By Garrett Hall, Jasdeep Bains, Katerina Jou, Firooz Kabir, Marissa Kraynak, and Katie Heidorn
2021 Introduced Legislation
Overview: The deadline for introducing legislation for the first year of the 2021-2022 legislative session was February 19, 2021. Similar to Governor Newsom’s FY 2021-22 Budget Proposal, this year’s introduced legislation focuses on COVID-19 pandemic response, support, and economic recovery as well as key ideas to harness the lessons learned during the pandemic to improve the health of Californian’s and to promote an equitable health care system.
Summary and Policy Areas: This blog summarizes legislation introduced that proposes to solve issues related to ITUP’s three priority policy issues: health care coverage and access, delivery system transformation, and the future of health.
Additionally, we noted which bills address:
Legislative Bill Process Guide: At the end of this blog, we also included important technical information, helpful links, and dates that can be used to follow these bills throughout the legislative process.
Note: this is not a comprehensive list of all the health and healthcare-related bills that were introduced. If you have questions about a bill not listed here, please feel free to contact us at [email protected].
Health Care Coverage and Access
Expanding Medi-Cal Eligibility
Expansion of Medi-Cal Eligibility for Undocumented Californians: This year, there were two bills introduced that extend Medi-Cal eligibility for undocumented adults and seniors. Both bills improve upon California’s Medi-Cal extension to youth and young adults ages 19-25 regardless of their immigration statuses in 2016 and 2020, respectively. Participants at ITUP’s 2020 regional workgroups highlighted that when we talk about the uninsured, we are really talking about undocumented individuals.
AB 4 (Arambula) extends eligibility for full-scope Medi-Cal benefits to all individuals regardless of their age or immigration status and requires the Department of Health Care Services (DHCS) to work with stakeholders to ensure continuity of care between an individual and their primary care provider.
SB 56 (Durazo) extends and expedites approval of Medi-Cal eligibility to individuals 65 and older regardless of immigration status.
Eliminating the Asset Tests for Medi-Cal Eligibility: AB 470 (Carrillo) modifies Medi-Cal eligibility standards by eliminating the use of an asset test. The vast majority of people (about 10.5 million) eligible for Medi-Cal have their income eligibility determined by the Modified Adjusted Gross Income (MAGI) formula. However, some people eligible for Medi-Cal (2 million) have their income eligibility determined by an “asset test” or “non-MAGI” standard which evaluates an individual’s assets and resources such as property and savings. Current asset levels are set at $2,000 for an individual or $3,000 for two people. You can read more about the asset test and non-MAGI Medi-Cal eligibility here.
Medi-Cal Eligibility for Formerly Incarcerated Individuals: AB 112 (Holden) requires the suspension of Medi-Cal benefits for juvenile and adult incarcerated individuals to end on the last day of incarceration, or three years from the date they become incarcerated. Suspension of Medi-Cal benefits, instead of terminating Medi-Cal coverage and re-enrolling post-incarceration, allows easier access to health care coverage following an incarcerated individual’s release and this bill increases the duration of the suspension from one year to three years.
Health Care Coverage
Health Care Coverage: Federal Health Care Reform SB 326 (Pan) deletes the provisions in health insurance law that would make health plan pre-existing conditions, premium rate limitations, and other anti-discrimination requirements adopted by the Affordable Care Act (ACA) inoperative if part of the ACA are repealed or amended. This bill protects existing ACA expansion in California from any negative federal action on the ACA. For more about the history of the ACA, see ITUP’s resource: “The Historical Journey of the ACA.”
Health Care Coverage Outreach: SB 644 (Leyva) requires the California Health Benefit Exchange (Exchange), the state’s ACA health insurance marketplace, also known as Covered California, to obtain contact information of applicants for programs administered by the Employment Development Department to aid in determining eligibility for health subsidy programs provided through the Exchange or DHCS. SB 644 requires the Exchange to publicize its health care coverage options to applicants.
Guaranteed Health Care for All: AB 1400 (Kalra) creates the California Guaranteed Health Care for All program, also called CalCare, to provide comprehensive universal single-payer health coverage and a health care cost control system. To establish CalCare, AB 1400 creates a CalCare Board to determine the enrollment timeline, employ necessary staff, and negotiate necessary contracts (including agreements between health care providers and the Board) in addition to an Advisory Commission on Long-Term Services and Supports to advise the Board on matters of policy related to CalCare. The majority of the bill would not become operative until the Secretary of the California Health and Human Services Agency (CHHS) notifies the Senate and Assembly that the CalCare Trust Fund has sufficient funds to support the program.
Making Coverage Meaningful
Medi-Cal Enrollment and Services for Persons Experiencing Homelessness: AB 369 (Kamlager) prohibits DHCS from imposing prior authorizations or other utilization controls on an item or service intended to prevent, test, treat, or mitigate COVID-19. This bill requires DHCS to implement a presumptive eligibility program to provide Medi-Cal benefits without cost-sharing to people experiencing homelessness. Additionally, the bill authorizes Medi-Cal providers to bill the Medi-Cal program for services rendered to people experiencing homelessness outside of traditional medical facilities and requires DHCS to reimburse for specialty care and diagnostics regardless of the care setting.
Timely Access for Mental Health and Substance Use Disorder Care: SB 221 (Weiner) requires health plans for non-emergency health care services, including Medi-Cal Managed Care plans, to ensure that individuals have timely access to appointments with nonphysician mental health and substance use disorder providers and can schedule follow-up appointments within 10 business days of the prior appointment. The timely access standards in this bill apply to referrals and providers must arrange other means of out-of-network coverage for patients if the timely access to care standards cannot be met due to physician shortages.
Same Day Visits: Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) SB 316 (Eggman) authorizes the reimbursement of a maximum of two visits that occur on the same day and at the same location. Under this bill, the two visits are permitted if the patient suffers from an illness or injury that necessitates additional treatment or if the patient has a medical visit and a mental health or dental visit on the same day and at the same location. SB 316 requires DHCS to submit a state plan amendment to the federal Centers for Medicare and Medicaid Services by July 1, 2022, to reflect the changes made and seek necessary approvals.
Coverage for Adverse Childhood Experiences (ACEs) Screenings SB 428 (Hurtado) requires a health care service contract, or health insurance policy issued, amended, or renewed on or after January 1, 2022, to cover screenings for adverse childhood experiences.
COVID-19 Cost Sharing: SB 510 (Pan) creates a mandate for health plans to cover costs for testing and immunizations for COVID-19 and other pandemic diseases that result in the declaration of a public health emergency. This bill prohibits in-network and out-of-network cost-sharing and prior authorization requirements for such services to maximize testing and vaccination as part of the state’s pandemic mitigation strategy and health care access for consumers.
Health Care Delivery System Transformation
CalAIM (California Advancing and Innovating Medi-Cal)
In Lieu of Services (ILOS) and Enhanced Care Management Medi-Cal Covered Benefits: This year, there are two bills, AB 875 (Wood) and SB 256 (Pan), that 1) add enhanced care management as a Medi-Cal benefit and 2) require that rates paid to Medi-Cal Managed Care Plans include the cost of providing in lieu of services.
CalAIM Implementation: Addressing Quality of Behavioral Health Care: This year, there are two bills, carried by the chairs of both the Assembly and Senate Health Committees, to address proposals in CalAIM related to preventing and treating mental health and substance use disorders.
AB 942 (Wood) establishes that “medically necessary” standards do not preclude coverage and reimbursement of a clinically appropriate and covered mental health and substance use disorder (SUD) assessment, screening, or treatment before a diagnosis is determined by a provider. This bill requires DHCS to implement the Behavioral Health Quality Improvement Program to assist county mental health plans and counties that administer the Drug Medi-Cal Treatment Program or the Drug Medi-Cal Organized Delivery System with preparations to implement the behavioral health components of the CalAIM proposal.
SB 279 (Pan) expands the “medically necessary” standards of the Medi-Cal program to include coverage and reimbursement of covered mental health or substance abuse disorder assessment, screening, or treatment before a diagnosis. SB 279 requires DHCS to establish and administer the Behavioral Health Quality Improvement Program for implementation of behavioral health components included in the CalAIM initiative. This bill requires DHCS, by January 1, 2023, to have secured necessary federal approvals and matching funds to implement these changes.
Achieving Health Equity in the Health Care Delivery System
Hospital Equity Reporting: AB 1204 (Wicks) requires hospitals to include minority racial and ethnic groups and socially disadvantaged groups such as the unhoused, communities with inadequate access to clean air and safe drinking water, people with disabilities, and LGBTQ+ individuals in their community a benefits plan. This bill also requires providers to prepare an annual equity report submitted to the Office of Statewide Health Planning and Development (OSHPD) detailing analyses of health status, access to care disparities, employment disparities, and plans to address those disparities.
Office of Racial Equity SB 17 (Pan) establishes an Office of Racial Equity that is independent of existing state agencies or departments. The proposed Office of Racial Equity is dedicated to examining current state policies that exacerbate racial disparities and developing a Racial Equity Framework that presents strategies and guidelines for state agencies and departments to address institutional and structural racism. This bill proposes to formally incorporate an anti-racist approach to policymaking and establish goals and methodologies to evaluate the extent to which state policies and practices help dismantle or maintain racial inequities that produce negative health outcomes and disparities among communities of color.
Childhood Chronic Health Conditions: Racial Disparities: SB 682 (Rubio) establishes a statewide anti-racism plan, developed and implemented by CHHS, that focuses on reducing racial disparities among children with chronic health conditions such as asthma, depression, and diabetes which can produce lifelong adverse health outcomes. SB 682 requires CHHS to present a strategic plan to achieve a 50 percent reduction in racial disparities in childhood chronic conditions by December 31, 2030.
Reducing Health Care Costs, Increasing Quality, and Increasing Market Competition
California Health Care Quality and Affordability Act: AB 1130 (Wood), establishes the Office of Health Care Affordability within the Office of Statewide Health Planning and Development. This bill requires the Office of Health Care Affordability to analyze the health care market, develop polices for lowering health care costs, set and enforce cost targets, and create a state strategy for controlling the cost of health care and ensuring health care affordability for consumers and purchasers. AB 1130 also requires the Office of Health Care Affordability to set priority standards for various health care metrics, including metrics for health care quality and equity, alternative payment methods, primary care behavioral investments, and health care workforce stability. This bill requires, by June 1, 2024, and annually thereafter, a report on baseline health care spending trends and underlying factors, along with policy recommendations, to be produced and a public meeting on the report to be held by June 1, 2025.
Health Care Consolidation and Contracting Fairness Act: AB 1132 (Wood), prohibits a contract issued, amended, or renewed on or after January 1, 2022, between a health plan, insurer, provider, or facility from containing terms that restrict the plan or insurer from steering an enrollee or insured to another provider or facility or require the plan or insurer to contract with other affiliated providers or facilities. The bill authorizes the appropriate regulatory agency to refer a contract to the Attorney General. It authorizes the Attorney General or state entity charged with reviewing health care market competition to review a health care practitioner’s entrance into a contract that contains specified terms. This bill would additionally require a plan that intends to acquire or obtain control of an entity to give notice to, and secure prior approval from, the director of Department of Managed Health Care (DMHC). The bill authorizes the DMHC director to disapprove a transaction or agreement if it would substantially lessen competition in the health system or among a particular category of health care providers and would require the director to provide information related to competition to the Attorney General. This bill would require a medical group, hospital or hospital system, health care service plan, health insurer, or pharmacy benefit manager to provide written notice to the Attorney General at least 90 days before entering an agreement to make a specified material change with a value of $5,000,000 or more. The bill would prohibit an entity from entering into an agreement without the Attorney General’s written consent.
Medi-Cal County of Sacramento: SB 226 (Pan) authorizes a Sacramento County Board of Supervisors- established health authority to negotiate and enter into contracts and health plans. The bill requires the health plans intending to or interested in contracting with DHCS to meet with the health authority and to subsequently designate at least two licensed health plans to DHCS for approval.
The Future of Health
Using Technology and Data in Delivering Health Care
Making COVID-19 Telehealth Flexibilities Permanent: AB 32 (Aguiar-Curry) requires specific telehealth flexibilities put in place during the COVID-19 pandemic to be extended indefinitely. The permanent flexibilities listed in this bill include requirements for telehealth services to be reimbursed to the same extent and at the same rate as in-person visits by Medi-Cal. This bill requires DHCS, by January 2022, to develop a revised Medi-Cal telehealth policy, and to evaluate and present findings to the Legislature on the role of telehealth in Medi-Cal by December 2024.
Broadband for All Act of 2022: AB 34 (Muratsuchi) permits the Legislature to submit the Broadband for All Act as a ballot measure for the statewide general election of November 2022, allowing voters to determine whether state bonds can be issued to improve broadband infrastructure and access to reliable internet service in underserved urban and rural communities. This bill provides funding for broadband projects that focus on closing the digital divide and reducing inequities by increasing the availability and affordability of high-quality internet throughout all parts of the state. With the expansion of telehealth use and health information technology, effective broadband is necessary for accessible, quality health care.
Health Information Exchange (HIE) Network: AB 1131 (Wood), establishes a statewide health information network governing board not affiliated with any state agency or department. This bill requires this governing board to provide the data infrastructure for a statewide HIE network that supports California in goals related to health access, equity, affordability, public health, and health care quality. AB 1131 requires the governing board to request proposals for interested operating entities with specific capabilities to support HIE and integration of data from multiple sources. This bill includes technical language for the security of the data exchange and a pathway for stakeholder engagement to give input on the workings of the HIE network. Additionally, AB 1131 requires health care entities to submit their data, include health equity metrics, to the HIE network.
Health Information Technology: SB 371 (Caballero) authorizes CHHS to use federal funding to help health care providers increase implementation of health information technology and create a unified state health information exchange gateway to the California Trusted Exchange Network. This bill creates the Deputy Secretary for Health Information Technology position, and, with the new California Health Information Technology Advisory Committee, requires them to devise a plan to use federal funding to increase data exchange and provide annual reports to the Legislature.
What’s Next: Legislative Process Information
Below, we have highlights key events and deadlines that are important for tracking legislation. The 2021 Legislative calendars for the California Assembly and Senate includes all constitutional deadlines that must be met in order for bills to be signed into law. The ‘house of origin’ or the ‘first house’ is the branch of the Legislature where the bill was introduced (ABs= Assembly Bills, the Assembly is the first house the bill must pass through; SBs= Senate Bills, the Senate is the first house the bill must pass through). Bills can be amended throughout the process.
Policy committees began hearing bills in March 2021. The committee committees are made up of a subset of assemblymembers or senators to hear bills on a specific policy topic, such as health. The committee chairs set bills for hearing dates throughout March and April, and public hearings are recorded and can be watched live, typically in person, but livestream video is available and preferred during the public health emergency. Assembly and Senate Health Committee hearings dates, agenda’s that list the bills being heard, and a link to where you can watch the hearings, can be found on the policy committee websites. The deadline for bills to be discussed in committees is April 30, 2021, for fiscal bills (legislation that has a cost to the state) and May 7, 2021, for non-fiscal bills.
- Assembly Health Committee: Meets on Tuesdays at 1:30pm PST
- Senate Health Committee: Meets on Wednesdays at 1:00pm PST
Appropriations Committee Hearing
Once a bill passes in policy committee(s), the next step in the Legislative process for most bills is a hearing in the Appropriations Committee. The Appropriations Committee reviews all bills that have a designated fiscal impact, and the deadline for bills to be heard in the house of origin appropriations committee is May 21, 2021. At this point in the Legislative process, many bills will be ‘held on suspense’ which effectively means they will not move forward in the process. In the Assembly, any bill that has an annual cost of $150,000 or more, from any fund, gets placed on the suspense file. In the Senate, legislation with an annual cost of $50,000 General Fund or $150,000 special funds, get placed on the suspense file. Similar to the policy committees, the appropriation committees hold public hearings. Most bills get placed on the suspense file and are heard in committee close to the May 21, 2021 deadline.
- Assembly Appropriations Committee: Meets on Wednesdays at 9:00am PST
- Senate Appropriations Committee: Meets on Mondays at 9:00am PST
House of Origin Floor Vote
The last stop for a bill before the opposite house begins to weigh in on the policy, is the ‘floor vote’. This is where all Assemblymembers vote on AB bills and all Senators vote on SB bills. The deadline for bills to be voted on the floor is June 4, 2021.
Following a bills successful passage out of its house of origin, the entire process listed above is repeated in the opposite house. (Ex. ABs will then go through the Legislative process in the Senate). The last day of this year’s Legislative session, and subsequently the last day a bill can pass through the entire process, is September 10, 2021. Bills that successfully passed through the Legislature will either be signed or vetoed by Governor Newsom no later than October 10, 2021.