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Home/Bills/AB 164California · 2025–2026 Regular Session
Assembly BillPassed first houseBusiness and Professions

AB 164: Health.

California · Assembly · 2025–2026 Regular Session · last verified August 8, 2026

What AB 164 does, verified August 8, 2026

<p>This bill expresses the intent of the legislature to enact statutory changes relating to the budget act of 2025. The changes aim to address various aspects of the budget act, including its implementation, funding, and oversight.</p> <p>The proposed changes are intended to improve the efficiency and effectiveness of the budget process, ensuring that the state's financial resources are utilized in a responsible and sustainable manner.</p> <p>The bill's primary goal is to enhance the state's fiscal management, providing a more stable and predictable financial environment for the citizens of the state.</p>

Bill journey
✓IntroducedComplete
✓In CommitteeComplete
✓First Chamber FloorComplete
4Second ChamberCurrent
5GovernorPending
6ChapteredPending
Last action: Ordered to inactive file at the request of Senator Laird. (2026-08-06)Alert me
Recent actions14 total · showing 5
Aug. 06, 2026Ordered to inactive file at the request of Senator Laird.
Jun. 29, 2026Read second time. Ordered to third reading.
Jun. 29, 2026From committee: Do pass. (Ayes 13. Noes 5.) (June 29).
Jun. 26, 2026From committee chair, with author's amendments: Amend, and re-refer to committee. Read second time, amended, and re-referred to Com. on B. & F. R.
Apr. 02, 2025Referred to Com. on B. & F. R.
Full action history, 9 earlier actionsConnect Plus
Latest bill textAmended version, June 26, 2026 · 11,176 words

Amended IN Senate June 26, 2026

CALIFORNIA LEGISLATURE— 2025–2026 REGULAR SESSION

Assembly Bill
No. 164


Introduced by Assembly Member Gabriel Committee on Budget (Assembly Members Gabriel (Chair), Addis, Ahrens, Alvarez, Bennett, Bonta, Caloza, Connolly, Fong, Haney, Hart, Jackson, Lee, Ortega, Patel, Petrie-Norris, Quirk-Silva, Ramos, Rogers, Schiavo, Schultz, Sharp-Collins, Solache, Stefani, Ward, and Wilson)

January 08, 2025


An act relating to the Budget Act of 2025. An act to amend Sections 2191 and 2811.5 of, and to add Sections 2190.4, 2454.7, and 3524.65 to, the Business and Professions Code, to amend Section 100520.5 of the Government Code, to amend Sections 1254, 1256.05, 1256.06, 1367.03, 1367.04, 1367.626, 1728.1, 1728.3, 1728.7, 1734, 1735, 11832.2, 11832.18, 11834.015, 11834.02, 11834.026, 11834.26, 11834.30, 11834.31, 11834.40, 11834.50, 11839.2, 11839.3, 11839.6.1, 11839.16, 120956, 127630, 127631, 127632, 127633, 127634, 127635, 127638, 130201, and 130290 of, to add Sections 1253.4, 1367.252, 1367.253, 1728.75, 1728.9, 1728.95, 127437, and 127631.1 to, to add Chapter 11 (commencing with Section 127770) to Part 2 of Division 107 of, and to repeal Sections 11834.29, 130204, 130206, 130208, and 130209 of, the Health and Safety Code, to amend Section 10133.8 of, and to add Sections 10123.861 and 10123.862 to, the Insurance Code, to amend Sections 1602, 1603, and 1604 of the Penal Code, to amend Section 30461.6 of the Revenue and Taxation Code, and to amend Sections 5892, 5963.02, 5963.04, 14005.36, 14005.37, 14007.5, 14007.65, 14007.8, 14016.2, 14019, 14019.6, 14043.26, 14132.100, 14154, 14184.101, 14184.102, 14184.200, 14184.404, 14197.2, and 15926 of, to amend, repeal, and add Sections 14005.62 and 14005.11 of, and to add Sections 4360.5, 5892.2, 14005.365, 14005.69, 14007.12, 14132.14, and 14184.900 to, the Welfare and Institutions Code, relating to health, and making an appropriation therefor, to take effect immediately, bill related to the budget.


LEGISLATIVE COUNSEL'S DIGEST


AB 164, as amended, Committee on Budget. Budget Act of 2025. Health.
(1) Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is in part governed by, and funded pursuant to, federal Medicaid program provisions.
Existing federal law, H.R. 1 (Public Law 119-21), enacted in 2025, sets forth various Medicaid eligibility changes for implementation at different stages of a certain timeline, including changes applied to beneficiaries between 19 and 64 years of age, inclusive, with income up to 138% of the federal poverty level, commonly known as Medicaid expansion adults.
Federal H.R. 1 generally requires a Medicaid expansion adult to undergo an eligibility redetermination once every 6 months, instead of an annual redetermination. The federal law generally requires a Medicaid expansion adult to demonstrate community engagement through any of certain methods for the corresponding month, including a minimum of 80 hours of work or community service or a minimum of half-time enrollment in an educational program. The federal law reduces the period of retroactive coverage prior to the date of Medicaid application from 3 months to one month for Medicaid expansion adults and to 2 months for other Medicaid beneficiaries. The federal law requires the state to provide for a process to regularly obtain beneficiary address information from reliable data sources, and to utilize a system to prevent an individual from being simultaneously enrolled under Medicaid state plans or waivers of multiple states.
This bill would make various changes to related state provisions, or would add new provisions, conforming them to the above-described changes under federal H.R. 1. The bill would require a county to accept specified methods of signatures for renewal forms.
Federal H.R. 1 restricts the scope of certain categories of immigrants who qualify for Medicaid eligibility.
This bill would make conforming changes to related state provisions. The bill would also modify provisions regarding individuals with certain immigration statuses, so that they would be eligible for the full scope of Medi-Cal state-funded benefits, subject to certain service limitations.
Existing law requires an individual without satisfactory immigration status, as specified, who is eligible for full-scope Medi-Cal to enroll in a Medi-Cal managed care plan.
This bill would instead specify that an individual without satisfactory immigration status who is eligible for the Medi-Cal program is eligible for services in the Medi-Cal fee-for-service delivery system. The bill would make conforming changes to related provisions.
Existing law requires the department to develop an application for insurance affordability programs, including Medi-Cal, for use by all entities authorized to make an eligibility determination for those programs. Existing law authorizes the department to develop and require use of supplemental forms to collect additional information needed to determine eligibility.
This bill would make various changes to those provisions, relating to user testing, accuracy, readability, and the work or community engagement requirements under federal H.R. 1.
The bill would require the department to undertake efforts to conduct outreach regarding the changes made under federal H.R. 1, and to establish a data dashboard. Under the bill, beneficiary outreach and education would be coordinated across public social services programs to help minimize barriers to administrative disenrollments. The bill would incorporate federal H.R. 1 requirements into county outreach efforts, as specified.
By creating new duties for counties regarding Medi-Cal eligibility determinations, procedures, and outreach, the bill would impose a state-mandated local program.
(2) Existing law, beginning no sooner than July 1, 2027, requires certain individuals who do not have satisfactory immigration status to pay a monthly premium of $30 as a condition of eligibility for the full scope of Medi-Cal benefits, subject to certain exceptions.
This bill would require, no sooner than May 14, 2027, the Governor’s 2027–28 May Revision to include the level of the monthly premiums, to be set at no less than $30 and no greater than $50 per beneficiary.
Under existing law, no sooner than July 1, 2026, the above-described individuals who are 19 years of age or older are not eligible for dental services under the Medi-Cal program, except as specified.
This bill would delay the ineligibility for dental services to a period no sooner than July 1, 2027.
(3) Under existing law, to the extent that federal financial participation is available, federally qualified health center (FQHC) services and rural health clinic (RHC) services are covered Medi-Cal benefits. Under existing law, FQHC and RHC services are reimbursed on a per-visit basis, as defined. Under existing law, commencing on July 1, 2026, that reimbursement is conditioned on the services being eligible for federal financial participation.
This bill would instead apply that condition commencing on July 1, 2027.
(4) Existing law, the California Advancing and Innovating Medi-Cal (CalAIM) Act, subject to receipt of any necessary federal approvals, establishes the CalAIM initiative in order to, among other things, improve quality outcomes, reduce health disparities, and transition and transform the Medi-Cal program to a more consistent and seamless system by reducing complexity and increasing flexibility. Under existing law, the CalAIM initiative ends on December 31, 2026.
Existing law appropriates to the department certain amounts of federal financial participation that the department is authorized to claim for expenditures associated with the designated state health programs identified in the CalAIM Terms and Conditions. Existing law appropriates to the Health Care Deposit Fund, a continuously appropriated fund, an amount of General Fund moneys equal to the federal financial participation for use by the department for CalAIM implementation purposes. Existing law also continuously appropriates moneys from the Medi-Cal County Behavioral Health Fund to the department for purposes of implementing certain behavioral health provisions within CalAIM.
This bill, subject to receipt of any necessary federal approvals, would extend the CalAIM initiative to December 31, 2031, thereby making an appropriation.
The bill would require the department to seek federal approval for implementation of Employment Supports and BridgeCare, the latter of which is to provide home- and community-based services and caregiver supports to individuals enrolled in the federal Medicare Program who meet the near dual eligibility criteria, as specified.
Existing law requires an individual county, or counties acting jointly, to provide and administer covered behavioral health Medi-Cal benefits under a single Medi-Cal behavioral health delivery system contract, in accordance with the CalAIM Terms and Conditions.
This bill would require the county or counties, if participating in the Drug Medi-Cal organized delivery system, to deliver the behavioral health benefits through a single Prepaid Inpatient Health Plan.
(5) Existing law sets forth various requirements and procedures for the enrollment of providers in the Medi-Cal program.
This bill, for the period beginning on July 1, 2026, and ending on June 30, 2027, would prohibit the granting of provisional or preferred provisional enrollment status in the Medi-Cal program to an applicant or provider as a result of the department’s failure to act within any of specified timeframes. Under those circumstances, the bill would require that the application remain pending unless and until the department issues a written determination consistent with all applicable state and federal Medicaid screening requirements.
(6) Existing law prohibits the use of an assets or resources test for individuals whose income eligibility for Medi-Cal is determined based on the application of a modified adjusted gross income (MAGI). Existing federal law authorizes a state to establish a non-MAGI standard for determining the eligibility of certain populations.
Existing law, subject to receipt of any necessary federal approvals, implements a disregard of $130,000 in nonexempt property for a case with one member and $65,000 for each additional household member, up to a maximum of 10 members, as specified.
This bill, beginning July 1, 2027, would instead implement a resource limit of $21,000 in nonexempt property for a household with one member, $31,000 for a household with 2 members, and $1,550 for each additional household member, up to a maximum of 10 members, as specified. The bill would make conforming changes to related provisions.
By creating new duties for counties relating to the consideration of resources for determining Medi-Cal eligibility, the bill would impose a state-mandated local program.
(7) Existing law requires a Medi-Cal managed care plan to comply with a minimum 85% medical loss ratio consistent with certain federal regulations. Under existing law, after the department returns the requisite federal share amounts associated with any remittance funds collected in any applicable fiscal year to the federal Centers for Medicare and Medicaid Services, the remaining amounts remitted by a Medi-Cal managed care plan under these provisions are transferred to the Medi-Cal Loan Repayment Program Special Fund for purposes of the Medi-Cal Physicians and Dentists Loan Repayment Program.
This bill instead would deposit the remaining amounts remitted by a Medi-Cal managed care plan into the General Fund. The bill would remove an inoperative provision.
(8) Existing law requires the department to establish and maintain a plan, known as the County Administrative Cost Control Plan, whereby costs for county administration of the determination of eligibility for Medi-Cal benefits are effectively controlled within the amounts annually appropriated for that administration. Existing law makes legislative findings that, in order for counties to do the work that is expected of them, it is necessary that they receive adequate funding, including adjustments for reasonable annual cost-of-doing-business increases. Existing law expresses the intent of the Legislature to not appropriate funds for cost-of-doing-business adjustments for the 2024–25 to 2027–28, inclusive, fiscal years, among certain other previous fiscal years.
This bill would remove the 2026–27 and 2027–28 fiscal years from the above-described statement of intent regarding the lack of appropriation of funds for the cost-of-doing-business adjustments.
(9) Existing law provides for the licensure and regulation of health facilities, including general acute care hospitals and skilled nursing facilities, by the State Department of Public Health. A violation of these provisions is generally a crime.
Existing law sets forth various provisions relating to distinct parts of acute care hospitals, including those operating skilled nursing facilities. Existing regulations define “distinct part” as an identifiable unit accommodating beds, including, but not limited to, contiguous rooms, a wing, floor, or building that is approved by the department for a specific purpose.
This bill would require a general acute care hospital seeking to provide skilled nursing services in a distinct part, as defined, to submit an application and documentation to the department. If the distinct part meets certain criteria, the bill would authorize the department to approve a hospital’s application for a distinct part on a case-by-case basis. The bill would require a skilled nursing distinct part to meet specified conditions, including, among others, being wholly owned by the hospital and being subject to the bylaws and operating decisions of the hospital’s governing body.
The bill would require a general acute care hospital seeking to add a composite distinct part to its license to submit a proposal to the department, as specified. Under the bill, “composite distinct part” would be defined as a distinct part consisting of 2 or more noncontiguous components that are not located within the same campus. If the department determines that the composite distinct part may improve access to care and address a specific unmet need in the geographical area served by the hospital, the bill would authorize the hospital to submit an application for approval of a composite distinct part.
The bill would require a freestanding component of a composite distinct part to independently meet all of the licensing requirements applicable to a freestanding skilled nursing facility, including staffing requirements and ratios. The bill would prohibit a hospital from using composite distinct parts to segregate residents by payment source or on a basis other than care needs.
The bill would limit the hospital to a maximum of only one licensed skilled nursing distinct part, which may be a composite distinct part, with the hospital and the distinct part or composite distinct part having only one license number. The bill would set forth related identification duties for the department.
Existing law requires the department, upon approval, to issue a separate license for the provision of basic services relating to skilled nursing or intermediate care, whenever these basic services are to be provided by an acute care hospital in a separate freestanding facility, whether or not contiguous to the hospital. Existing law sets forth various exemptions to this requirement, including for beds licensed to an acute care hospital and located within the physical structure in which acute care is provided.
This bill would exempt, from the above-described requirement, licensed skilled nursing beds in a distinct part located on a general acute care hospital’s campus, as specified. Under the bill, a composite distinct part would be exempt only if the hospital’s license has a distinct part on its campus approved for skilled nursing.
By creating new requirements for general acute care hospitals, distinct parts, and composite distinct parts, the violation of which would be a crime, the bill would impose a state-mandated local program.
(10) Existing law requires the State Department of Public Health to develop and maintain a statewide comprehensive community-based perinatal services program, as specified, to deliver services in medically underserved areas or areas with demonstrated need.
Existing law requires the department, by July 1, 2026, to establish a 10-year pilot project within up to 5 critical access hospitals to allow participating hospitals, on an application basis, to establish standby perinatal services, as defined. Existing law requires, if qualified, the first 2 hospitals selected to be nonprofit and located in the Counties of Humboldt and Plumas.
This bill would require, if qualified, a nonprofit hospital located in the County of Lake to be one of the first 3 hospitals selected. The bill would make various changes to certain criteria, with regard to staff responsibilities and procedures, for a hospital requesting approval to establish a standby perinatal service. Because a violation of these provisions would be a crime, the bill would impose a state-mandated local program.
The bill would make legislative findings and declarations as to the necessity of a special statute for the County of Lake.
(11) Existing law provides for the licensure and regulation of home health agencies by the State Department of Public Health. Existing law generally makes a violation of those provisions a misdemeanor. Existing law prescribes various requirements for the application for a home health agency license, including a provisional license for an applicant that has not been previously licensed.
This bill, except as provided, would require a home health agency to have an administrator, administrator designee, director of patient care services, and director of patient care services designee, and to submit to the department specified information for each individual on an initial application. The bill would require existing agencies to provide this information no later than March 31, 2027. The bill would require the department to verify specified details of home health agency management personnel. The bill, except as provided, would require an applicant for licensure of a home health agency or a branch office to demonstrate an unmet need for home health services in the agency’s geographic service area. The bill would specify additional grounds by which the department is authorized to deny an application for, or suspend or revoke, a license. Because a violation of these provisions would be a crime, the bill would impose a state-mandated local program.
The bill would prohibit the transfer of a license that is issued pursuant to these provisions. The bill would prohibit the department from approving a change of ownership of a licensed home health agency within 5 years of the date a license was initially issued to the licensee. The bill would authorize the department to make an exception for extenuating circumstances, as specified.
The bill, for a specified period of time, would prohibit the department from issuing a new license to operate a home health agency or add a branch office to an existing license. The bill would authorize the department to grant an exception upon a written finding that an applicant for a new license or with a pending application has demonstrated an unmet need for home health services in the area where the applicant proposes to operate.
The bill would require the department to update existing home health agency regulations as necessary and adopt regulations that, among other things, clarify the maximum time and distance that home health agency staff may travel to reach patients, as specified.
(12) Existing law requires the State Department of Health Care Services to license and regulate alcohol or other drug programs that provide recovery, treatment, or detoxification services or medications for addiction treatment. Under existing law, a licensee is required to provide at least one specified nonmedical service. Existing law requires the department to adopt American Society of Addiction Medicine (ASAM) treatment criteria, or an equivalent evidence-based standard, as the minimum standard of care for licensed facilities, and required the department to adopt regulations to implement the ASAM Criteria by January 1, 2023. The ASAM Criteria, 4th Edition, changes the levels of care for substance use treatment and integrates withdrawal management services, formerly referred to as detoxification services, into other care levels.
This bill would recast detoxification as withdrawal management and would make conforming changes. The bill would require a licensee to provide recovery and treatment services or recovery, treatment, and withdrawal management services. The bill would require a license to provide detoxification-only services to expire on July 1, 2027. The bill would prohibit a licensee from providing detoxification-only services on and after that date and would prohibit the department from issuing or extending a license for detoxification-only services on or after that date. The bill would require the department to promulgate regulations to implement the ASAM Criteria by January 1, 2030, and in the interim would authorize the department to implement the ASAM Criteria through all-county letters, plan letters, information notices, or similar instructions. On and after July 1, 2027, the bill would require a licensee that provides withdrawal management services to provide those services as required in guidance issued by the department.
(13) Existing law imposes certain fair pricing requirements on hospitals, including, among other things, requiring that hospitals provide patients with a written notice containing information about the availability of the hospital’s discount payment and charity care policies and restricting the sale of patient debts. Existing law requires the Director of the Department of Health Care Access and Information to impose administrative penalties for each violation against a hospital that fails to comply with these provisions, except as specified.
This bill would establish the Hospital Fair Pricing Penalties Fund and would require any moneys collected from the above-described administrative penalties to be deposited into the fund. The bill would, upon appropriation, authorize the department to use moneys from the fund to carry out the above-described fair-pricing provisions.
(14) Existing law requires the Center for Data Insights and Innovation to compile an annual quality of care report card and produce an annual report regarding health care consumer or patient assistance help centers. Existing law establishes the Health Plan Improvement Trust Fund and requires moneys in the fund to be used for these purposes, upon appropriation by the Legislature. Existing law sets forth the shares of funding from the Managed Care Fund and Insurance Fund to be deposited into the Health Plan Improvement Trust Fund. Existing law makes personal information obtained or maintained by the center confidential and exempt from other disclosure requirements.
This bill would repeal and recast the above-described provisions to be administered by the Department of Health Care Access and Information beginning July 1, 2026. The bill would also make conforming changes.
Existing law requires the Department of Health Care Access and Information to establish and implement the California Health and Human Services Data Exchange Framework, which is required to include a single data sharing agreement and common set of policies and procedures that will leverage and advance national standards for information exchange and data content, and that will govern and require the exchange of health information among health care entities and governmental agencies in the state. Existing law generally requires specified entities to execute the data sharing agreement on or before January 31, 2023, and to exchange health information or provide access to health information pursuant to the framework by July 1, 2026.
This bill would delay required compliance with the above-described provisions until July 1, 2027, for specified community clinics, intermittent clinics, and rural health clinics.
(15) Existing law establishes the California Reproductive Health Equity Program within the Department of Health Care Access and Information to ensure abortion and contraception services are affordable for and accessible to all patients and to provide financial support for safety net providers of these services. Existing law authorizes a Medi-Cal enrolled provider to apply to the department for a grant, and a continuation award after the initial grant, to provide abortion and contraception services if specified criteria are met. Existing law establishes the California Reproductive Health Equity Fund, a continuously appropriated fund, to provide this grant funding. Existing law establishes the Abortion Access Fund, a continuously appropriated fund in the State Treasury, to provide funding for abortion services.
This bill would rename the program as the California Reproductive and TGI Health Equity Program, would expand the program’s purposes to ensure affordability and access to gender-affirming care, and would make conforming changes. The bill would require the department to develop an application form and begin accepting grant applications on or before January 1, 2027. The bill would authorize the department to use the money in the Abortion Access Fund to provide grant funding to safety net providers for abortion services through the program and would expand the purposes of the California Reproductive Health Equity Fund to include grant funding for gender-affirming care services, thus making an appropriation. The bill would make contracts, grants, and related program information confidential and exempt from disclosure to the public.
(16) Existing law, the Medical Practice Act, provides for the licensure and regulation of physicians and surgeons by the Medical Board of California and requires the board to adopt and administer standards for the continuing education of those licensees. Existing law requires the board, in determining its continuing education requirements, to consider including a course in menopausal mental or physical health. Existing law, the Osteopathic Act, provides for the licensure and regulation of osteopathic physicians and surgeons by the Osteopathic Medical Board of California and requires the board to adopt and administer standards for the continuing education of those licensees.
Under this bill, beginning July 1, 2027, a qualifying physician and surgeon or osteopathic physician and surgeon who completes continuing medical education courses in perimenopause, menopause, and postmenopausal care would receive 2 hours of credit for each hour completed of that coursework, as specified. The bill would make changes to related provisions regarding course hours for nurse practitioners and physician assistants.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and generally makes a willful violation of the act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance.
This bill would require a health care service plan contract or health insurance policy, as specified, to include coverage for certain treatments for menopausal symptoms, as medically necessary. The bill would require these contracts and policies to include a program that meets specified criteria to ensure the individuals have access to current menopause information and covered items and services.
The bill would require a plan or insurer to base a medical necessity determination or utilization review criteria for the treatment of symptoms resulting from menopause on current generally accepted standards of menopause care. Beginning January 1, 2027, the bill would require a plan or insurer conducting utilization review for the treatment of symptoms resulting from menopause to apply certain criteria and guidelines, as specified.
Because a willful violation of these provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program.
Existing law sets forth a schedule of benefits under the Medi-Cal program.
This bill would cover certain treatments for menopausal symptoms under the Medi-Cal program, subject to medical necessity and to the extent that federal financial participation is available. The bill would require the department to establish and maintain a policy to reimburse providers for provision of services related to menopause care.
(17) Existing law establishes the Breast Cancer Fund, which consists of 2 accounts, the Breast Cancer Research Account and the Breast Cancer Control Account. Under existing law, revenues from a specified cigarette tax are deposited into the fund and divided between the 2 accounts, to be allocated upon appropriation by the Legislature. Existing law requires 10% of moneys in the Breast Cancer Research Account to be allocated to the Cancer Surveillance Section, as specified.
This bill would correct an erroneous reference within the above provisions.
(18) Existing law creates the California Health Benefit Exchange, also known as Covered California, to facilitate the enrollment of qualified individuals and qualified small employers in qualified health plans as required under the Patient Protection and Affordable Care Act (PPACA). Existing law establishes the Health Care Affordability Reserve Fund to be used, upon appropriation, for health care affordability programs operated by the Exchange, among other things.
Existing law requires the Exchange, upon appropriation, to provide payments equaling the cost of providing coverage of abortion services for which federal funding is prohibited to individuals enrolled in a qualified health plan through the Exchange in the individual market. Existing law prohibits the payments from being less than $1 per enrollee per month.
This bill would require that the Health Care Affordability Reserve Fund be utilized, upon appropriation, for the above-described payments.
(19) Existing law, the Mental Health Services Act (MHSA), an initiative measure enacted by the voters as Proposition 63 at the November 2, 2004, statewide general election, creates the Mental Health Service Fund, a continuously appropriated fund, for the purpose of funding a system of county mental health plans for the provision of mental health services. Existing law authorizes the Legislature to clarify procedures and terms of the MHSA by majority vote.
Existing law, the Behavioral Health Services Act (BHSA), a legislative act amending the MHSA that was approved by the voters as Proposition 1 at the March 5, 2024, statewide primary election, recast the MHSA by, among other things, renaming the Mental Health Service Fund as the Behavioral Health Service Fund, expanding the MHSA to include treatment of substance use disorders, changing the county planning process, and expanding services for which counties and the state can use funds. Existing law requires a county to calculate a maximum amount it establishes as the funding level for its prudent reserve for its Local Behavioral Health Services Fund, not to exceed 20% of the average of the total funds distributed to the county, as specified, and requires a county with a population of less than 200,000 to calculate a maximum amount it establishes as the prudent reserve for its Local Behavioral Health Services Fund, not to exceed 25% of the average of the total funds distributed to the county, as specified.
This bill would, commencing with the 2029–30 fiscal year and every 3 fiscal years thereafter, require a county to calculate the maximum funding level of its prudent reserve, as specified, and include a plan for the expenditure of funds exceeding the maximum amount funding level in the county’s integrated plan.
Existing law requires the Controller, on or before the 15th day of each month, to distribute to each Local Behavioral Health Service Fund established by counties all unexpended and unreserved funds on deposit as of the last day of the prior month in the Behavioral Health Services Fund for the provision of behavioral health programs and other related activities pursuant to a methodology provided by the State Department of Health Care Services.
This bill, commencing July 1, 2028, would require the department to establish a methodology for determining annual minimum expenditure levels for funds distributed to counties, as described above. The bill would, beginning in the 2028–29 fiscal year, set the minimum expenditure level at the average annual amount of distributed funds for a county in the preceding 3 years. The bill would require a county, commencing with the 2029–30 fiscal year and each fiscal year thereafter, to spend an amount of distributed funds that is equal to or greater than the minimum expenditure level for that fiscal year, as specified. The bill would authorize a county to spend funds from its prudent reserve only during a fiscal year for which the department publishes a revised minimum expenditure level, during any fiscal year in which the amount of distributed funds is less than the minimum expenditure level calculated for that fiscal year, or during a fiscal year in which the county determines that there has been a change in local behavioral health needs or circumstances.
Existing law requires each county to prepare and submit an integrated plan and annual updates to the Behavioral Health Services Oversight and Accountability Commission and the department. Existing law requires the integrated plan and annual update to include a budget that includes the county planned expenditures and reserves for the county distributions from the Behavioral Health Service Fund and any other funds allocated to the county to provide specified services and programs. Existing law requires all expenditures for county behavioral health programs to be consistent with a currently approved county integrated plan, annual update, or intermittent update. If a county fails to submit certain data and information or fails to allocate funding as specified, existing law authorizes the department to impose a corrective action plan, monetary sanctions, or temporarily withhold payments to the county. Existing law requires these monetary sanctions to be deposited in the Behavioral Health Services Act Accountability Fund, a continuously appropriated fund, to be allocated and distributed to the county that paid the monetary sanction upon the department’s determination that the county has come into compliance.
If a county fails to comply with the minimum expenditure requirements described above, this bill would authorize the department to impose a corrective action plan, monetary sanctions, or temporarily withhold payments to the county. Because the monetary sanctions would be a new source of moneys for the Behavioral Health Services Act Accountability Fund, a continuously appropriated fund, this bill would make an appropriation.
By creating additional duties for counties, the bill would impose a state-mandated local program.
(20) Existing law requires the State Department of State Hospitals to designate a community program director who is responsible for administering community treatment programs for certain committed persons. Existing law establishes the Forensic Conditional Release Program to provide outpatient and community-based treatment to committed persons. Existing law requires the department, until June 30, 2026, to establish a statewide panel of independent evaluators to identify and evaluate state hospital patients who are appropriate for participation in the program.
This bill would rename the independent evaluation panel as the independent placement panel. The bill would make certain changes to the designation process for case reviews and placement recommendations. The bill would extend these provisions indefinitely.
Existing law prohibits outpatient status for a person who is charged with and found incompetent on a charge of, convicted of, or found not guilty by reason of insanity of, certain crimes until the person has actually been confined in a state hospital or other treatment facility for at least 180 days. Existing law permits outpatient status, without a person first being confined in a state hospital or other treatment facility, in the case of other crimes. Existing law requires the court to consider certain criteria before placing those persons on outpatient status.
This bill would modify some of those factors that the court would be required to consider. The bill would also make changes to related provisions regarding procedures for the independent placement panel or designee to submit certain recommendations and for the court to give notice of hearing dates to specified entities.
(21) Existing law authorizes the State Public Health Officer, to the extent allowable under federal law, and upon the availability of funds, to expend moneys from the continuously appropriated AIDS Drug Assistance Program (ADAP) Rebate Fund for a program to cover the costs of prescribed ADAP formulary medications for the prevention of HIV infection and other specified costs.
This bill would additionally allow moneys from the ADAP Rebate Fund to be used to cover costs related to state and local public health department disease intervention and investigation activities and services for specified communicable diseases, to the extent that funds are available for these purposes. The bill would also allow moneys from the fund to be used to cover costs related to housing support and other programs or initiatives relating to HIV treatment or overdose prevention and harm reduction.
The bill would, to the extent deemed an allowable use of the fund, authorize the State Department of Public Health to spend up to $134,840,000 in fiscal year 2026–27, $134,490,000 in fiscal year 2027–28, $126,590,000 in fiscal year 2028–29, and $130,090,000 in fiscal year 2029–30, from the fund to implement specified programs. The bill would authorize the department to spend up to $50,000,000 for related purposes, as specified.
By adding to the purposes of the ADAP Rebate Fund, the bill would make an appropriation.
(22) The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that with regard to certain mandates no reimbursement is required by this act for a specified reason.
With regard to any other mandates, this bill would provide that, if the Commission on State Mandates determines that the bill contains costs so mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.
(23) Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest.
This bill would make legislative findings to that effect.
(24) This bill would declare that it is to take effect immediately as a bill providing for appropriations related to the Budget Bill.

This bill would express the intent of the Legislature to enact statutory changes relating to the Budget Act of 2025.

Vote: MAJORITY Appropriation: NOYES Fiscal Committee: NOYES Local Program: NOYES

The people of the State of California do enact as follows:


SECTION 1.

Section 2190.4 is added to the Business and Professions Code, to read:

2190.4.

(a) Beginning July 1, 2027, a qualifying physician and surgeon who completes continuing medical education courses in perimenopause, menopause, and postmenopausal care shall receive two hours of credit for each hour completed of that coursework, for a total earned credit that does not exceed eight course hours, toward the requirement set forth in Section 1336 of Title 16 of the California Code of Regulations.
(b) For purposes of this section, “qualifying physician and surgeon” means a holder of a physician’s and surgeon’s certificate from the board who is certified by a member board of the American Board of Medical Specialties in internal medicine, family medicine, obstetrics and gynecology, neurology, neurological surgery, or psychiatry and whose patient population includes adult women under 65 years of age.

SEC. 2.

Section 2191 of the Business and Professions Code is amended to read:

2191.

(a) In determining its continuing education requirements, the board shall consider including a course in human sexuality, defined as the study of a human being as a sexual being and how they function with respect thereto, and nutrition to be taken by those licensees whose practices may require knowledge in those areas.
(b) The board shall consider including a course in child abuse detection and treatment to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with abused or neglected children.
(c) The board shall consider including a course in acupuncture to be taken by those licensees whose practices may require knowledge in the area of acupuncture and whose education has not included instruction in acupuncture.
(d) The board shall encourage every physician and surgeon to take nutrition as part of their continuing education, particularly a physician and surgeon involved in primary care.
(e) The board shall consider including a course in elder abuse detection and treatment to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with abused or neglected persons 65 years of age and older.
(f) In determining its continuing education requirements, the board shall consider including a course in the early detection and treatment of substance abusing pregnant women to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with these women.
(g) In determining its continuing education requirements, the board shall consider including a course in the special care needs of drug-addicted infants to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with these infants.
(h) In determining its continuing education requirements, the board shall consider including a course providing training and guidelines on how to routinely screen for signs exhibited by abused women, particularly for physicians and surgeons in emergency, surgical, primary care, pediatric, prenatal, and mental health settings. In the event the board establishes a requirement for continuing education coursework in spousal or partner abuse detection or treatment, that requirement shall be met by each licensee within no more than four years from the date the requirement is imposed.
(i) In determining its continuing education requirements, the board shall consider including a course in the special care needs of individuals and their families facing end-of-life issues, including, but not limited to, all of the following:
(1) Pain and symptom management.
(2) The psychosocial dynamics of death.
(3) Dying and bereavement.
(4) Hospice care.
(j) In determining its continuing education requirements, the board shall give its highest priority to considering a course on pain management and the risks of addiction associated with the use of Schedule II drugs.
(k) In determining its continuing education requirements, the board shall consider including a course in geriatric care for emergency room physicians and surgeons.

(l)In determining its continuing education requirements, the board shall consider including a course in menopausal mental or physical health.

SEC. 3.

Section 2454.7 is added to the Business and Professions Code, to read:

2454.7.

(a) Beginning July 1, 2027, a qualifying osteopathic physician and surgeon who completes continuing medical education courses in perimenopause, menopause, and postmenopausal care shall receive two hours of credit for each hour completed of that coursework, for a total earned credit that does not exceed eight course hours, toward the requirement set forth in Section 1635 of Title 16 of the California Code of Regulations.
(b) For purposes of this section, “qualifying osteopathic physician and surgeon” means a holder of a physician’s and surgeon’s certificate who is certified by a member board of the American Board of Medical Specialties or the American Osteopathic Association in internal medicine, family medicine, obstetrics and gynecology, neurology, neurological surgery, or psychiatry and whose patient population is composed of adult women under 65 years of age.

SEC. 4.

Section 2811.5 of the Business and Professions Code is amended to read:

2811.5.

(a) Each person renewing their license under Section 2811 shall submit proof satisfactory to the board that, during the preceding two-year period, they have been informed of the developments in the registered nurse field or in any special area of practice engaged in by the licensee, occurring since the last renewal thereof, either by pursuing a course or courses of continuing education in the registered nurse field or relevant to the practice of the licensee, and approved by the board, or by other means deemed equivalent by the board.
(b) Notwithstanding Section 10231.5 of the Government Code, the board, in compliance with Section 9795 of the Government Code, shall do the following:
(1) By January 1, 2019, deliver a report to the appropriate legislative policy committees detailing a comprehensive plan for approving and disapproving continuing education opportunities.
(2) By January 1, 2020, report to the appropriate legislative committees on its progress implementing this plan.
(c) For purposes of this section, the board shall, by regulation, establish standards for continuing education. The standards shall be established in a manner to ensure that a variety of alternative forms of continuing education are available to licensees, including, but not limited to, online, academic studies, in-service education, institutes, seminars, lectures, conferences, workshops, extension studies, and home study programs. The standards shall take cognizance of specialized areas of practice, and content shall be relevant to the practice of nursing and shall be related to the scientific knowledge or technical skills required for the practice of nursing or be related to direct or indirect patient or client care. The continuing education standards established by the board shall not exceed 30 hours of direct participation in a course or courses approved by the board, or its equivalent in the units of measure adopted by the board.
(d) The board shall audit continuing education providers at least once every five years to ensure adherence to regulatory requirements, and shall withhold or rescind approval from any provider that is in violation of the regulatory requirements.
(e) The board shall encourage continuing education in spousal or partner abuse detection and treatment. In the event the board establishes a requirement for continuing education coursework in spousal or partner abuse detection or treatment, that requirement shall be met by each licensee within no more than four years from the date the requirement is imposed.
(f) In establishing standards for continuing education, the board shall consider including a course in the special care needs of individuals and their families, including, but not limited to, all of the following:
(1) Pain and symptom management, including palliative care.
(2) The psychosocial dynamics of death.
(3) Dying and bereavement.
(4) Hospice care.
(g) (1) In establishing standards for continuing education, the board shall consider including a course in menopausal mental or physical health.
(2) In establishing standards for continuing education, the board shall consider including a course in maternal mental health.
(h) This section shall not apply to licensees during the first two years immediately following their initial licensure in California or any other governmental jurisdiction, except that, beginning January 1, 2023, those licensees shall complete one hour of direct participation in an implicit bias course offered by a continuing education provider approved by the board that meets all the same requirements outlined in paragraph (1) of subdivision (f) of Section 2786, including, but not limited to, the identification of the licensees’ previous or current unconscious biases and misinformation and corrective measures to decrease implicit bias at the interpersonal and institutional levels, including ongoing policies and practices for that purpose.
(i) The board may, in accordance with the intent of this section, make exceptions from continuing education requirements for licensees residing in another state or country, or for reasons of health, military service, or other good cause.
(j) For the purpose of fulfilling the requirements of subdivision (a), a the following apply:
(1) A
nurse practitioner who provides primary care to a patient population of which over 25 percent are 65 years of age or older shall certify that they have completed at least 20 percent of all existing mandatory continuing education hours in a course in the field of gerontology, the special care needs of patients with dementia, or the care of older patients at the time of renewal.

(2) Beginning July 1, 2027, a nurse practitioner who provides care to a patient population composed of adult women under 65 years of age who completes one or more continuing education courses in perimenopause, menopause, or postmenopausal care shall receive two hours for each hour of a completed course, not to exceed six hours, if the following are met:
(A) The course or course provider is accredited by one of the following:
(i) American Nurses Credentialing Center.
(ii) American Association of Nurse Practitioners.
(iii) Accreditation Council for Continuing Medical Education.
(iv) Joint Accreditation for Interprofessional Continuing Education.
(v) The successor organization to an organization specified under this subparagraph.
(B) If the course covers multiple topics, the additional hours are only granted for the hours specified by the course provider as covering perimenopause, menopause, or postmenopausal care.

SEC. 5.

Section 3524.65 is added to the Business and Professions Code, immediately following Section 3524.6, to read:

3524.65.

Notwithstanding subdivision (e) of Section 3524.5, beginning July 1, 2027, a physician assistant who provides care to a patient population composed of adult women under 65 years of age who completes one or more continuing education courses in perimenopause, menopause, or postmenopausal care shall receive two hours towards the requirement in Section 3524.5 for each hour of a completed course, not to exceed eight hours.

SEC. 6.

Section 100520.5 of the Government Code is amended to read:

100520.5.

(a) The Health Care Affordability Reserve Fund is hereby created in the State Treasury.
(b) Notwithstanding any other law, the Controller may use the funds in the Health Care Affordability Reserve Fund for cashflow loans to the General Fund as provided in Sections 16310 and 16381.
(c) Upon the enactment of the Budget Act of 2021, and upon order of the Director of Finance, the Controller shall transfer three hundred thirty-three million four hundred thirty-nine thousand dollars ($333,439,000) from the General Fund to the Health Care Affordability Reserve Fund.
(d) Upon appropriation by the Legislature, the Health Care Affordability Reserve Fund shall be utilized, in addition to any other appropriations made by the Legislature for the same purpose, for the purpose of health care affordability programs, and benefit programs pursuant to Section 100503.6, and payments authorized pursuant to Section 100503.5, operated by the California Health Benefit Exchange.
(e) (1) The California Health Benefit Exchange shall, in consultation with stakeholders and the Legislature, develop options for providing cost sharing reduction subsidies to reduce cost sharing for low- and middle-income Californians. On or before January 1, 2022, the Exchange shall report those developed options to the Legislature, Governor, and the Healthy California for All Commission, established pursuant to Section 1001 of the Health and Safety Code, for consideration in the 2022–23 budget process.
(2) In developing the options, the Exchange shall do all of the following:
(A) Include options for all Covered California enrollees with income up to 400 percent of the federal poverty level to reduce cost sharing, including copays, deductibles, coinsurance, and maximum out-of-pocket costs.
(B) Include options to provide zero deductibles for all Covered California enrollees with income under 400 percent of the federal poverty level and upgrading those with income between 200 percent and 400 percent, inclusive, of the federal poverty level to gold-tier cost sharing.
(C) Address any operational issues that might impede implementation of enhanced cost-sharing reductions for the 2023 calendar year.
(D) Maximize federal funding and address interactions with federal law regarding federal cost-sharing reduction subsidies.
(3) The Exchange shall make the report publicly available on its internet website.
(4) The Exchange shall submit the report in compliance with Section 9795 of the Government Code.
(f) Upon order of the Department of Finance, a loan of six hundred million dollars ($600,000,000) is authorized from the Health Care Affordability Reserve Fund to the General Fund in the 2023–24 fiscal year. The loan shall be repaid in annual installments of two hundred million dollars ($200,000,000) over the 2026–27, 2027–28, and 2028–29 fiscal years.

SEC. 7.

Section 1253.4 is added to the Health and Safety Code, to read:

1253.4.

(a) (1) A general acute care hospital, as defined in subdivision (a) of Section 1250, seeking to provide skilled nursing services in a distinct part shall submit an application and documentation to the State Department of Public Health. If the distinct part meets the requirements and criteria specified in this section, the department may approve a hospital’s application for a distinct part on a case-by-case basis consistent with Section 1254.
(2) “Distinct part” means an identifiable unit accommodating beds and related facilities, including, but not limited to, contiguous rooms, a wing, a floor, or a building. A skilled nursing distinct part may comprise one or more buildings or designated parts of buildings. The term “distinct part” includes a “composite distinct part” that is not on the hospital’s campus and that meets the definition, requirements, and other criteria specified in this section.
(A) “Composite distinct part” means a distinct part consisting of two or more noncontiguous components that are not located within the same campus.
(B) “Campus” means the physical area immediately adjacent to the hospital’s main buildings or to other areas and structures that are not strictly contiguous to the main buildings.
(C) If the requirements for a “distinct part” and a “composite distinct part” conflict, then the more specific and strict standards shall apply.
(b) A skilled nursing distinct part shall meet and be subject to state licensing statutes and regulations applicable to skilled nursing facilities, unless there is a specific exception or exemption applicable to a distinct part.
(c) (1) A skilled nursing distinct part shall meet all of the following conditions:
(A) Be under the same ownership, control, and governance as the general acute care hospital of which it is a distinct part.
(B) Be wholly owned by the general acute care hospital of which it is a distinct part.
(C) Be subject to the bylaws and operating decisions of the hospital’s governing body.
(2) The general acute care hospital shall have final responsibility for the skilled nursing distinct part’s administrative decisions and personnel policies and procedures.
(d) A general acute care hospital seeking to add a composite distinct part to its license shall submit a proposal to the department demonstrating that a composite distinct part would improve access to care and serve a specific unmet need in the geographical area served by the hospital. If the department determines that the composite distinct part may improve access to care and address a specific unmet need in the geographical area served by the hospital, the general acute care hospital may submit an application with documentation for approval of a composite distinct part.
(e) In deciding whether to approve a general acute care hospital’s application for a composite distinct part, the department may consider the following additional criteria:
(1) Whether the facility is in a rural or underserved area.
(2) The compliance history of the general acute care hospital, the existing distinct part, and the entities and individuals involved with the ownership, administration, operation, and governance of the facilities.
(3) The plan of operation and plan for sharing services with the general acute care hospital and other components of the composite distinct part.
(4) Ability to demonstrate and maintain compliance with the requirements of this section and the licensing statutes and regulations applicable to skilled nursing facilities.
(5) Whether the general acute care hospital and the components of the composite distinct part are so organizationally or geographically separate that it is not feasible to operate and provide safe, quality, and adequate care as a single licensed entity.
(6) Any additional criteria that the department deems relevant or necessary to protect resident safety or ensure quality of care.
(f) Each composite distinct part component that is not located on the general acute care hospital’s campus shall have a dedicated nursing home administrator.
(g) The skilled nursing distinct part shall be integrated with the general acute care hospital of which it is a distinct part. The skilled nursing distinct part shall function as an integral and subordinate part of the hospital of which it is a distinct part, which includes, but is not limited to, common resource usage of buildings, equipment, personnel, and services.
(h) A general acute care hospital shall have a maximum of only one licensed skilled nursing distinct part, which may be a composite distinct part.
(1) A general acute care hospital with a distinct part or composite distinct part shall have only one license number.
(2) The department shall identify on the general acute care hospital’s license each distinct part, including the number of beds, location, and address of each distinct part and components of a composite distinct part.
(i) Each freestanding component of a composite distinct part shall independently meet all of the licensing requirements applicable to a freestanding skilled nursing facility, including staffing requirements and ratios. Staffing exceptions for distinct parts, including, but not limited to, the distinct part exception in Section 1276.65, shall not apply to a freestanding component of a composite distinct part.
(j) The general acute care hospital shall not use composite distinct parts to segregate residents by payment source or on a basis other than care needs.
(k) Existing distinct parts shall meet the requirements of this section before they are approved as a composite distinct part. In deciding whether to approve a consolidation, change of ownership, or other similar restructuring, the department shall consider whether the composite distinct part meets the requirements and satisfies the criteria described in this section.
(l) Notwithstanding any other law, the department may, without taking any regulatory actions pursuant to Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, implement, interpret, or make specific this section by means of an All Facilities Letter (AFL) or similar instruction.

SEC. 8.

Section 1254 of the Health and Safety Code is amended to read:

1254.

(a) Except as provided in subdivisions (e) and (f), the state department shall inspect and license health facilities. The state department shall license health facilities to provide their respective basic services specified in Section 1250. Except as provided in Section 1253, the state department shall inspect and approve a general acute care hospital to provide special services as specified in Section 1255. The state department shall develop and adopt regulations to implement the provisions contained in this section.
(b) Upon approval, the state department shall issue a separate license for the provision of the basic services enumerated in subdivision (c) or (d) of Section 1250 whenever these basic services are to be provided by an acute care hospital, as defined in subdivision (a), (b), or (f) of that section, where the services enumerated in subdivision (c) or (d) of Section 1250 are to be provided in any separate freestanding facility, whether or not the location of the separate freestanding facility is contiguous to the acute care hospital. The same requirement shall apply to any new freestanding facility constructed for the purpose of providing basic services, as defined in subdivision (c) or (d) of Section 1250, by any acute care hospital on or after January 1, 1984.
(c) (1) Those beds licensed to an acute care hospital which, prior to January 1, 1984, were separate freestanding beds and were not part of the physical structure licensed to provide acute care, and which beds were licensed to provide those services enumerated in subdivision (c) or (d) of Section 1250, are exempt from the requirements of subdivision (b).
(2) (A) All beds licensed to an acute care hospital and located within the physical structure in which acute care is provided are exempt from the requirements of subdivision (b) irrespective of the date of original licensure of the beds, or the licensed category of the beds.
(B) Licensed skilled nursing beds in a distinct part located on a general acute care hospital’s campus are exempt from subdivision (b). If a general acute care hospital has a distinct part approved for skilled nursing beds on its campus, the state department may approve additional licensed skilled nursing beds in a composite distinct part that meets the applicable definition, requirements, and criteria set forth in Section 1253.4. A composite distinct part is exempt from subdivision (b) only if the general acute care hospital’s license has a distinct part on its campus approved for skilled nursing.
(3) All beds licensed to an acute care hospital owned and operated by the State of California or any other public agency are exempt from the requirements of subdivision (b).
(4) All beds licensed to an acute care hospital in a rural area as defined by Chapter 1010, of the Statutes of 1982, are exempt from the requirements of subdivision (b), except where there is a freestanding skilled nursing facility or intermediate care facility which that has experienced an occupancy rate of 95 percent or less during the past 12 months within a 25-mile radius or which that may be reached within 30 minutes using a motor vehicle.
(5) All beds licensed to an acute care hospital which that meet the criteria for designation within peer group six or eight, as defined in the report entitled Hospital Peer Grouping for Efficiency Comparison, dated December 20, 1982, and published by the California Health Facilities Commission, and all beds in hospitals which that have fewer than 76 licensed acute care beds and which that are located in a census designation place of 15,000 or less population, are exempt from the requirements of subdivision (b), except where there is a freestanding skilled nursing facility or intermediate care facility which that has experienced an occupancy rate of 95 percent or less during the past 12 months within a 25-mile radius or which that may be reached within 30 minutes using a motor vehicle.
(6) All beds licensed to an acute care hospital which that has had a certificate of need approved by a health systems agency on or before July 1, 1983, are exempt from the requirements of subdivision (b).
(7) All beds licensed to an acute care hospital are exempt from the requirements of subdivision (b), if reimbursement from the Medi-Cal program for beds licensed for the provision of services enumerated in subdivision (c) or (d) of Section 1250 and not otherwise exempt does not exceed the reimbursement which that would be received if the beds were in a separately licensed facility.
(d) Except as provided in Section 1253, the state department shall inspect and approve a general acute care hospital to provide special services as specified in Section 1255. The state department shall develop and adopt regulations to implement subdivisions (a) to (d), inclusive, of this section.
(e) The State Department of Health Care Services shall inspect and license psychiatric health facilities. The State Department of Health Care Services shall license psychiatric health facilities to provide their basic services specified in Section 1250.2. The State Department of Health Care Services shall develop, adopt, or amend regulations to implement this subdivision.
(f) The State Department of Health Care Services shall inspect and license psychiatric residential treatment facilities as defined in Section 1250.10.

SEC. 9.

Section 1256.05 of the Health and Safety Code is amended to read:

1256.05.

(a) For purposes of this section and Section 1256.06, the following definitions apply:
(1) “Critical access hospital” means a hospital designated by the State Department of Public Health as a critical access hospital, and certified as such by the Secretary of the United States Department of Health and Human Services under the federal Medicare Rural Hospital Flexibility Program.
(2) “Department” means the State Department of Public Health, unless otherwise specified.
(3) “Standardized order sets” means predefined groups of orders that support clinical decisions, including, but not limited to, appropriate treatments, medications, and dosages, for specific conditions or procedures and that are developed using relevant evidence-based guidelines.
(4) “Standby perinatal services” means the provision of obstetric and neonatal medical care to patients who are transferred from an alternative birth center, or who present to the hospital’s emergency department with an urgent or emergent obstetric issue, in a specifically designated area of the hospital that is equipped and maintained at all times to receive patients and capable of providing physician, midwifery, and nursing services within a reasonable time not to exceed 30 minutes.
(b) The department shall do all of the following:
(1) By July 1, 2026, establish a 10-year pilot project within up to five critical access hospitals to allow participating hospitals to establish standby perinatal services. If qualified, the first two three hospitals selected shall be nonprofit and located in the County of Humboldt and the County of Counties of Humboldt, Lake, and Plumas. Up to three two additional critical access hospitals may be selected at any time if the application includes a signed agreement from the exclusive employee representatives of the workforce that the proposed pilot project site would not adversely impact the workforce or includes an attestation that there is no existing exclusive employee representative.
(2) Within a reasonable time, determine whether hospitals requesting to participate meet applicable statutory requirements, including, but not limited to, maintaining all of the following:
(A) Ability to meet the standards of the standby perinatal service, as described in Section 1256.06.
(B) Provide surgery Surgery and anesthesia as basic services of the hospital.
(C) Maintain capability Capability for obtaining or performing timely blood gas, pH, and microbiologic analyses.
(D) Provide ability Ability to maintain premixed infusions.
(E) Maintain a A basic emergency medical service, comprehensive emergency medical service, or standby emergency medical service licensed as a supplemental service.
(F) (i) Have a A designated room or rooms for the standby perinatal service space. A hospital may designate an existing room or rooms with a licensed general acute care bed as the standby perinatal service space. If a hospital designates an existing room or rooms for the standby perinatal service space, the hospital may continue to provide general acute care services in that room or rooms when the room or rooms are not in use by the standby perinatal services only if all remaining general acute care beds are occupied or a plan for management of perinatal patients using alternate space is approved by the department.
(ii) The operating room may serve as the delivery room in hospitals having a licensed bed capacity of 25 or less, but the operating room shall not serve as the sole standby perinatal service space.

(G)

(3)
In consultation with stakeholders, establish any additional requirements that the department deems necessary to protect patient safety or to ensure quality of care under the pilot project.

(3)

(4)
(A) Develop a template to collect and evaluate data on safety, outcomes, utilization, and populations served under the pilot project using stratified demographic data, to the extent statistically reliable data are available and comply with medical privacy laws and practices. The department may, in consultation with relevant stakeholders, establish additional requirements for participating hospitals to collect and report any additional data under the pilot project that the department deems necessary.
(B) Compile the data collected pursuant to subparagraph (A), prepare and submit an evaluation to the Legislature, and make the evaluation publicly available. The department shall submit the evaluation to the Legislature on or before two years after the completion of the pilot project. Data-collection requests shall be provided in a timely manner to enable the pilot hospital to collect and report the data before the deadline. The evaluation to be submitted to the Legislature pursuant to this subparagraph shall be submitted in compliance with Section 9795 of the Government Code.

(4)

(5)
Consult with relevant state departments and stakeholders on the matter of meeting implementation of the requirements of this subdivision. Stakeholders shall include The department shall invite representatives of hospitals, consumers, the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Nurse-Midwives, health plans, labor, and other health care professionals who provide pediatric and pregnancy-related services, including, but not limited to, registered nurses, certified nurse-midwives, and licensed midwives.
(c) A hospital seeking to participate in the pilot project shall submit an application to the department.
(d) An approved standby perinatal service shall be subject to all relevant licensing enforcement provisions as established under this chapter and Chapter 1 (commencing with Section 70001) of Division 5 of Title 22 of the California Code of Regulations.
(e) If, at any time, a hospital with a standby perinatal service fails to meet the requirements set forth in this section or Section 1256.06, or fails to ensure patient health and safety, as determined by the department, the department may suspend or revoke its approval of the hospital’s participation in the pilot project.

(f)(1)Notwithstanding any other law or regulation, a hospital participating in the pilot project may, in consultation with the medical and any other relevant staff, request program flexibility for the statutory requirements of this section or Section 1256.06, in order to meet the particular capacities and needs of the hospital and community.

(2)If the department approves the request described in paragraph (1), the department’s approval shall provide for the terms and conditions under which the program flexibility is granted.

(3)To request program flexibility for the statutory requirements of this section or Section 1256.06, the hospital shall follow existing procedures established by the department for program flexibility requests pursuant to subdivision (b) of Section 1276.

(g)

(f) Notwithstanding any other law, the department may, without taking any regulatory actions pursuant to Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, implement, interpret, or make specific this section and Section 1256.06 by means of an All Facilities Letter (AFL) or similar instruction.
Text of AB 164 as amended, from the official record. Connect Plus keeps every version and highlights what changed.Compare versions
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