Signed by Governor Gavin Newsom

Vote Smart's Synopsis:

Vote to concur with Senate amendments and pass a bill that establishes regulations for the health omnibus Trailer Budget in California.

Highlights:

• Extends the date of repeal for provisions regarding Enhanced Treatment Program (ETP) until January 1, 2030, and imposes a state-mandated local program for ETP requirements that are extended by this change (Sec. 1).

• Requires the State Department of State Hospitals to adopt emergency regulations for acute psychiatric hospitals not operated by the Department by January 31, 2026, and permanent regulations thereafter (Sec. 1).

• Amends the Special Deposit Fund by removing the following accounts (Sec. 3-35):

• The Skilled Nursing Facility Minimum Staffing Penalty Account;

• The Internal Departmental Quality Improvement Account;

• The State Health Facilities Citation Penalties Account; and

• The Federal Health Facilities Citation Penalties Account.

• Transfers all funds in the Internal Health Information Integrity Quality Improvement Account to the Internal Departmental Quality Improvement Account (Sec. 5).

• Requires pharmacy benefit managers contracted with a health care service plan or health insurer to secure a license from the Department of Managed Health Care on or after January 1, 2027, or the date on which the department establishes the licensure process (Sec. 11).

• Establishes the Pharmacy Benefit Manager Fund in the State Treasury, into which fees, fines, penalties, and reimbursements collected from pharmacy benefit managers will be deposited (Sec. 25).

• Requires pharmacy benefit managers to submit certain data to the Department of Health Care Access and Information regarding drug pricing, fees, and other information (Sec. 41).

• Expands the requirement for large group health care and disability insurance policies to provide coverage for the diagnosis and treatment of infertility to apply to small group health care service plans (Sec. 8, 46).

• Authorizes funds allocated to the Transgender, Gender Nonconforming, and Intersex Wellness and Equity Fund to fund services related to HIV prevention (Sec. 83).

• Authorizes, subject to an appropriation by the Legislature, the California Health and Human Services Agency to enter into partnerships to increase competition, lower prices, and address supply shortages for generic or brand name drugs (Sec. 43).

• Requires a Medi-Cal managed care plan to cover COVID-19 screening, testing, immunizations, and therapeutics in accordance with applicable statutes, regulations, plan letters, the Medi-Cal provider manual, Medi-Cal managed care plan contracts, and other guidance (Sec. 106).

• Authorizes beneficiaries to continue to receive drugs previously prescribed but now subject to prior authorization if their pharmacy provider initiates a prior authorization request that is approved by the Department (Sec. 93).

• Increases the state rebate minimum threshold for certain drugs from 20% to 25% of the average manufacturer price (Sec. 97).

• Establishes the Medi-Cal Anti-Fraud Special Deposit Fund for the deposit of outstanding Medi-Cal payments intercepted as a result of payment suspension (Sec. 98).

• Repeals the requirement for Medi-Cal providers to complete specified cognitive health assessment training to be eligible to receive payment for assessments provided to beneficiaries age 65 and older who are ineligible for the assessment through Medicare (Sec. 105).

• Requires nondesignated public hospitals participating in the Nondesignated Public Hospital Intergovernmental Transfer Program to reimburse the Department for administrative costs as a condition of receiving supplemental payments (Sec. 110).

• Amends Medi-Cal dental benefit requirements to exclude individuals who are 19 years of age or older and who do not have satisfactory immigration status (Sec. 75).

• Authorizes the use of resources for determining Medi-Cal eligibility in non-modified adjusted gross income cases and establishes a disregard level of $130,000 in nonexempt property for a case with one member and $65,000 for each additional household member (Sec. 59).

• Specifies that this Act does not require any reimbursements of local agencies or school districts for costs mandated by the state (Sec. 117).

• Specifies that this Act takes effect immediately upon passage (Sec. 119).

Full Bill Text

Vote Smart's Synopsis:

Vote to amend and pass a bill that establishes regulations for the health omnibus Trailer Budget in California.

Highlights:

• Extends the date of repeal for provisions regarding Enhanced Treatment Program (ETP) until January 1, 2030, and imposes a state-mandated local program for ETP requirements that are extended by this change (Sec. 1).

• Requires the State Department of State Hospitals to adopt emergency regulations for acute psychiatric hospitals not operated by the Department by January 31, 2026, and permanent regulations thereafter (Sec. 1).

• Amends the Special Deposit Fund by removing the following accounts (Sec. 3-35):

• The Skilled Nursing Facility Minimum Staffing Penalty Account;

• The Internal Departmental Quality Improvement Account;

• The State Health Facilities Citation Penalties Account; and

• The Federal Health Facilities Citation Penalties Account.

• Transfers all funds in the Internal Health Information Integrity Quality Improvement Account to the Internal Departmental Quality Improvement Account (Sec. 5).

• Requires pharmacy benefit managers contracted with a health care service plan or health insurer to secure a license from the Department of Managed Health Care on or after January 1, 2027, or the date on which the department establishes the licensure process (Sec. 11).

• Establishes the Pharmacy Benefit Manager Fund in the State Treasury, into which fees, fines, penalties, and reimbursements collected from pharmacy benefit managers will be deposited (Sec. 25).

• Requires pharmacy benefit managers to submit certain data to the Department of Health Care Access and Information regarding drug pricing, fees, and other information (Sec. 41).

• Expands the requirement for large group health care and disability insurance policies to provide coverage for the diagnosis and treatment of infertility to apply to small group health care service plans (Sec. 8, 46).

• Authorizes funds allocated to the Transgender, Gender Nonconforming, and Intersex Wellness and Equity Fund to fund services related to HIV prevention (Sec. 83).

• Authorizes, subject to an appropriation by the Legislature, the California Health and Human Services Agency to enter into partnerships to increase competition, lower prices, and address supply shortages for generic or brand name drugs (Sec. 43).

• Requires a Medi-Cal managed care plan to cover COVID-19 screening, testing, immunizations, and therapeutics in accordance with applicable statutes, regulations, plan letters, the Medi-Cal provider manual, Medi-Cal managed care plan contracts, and other guidance (Sec. 106).

• Authorizes beneficiaries to continue to receive drugs previously prescribed but now subject to prior authorization if their pharmacy provider initiates a prior authorization request that is approved by the Department (Sec. 93).

• Increases the state rebate minimum threshold for certain drugs from 20% to 25% of the average manufacturer price (Sec. 97).

• Establishes the Medi-Cal Anti-Fraud Special Deposit Fund for the deposit of outstanding Medi-Cal payments intercepted as a result of payment suspension (Sec. 98).

• Repeals the requirement for Medi-Cal providers to complete specified cognitive health assessment training to be eligible to receive payment for assessments provided to beneficiaries age 65 and older who are ineligible for the assessment through Medicare (Sec. 105).

• Requires nondesignated public hospitals participating in the Nondesignated Public Hospital Intergovernmental Transfer Program to reimburse the Department for administrative costs as a condition of receiving supplemental payments (Sec. 110).

• Amends Medi-Cal dental benefit requirements to exclude individuals who are 19 years of age or older and who do not have satisfactory immigration status (Sec. 75).

• Authorizes the use of resources for determining Medi-Cal eligibility in non-modified adjusted gross income cases and establishes a disregard level of $130,000 in nonexempt property for a case with one member and $65,000 for each additional household member (Sec. 59).

• Specifies that this Act does not require any reimbursements of local agencies or school districts for costs mandated by the state (Sec. 117).

• Specifies that this Act takes effect immediately upon passage (Sec. 119).

Full Bill Text