November 27, 2023

By Shirley Lam, Indira Galvez, and Daven Crossland

2023 Legislation Round Up

This year, Governor Newsom signed 85 percent of the bills that crossed his desk by the October 14, 2023, 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

Health Care: Unified Health Care Financing: SB 770 (Weiner), Chapter 412, Statutes of 2023—Effective January 1, 2024, this bill requires the California Health and Human Services Agency (CalHHS) to research, develop, and pursue discussions with the federal government to develop a unified health care system in California that guarantees medical, behavioral, pharmaceutical, dental, and vision benefits without cost-sharing for essential services that do not vary by age, employment status, disability, income, immigration status, or other demographics.

Health Care Coverage for Hearing Aids: SB 635 (Menjivar & Portantino) (Vetoed)—This bill would have mandated health plans to include coverage, up to $3000 per individual without any cost sharing, for hearing aids for all their members under 21 years old, if deemed medically necessary. The inclusion of hearing aids would have applied to health care plans and policies issued, amended, or renewed on or after January 1, 2025. The Governor’s veto message stated progress and strategies for increasing provider participation and uptake in the existing program from hearing aids, Hearing Aid Coverage for Children Program (HACCP) to ensure that children have access to the hearing supports and services they need.

Addressing Surprise Billing for Ambulance Services: AB 716 (Boerner), Chapter 454, Statutes of 2023—Effective January 1, 2024, this bill requires the Emergency Medical Services Authority to annually report the allowable maximum rates of ground ambulance transportation services in each county. In addition, this bill requires health plans to pay locally set rates for ambulance services when a contract is not present and prevents ambulance providers from billing patients more than the in-network cost-sharing. AB 716 protects consumers from being sent to collections and having an adverse credit report for an unpaid bill or being sued. This bill also ensures that those without insurance will not be charged more than the Medi-Cal or Medicare rate for the service, whichever is greater.

Minor Consent for Substance Use Disorder: AB 816 (Haney), Chapter 456, Statutes of 2023—Effective January 1, 2024, this bill mandates that minors 16 years of age and older can consent to replacement narcotic abuse treatment with buprenorphine at a physician’s office, clinic, or health facility from a qualified health care provider, including licensed physicians, licensed surgeons, or other health care providers. If deemed appropriate, parent or guardian involvement in the treatment plan will still be required. The bill also mandates that minors 16 years of age and older can consent to treatment for opioid use disorder using medications prescribed by a licensed narcotic treatment program as replacement narcotic therapy. AB 816 specifies that as long as providers abide by federal law, parents’ consent will no longer be required.

Social Determinants of Health: Screening and Outreach: AB 85 (Weber) (Vetoed)—This bill would have mandated health plans, on or after January 1, 2027, to include screenings for social determinants of health as a covered benefit. This bill would have also deemed screenings of social determinants of health as a covered benefit under Medi-Cal, subject to reimbursement from the Department of Health Care Services (DHCS) or a Medi-Cal managed care plan. The bill also would have mandated health plans to provide primary care providers access to community health workers, peer support specialists, lay health workers, community health representatives, or social workers in counties where Medi-Cal members reside. The bill would have mandated the Department of Health Care Access and Information to assemble a working group that would have researched and provided best practices to document data, best-standardized model, and practices to refer patients to community resources, and gaps in research and data that would have helped policymakers address and take action on the social determinants of health. The Governor’s veto message states that while the Administration supports work to address the social determinants of health, this bill would have duplicated other efforts to do so.

Health Care Delivery System Transformation

Housing Support Services in Medi-Cal: AB 1085 (Maienschein) (Vetoed) – This bill would have deleted the requirement for an independent analysis of housing provider network adequacy and instead would have officially added housing support services as a covered Medi-Cal benefit, following a mandated evaluation under the California Advancing and Innovating Medi-Cal (CalAIM) Waiver Special Terms and Conditions and an appropriation from the Legislature for housing support services. Housing support services include housing transition and navigation services, housing deposits, and housing tenancy and sustaining services. The bill would have required DHCS to seek federal approval to add housing support services as a covered Medi-Cal benefit from January 1, 2025, to July 1, 2026. The Governor’s veto message cites the fiscal constraints of the Fiscal Year (FY) 2023-24 budget and future budget uncertainty as the reason for vetoing this bill.

Patient Choice in Telehealth: AB 1241 (Weber), Chapter 172, Statutes of 2023—Effective, January 1, 2024, this bill authorizes providers 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. In addition, this bill specifies the referral and facilitation arrangement need not require a provider to schedule an appointment with a different provider on behalf of a patient.

Out-of-State Physicians and Surgeons: Telehealth License Exemption: AB 1369 (Bauer-Kahan), Chapter 837, Statutes of 2023—Effective, January 1, 2024, this bill authorizes an eligible out-of-state physician or surgeon to practice medicine in California without a license if the practice is limited to delivering health care via telehealth to an eligible patient who has a disease or condition that is immediately life-threatening.  

Health Information on Abortion Care: AB 352 (Bauer-Kahan), Chapter 255, Statutes of 2023—Effective January 1, 2024, this bill prohibits any health care provider, health plan, contractor, or employee from providing individually identifiable medical information related to abortion or abortion-related services to an individual or agency from another state. This bill also prohibits a health care provider, health plan, pharmaceutical company, contractor, or employee from sharing this information via electronic health records or health information exchanges with an individual or agency from another state, unless authorized. This bill also requires businesses that electronically store medical information to segregate information for sensitive services from the rest of the patient’s medical record, prevent disclosure outside of the state, and automatically disable access to this information by unauthorized individuals as well as entities in another state.

Minimum Wages for Health Care Workers: SB 525 (Durazo), Chapter 890, Statutes of 2023—Effective January 1, 2024, this bill establishes five separate minimum wage schedules for covered health care employees. In addition, this bill prohibits local governments from enacting local laws related to wages or compensation for health care facility employees. Provisions in this bill include:

• Organizations with 10,000 full-time equivalent workers or more will pay a minimum wage of $23/hour on June 1, 2024, to May 31, 2025, $24/hour on June 1, 2025, to May 31, 2026, and $25/hour on June 1, 2026.
• Starting on June 1, 2024, the specified hospitals will have to pay workers $18/hour, and the minimum wage after 2024 will be increased by 3.5% annually until it reaches $25 in June 2033:
• Starting on June 1, 2024, specified clinics that meet certain requirements will have to pay covered health care employees $21/hour until May 31, 2026, $22/hour on June 1, 2026, to May 31, 2027, and $25/hour on June 1, 2027.
• Starting on June 1, 2024, all other covered health care facility employers will have to pay covered health care employees $21/hour until May 31, 2026, $23/hour on June 1, 2026, to May 31, 2028, and $25/hour on June 1, 2028.
• Starting on June 1, 2024, licensed skilled nursing facilities will have to pay covered health care employees $21/hour until May 31, 2026, $23/hour on June 1, 2026, to May 31, 2028, and $25/hour on June 1, 2028.

Transforming California’s Behavioral Health System

Minors: Consent to Mental Health Services: AB 665 (Carillo), Chapter 338, Statutes of 2023—Effective July 1, 2024, this bill authorizes minors aged 12 years and older covered by Medi-Cal, to consent to mental health treatment, counseling, or residential shelter services as they long as they demonstrate they have enough maturity to participate in these services. AB 665 aligns Medi-Cal policy for mental health treatment consent with private insurance requirements.

Mental Health Services Act Reform: SB 326 (Eggman), Chapter 790, Statutes of 2023—Effective upon voter approval, the bill will have phased implementation dates from January 2025 through January 2027. If approved by voters, SB 326 revises and recasts the Mental Health Services Act (MHSA) as the Behavioral Health Services Act (BHSA). This bill permits county behavioral health programs to use BHSA funds to treat primary substance use disorder conditions by implementing a new funding structure completely different than the existing and longstanding MHSA structure, changing the county planning process, and including more services counties and the state can fund. Among other provisions, the bill includes $36 million for a behavioral health workforce (BH-CONNECT) and requires counties to administer evidence-based practices. The bill authorizes DHCS to implement monetary sanctions or temporarily withhold funds for non-compliant county mental health programs that do not abide by contracts detailing the behavioral health services provided. This bill, paired alongside AB 531 (described below), will be on the ballot on March 5, 2024, as Proposition 1.

The Behavioral Health Infrastructure Bond Act of 2023: AB 531 (Irwin), Chapter 789, Statues of 2023— Effective upon voter approval, this bill will be, alongside SB 326, on the ballot on March 5, 2024 as Proposition 1. If approved by voters, DHCS will provide implementation guidance by July 1, 2025. Paired alongside SB 326, BHSA, this bill includes $6.38 billion of general obligation bonds that aim to serve veterans and people experiencing homelessness and behavioral health challenges through building permanent supportive housing units, behavioral treatment resources, and behavioral treatment residential settings funded from the Department of Housing and Community Development (HCD), the Department of Veterans Affairs (DVA), and the Behavioral Health Continuum Infrastructure Program (BHCIP). The construction of these housing units will not need to be approved under the California Environmental Quality Act. This bill will mandate that BHCIP, which awards grants to fund behavioral health treatment resources, continues indefinitely. The bill also establishes the Behavioral Health Infrastructure Finance Committee, which will authorize the issuing and selling of the general obligation bonds.

Pupil Health: Social-Emotional, Behavioral, and Mental Health Supports: AB 1479 (Garcia) (Vetoed)—This bill would have established the Pupil Social-Emotional, Behavioral, and Mental Health Program, which would have provided state funding for local educational agencies to provide evidence-based, holistic social-emotional, behavioral, and mental health supports (referred to as Model Tier 1 supports) to pupils and families. The supports would have been delivered by school staff or community-based organizations. Schools within a district or county office, as well as certain charter schools. The Governor’s veto message cites fiscal uncertainty as the reason for vetoing this bill.

Urgent and Emergency Mental Health and Substance Use Disorder Treatment: AB 1451 (Jackson) (Vetoed)—This bill would have required health coverage issued, amended, renewed, or delivered on or after January 1, 2024, to provide coverage for treatment of urgent and emergency mental health and substance use disorders. This bill would have required the treatment to be provided without preauthorization and be reimbursed in a timely manner. The Governor’s veto message cites fiscal uncertainty as the reason for vetoing this bill.

Improving Reproductive, Perinatal Health Care Delivery

Advancing Equity for Black Birthing Californians with Doulas: AB 904 (Calderon), Chapter 349, Statutes of 2023—Effective January 1, 2024, this bill requires health plans, by January 1, 2025, to form a maternal and infant health equity program to address racial health disparities in maternal and infant health outcomes by means of doulas. This bill will authorize Medi-Cal managed care plans to be compliant with this requirement as long as the doula services are a covered Medi-Cal benefit. This bill requires the Department of Managed Health Care (DMHC), in consultation with the Department of Insurance (CDI), to submit a report to the Legislature on doula coverage and the health equity program by January 1, 2027.

Medi-Cal Presumptive Eligibility for Pregnant People: AB 1481 (Boerner), Chapter 372, Statutes of 2023— Effective January 1, 2024, this bill updates and renames the Presumptive Eligibility for Pregnant Women as the Presumptive Eligibility for Pregnant People Program (PE4PP) to make the name more inclusive for eligible people who are pregnant but do not identify as women, including the non-binary and trans community. For pregnant people who apply to Medi-Cal at any time during a specific time period, this bill ensures they maintain coverage under the PE4PP program until DHCS accepts or denies their Medi-Cal application.

Menstrual Equity for All Act of 2021: AB 230 (Reyes), Chapter 421, Statutes of 2023—Effective July 1, 2024, this bill mandates that all public schools, with any combination of classes from grades 3-12, provide free, available, and accessible menstrual products in all girls’ bathrooms, all-gender restrooms, and in at least one boy’s restroom. This bill also mandates that schools post a notice of this requirement in all restrooms with the contact information of a person responsible for keeping the restroom stocked with free, available, and accessible menstrual products.

Expanding the Black Infant Health Program: AB 1701 (Weber), Chapter 174, Statutes of 2023—Effective January 1, 2024, this bill expands the Black Infant Health Program (BIH), as part of the California Perinatal Equity Initiative (PEI), to include city health departments rather than just county health departments. AB 1701 removes statutory barriers to PEI funding that can be leveraged to enhance the reach of BIHs.

Medi-Cal: Comprehensive Perinatal Services: AB 608 (Schiavo) (Vetoed)—This bill would have expanded comprehensive perinatal services coverage in Medi-Cal from 60 days to one year post-pregnancy. This bill also would have required DHCS to cover comprehensive perinatal services by non-licensed perinatal health workers in a non-medical setting such as members’ home or other community settings as long as the non-licensed perinatal health worker is supervised by a community-based organization or local health jurisdiction contracted with a comprehensive perinatal services program provider. The Governor’s veto message cites fiscal uncertainty as the reason for vetoing this bill.

Future of Health

Health Information Exchange: SB 582 (Becker) (Vetoed)—This bill would have required CalHHS Data Exchange Framework (DxF) stakeholder advisory group to consider creating standards for including electronic health record (EHR) vendors in the DxF requirements. It also would have required CalHHS to impose fines and penalties on EHR vendors charging fees for information exchanges that are non-compliant with regulations. The Governor’s veto message states that the state should focus on implementing the DxF before modifications like the one proposed in this bill. See ITUP’s California Data Exchange Framework 101 Fact Sheet & Policy Toolkit for more information.

Privacy of Reproductive or Sexual Health Application Information: AB 254 (Bauer-Kahan), Chapter 254, Statutes of 2023—Effective January 1, 2024, this bill revises the Confidentiality of Medical Information Act (CMIA) definition of “medical information” to include reproductive or sexual health application, which the bill defines as information related to a consumer’s reproductive or sexual health collected by a reproductive or sexual health digital service. In addition, this bill designates businesses that provide such services/applications to be deemed a “provider of health care.”

Legally Protected Health Care Activities in California: SB 345 (Skinner), Chapter 260, Statutes of 2023—Effective January 1, 2024, this bill states that California law governs in any action against a person who provides or receives by any means, including telehealth, reproductive health care services or gender-affirming health care services, as specified if the care was legal in the state in which it was provided at the time of the challenged conduct. In addition, this bill prohibits a person or business from collecting, using, disclosing, or retaining the personal information of a person who is physically located at, or within a precise geolocation of, a family planning center, except as necessary to perform the services or provide the goods requested. This bill prohibits the sale or sharing of this information.

Digital Equity Bill of Rights: AB 414 (Reyes), Chapter 436, Statutes of 2023—This bill establishes the Digital Equity Bill of Rights, stating that it is the principle of the state to ensure digital equity for all residents of the state, that residents shall have access to broadband that meets specific requirements, and that broadband internet subscribers benefit from equal access to broadband, as those terms are defined.

Telecommunications: The Digital Equity in Video Franchising Act of 2023: AB 41 (Holden) (Vetoed) –This bill would have revised the Digital Infrastructure and Video Competition Act of 2006 (DIVCA) to be renamed as the Digital Equity in Video Franchising Act. This bill would have established a policy of the state that subscribers and potential subscribers of a state video franchise holder should benefit from equal access, as defined, to video service within the franchise service area, and expand the prohibition on certain cable operators or video service providers from discriminating against, or denying access to service to, any group of potential residential subscribers to include denial of equal access, as specified. The Governor’s veto message indicates that the bill, as it was passed by the Legislature, does not go far enough to reform DIVCA.  

Broadband Infrastructure: Mapping: AB 286 (Wood), Chapter 645, Statutes of 2023—Effective January 1, 2024, requires the California Public Utilities Commission (CPUC) publicly accessible broadband service map to identify:

• Each provider of broadband services, and,
• The maximum speed of broadband services offered by each provider at each address.

This bill requires the map to include 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 via end-user-run speed tests. In addition, AB 286, makes self-reported data publicly available by address and requires the CPUC to obtain consent from an individual before publicly disclosing information submitted. This bill also prohibits the CPUC from accepting certain self-reported information by the commission as evidence in a commission proceeding unless the self-reported information is validated for accuracy.

Noteworthy Two-Year Bills

California Health and Human Services Data Exchange Framework: AB 1331 (Wood) – This bill requires the Center for Data Insights and Innovation (CDII), a division of CalHHS to oversee CalHHS DxF and establish a DxF Governing Board. The Governing Board will review, modify, and approve modifications to the existing Data Sharing Agreement (DSA), which oversees the sharing of health information among health care organizations and government agencies in California. CDII will also investigate Data Sharing Agreement Policies & Procedures (DSA P&Ps) violations, enforce compliance, and report noncompliance.  AB 1331 is currently in the Senate Appropriations Committee and is a two-year bill meaning that it may move through the rest of the Legislative session no sooner than January 2024. See ITUP’s California Data Exchange Framework 101 Fact Sheet & Policy Toolkit for more information.

Public Utilities: Broadband Service Providers: AB 1714 (Wood)–This bill defines “public utility” to include broadband service providers, outing broadband services, and regulation under the CPUC. See ITUP’s Snapshot: Addressing Digital Equity for Equitable and Accessible Health Care for more information on California’s current broadband landscape.

Covered California Expansion: AB 4 (Arambula) – This bill expands access to Covered California by allowing all Californians, regardless of immigration status, to purchase health insurance through the marketplace. AB 4 requires Covered California to execute a mirror exchange program on its own to expand coverage to undocumented people under existing federal rules and subsidies if they are available. See ITUP’s Issue Brief on Expanding Health Coverage for California Farmworkers for more details on the impact of AB 4.

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.