By Mary Nguyen, Jasdeep Bains, and Marissa Kraynak
2021 Legislative Round Up
While the COVID-19 pandemic continues to remain a top concern for Californians, ITUP is looking towards the future of health in California, where we can not only recover from the pandemic but make meaningful progress in our health care delivery system. Grounding California’s health system in equity, community, and one that meets the needs of all Californians is essential in our progress moving forward.
Ahead of the October 10th deadline, and following the historic state budget passed in July, Governor Gavin Newsom approved and signed 92 percent of the bills that crossed his desk at the end of the Legislative session, including many health and health-related pieces of legislation. Here is a round-up of some significant bills that were signed into law and some that were vetoed (shown in italics) that would have increased accessibility and flexibility to Medi-Cal services, made changes to the health care delivery system, and address social determinants of health.
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:
Note: this is not a comprehensive list of all the health and health care-related bills that went to the Governor’s desk this year. If you have questions about a bill not listed here, please feel free to contact us at [email protected].
Health Care Coverage and Access
Health Care Coverage
Coverage for Dependent Parents: AB 570 (Santiago), Chapter 468, Statutes of 2021 – Effective January 1, 2023, requires an individual health plan that provides dependent coverage to extend that coverage to a qualified dependent parent or stepparent.
Medi-Cal: Annual Cognitive Health Assessment Benefit: SB 48 (Limon), Chapter 484, Statutes of 2021 – Effective January 1, 2022, expands Medi-Cal benefits to include an annual cognitive health assessment for Medi-Cal beneficiaries aged 65 years or older if they are otherwise ineligible for a similar assessment as part of an annual wellness visit under the Medicare Program, covering this service for undocumented Californians who are not eligible for the federal Medicare program. The bill also requires the Department of Health Care Services (DHCS) to consolidate and analyze and publish the data on this benefit every two years.
Federal Health Care Reforms: SB 326 (Pan), Chapter 764, Statutes of 2021 —Removes provisions present in the Patient Protection and Affordable Care Act (ACA) that could render health plan and insurer preexisting condition protections, premium ration limitations, and other anti-discrimination requirements inoperative if the ACA were repealed. Federal health care market reforms will continuously apply to health plans and health insurers even if the ACA, federal individual mandate, federal coverage guarantee, and federal essential health benefits coverage requirements are discontinued.
Making Health Care Coverage Meaningful
Medi-Cal Services for People Experiencing Homelessness: AB 369 (Kamlager)- This bill was veto’d. It would have required DHCS to implement a presumptive eligibility enrollment process for unhoused Californians, and for Medi-Cal and Covered California applications to collect information on an applicant’s housing status. This bill would have required DHCS to reimburse Medi-Cal providers for providing services away from their office, for example directly in a homeless encampment (also referred to as street medicine). The governor’s veto message states that the upcoming implementation of California Advancing and Innovating Medi-Cal (CalAIM) initiative will address the unique needs of the unhoused population, and directs DHCS to identify and address interim gaps for the unhoused and lists possible supports as resources and technical assistance for street medicine providers.
Maternal Care and Services: SB 65 (Skinner), Chapter 449, Statutes of 2021 — This bill, termed the California Momnibus Act, establishes a program to address the persistent racial gaps in maternal and infant mortality rates, particularly in families of color. Among other things, SB 65:
- Creates, by August 1, 2022, the California Pregnancy-Associated Review Committee under the authority of the Department of Public Health. This committee is required to identify and review all pregnancy-related deaths and maternal morbidities to identify and publish prevention opportunities and recommend best-practices;
- Beginning January 1, 2022, requires the California Department of Health Care Access and Information (HCAI), formerly known as the Office of Statewide Planning and Development, to contract with programs that train certified nurse-midwives and programs that train licensed midwives to increase the number of students receiving quality education and training as a certified nurse-midwife or a licensed midwife. HCAI can only contract with programs that include training designed for, and prepare program graduates for service in: medically underserved multicultural communities, lower socioeconomic neighborhoods, or rural communities; and,
- Requires DHCS to convene a workgroup to examine the implementation of the doula benefit provided under the Medi-Cal program and produce a report by July 1, 2024. The report will examine, among other things, the number of Medi-Cal recipients using doula services and the barriers that impede access to doula services. The report will also make recommendations to combat the barriers.
Timely Access to Care: Reducing Wait Times for Behavioral Health: SB 221 (Weiner), Chapter 724, Statues of 2021 — Effective July 1, 2022, health plans, including Medi-Cal managed care plans, must ensure that enrollees a part of an ongoing treatment plan for mental health conditions or substance use disorder are able to obtain a follow-up appointment with a nonphysician mental health care or substance use disorder provider within 10 business days of the prior appointment. If the health plan or insurer is operating in a service area with a shortage of providers and is unable to meet the timely access requirements with an in-network provider, then the plan or insurer must arrange for patient coverage outside of the network. Patient referrals to a specialist by another provider are also subject to these timely access requirements. SB 221 codifies the regulations adopted by the Department of Managed Health Care (DMHC) and the Department of Insurance (CDI) to close loopholes in existing law that can delay follow-up care for behavioral health care.
COVID-19 Cost Sharing: SB 510 (Pan), Chapter 729, Statutes of 2021- Effective January 1, 2022, requires health plans and insurers to cover COVID-19 diagnostic and screening testing, immunizations, and health care services with no cost-sharing or prior authorization during and following a federal public health emergency.
Mental Health Services Act: Early Intervention and Prevention Programs: AB 638 (Quirk-Silva), Chapter 584, Statutes of 2021 – Effective January 1, 2022, authorizes the Mental Health Services Act to use continuously appropriated funds to include prevention and early intervention services, prevention and early intervention strategies that address mental health needs, substance misuse or substance use disorders, or needs relating to cooccurring mental health and substance use services.
Program of All-Inclusive Care for the Elderly (PACE): AB 523 (Nazarian) This bill was veto’d. It would have made public health emergency flexibilities implemented on or before January 1, 2021, including the authorization to use telehealth for eligibility assessments, permanent within the DHCS managed PACE Program. The governor’s veto message states that the path forward for telehealth flexibilities, including those specific to the PACE program, will be determined through the legislature mandates Telehealth Advisory Workgroup.
ACEs Screenings: SB 428 (Hurtado), Chapter 641, Statutes of 2021 — Effective January 1, 2022, all health plan contracts or health insurance policies that provide coverage of pediatric services and preventive care must expand their coverage to include adverse childhood experiences (ACEs) screenings. DMHC and CDI can adopt rules and regulations necessary to implement this change and establish the minimum ACEs coverage requirements. These minimum requirements will be drawn from the rules and regulations in the Medi-Cal program for screening for trauma.
Farmworker Assistance: Resource Centers: AB 941 (Bennett), Chapter 203, Statutes of 2021 – Effective January 1, 2022, the Department of Community Services and Development within the California Health and Human Services Agency (CalHHS) is required to establish a grant program for counties to establish farmworker resource centers that provide farmworkers and their families information and access to services related to, among other things, labor and employment rights, education, housing, immigration, and health and human services.
Health Care Delivery System Transformation
Medi-Cal: County of Sacramento: SB 226 (Pan), Chapter 446, Statutes of 2021 — Effective January 1, 2022, authorizes the Sacramento County Board of Supervisors to establish a health authority to assist in the delivery of publicly assisted medical care in the County and promote timely access to care, quality care, and cost efficiency. The health authority is authorized to negotiate and enter into contracts with health plans for the purposes of the DHCS Medi-Cal managed care plan procurement for the county. SB 226 requires the health authority to meet with any health plans intending to contract with or submit a proposal to the DHCS, and to submit at least two licensed health plans for the DHCS’s approval.
Health Care Provider Reimbursements: SB 242 (Newman), Chapter 538. Statutes of 2021 — Effective for public health emergencies declared on or after January 1, 2022, health plans are required to reimburse contracting health care providers for business expenses incurred to prevent the spread of a respiratory-transmitted infectious disease causing a public health emergency. Medi-Cal managed care plans are not subject to these requirements. This does not apply to the state of emergency related to the COVID-19 pandemic.
Consumer Transparency for Deductible and Out-of-Pocket Expenses: SB 368 (Limon), Chapter 602, Statutes of 2021 — Effective July 1, 2022, SB 368 requires health care service plan contracts and health insurance policies to monitor an enrollee’s accrual balance toward their annual deductible and out-of-pocket maximum, and provide the enrollee with the accrual balance for every month benefits were used. Health plans must establish and maintain a system that allows their enrollees to request their most up-to-date accrual balances at any time. Enrollees must also be notified of their rights under SB 368.
Addressing Racial Disparities Among Children with Chronic Illness: SB 682 (Rubio)- This bill was veto’d. It would have created the End Racial Inequities in Children’s Health in California Initiative. This initiative would have required, by December 31, 2031, the CHHS to bring together an advisory workgroup with the goal of developing and implementing a plan to reduce racial disparities in childhood chronic disease by at least 50%. The governor’s veto message expresses support for the intent of the bill but states that the bill is duplicative and would create unnecessary burden because it would place performance measures and targets into state statute.
Mental Health: Involuntary Treatment Procedure Training: AB 1443 ( (McCarty), Chapter 399, Statutes of 2021 – Effective January 1, 2022, authorizes a county to develop training related to the procedures for designation of involuntary detention and treatment of persons with specified mental health disorders. Under this existing law, when a person, as a result of a mental health disorder, is a danger to others, or to themselves, or gravely disabled, the person may be taken into custody and placed in a facility designated by the county for up to 72 hours for evaluation and treatment. AB 1443 requires the County of Sacramento, if the county has adopted those procedures by April 1, 2022, to develop a written policy for employees of the City of Sacramento who meet the criteria to involuntarily detain individuals.
Homelessness Program Data Reporting: AB 977 (Gabriel), Chapter 397, Statutes of 2021 – Effective January 1, 2023, AB 977 requires that any entity receiving state funds must enter Universal Data Elements and Common Data Elements, as defined by the United States Department of Housing and Urban Development Homeless Management Information System Data Standards, on the individuals and families it serves into its local Homeless Management Information System, unless otherwise exempted by state or federal law. The bill would apply the data entry requirements to all new state homelessness programs that commence on or after July 1, 2021.
The Future of Health
Health Emergencies: Agricultural Workers and Wildfire Smoke: AB 73 (R. Rivas), Chapter 322, Statutes of 2021 – Effective January 1, 2022, wildfire smoke events are considered health emergencies and include agricultural workers in the definition of essential workers in existing law requiring the California Department of Public Health (CDPH) to implement various programs throughout the state relating to public health, including licensing and regulating health facilities and control of infectious diseases. The Personal Protective Equipment Advisory Committee is required to include a representative of a labor organization representing agricultural workers and a representative of an organization that represents agricultural employers. The bill also requires CDPH to report to the Legislature regarding the PPE stockpile within 6 months. Under this law, the Division of Occupational Safety and Health is required to review and update the contents of the protection from wildfire smoke training and thereafter post it on its website. The training provided by the employer is required to be in a language and manner readily understandable by employees, considering their ethnic and cultural backgrounds and education levels.
Medi-Cal Reimbursements for E-Consults: AB 365 (Caballero)- This bill was veto’d. It would have required e-consult services, or a provider-to-provider interaction as part of a patients care. To be reimbursable by the Medi-Cal program for an enrolled provider, including providers at federally qualified health centers (FQHCs) and Rural Health Centers (RHCs). The governor’s veto message states that the definition of e-consult provided in AB 365 is inconsistent with federal law resulting in a lack of federal matching funds to cover reimbursements for e-consults particularly those conducted by FQHCs and RHCs.
Broadband Policy: California Advanced Services Fund (CASF): SB 4 (Gonzalez), Chapter 671, Statutes of 2021- Effective January 1, 2022, extends the CASF program to 2032 (previously 2026), increases the annual funding cap, and expands projects eligible for CASF grants. The CASF program is a state-funded broadband program administered by the California Public Utilities Commission (CPUC) that provides funding to expand broadband adoptions across California communities, primarily focused on last-mile broadband connections, or connections to households. (For more broadband information, check out ITUP’s Broadband for Health fact sheet). In addition to SB 4, AB 14 (Aguiar-Curry), Chapter 658, Statues of 2021, augments this legislation by revising the surcharge collections, which allows the CPUC to implement the program with more stable funding.
What’s Next: Legislative Process Information
This year was the first year in California’s two-year legislative cycle. This means that although the year’s legislative session is completed, some of the bills introduced this year, can be taken up by the Legislature this winter. Such bills are known as two-year bills.
If you or your organization are tracking two-year bills and may want to engage on them during the process in January, now is the time to reach out to the Senate and Assembly Health and the Senate and Assembly Appropriations Committees to ask questions, find out when/if a two-year bill will be set for a hearing in January, and provide additional information to the committee consultants on why you believe the bill should or should not move forward.