to prescribed standards, including a modified adjusted gross income (MAGI) eligibility standard. Existing law prohibits the use of an asset or resources test for individuals whose financial eligibility for Medi-Cal is determined based on the application of MAGI. Existing federal law authorizes a state to establish a non-MAGI standard for determining the eligibility of specified individuals, and existing law imposes the use of a resources test for establishing Medi-Cal eligibility for prescribed populations. Existing law prohibits the use of resources, including property or other assets, to determine Medi-Cal eligibility for applicants or beneficiaries whose eligibility is not determined using the MAGI-based financial methods, and requires the department to seek federal authority to disregard all resources as authorized by the flexibilities provided pursuant to federal law. Existing law conditions implementation of that provision on the Director of Health Care Services determining that systems have been programmed for those disregards and their communicating that determination in writing to the Department of Finance, no sooner than January 1, 2024. Existing law also conditions implementation of that provision on the department obtaining any necessary federal approvals, and to the extent federal financial participation under the Medi-Cal program is available and not otherwise jeopardized. This bill, subject to the above-described timeline and implementation of the prohibition on the use of resources for determining Medi-Cal eligibility, would make various conforming changes to related provisions. Because this bill would increase county duties relating to the prohibition on the use of resources for determining Medi-Cal eligibility, the bill would impose a state-mandated local program. (7) Existing law requires Medi-Cal reimbursement rates to be set by an applicable methodology for specified dates of service operative on August 1 of a given year. This bill would, for dates of services on or after January 1, 2024, require the department to adopt a rate year based on the calendar year for intermediate care facilities for the developmentally disabled and facilities providing continuous skilled nursing care to developmentally disabled individuals, nursing facilities, licensed intermediate care facilities, freestanding pediatric subacute care units, and skilled nursing facilities, as specified. The bill would make these provisions subject to any necessary federal approvals and to the extent federal financial participation is available and is not otherwise jeopardized. (8) Existing law requires the State Department of Health Care Services, no later than April 1, 2022, and until December 31, 2023, to convene a workgroup to examine the implementation of the doula benefit provided under the Medi-Cal program. Existing law requires the department, no later than July 1, 2024, to publish a report relating to Medi-Cal recipients utilizing doula services, as specified. Existing law repeals those provisions on January 1, 2025. This bill would instead require the department to convene the workgroup no later than April 1, 2023, and until June 30, 2025, and to publish the report no later than July 1, 2025. The bill would extend the repeal date of those provisions to January 1, 2026. (9) Existing law, until July 1, 2024, requires the State Department of Health Care Services 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, 2024. This bill would extend these provisions until July 1, 2025, and make those funds available until June 30, 2025. By extending the period of time in which previously appropriated funds are available for encumbrance, the bill would make an appropriation. (10) 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 counties for various drug treatment services to Medi-Cal recipients, or is required to directly arrange for these services if a county elects not to do so. Existing law specifies the method of determining the maximum allowable reimbursement rates for Drug Medi-Cal and group outpatient drug free services, as described. Existing law requires the claims for reimbursement of Drug Medi-Cal services to be submitted within 6 months from the date of service. This bill would instead require claims for reimbursement of Drug Medi-Cal services to be submitted within 12 months from the date of service. (11) Under existing law, certain medically needy persons, including those in long-term care, with higher incomes qualify for Medi-Cal with a share of cost, if they meet specified criteria. Under existing law, the term "share of cost" means the amount of the costs of health care that a specified person or family must incur prior to being certified by the department. This bill would instead apply the term "spend down of excess income" to the above-described definition for "share of cost" for medically needy persons. The bill would change references from "share of cost" to "long-term care patient liability," in the context of those entering or in long-term care and define that term as the result of the "post-eligibility treatment of income" calculation and the amount of medical expenses the person in long-term care or an institutionalized spouse must incur or expect to incur. The bill would define the term "post-eligibility treatment of income" as the determination of long-term care patient liability for each month the person is in long-term care or as an institutionalized spouse, as specified. (12) Existing law requires the State Department of Health Care Services to prepare and submit assumptions and estimates, as prescribed, relating to the Medi-Cal program to the Department of Finance on a semiannual basis for the purpose of clearly identifying changes within the Medi-Cal program and producing reliable forecasts of Medi-Cal expenditures. Existing law requires the department to separately identify expenditures for rate increases and fiscal intermediary services, requires that certain assumptions or estimates contain a narrative description of how the forecast is prepared, and requires that estimates compare budgeted to implemented rate increases for the current year, by provider category, among other things. This bill would, effective July 1, 2023, strike these latter requirements and require, beginning with the estimates for the 2024–25 fiscal year, that they include separately identifying expenditures for county and other local assistance administration and a narrative description of how those forecasts were prepared. (13) Existing law establishes the Medi-Cal Access Program, which provides health care services to a person who is pregnant or in their 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 the State Department of Health Care Services to provide presumptive eligibility to qualified individuals through programs in which authorized Medi-Cal providers make presumptive eligibility determinations. Existing law requires the department to adopt the Newborn Hospital Gateway, which is an electronic process for families to enroll a deemed eligible newborn in the Medi-Cal program from hospitals that have elected to participate in the process. Existing law authorizes the expenditure of moneys in the Gateway Fund, upon appropriation, for purposes of establishing and maintaining the gateway. Existing law conditions adoption of the gateway on the deposit of sufficient moneys in the Special Funds Account of the Gateway Fund and on the availability of sufficient new staff, as specified, and would require the department to implement the gateway within 12 months after the occurrence of those conditions. This bill would require that the gateway be accessed through existing presumptive eligibility portals. The bill would require all qualified Medi-Cal providers participating in presumptive eligibility programs to use the gateway system to report a Medi-Cal eligible newborn born in their facilities, as specified, within 72 hours after birth, or one business day after discharge, whichever is sooner. The bill would impose a related requirement on Medi-Cal providers for purposes of reporting the birth of an infant eligible under the Medi-Cal Access Program, as specified. The bill would delete the conditions of sufficient moneys and staff and the 12-month timeline from the above-described provisions. The bill would make other changes to related contracting provisions. The bill would make the above-described changes operative on July 1, 2024, or the effective date for implementation of the Children's Presumptive Eligibility Program portal, whichever is later. Existing law requires the department to develop an electronic application to serve as the application for the Children's Presumptive Eligibility Program, to the extent allowed under federal law. Existing law authorizes the department to also use the electronic application as a means to enroll newborns into the Medi-Cal program as is authorized under specified federal law. Existing law conditions implementation of these provisions on receipt of any necessary federal approvals and the availability of federal financial participation. This bill would authorize providers to submit newborn enrollments through the electronic application on behalf of patients without a patient's signature. To the extent that the above-described provisions would create new duties for counties relating to Medi-Cal eligibility determinations, the bill would impose a state-mandated local program. (14) Existing law authorizes the State Department of Health Care Services to establish a Whole Child Model program, under which managed care plans served by a county organized health system or Regional Health Authority in designated counties provide California Children's Services (CCS) to Medi-Cal eligible CCS children and youth. Existing law, commencing no sooner than January 1, 2024, expands managed care plans under the Whole Child Model program to also include an alternate health care service plan (AHCSP) , requires the department, in implementing the program, to develop specific CCS program monitoring and oversight standards for managed care plans, and establish a statewide Whole Child Model program stakeholder advisory group that includes specified persons, including CCS case managers, and to consult with that advisory group on prescribed matters. Existing law terminates the advisory group on December 31, 2023. Existing law requires a Medi-Cal managed care plan participating in the Whole Child Model program to meet certain requirements, such as ensuring that each CCS-eligible child receives case management, care coordination, provider referral, and service authorization services from an employee or contractor of the plan, as described. Existing law imposes various requirements on a Medi-Cal managed care plan serving children and youth with CCS-eligible conditions under the CCS program, including, but not limited to, coordinating services, as specified, providing appropriate access to care, services, and information, and providing for case management, among others. This bill, no sooner than January 1, 2025, would expand the above-described authorization to establish a Whole Child Model program to additional counties, as specified, and would extend the operation of the advisory group until December 31, 2026. The bill would require the department, no later than January 1, 2025, to take certain actions related to oversight standards, such as developing utilization and quality measures that relate to CCS specialty care and providing analysis regarding trends on CCS enrollment for Whole Child Model counties, among others. The bill would require a managed care plan participating in the Whole Child Model program to ensure that a CCS-eligible child has a primary point of contact who shall be responsible for the child's care coordination and would require a Medi-Cal managed care plan serving children and youth with CCS-eligible conditions under the CCS program to support the establish referral pathways in the non-Whole Child Model counties, as described. Existing law authorizes the department to standardize those populations that are subject to mandatory enrollment in a Medi-Cal managed care plan across all aid code groups and Medi-Cal managed care models statewide, subject to a Medi-Cal managed care plan readiness, continuity of care transition plan, and disenrollment process developed in consultation with stakeholders, in accordance with specified requirements and the CalAIM Terms and Conditions. Existing law, if the department standardizes those populations subject to mandatory enrollment, exempts dual and non-dual beneficiary groups from that mandatory enrollment, including, among others, non-dual-eligible beneficiaries eligible on the basis of their receipt of services through a state foster care program, but excludes from that exemption, those who reside in a county that is authorized to operate a county organized health system. This bill would additionally exclude those non-dual-eligible beneficiaries who reside in a county operating a Single Plan model of managed care from that exemption, thereby subjecting that population to mandatory enrollment in a Medi-Cal managed care plan and would prescribe certain requirements for Medi-Cal managed care plans and the department in transitioning that population to a Medi-Cal managed care plan, such as compliance with access requirements and department guidance and use of a specified transfer process for immediate access to care and treatment services. (15) Under existing law, specialty mental health services include federal Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services provided to eligible Medi-Cal beneficiaries under 21 years of age. Existing law requires each local mental health plan to establish a procedure to ensure access to outpatient specialty mental health services, as required by the EPSDT program standards, for youth in foster care who have been placed outside their county of adjudication, as described. Existing law requires the State Department of Health Care Services to issue policy guidance on the conditions for, and exceptions to, presumptive transfer of responsibility for providing or arranging for specialty mental health services to a foster youth from the county of original jurisdiction to the county in which the foster youth resides, as prescribed. On a case-by-case basis, and when consistent with the medical rights of children in foster care, existing law authorizes the waiver of presumptive transfer, with the responsibility for the provision of specialty mental health services remaining with the county of original jurisdiction if certain exceptions exist. Under existing law, the county probation agency or the child welfare services agency is responsible for determining whether waiver of the presumptive transfer is appropriate, with notice provided to the person requesting the exception. Under existing law, commencing July 1, 2023, in the case of placement of foster children in short-term residential therapeutic programs, community treatment facilities, or group homes, or in the case of admission of foster children to children's crisis residential programs, the county of original jurisdiction is required to retain responsibility and presumptive transfer provisions apply only if certain circumstances exist. This bill, for purposes of foster children placed or admitted in those specific settings, would delay, until July 1, 2024, the requirement on the county of original jurisdiction to retain responsibility and the limitation on the presumptive transfer provisions. By extending the period during which a county agency is responsible for making determinations about presumptive transfer waivers and making certain notifications, the bill would impose a state-mandated local program. Existing law conditions implementation of the above-described provisions on the availability of federal financial participation and receipt of all necessary federal approvals. If the department makes the determination that it is necessary to seek federal approval, existing law requires the department to make an official request for approval from the federal government no later than July 1, 2024. This bill would delay the deadline for any necessary federal approval requests to July 1, 2025. (16) Existing law establishes the California Advancing and Innovating Medi-Cal (CalAIM) initiative, subject to receipt of any necessary federal approvals and the availability of federal financial participation, in order to, among other things, improve quality outcomes, reduce health disparities, and increase flexibility. Existing law authorizes the State Department of Health Care Services, to the extent authorized by the CalAIM Terms and Conditions, to claim federal financial participation for expenditures associated with the designated state health programs identified in those terms and conditions for use solely by the department. Existing law requires that any federal financial participation claimed be used to offset applicable General Fund expenditures. Existing law makes an appropriation of those amounts to the department and makes them available for transfer to the General Fund for that purpose. Existing law appropriates an amount of General Fund moneys, equal to the federal financial participation that may be claimed, to the continuously appropriated Health Care Deposit Fund for use by the department for purposes of implementing the CalAIM initiative. This bill would require the department to maintain reimbursement rates in the Medi-Cal program for primary care, obstetric care, and behavioral health services, and to increase reimbursement rates for those service codes as necessary to meet federally imposed minimum requirements specified in the terms and conditions for dates of service on or after January 1, 2024, to the extent required by the federal Centers for Medicare and Medicaid Services as a condition of claiming federal financial participation for designated state health programs as set forth in the above-described provisions, thereby making an appropriation. The bill would, to the extent required by the CalAIM Terms and Conditions, apply those provisions to claims for the identified codes paid by the department in fee-for-service and to claims paid by a Medi-Cal managed care plan. Existing law requires the department to standardize 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 July 1, 2023, and subject to CalAIM implementation, requires the department to include, or continue to include, institutional long-term care services, with exceptions, as capitated benefits in the comprehensive risk contract with each Medi-Cal managed care plan. Existing law, for contract periods from July 1, 2023, to December 31, 2025, inclusive, requires each Medi-Cal managed care plan to reimburse a network provider furnishing those services to a Medi-Cal beneficiary enrolled in that plan, as specified. This bill would delay the above-described requirements for institutional long-term care services, from July 1, 2023, to January 1, 2024. Existing law, subject to implementation of the CalAIM initiative, requires each Medi-Cal behavioral health delivery system to comply with the behavioral health payment reform provisions approved in the CalAIM Terms and Conditions and any associated instruction issued by the department, as specified. Existing law requires the department, as a component of that reform, to design and implement an intergovernmental transfer-based reimbursement methodology to replace the use of certified public expenditures for claims associated with covered Specialty Mental Health and Drug Medi-Cal services provided through Medi-Cal behavioral health delivery systems. Existing law requires that the nonfederal share of any payments consist of voluntary intergovernmental transfers of funds provided by eligible governmental agencies or public entities associated with a respective Medi-Cal behavioral health delivery system. Existing law requires the department to establish and implement prospective reimbursement rate methodologies, as specified. This bill would create the Medi-Cal County Behavioral Health Fund for the deposit of the nonfederal moneys collected by the department pursuant to the above-described provisions. Under the bill, deposited moneys would be continuously appropriated to the department for purposes of implementing those provisions. For counties that elect to participate in the offset and transfer of funds, moneys would be offset and transferred by the Controller into the fund from the Behavioral Health Subaccount in the Support Services Account in the Local Revenue Fund 2011, the Mental Health Subaccount in the Sales Tax Account in the Local Revenue Fund, and the Mental Health Services Fund. The bill would require that the fund contain all interest and dividends earned on moneys in the fund and be used only for the purpose of implementing those provisions. The bill would require the department to provide schedules under specified procedural steps and timelines. Existing law, the Mental Health Services Act (MHSA) , an initiative measure enacted by the voters as Proposition 63 at the November 2, 2004, statewide general election, establishes the continuously appropriated Mental Health Services Fund to fund various county mental health programs. The MHSA may be amended by a 23 vote of each house of the Legislature if the amendment is consistent with, and furthers the intent of, the act. The Legislature may clarify procedures and terms of the act by majority vote. This bill would make legislative findings that the above-described provisions are consistent with, and further the intent of, the MHSA. (17) Existing law creates the continuously appropriated Medical Providers Interim Payment Fund for the purposes of paying Medi-Cal providers, providers of drug treatment services for persons infected with HIV, and providers of services for the developmentally disabled, during a fiscal year for which a budget has not yet been enacted or there is a deficiency in the Medi-Cal budget. During a fiscal year in which these payments are necessary, existing law requires the Controller to transfer up to $2,000,000,000 from the General Fund in the form of loans, and appropriates $2,000,000,000 from the Federal Trust Fund to the Medical Providers Interim Payment Fund. This bill would increase the General Fund loan amount to up to 10% of the amount appropriated from the General Fund to Medi-Cal benefit costs from the most recent fiscal year. The bill would also appropriate an amount not to exceed 6% of the amount appropriated from the Federal Trust Fund to Medi-Cal benefit costs in the most recent fiscal year. By increasing the amount of an appropriation, the bill would make an appropriation. (18) Existing law grants the State Department of Health Care Services the sole authority to issue, deny, suspend, or revoke the license of a driving-under-the-influence program. This bill would require the department to develop regulations on or before January 1, 2026, governing the provision of alcohol or drug recovery services pursuant to those provisions in virtual settings. The bill would authorize the department to implement those provisions by means of all-county letters, plan letters, information notices, or similar instructions, until regulations are promulgated. (19) Existing law requires the State Department of Health Care Services to license and regulate facilities that provide residential nonmedical services to adults who are recovering from problems related to alcohol, drug, or alcohol and drug misuse or abuse, and who need alcohol, drug, or alcohol and drug recovery treatment or detoxification services. Existing law also requires the department to implement a voluntary certification procedure for alcohol and other drug treatment recovery services. This bill would repeal the voluntary certification procedure for alcohol and other drug treatment recovery services, and would instead require those programs to be certified, except as specified. The bill would prohibit a program from offering alcohol and other drug treatment recovery services without certification, and would impose civil penalties on programs that violate those provisions, as specified. The bill would establish procedures for certification, as well as for inspections of certified programs and for revocation of certification from noncompliant programs. (20) Existing federal law, the National Suicide Hotline Designation Act of 2020, designates the 3-digit telephone number "988" as the universal number within the United States for the purpose of the national suicide prevention and mental health crisis hotline system operating through the 988 Suicide & Crisis Lifeline. Existing law, the Miles Hall Lifeline and Suicide Prevention Act, requires, among other things, the Office of Emergency Services (OES) to verify that technology that allows for transfers between 988 centers as well as between 988 centers and 911 public safety answering points, is available to 988 centers and 911 public safety answering points throughout the state, to appoint a 988 system director, and to verify interoperability between and across 911 and 988. Existing law defines "988" for these purposes as the 3-digit telephone number designated by the Federal Communications Commission (FCC) for the purpose of connecting individuals experiencing a behavioral health crisis with counselors trained in suicide prevention and behavioral health crisis and with the capacity to connect callers to behavioral health crisis services through the National Suicide Prevention Lifeline network. Existing law includes crisis receiving and stabilization services in the definition of "behavioral health crisis services." This bill would instead define "988" as the 3-digit telephone number designated by the FCC for the purpose of connecting individuals experiencing a behavioral health crisis with the national suicide prevention and mental health hotline system in accordance with specified federal law. The bill would remove "crisis receiving services" from the definition of "behavioral health crisis services." This bill would authorize the State Department of Health Care Services to enter into exclusive or nonexclusive contracts, or amend existing contracts, on a bid or negotiated basis, and implement changes to existing information technology systems, as described. The bill would make conforming and other technical changes. The act requires the agency to create, no later than December 31, 2023, a set of recommendations to support a 5-year implementation plan for a comprehensive 988 system. Existing law requires the agency to convene a state 988 advisory group for purposes of advising the agency on the set of recommendations and requires the recommendations to include specified information. Existing law requires the advisory group to meet once per quarter until December 31, 2023, and prohibits the group from being disbanded before January 1, 2024. Existing law also requires the agency to annually report, commencing December 31, 2024, and until December 31, 2029, to the Legislature on the status of 988 implementation in the state, as provided. This bill would instead extend the deadline for the recommendations to December 31, 2024, require the advisory group to meet once per quarter until December 31, 2024, and prohibit the group from disbanding before January 1, 2025. The bill would revise the information required in the set of recommendations. The bill would also remove the annual reporting requirement. The bill would require, until December 31, 2029, the California Health and Human Services Agency to post regular updates, no less than annually, regarding the implementation of 988 on its public internet website. (21) Existing law, the Emergency Telephone Users Surcharge Act, creates a separate surcharge, beginning January 1, 2023, on each access line for each month or part thereof for which a service user subscribes with a service supplier, as described (988 surcharge) . Existing law establishes the 988 State Suicide and Behavioral Health Crisis Services Fund and requires revenues generated from the 988 surcharge to be used for purposes of funding the operations of the 988 center and mobile crisis teams, as defined. Existing law, however, requires the 988 surcharge revenues to be used for certain refunds, costs of administering the surcharge, and OES costs related to the administration of the 988 Suicide & Crisis Lifeline, before being disbursed to OES for purposes of the act. This bill would allow the 988 surcharge revenue to be used to pay state departments for their costs in administering the 988 Suicide & Crisis Lifeline before disbursement of the revenue to OES for purposes of the act. The bill would require the fund to consist of any other appropriations made to it by the Legislature. The bill would authorize the Legislature to consider additional uses for the revenue generated by the 988 surcharge based on recommendations made by the California Health and Human Services Agency and the advisory group, as specified. Existing law sets forth priorities for the moneys in the fund and prohibits money in the fund from being transferred to any fund or from being transferred, assigned, or reassigned for any other use or purpose outside of the act. Existing law requires revenue generated by the 988 surcharge to be used to supplement and not supplant federal, state, and local funding for 988 centers and mobile crisis services. Existing law requires an entity seeking funds available through the fund to annually file an expenditure and outcomes report, as described. The bill would revise the priority uses for 988 surcharge revenues, as described. The bill would instead require the 988 surcharge revenue to be used to supplement and not supplant federal, state, and local funding for 988 centers and behavioral health crisis services. This bill would require the expenditure and outcomes report to include information regarding billing to and reimbursement by health care service plans or insurers, beginning January 1, 2030, and measures of system performance, beginning July 1, 2025. (22) Existing law, the California Affordable Drug Manufacturing Act of 2020, requires CHHSA to enter into partnerships resulting in the production or distribution of generic prescription drugs to, among other things, increase patient access to affordable drugs. Existing law requires CHHSA to have the ability to hire staff to oversee and project-manage these partnerships. Existing law, for the purposes of implementing the California Affordable Drug Manufacturing Act of 2020, until December 31, 2027, permits CHHSA and its departments to enter into exclusive or nonexclusive contracts on a bid or negotiated basis. This bill would require CHHSA to enter into these partnerships for the procurement of general prescription drugs and would also give CHHSA the ability to hire contractors to oversee and project-manage these partnerships. The bill would indefinitely authorize the CHHSA and its departments to enter into exclusive or nonexclusive contracts on a bid or negotiated basis. (23) Existing law, contingent upon an appropriation in the annual Budget Act, requires CHHSA to establish a grant program to reduce fentanyl overdoses and use throughout the state by giving out 6 one-time grants to increase local efforts in education, testing, recovery, and support services, as specified. Existing law requires the participating entities to provide the agency with specified information on the results of the program and requires the agency to report those results to the Legislature and Governor's office on or before January 1, 2026. This bill would require that, contingent upon an appropriation in the annual Budget Act, the State Department of Public Health is to establish the grant program, as specified. The bill would require that the department submit an interim report on the progress of the programs with all available information by January 1, 2026, and a final report with all specified information by January 1, 2028. The bill would extend these provisions until January 1, 2029. (24) Existing law establishes the California Reproductive Health Service Corps within the Department of Health Care Access and Information for the purposes of recruiting, training, and retaining a diverse workforce of reproductive health care professionals who will be part of reproductive health care teams to work in underserved areas. For the purposes of this program, existing law defines "reproductive health care professionals" to include, among others, medical doctors, licensed midwives, registered nurses, and medical assistants. This bill would add pharmacists to the list of reproductive health care professionals as defined under this program. (25) Existing law, the Radiologic Technology Act, requires the State Department of Public Health to provide for the certification of radiologic technologists and for granting limited permits to persons to conduct radiologic technology, as specified. Existing law also makes the department responsible for regulating people who perform nuclear medicine technology and mammography. Existing law subjects a person who is regulated as radiologic technologist or competent to perform nuclear medicine technology to discipline for specified reasons, including habitual intemperance in the use of alcoholic beverages, narcotics, or stimulants, as to incapacitate for the performance of professional duties, incompetence, negligence, or gross negligence in performing their functions, and violation of specified statutes or regulations. Existing law also authorizes the department to deny, revoke, or suspend a certificate or permit for a conviction of more than one misdemeanor or a felony involving moral turpitude that was committed during the performance of radiologic technology duties. This bill would revise and recast the provisions relating to the discipline of a radiologic technologist or a person competent to perform nuclear medicine technology by, among other things, expanding the list of conduct for which they may be disciplined, including the addition of unprofessional conduct and making or giving a false statement or information in conjunction with the application for establishment of competence. Under existing law, a person who violates, or aids or abets the violation of, provisions relating to radiological technologists or nuclear medicine technology is guilty of a misdemeanor. A person who violates the provision relating to mammography is guilty of a misdemeanor punishable by a fine not to exceed $5,000 per day, per offense or by imprisonment in the county jail not to exceed 180 days, or by both the fine and imprisonment. Under existing law, a person who intentionally or through gross negligence violates the act relating to mammography, or who fails or refuses to comply with a cease and desist order or other order of the department and causes a substantial danger to the health of others is also liable for a civil penalty not to exceed $5,000 per day, per offense. This bill would also make it a misdemeanor for an entity to violate, or aid and abet the violation of, the act. The bill would make any violation of the act punishable in the same manner as the provisions relating to mammography and would make conforming changes. By expanding the scope of existing crimes, this bill would create a state-mandated local program. (26) Existing law establishes the Emergency Medical Services Authority, and requires the authority to be headed by a director who is a licensed physician and surgeon with substantial experience in the practice of emergency medicine. This bill would remove the requirement that the director be a licensed physician with substantial experience in the practice of emergency medicine. The bill would require the authority to have a chief medical officer that is appointed by the Governor, upon nomination by the Secretary of California Health and Human Services, who is a physician and surgeon licensed in California, as specified, and who has substantial experience in the practice of emergency medicine or emergency response in California. The bill would require the chief medical officer to provide clinical leadership and oversight concerning treatment, education, and other matters involving medical decisionmaking and delivery of patient care. (27) Under existing law, an adult having capacity may execute an advance health care directive to set forth health care instructions. Existing law requires the Secretary of State to establish an Advance Health Care Directive Registry through which a person may register information regarding their advance directive in a central information center. Under existing law, a Physician Orders for Life Sustaining Treatment (POLST) form is a request regarding resuscitative measures. Existing law, the California POLST eRegistry Act, requires the Emergency Medical Services Authority to establish a statewide electronic POLST registry system to collect a patient's POLST information and disseminate that information to an authorized user. Existing law requires the authority to incorporate the Advance Health Care Directive Registry into the POLST eRegistry. This bill would the delete the requirement that the authority incorporate the Advance Health Care Directive Registry into the POLST eRegistry. (28) Existing law establishes within the State Treasury the Litigation Deposits Fund (LDF) , under the control of the Department of Justice and consisting of moneys received as litigation deposits for which the state is a party to the litigation. The State of California is a party to certain opioid-related settlements, through which the state receives funds for opioid remediation. Existing law also establishes the Opioid Settlements Fund (OSF) within the State Treasury, and requires the State Department of Health Care Services to administer the fund. Existing law requires the Controller, upon order of the Director of Finance, to transfer funds received in the LDF allocated to the state for state opioid remediation from the 2022 opioid settlements with specified pharmaceutical companies to the OSF. Existing law also requires funds received from those settlements and any future settlements for these purposes that are not deposited in the LDF to be deposited into the OSF. Existing law requires moneys in the OSF, upon appropriation by the Legislature, to be used for opioid remediation in accordance with the terms of the judgment or settlement from which the funds were received. This bill would revise the above provision regarding the transfer of funds to the OSF from specified 2022 opioid settlements with pharmaceuticals to include Mallinckrodt Pharmaceuticals. The bill would also delete the above provision regarding the deposit of funds into the OSF. The bill would also require the Controller, upon order of the Director of Finance, to transfer funds received in the LDF allocated to the state for opioid remediation from the 2023 opioid settlements with manufacturers Teva Pharmaceutical Industries Ltd. and Allergan, and pharmacies CVS, Walgreens, and Walmart to the OSF. The bill would further require the Controller, upon order of the Director of Finance, to transfer funds received in the LDF allocated to the state for state opioid remediation from any future judgments, bankruptcies, or settlements pursuant to future Budget Act appropriation to the OSF. The bill would require funds received from the settlements outlined in the above provisions or from future judgments, bankruptcies, or settlements allocated to the state for state opioid remediation that are not deposited in the LDF to be deposited in the OSF. (29) Existing law, the Lanterman-Petris-Short Act, provides for the involuntary commitment and treatment of a person who is a danger to themselves or others or who is gravely disabled. Existing law also provides for a conservator of the person or estate to be appointed for a person who is gravely disabled. Existing law requires the Director of Health Care Services to administer the act and adopt rules, regulations, and standards, as necessary. Existing law requires the State Department of Health Care Services to collect and publish annually quantitative information concerning the operation of various provisions relating to community mental health services, including the number of persons admitted for evaluation and treatment for certain periods, transferred to mental health facilities, or for whom certain conservatorships are established, as specified. Existing law requires each county behavioral health director, each designated and approved facility, and each other entity, as specified, to provide accurate and complete data as prescribed by the department. This bill would instead require those designated and approved facilities and other entities to collect and provide data to the county behavioral health director in the county in which they operate, as specified, and would authorize a county to establish policies and procedures for this purpose. The bill would require the data provided by each county behavioral health director to the department to include that accurate and complete data. By increasing the data reporting obligations of county behavioral health agencies, this bill would create a state-mandated local program. Existing law authorizes the department to impose a plan of correction against a county that fails to submit data on a timely basis or as otherwise required. This bill would also authorize the department to assess a civil money penalty, as specified, against a county for those same reasons. The bill would create an informal written appeals process for the civil money penalty and would require the department to make a determination on the appeal within 60 calendar days of receipt of the appeal. This bill would also authorize a designated and approved facility or county to request a formal hearing, as specified. The bill would require civil money penalties to accrue until the effective date of the department's final decision. This bill would establish the Lanterman-Petris-Short Act Data and Reporting Oversight Fund, a continuously appropriated fund, to be administered by the State Department of Health Care Services. The bill would require civil money penalties assessed and collected to be deposited into the fund to be used for specified purposes. This bill would authorize the Controller to use moneys from the Lanterman-Petris-Short Act Data and Reporting Oversight Fund for cashflow loans to the General Fund. By continuously appropriating funds, this bill would make an appropriation. (30) Existing law provides for the licensure of long-term health care facilities by the State Department of Public Health. Existing law establishes the Federal Health Facilities Citation Penalties Account into which moneys from civil penalties for violations of federal law are deposited. Existing law authorizes up to $130,000 of the money in that account to be used, upon appropriation by the Legislature, for the improvement of quality of care and quality of life for long-term health care facility residents, as specified. This bill would delete the provision limiting how much money in the account can be used for that purpose. (31) Existing law requires the Department of Justice to maintain state summary criminal history information, as defined, and to furnish this information to various state and local government officers, officials, and other prescribed entities, if needed in the course of their duties. This bill would authorize the Department of Justice to furnish state summary criminal history to the State Department of State Hospitals for specified research and reporting purposes and would require the State Department of State Hospitals to use that information only for specified purposes. (32) Existing law authorizes a court to grant pretrial diversion, as specified, to a defendant suffering from a mental disorder, on an accusatory pleading alleging the commission of a misdemeanor or felony offense, in order to allow the defendant to undergo mental health treatment. Existing law conditions eligibility on, among other criteria, the diagnosis of a mental disorder, as specified, and that the defendant's mental disorder played a significant role in the commission of the charged offense. Existing law makes defendants ineligible for the diversion program for certain offenses, including murder, voluntary manslaughter, and rape. This bill would make technical changes to Section 1370 of the Penal Code that were necessitated by changes to these provisions that were enacted by Senate Bill 1223 of the 2021–2022 session. (33) The Budget Act of 2022 made appropriations for the support of state government for the 2022–23 fiscal year. This bill would revert specified items of appropriation regarding health care workforce grants to the General Fund and would state specified total program funding allocations for health care workforce grants that are reflected in the Budget Act of 2023. (34) 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. (35) Specified sections of this bill would become operative only if AB 119 or SB 119 of the 2023–24 Regular Session is enacted and takes effect on or before July 1, 2023. (36) This bill would declare that it is to take effect immediately as a bill providing for appropriations related to the Budget Bill.