By Katie Heidorn, Shirley Lam, Mary Nguyen, Olivia Bundschuh, and Ty Pearson
2022 Legislative Round Up
This year, Governor Newsom signed 86 percent of the bills that crossed his desk by the September 30, 2022, deadline. Here is a round-up of some significant health and health-related bills that were signed into law and some that were vetoed (shown in italics). We have grouped them into ITUP’s three policy focus areas: health care coverage and access, delivery system transformation, and the future of health.
Note: This blog is not a comprehensive list of all the health and health-related bills that went to the Governor’s desk this year. If you have any questions about a bill not listed here, please contact us at [email protected].
Health Care Coverage and Access
California Health Benefit Exchange: Financial Assistance AB 2530 (Wood and Kalra), Chapter 695, Statutes of 2022—Effective January 1, 2023, this bill requires the California Health Benefit Exchange to provide and maintain health benefits through the exchange to individuals who have lost employer-provided health coverage as a result of a labor dispute. The individual would then receive the same premium assistance and cost-sharing reductions as an individual with a household income of 138.1% of the federal poverty level, and, starting January 1, 2024, would also not pay a deductible for any covered benefit if the standard benefit design for a household income of 138.1% of the federal poverty level has zero deductibles.
Health Care Coverage: Timely Access to Care SB 225 (Wiener), Chapter 601, Statutes of 2022—Effective January 1, 2023, this bill requires health plans or health insurers to include timely access to care standards into quality assurance system. This bill authorizes the Department of Managed Health Care to create and enforce methodologies for appropriate wait time compliance and averages. The bill would authorize the Department of Managed Health Care and the Department of Insurance to take compliance or disciplinary action.
Health Care Coverage Outreach: SB 644 (Leyva, Rubio, Chiu), Chapter 983, Statutes of 2022—This bill requires the Exchange, at least monthly beginning no later than September 1, 2023, to request from the Employment Development Department (EDD) specified information of each new applicant for unemployment compensation, state disability, and paid family leave. The bill requires EDD to provide specified information to the Exchange to assist the Exchange or the State Department of Health Care Services (DHCS) in determining eligibility for the insurance affordability programs administered by those state agencies, to enable the Exchange to notify an employer that an employee is eligible for advance payments of the premium tax credit and cost-sharing reductions and has enrolled in a qualified health plan, and to enable the Exchange to verify if a consumer has been offered comprehensive employer-sponsored health care coverage. The bill requires the Exchange to market and publicize the availability of health care coverage through the Exchange, and engage in outreach activities, to the individuals whose information the Exchange receives from EDD.
Health Coverage: Mental Health and Substance Use Disorders: SB 999 (Cortese and Low) (Vetoed)—This bill would have required a health care service plan and a disability insurer to ensure compliance to maintain telephone access during California business hours for a health care provider to request authorization for mental health and substance use disorder care and conduct peer-to-peer discussions related to treatment.
Medi-Cal Managed Care Plans: Mental Health Benefits SB 1019 (Gonzalez) Chapter 879, Statutes of 2022—This bill requires a Medi-Cal managed care plan, no later than January 1, 2025, to conduct annual outreach and education for its enrollees, based on a plan that the Medi-Cal managed care plan develops and submits to DHCS, as specified, regarding the mental health benefits that are covered by the Medi-Cal managed care plan. The bill requires a Medi-Cal managed care plan to also conduct annual outreach and education, based on a plan that it develops, to inform primary care providers regarding those mental health benefits. The bill requires that the outreach and education plan for the enrollees be informed by stakeholder engagement, the Medi-Cal managed care plan’s Population Needs Assessment, and a utilization assessment, as specified, and that the plan meet cultural and linguistic appropriateness standards and incorporate best practices in stigma reduction. The bill requires the department to review the new or updated outreach and education plan and to approve or modify it within 180 calendar days since submission to ensure specified conditions are met, and to consult with stakeholders to develop the standards for the review and approval. The bill requires the department, once every three years, to assess enrollee experience with mental health benefits covered by Medi-Cal managed care plans, as specified. The bill requires the department, no later than January 1, 2025, to adopt survey tools and methodologies relating to the assessment of consumer experience, including best practice methods for data collection and reporting, as specified. The bill requires the department to publish reports, commencing with a report in April 2026 and once every three years thereafter, on its internet website on consumer experience with mental health benefits covered by Medi-Cal managed care plans. The bill requires the reports to include plan-by-plan data, provide granularity for subpopulations, address inequities based on key demographic factors, and provide recommendations, as specified.
Health Care Coverage: Maternal and Pandemic-Related Mental Health Conditions: SB 1207 (Portantino), Chapter 618, Statutes of 2022—The bill extends the deadline for establishment of the maternal mental health program to July 1, 2023. The bill revises the requirements of the program to include quality measures to encourage screening, diagnosis, treatment, and referral. The bill encourages health care service plans and health insurers to improve screening, treatment, and referral to maternal mental health services, include coverage for doulas, incentivize training opportunities for contracting obstetric providers, and educate enrollees and insureds about the program.
Family Planning, Access, Care and Treatment Program (Family PACT Program) SB 1234 (Pan and Wood) (Vetoed)—This bill would have required an office visit to a Family PACT provider or Medi-Cal provider for specified services for uninsured, income-eligible patients, or patients with health care coverage who have confidentiality concerns, who are not at risk of experiencing or causing an unintended pregnancy, and who are not in need of contraceptive services, to be reimbursed at the same rate as comprehensive clinical family planning services. The bill would also have required the department to issue a report to the Legislature with information regarding the total number of persons treated under this provision and the total cost, among other things.
Health Care Delivery System Transformation
Medi-Cal Comprehensive Perinatal Services: AB 1930 (Arambula) (Vetoed)—This bill would have required DHCS to cover additional comprehensive perinatal assessments, individualized care plans, and services for during and up to 60 days following pregnancy for Medi-Cal members, the scope of which will be determined by DHCS, California Department of Public Health (CDPH), and outside stakeholders. This bill also would have required DHCS to seek federal approvals to allow non-licensed health workers to render preventive services in non-medical settings under the supervision of an enrolled Medi-Cal provider or licensed practitioner.
Reproductive Health Care Pilot Program: AB 2320 (Garcia) (Vetoed)—This bill would have required, January 1, 2028, the California Health and Human Services Agency, or an entity designated by the agency, to establish and administer a pilot program to direct funds to primary care clinics that provide reproductive health care services in five counties. The bill would have required a participating primary care clinic to implement at least one of a number of specified activities to improve health care delivery for marginalized patients, and to annually report to the agency over two years regarding its efforts and progress with those activities. The bill would have required the agency to report to the Legislature on the program on or before June 1, 2026.
Medi-Cal Benefit: Community Health Workers and Promotores: AB 2697 (Aguiar-Curry), Chapter 488, Statutes of 2022—This bill codifies the requirement that community health worker (CHW) services be a covered Medi-Cal benefit. The bill requires a Medi-Cal managed care plan to engage in outreach and education efforts to enrollees, as determined by the department, but that would include, at a minimum, specified information to enrollees, including, among other things, a description of CHW services benefit and a list of providers that are authorized to refer an enrollee to community health worker services. The bill requires the department, through existing and regular stakeholder processes, to inform stakeholders about, and accept input from stakeholders on, implementation of the community health worker services benefit. The bill authorizes the department to implement, interpret, or make specific this bill by means of policy letters, provider bulletins, or other similar instructions, without taking any further regulatory action. To learn more about the role of community health workers, check out an ITUP Fact Sheet on Community Health Workers and California’s Health Care Delivery System.
Community Mental Health Services: Data Collection: SB 929 (Eggman, Grove, Hurtado, Rubio, and Stern), Chapter 539, Statutes of 2022—Existing law requires each local mental health director, and each facility providing services to persons under those provisions, to provide DHCS, upon its request, with any information, records, and reports that the department deems necessary for purposes of data collection and publication. This bill additionally requires the department to collect data quarterly and publish, on or before May 1 of each year, a report including quantitative, deidentified information relating to, among other things, the number of persons in designated and approved facilities admitted or detained for 72-hour evaluation and treatment, clinical outcomes and services for certain individuals, waiting periods prior to receiving an evaluation or treatment services in a designated and approved facility, demographic data of those receiving care, the number of all county-contracted beds, and an assessment of the disproportionate use of detentions and conservatorships on various groups. The bill requires the Judicial Council to provide the department, by October 1 of each year, with data from each superior court to complete the report, including, among other things, the number and outcomes of certification review hearings, petitions for writs of habeas corpus, and judicial review hearings. Beginning with the report due May 1, 2025, the bill requires the report to also include the progress that has been made on implementing recommendations from prior reports. The bill requires each county behavioral health director or other entity involved in implementing the provisions relating to detention, assessment, evaluation, or treatment for up to 72 hours, to provide data as prescribed by the department. The bill authorizes the department to impose a plan of correction against a facility or county that fails to submit data timely or as required. The bill authorizes the department to implement these provisions through information notices or other similar written instructions. The bill exempts contracts entered into by the department for purposes of these provisions from certain contract-related requirements.
Contraceptive Equity Act of 2022: SB 523 (Leyva), Chapter 630, Statutes of 2022—This bill makes various changes to expand coverage of contraceptives by a health care service plan contract or health insurance policy issued, amended, renewed, or delivered on and after January 1, 2024, including requiring a health care service plan or health insurer to provide point-of-sale coverage for over-the-counter FDA-approved contraceptive drugs, devices, and products at in-network pharmacies without cost sharing or medical management restrictions. The bill requires health care service plans and insurance policies offered by public or private institutions of higher learning that directly provide health care services only to its students, faculty, staff, administration, and their respective dependents, issued, amended, renewed, or delivered, on or after January 1, 2024, to comply with these contraceptive coverage requirements. This bill prohibits a health care service plan contract or disability insurance policy issued, amended, renewed, or delivered on or after January 1, 2024, with certain exceptions, from imposing a deductible, coinsurance, copayment, or any other cost-sharing requirement on vasectomy services and procedures, as specified, under conditions similar to those applicable to other contraceptive coverage. This bill requires a health benefit plan or contract with the Board of Public Relations of the Public Employees’ Retirement System to provide coverage for contraceptives and vasectomies consistent with the bill’s requirements, commencing January 1, 2024. The bill prohibits the California State University and the University of California from approving a health benefit plan that does not comply with the contraceptive coverage requirements of the bill on and after January 1, 2024.
Federally Qualified Health Centers (FQHCS) and Rural Health clinics (RHCs): Visits: SB 966 (Limón and Salas), Chapter 607, Statutes of 2022—Effective January 1, 2023, this bill requires DHCS to seek federal approval and issue guidance that allows FQHCs and RHCs to bill the Medi-Cal program for visits with clinical social workers or marriage and family therapists under a supervising licensed behavioral health practitioner.
Gender-Affirming Care: SB 923 (Weiner, Atkins, and Wilson), Chapter 822, Statutes of 2022—This bill requires a Medi-Cal managed care plan, a PACE organization, a health care service plan, or a health insurer, and delegated entities, as specified, to require its staff to complete evidence-based cultural competency training for the purpose of providing trans-inclusive health care, as defined, for individuals who identify as transgender, gender diverse, or intersex (TGI). The bill specifies the required components of the training and makes use of any training curricula subject to approval by the respective departments. The bill would require an individual to complete a refresher course if a complaint has been filed, and a decision has been made in favor of the complainant, against that individual for not providing trans-inclusive health care, or on a more frequent basis if deemed necessary. The bill requires the respective departments to develop and implement procedures, and would authorize them to impose sanctions, to ensure compliance with the above-described provisions. The bill would also require the departments to track and monitor complaints received by the departments related to trans-inclusive health care and to publicly report this data, as specified. The bill requires the respective departments to implement these provisions without taking any regulatory action, and would require them to adopt regulations by July 1, 2027, providing semiannual status reports to the Legislature until regulations are adopted. This bill expands cultural competency training to include, as appropriate, information and evidence-based cultural competency training pertinent to the treatment of, and provision of care to, individuals who identify as queer, questioning, asexual, or gender diverse, and the processes specific to those seeking gender-affirming care services. The bill provides specific components, including health inequities within the TGI community, that would be suitable for evidence-based cultural competency training pursuant to these provisions. This bill requires a full-service health care service plan, an insurer, and a Medi-Cal managed care plan, no later than March 1, 2025, to include information, within or accessible from the plan’s or insurer’s provider directory, that identifies which of a plan’s or insurer’s in-network providers have affirmed that they offer and have provided gender-affirming services, as specified. This bill requires, no later than March 1, 2023, the California Health and Human Services Agency to convene a working group that includes representatives from various departments, TGI-serving organizations, residents who identify as TGI, and health care providers to develop a quality standard for patient experience in order to measure cultural competency related to the TGI community and recommend training curriculum to provide trans-inclusive health care, as specified.
Nursing: Nurse Practitioners and Nurse-Midwives: Abortion and Practice Standards: SB 1375 (Atkins), Chapter 631, Statutes of 2022— Effective January 1, 2023, this bill authorizes a nurse practitioner, who has completed training required, is functioning pursuant to certain advanced practice provisions to perform an abortion by aspiration techniques without supervision by a physician and surgeon.
Future of Health
Equitable Outdoor Access Act: AB 30 (Kalra), Chapter 939, Statutes of 2022—This bill establishes the Equitable Outdoor Access Act, which sets forth the state’s commitment to ensuring all Californians can benefit from, and have meaningful access to, the state’s rich cultural and natural resources. The bill requires specified state agencies to consider and incorporate, as appropriate, the state policy when revising, adopting, or establishing policies, regulations, or grant criteria, or making expenditures, as specified. The bill requires all state agencies implementing the above-described state policy to do so in a manner consistent with the mission of their agency and that protects the health and safety of the public and conserves natural and cultural resources. The bill requires the state to encourage the types of access that promote, and are consistent with, specified conservation goals. The bill would require the Natural Resources Agency to prepare and submit a report to the Legislature with information related to the implementation of these provisions on or before January 1, 2024.
Telehealth: AB 32 (Aguiar-Curry and Rivas), Chapter 515, Statutes of 2022—This bill authorizes the Department of Health Care Services to authorize an FQHC or RHC to establish a new patient relationship using an audio-only synchronous interaction when the visit is related to sensitive services, as defined, and authorize an FQHC or RHC to establish a new patient relationship using an audio-only synchronous interaction when the patient requests an audio-only modality or attests they do not have access to video. This bill authorizes the department to take into consideration the availability of broadband access when providing those specific exceptions. The bill authorizes the department to authorize a health care provider to establish a new patient relationship using an audio-only synchronous interaction when the visit is related to sensitive services, as defined, and authorize a health care provider to establish a new patient relationship using an audio-only synchronous interaction when the patient requests an audio-only modality or attests they do not have access to video.
California Antihunger Response and Employment Training Act of 2022: AB 1965 (Wicks) (Vetoed)—This bill requires the Department of Social Services to establish the California Antihunger Response (CARE) to provide food assistance benefits to a person who has been determined ineligible for CalFresh benefits, or for whom CalFresh benefits have been discontinued as a result of the ABAWD time limit, and who also is ineligible for the discretionary exemption described above. The bill requires the person to receive CARE benefits in the same amount that they would have received under the CalFresh program if the ABAWD time limit did not make them ineligible. The bill requires the issuance of CARE benefits through the state-administered and state-funded electronic benefits transfer system, as specified. Under the bill, the CARE benefit is only available during a period of time in which a statewide time limit waiver is not granted by the federal government, and in that case, the CARE benefit is only applicable in those areas that are not granted an area time limit waiver by the federal government. The bill requires the CARE benefit to be operable one year after the above-mentioned CFAP provisions become operative. The bill requires the department to develop, in consultation with specified entities, and to issue, guidance to maximize the use of discretionary exemptions from the three-month time limit available under federal law and guidance relating to SNAP and CalFresh. The bill authorizes the guidance to include redistribution of the discretionary exemptions between counties, as specified. The bill requires the guidance to be issued no later than April 1, 2023, and to remain operative until the CARE benefit is operative, by which date the bill would require the department to issue new guidance to maximize the use of discretionary exemptions available under federal law, as well as the CARE benefit.
Perinatal and Infant Children Health: Extreme Heat: AB 2420 (Arambula), Chapter 265, Statutes of 2022—This bill requires the Department of Public Health, in consultation with subject matter experts, to review available literature on adverse effects of extreme heat on perinatal health, develop guidance for safe conditions and health considerations for pregnant individuals and infant children, and provide guidance to the Legislature by submitting a report that includes legislative or policy recommendations on best practices for connecting perinatal patients with the appropriate health and well-being information relating to extreme heat.
Broadband: California Advanced Services Fund: AB 2749 (Quirk-Silva) (Vetoed)—This bill would have expressly authorized otherwise eligible wireless broadband service providers to receive funding from the Broadband Infrastructure Grant Account and the Federal Funding Account. The bill would have, for purposes of the Federal Funding Account, required the CA Public Utilities Commission (CPUC) to review completed applications within a review period, to document the basis for denial of an application, to authorize the amendment and resubmission of denied applications for consideration in a future review period, and to periodically establish an application deadline. The bill would have, for purposes of the Federal Funding Account, authorized the commission to adopt affordability requirements for a recipient of a grant. For more broadband information, check out ITUP’s Broadband for Health fact sheet.
Broadband Infrastructure: Mapping: AB 2752 (Wood), Chapter 801, Statutes of 2022—Existing law requires the CPUC, in collaboration with relevant state agencies and stakeholders, to maintain and update a statewide, publicly accessible, and interactive map showing the accessibility of broadband service in the state, as provided. This bill authorizes the commission to collect information from providers of broadband services at the address level. The bill prohibits the commission from disclosing residential subscriber information, as provided. Existing law requires, among other things, the commission to collect granular data on the actual locations served by franchise holders. This bill specifies that actual locations include addresses.
What’s Next: Legislative Process Information
This year was the second year in California’s two-year legislative cycle. The next Legislative Session begins Monday, December 5, 2022. This Fall, stakeholders and Legislative offices are putting together ideas for bills that will be introduced in the next Legislative Session. While the exact date has not yet been released by the Senate and the Assembly, the bill introduction deadline for the first year of a Legislative Session is typically in mid-February 2023.