By Gina Cortez, Daven Crossland, Shirley Lam, MPH, and Marissa Montano, PhD
2023 Introduced Legislation
Overview: The deadline for introducing legislation for the first year of the 2023-2024 legislative session was February 17, 2023. Legislation introduced this year focuses on improving access to equitable and affordable health care and transforming the health care delivery system with a focus on reproductive, perinatal, and behavioral health care.
Summary and Policy Areas: This blog summarizes introduced legislation that proposes solutions relating 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 include important information on the legislative bill process, helpful links, and dates that can be used to follow these bills throughout the year.
Note: this is not a comprehensive list of all the health and health care-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
Covered California Expansion: AB 4 (Arambula) expands access to Covered California by allowing all Californians, regardless of immigration status, to purchase health insurance through the marketplace.
Cost Sharing Requirements: AB 1645 (Zbur) prohibits, after January 1, 2024, non-grandfathered health insurance policies from imposing a cost-sharing requirement for preventative care services and screenings, including sexually transmitted infection screenings. This bill also requires health plans to reimburse non-participating providers for sexually transmitted infection screening and prohibits non-participating providers from billing or cost-sharing for sexually transmitted infection screenings from an insured member.
Medi-Cal Enrollment: AB 564 (Villapudua) requires the California Department of Health Care Services (DHCS) to accept electronic signatures for all Medi-Cal enrollment.
Redetermination: SB 299 (Eggman) removes the requirement for a county to send notice of action terminating Medi-Cal eligibility if the member returns the pre-populated form from their annual renewal within 60 days of the date sent, and the purpose for redetermination is loss of contact.
Medi-Cal Housing Support Services: AB 1085 (Maienschein) requires, following an analysis of housing provider network adequacy, DHCS to seek federal approval to add housing support services as a covered Medi-Cal benefit within six months of the network analysis. If the independent analysis finds insufficient network to add the benefit, this bill requires DHCS to provide recommendations and a timeline sufficient to build network capacity.
Health Care Delivery System Transformation
Expanding the List of Approved Community Support Services in Medi-Cal: As a crucial part of the CalAIM initiative, Medi-Cal managed care plans (MCPs) can provide Community Support services as alternatives to traditional medical services or settings—intended to address the social drivers of health. There are currently 14 approved community supports MCPs can choose to cover, including services in housing transition, navigation services, food and nutrition services, housing deposits, and sobering centers. AB 586 and AB 1338 are bills that add to the list of Community Supports plans can offer.
Climate Change Remediation as a Community Support Service: AB 586 (Calderon) requires Medi-Cal to add devices required during extreme health events, such as air conditioners, heaters, filters, and generators, to the list of community support services MCPs can choose to cover. This bill requires participating MCPs to cover the cost of such devices and any installation costs.
Physical Fitness and Wellness Options as Community Supports: AB 1338 (Petrie-Norris) adds fitness, physical activity, recreational sports, and mental wellness memberships to the list of community support services MCPs can choose to cover.
Dual Eligible Special Needs Plan: AB 1230 (Valencia) requires, by January 1, 2025, DHCS to offer health plans contracts for Highly Integrated Dual Eligible Special Needs Plans (HIDE-SNPs) and Fully Integrated Dual Eligible Special Needs Plans (FIDE-SNPs) to provide care to dual eligible Californians. This bill requires health plans under contract to provide options to members to maintain their selected or established providers and to perform care coordination and data-sharing necessary to integrate care for these individuals through HIDE-SNP or FIDE-SNP contracts.
Disability Equity and Accountability Act of 2023: AB 1147 (Addis) requires the Department of Developmental Services (DDS), by July 1, 2024, to conduct evaluations and assessments of regional centers’ performance using seven specific domains: community integration, employment, equity in access, case management, client and family choice, experience and satisfaction, human and civil rights, and health and safety, and establish statewide standards for performance measures in the assessments. This bill requires, by March 1, 2024, DDS to submit a report to the Legislature on where regional centers are not delivering adequate and timely services and to provide specific steps for when and how requirements will be met. In addition, AB 1147 revises the timeframe to conduct client assessments to be completed within 60 days of intake and 30 days of intake for at-risk clients.
Older Individuals: Case Management and Visitation Services: AB 1313 (Ortega and Connolly) requires the California Department of Aging (CDA) to establish a case management and visiting services pilot program. This bill requires participating counties, selected by CDA, to coordinate with Area Agencies on Aging (AAAs), and other county or community-based entities to deliver services. AB 1313 also requires those counties to measure performance outcomes and submit periodic reports to CDA. This bill appropriates $6 million over three years to implement the pilot program.
Telehealth: AB 1241 (Weber) authorizes providers offering video or audio-only synchronous telehealth services to meet DHCS patient choice requirements by either offering their health care services in person or arranging a referral to and facilitating in-person care needed by an individual.
Transforming California’s Behavioral Health System
Emergency Services: psychiatric emergency medical conditions: AB 1316 (Irwin and Ward) expands the definition of “psychiatric emergency medical conditions” to include patients who voluntarily seek treatment and those who are involuntarily brought in for treatment and evaluation. This bill requires Medi-Cal to cover services and care for emergency medical conditions, including all physical and behavioral health services, regardless of the duration of the emergency or whether the person is receiving treatment voluntarily or involuntarily. This bill requires Medi-Cal to cover services used to determine if a patient is having a medical emergency and all services to stabilize them if they are.
Medi-Cal: Serious Mental Illness: AB 1437 (Irwin and Quirk-Silva) requires DHCS to approve prescribed drugs for non-foster youth Medi-Cal members over the age of 18 after verifying a serious mental illness diagnosis within 365 days of the prescription.
Behavioral Health Crisis Treatment: AB 1451 (Jackson) requires health insurance policies issued, amended, or delivered on or after January 1, 2024, to provide coverage for treatment of behavioral health crisis identified during an appointment with a provider at a contracted facility and authorizes treatment at the contracted facility. In addition, AB 1451 requires the treatment to be provided without preauthorization and authorizes the provider or facility to use same-day billing to obtain reimbursement for both medical and behavioral health services provided to enrollees.
Incarcerated Person: Mental Health: SB 513 (Wiener, Jackson, Smallwood-Cuevas) requires the California Department of Corrections and Rehabilitation (CDCR) to provide mental health treatment for state prison inmates with regular and consistent mental health therapy to inmates who seek care. In addition, SB 513 requires that an incarcerated person is provided an introductory mental health therapy appointment within two weeks of requesting care.
Health Care Coverage: Medication-Assisted Treatment: AB 1288 (Reyes) prohibits health plans from requiring prior authorization on prescribed buprenorphine, methadone, or long-acting injectable naltrexone for detoxification or ongoing treatment of a substance use disorder.
Improving Reproductive, Perinatal Health Care Delivery
Comprehensive Perinatal Services in Medi-Cal: AB 608 (Schiavo, Arambula) expands on DHCS’s comprehensive perinatal services for members that are pregnant or in the post-pregnancy period. This bill requires DHCS to cover additional perinatal assessments, individualized care plans, and additional services during and up to 60 days following pregnancy for Medi-Cal members. AB 608 also requires DHCS to seek federal approvals to allow non-licensed perinatal health workers to render preventive services in non-medical settings under the supervision of an enrolled Medi-Cal provider or licensed practitioner.
Reimbursement for Abortion Services: AB576 (Weber) requires DHCS to cover abortion medications that align with the most up-to-date clinical guidelines.
Health Care Coverage for Doula Services: AB 904 (Calderon) requires, by January 1, 2025, health plans to create a maternal and infant health equity program to improve racial health disparities in maternal and infant health outcomes through the use of doulas.
Coverage for Infertility and Fertility Treatment Services: SB 729 (Menjivar, Wicks, Low, Wiener) requires, after January 1, 2024, health plans to cover the diagnosis and treatment of infertility and fertility services. This bill revises the definition of infertility and removes the exclusion of in vitro fertilization (IVF) from coverage.
Future of Health
California Health and Human Services Data Exchange Framework: AB 1331 (Wood) establishes a governing board for the California Health and Human Services Data Exchange Framework (DxF). This bill requires the board to approve any modifications to the existing data-sharing agreement which oversees the sharing of health information among health care organizations and government agencies in California.
Data Exchange Framework and EHR Vendors: SB 582 (Becker) requires electronic health record (EHR) vendors or any company that develops and provides real-time digital health records that can be shared, to sign and execute the CalHHS data sharing agreement on or before July 1, 2024. This bill also requires the development of standards and review processes in the DxF to ensure that any fees charged by EHR vendors for entering the DxF follow federal regulations.
Public Utilities: Broadband Service Providers: AB 1714 (Wood) defines “public utility” to include broadband services providers, outing broadband services, and regulation under the California Public Utilities Commission (CPUC).
Broadband Infrastructure: Mapping: AB 286 (Wood) requires the CPUC publicly accessible broadband service map to identify:
- Each provider of broadband service, and,
- The maximum speed of broadband services offered by each provider at each address.
This bill requires the map to include certain features to receive self-reported data and to refute the broadband speed and/or technology that an internet service provider (ISP) claims to provide at an address. In addition, AB 286 requires notice to consumers that the self-reported data will be made publicly available by address.
What’s Next: Legislative Process Information
Below, we have highlighted key events and deadlines that are useful for tracking legislation. The 2023 Legislative calendars for the California Assembly and Senate include all deadlines that must be met 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 2023. The 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 live stream video is available and was preferred during the public health emergency. Assembly and Senate Health Committee hearing dates, agendas that list the bills being heard, and a link to where you the public can watch the hearings, are found on each policy committee’s website. The deadline for bills to be discussed in committees is April 28, 2023, for fiscal bills (legislation that has a cost to the state), and May 5, 2023, for non-fiscal bills.
- Assembly Health Committee: Meets on Tuesdays at 1:30 p.m. PST
- Senate Health Committee: Meets on Wednesdays at 1:30 p.m. PST
Appropriations Committee Hearings
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 19, 2023. 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 federal funds or special funds, gets placed on the suspense file. Like 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 19, 2023, deadline.
- Assembly Appropriations Committee: Meets on Wednesdays at 9:00 a.m. PST
- Senate Appropriations Committee: Meets on Mondays at 9:00 a.m. 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 house of origin floor this year is June 2, 2023.
Following a bill’s 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 14, 2023. Bills that successfully passed through the Legislature will either be signed or vetoed by Governor Newsom no later than October 14, 2023.