Home » ITUP Latest News » 2016 Legislative Wrap-Up

2016 Legislative Wrap-Up

At the end of August, the California Legislature adjourned the 2015-2016 legislative session.  The Governor had until September 30 to review and consider all bills the Legislature passed and sent to him.  This summary highlights key health care bills signed by the Governor, vetoed and those that failed in the Legislature.

Bills Signed Into Law

AB 72 (Bonta) – Payment for out-of-network providers

Starting July 1, 2017, limits consumer cost sharing, in the event a health plan enrollee receives services from a non-contracted provider when they have at a contracting health facility, to no more than what the consumer would pay for an in-network, contracted provider.  Requires health plans to pay non-contracted providers in these instances the greater of either the health plan’s contracted rate for the same or similar service, or 125% of the amount Medicare pays for the same or similar service.  (Chapter 492, Statutes of 2016)

AB 1568 (Bonta/Atkins) – Federal §1115 Medicaid Waiver

Implements specified components of California’s newly approved §1115 federal Medicaid waiver, Medi-Cal 2020. The waiver allocates more than $6.2 billion to specific pilot and demonstration programs aimed at redirecting Medi-Cal beneficiaries from costly inpatient and emergency room services to coordinated outpatient primary, preventive and specialty care services.  (Chapter 42, Statutes of 2016)

AB 2024 (Wood) – Critical Access Hospitals

Permits, until January 2024, federally certified critical access hospitals in rural areas to employ physicians and charge for professional services rendered by those physicians. With certain limited exceptions in law, California prohibits hospitals from employing physicians.  (Chapter 496, Statutes of 2016)

AB 2308 (Hernandez, R.) – Health Care Coverage: Information to Students

Requires California State University and California Community College campuses to provide students with information about insurance affordability programs, including how to apply for Medi-Cal and Covered California. Extends until January 1, 2021 the requirement that California public schools provide parents and guardians with information about health care coverage options and assistance.  (Chapter 570, Statutes of 2016)

SB 10 (Lara) – Coverage for Undocumented Immigrants: Federal Waiver

Requires Covered California, California’s state-based ACA exchange, to apply for a federal ACA §1332 waiver allowing undocumented immigrants to buy coverage through the Exchange.   Federal funds would not be available to subsidize the coverage.  (Chapter 22, Statutes of 2016)

SB 586 (Hernandez) – California Children’s Services: Whole Child Model

Authorizes the Department of Health Care Services to establish a “Whole Child Model” for the California Children’s Services (CCS) program in 21 counties; four county organized health system plans would provide both CCS and Medi-Cal services to children enrolled in Medi-Cal and CCS.  Under current arrangements in most counties, CCS services are “carved out” (excluded) from Medi-Cal managed care contracts.  (Chapter 625, Statutes of 2016)

SB 815 (Hernandez) – Federal §1115 Medicaid Waiver

Implements specified components of California’s newly approved §1115 federal Medicaid waiver, Medi-Cal 2020. The waiver allocates more than $6.2 billion to specific pilot and demonstration programs aimed at redirecting Medi-Cal beneficiaries from costly inpatient and emergency room services to coordinated outpatient primary, preventive and specialty care services.  (Chapter 111, Statutes of 2016)

SB 833 (Committee on Budget and Fiscal Review) – Health

Limits estate recovery in the Medi-Cal program to only those health care services required to be collected under federal law.  California currently implements several federal options to collect from Medi-Cal beneficiaries beyond what is required under federal law.  (Chapter 30, Statutes of 2016)

SB 908 (Hernandez) – Health Insurance Premiums: Consumer Notice

Requires health plans to notify individuals or small businesses in advance of any premium increase if state regulators find the proposed premium rate “unreasonable” or “unjustified.” Advance notice of the regulator findings allows individuals and businesses to shop for other coverage options prior to the renewal date of their existing plan.  The Department of Managed Health Care and California Department of Insurance conduct mandatory premium rate reviews for health plans under their jurisdiction according to ACA rules and implementing California law.  (Chapter 498, Statutes of 2016)

SB 1135 (Monning) – Timely Access to Care

Requires health plans, health insurers and Medi-Cal managed care plans to notify enrollees and contracted providers about California’s timely access to care standards and provide information about access to interpreter services, at least annually.  (Chapter 500, Statutes of 2016)

SB 1139 (Lara) – Health Professions Grants and Loans

Deems undocumented students eligible for admission to a medical school or medical residency program.  Prohibits grant and loan repayment and forgiveness program applications from being denied based on citizenship and immigration status.  (Chapter 786, Statutes of 2016)

SB 1159 (Hernandez) – Health Care Cost and Quality Data Atlas

Requires the Health and Human Services Agency to research the options for developing a cost, quality, and equity transparency database.  (Chapter 727, Statutes of 2016)

Vetoed Bills and Bills That Failed Passage

AB 1300 (Ridley-Thomas) – Mental Health: Involuntary Commitment

Authorizes an emergency physician or psychiatric professional, that work in a facility that has not been designated by the county for mental health treatment, to place an individual on an up to 72-hour involuntary hold for purposes of obtaining mental health evaluation and treatment. California law currently authorizes individuals to temporarily be held against their will for assessment if certain professionals believe that, due to a mental disorder, that individual is a danger to himself, a danger to others, or gravely disabled.  (Held in Senate Rules Committee)

AB 2077 (Burke/Bonilla) – Health Coverage Transitions: Medi-Cal and Covered California

Enacts eligibility, administrative and notice requirements to ensure that individuals whose eligibility fluctuates between Medi-Cal, Covered California and other health care coverage programs do not experience a break in coverage. Establishes a 20-day grace period after an individual is no longer eligible for Medi-Cal so they can apply for and enroll in Covered California or other health coverage without a coverage break.  (Vetoed by Governor)

AB 2216 (Bonta) – Teaching Health Center Program

Establishes the Teaching Health Center Primary Care Graduate Medical Education Fund to support primary care residency programs. Modeled after a limited federal program included in the federal Affordable Care Act (ACA).  (Held in Assembly Appropriations Committee)

AB 2436 (Hernandez, R.) – Prescription Drug Cost Transparency

Requires health plans in California to provide consumers with specified information on the costs of prescription drugs, including the consumer’s potential out-of-pocket costs.  (Failed Passage on Assembly Floor)

SB 932 (Hernandez) – Oversight of Mergers and Acquisitions

Requires prior approval by the Department of Managed Health Care for mergers between health plans and other organizations and prohibits specified provisions in health plan provider contracts.  (Held in Senate Appropriations Committee)

SB 997 (Lara) – Coverage for Undocumented Children

Authorizes undocumented children eligible for full-scope Medi-Cal coverage, who are enrolled in low-cost coverage through Kaiser Permanente or another Medi-Cal managed care plan, to be enrolled in full-scope Medi-Cal with the same health plan.  (Final bill text no longer relevant)

SB 1010 (Hernandez) – Prescription Drugs: Transparency

Requires health plans to provide regulators reviewing health care premium filings with specified information relating to prescription drug spending. In addition, this bill requires drug manufacturers to notify state purchasers of health care services when drug prices increase during any 12-month period by more than 25%, or when manufacturers introduce new drugs to the market costing more than $10,000 annually or per course of treatment.  (Held on the Assembly Floor)

SB 1418 (Lara) – Medi-Cal Coverage for All

Extends eligibility for full-scope Medi-Cal to all individuals 19 years of age and older, regardless of immigration status.  (Held in Senate Health Committee)

Tags: ,

Leave a Reply

Your email address will not be published. Required fields are marked *

*