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AB-133 Health.(2021-2022)

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Date Published: 07/27/2021 09:00 PM
AB133:v93#DOCUMENT

Assembly Bill No. 133
CHAPTER 143

An act to add Section 502 to, and to repeal Sections 2717, 2852.5, 3518.1, 3770.1, and 4506 of, the Business and Professions Code, to amend Section 100504 of, and to add Sections 100503.5 and 100520.5 to, the Government Code, to amend Sections 38074, 102430, 120511, 120780.2, 120956, 120972, 127000, 127005, 127010, 127280, 127285, 127345, 127346, 127350, 127360, 127400, 127435, 127450, 127671, 127671.1, 127672, 127672.8, 127672.9, 127673, 127673.1, 127673.2, 127673.3, 127673.4, 127673.5, 127673.6, 127673.7, 127673.8, 127673.81, 127673.82, 127673.83, 127673.84, 127674, 127674.1, 127675, 127677, 127679, 127681, 127683, 127685, 127885, 127900, 127940, 127985, 127995, 128000, 128005, 128020, 128030, 128035, 128040, 128050, 128051, 128052, 128130, 128135, 128140, 128155, 128165, 128170, 128175, 128180, 128190, 128195, 128205, 128215, 128220, 128230, 128235, 128330, 128345, 128350, 128355, 128365, 128370, 128371, 128375, 128385, 128401, 128454, 128458, 128485, 128550, 128551, 128552, 128553, 128555, 128556, 128690, 128700, 128705, 128730, 128734, 128735, 128736, 128737, 128738, 128740, 128745, 128747, 128748, 128750, 128755, 128760, 128765, 128766, 128770, 128775, 128782, 128785, 128790, 128795, 128800, 128805, 128810, 129010, 129015, 129020, 129022, 129030, 129035, 129040, 129045, 129049, 129050, 129051, 129052, 129055, 129065, 129070, 129075, 129080, 129085, 129087, 129090, 129092, 129095, 129100, 129105, 129110, 129125, 129130, 129135, 129140, 129145, 129150, 129152, 129155, 129160, 129165, 129170, 129172, 129173, 129174, 129174.1, 129175, 129180, 129185, 129200, 129205, 129210, 129220, 129221, 129230, 129295, 129330, 129335, 129355, 129680, 129715, 129730, 129740, 129750, 129760, 129761, 129765, 129770, 129775, 129785, 129787, 129790, 129795, 129800, 129805, 129810, 129812, 129820, 129825, 129830, 129835, 129840, 129850, 129851, 129853, 129855, 129856, 129875, 129875.1, 129880, 129885, 129890, 129895, 129900, 129905, 129925, 129930, 129940, 129950, 129975, 129980, 129985, 129990, 130000, 130005, 130010, 130020, 130025, 130050, 130055, 130060, 130061, 130061.5, 130062, 130063, 130063.1, 130064, 130065, 130066, 130070, and 131300 of, to amend the heading of Part 1 (commencing with Section 127000) of Division 107 of, to amend the heading of Division 107 (commencing with Section 127000) of, to amend the heading of Article 5 (commencing with Section 128050) of Chapter 2 of Part 3 of Division 107 of, to amend the heading of Article 1 (commencing with Section 128125) of Chapter 3 of Part 3 of Division 107 of, to amend the heading of Article 1 (commencing with Section 128330) of Chapter 5 of Part 3 of Division 107) of, and to amend the heading of Chapter 5 (commencing with Section 128330) of Part 3 of Division 107 of, to amend and repeal Section 128335 of, to add3 Sections 1374.722, 120972.1, 122445, 127002, 128337, and 128338 to, to add Article 11.9 (commencing with Section 1399.870 to Chapter 2.2 of Division 2 of, to add Chapter 14 (commencing with Section 1860) to Division 2.5 of, to add Chapter 13.8 (commencing with Section 121295) to Part 4 of Division 105 of, to add Chapter 1.5 (commencing with Section 127825) to Part 3 of Division 107 of, and to add Division 109.7 (commencing with Section 130290) to, to add and repeal Chapter 1.7 (commencing with Section 103871) of Part 2 of Division 102 of, to repeal Sections 103870.2, 125075, 127015, 127020, 127025, 127030, 127035, 127040, 127045, 127050, 127125, 127130, 127135, 127140, 127145, 127150, 127155, 127160, 127165, 127170, 127175, 127180, 127185, 127190, 127195, 127200, 127205, 127210, 127215, 127220, 127225, 127230, 127235, 127240, 127245, 127250, 127255, 127260, 127265, 127270, 127275, 127290, 127295, 127300,128207, 128224, 128240, 128240.1 128241, 128340, 128395, 128456, 128495, 128554, 128557, and 128681 of, to repeal the heading of Article 1 of Chapter 2 of Part 2 of Division 107 of, to repeal the heading of Article 3 of Chapter 4 of Part 3 of Division 107 of, to repeal the heading of Chapter 2 of Part 5 of Division 107 of, to repeal the heading of Chapter 3 of Part 5 of Division 107 of, to repeal the heading of Chapter 2 of Part 7 of Division 107 of, to repeal Article 1 (commencing with Section 127750) of Chapter 1 of Part 3 of Division 107 of, to repeal Article 2.5 (commencing with Section 127925) of Chapter 2 of Part 3 of Division 107 of, to repeal Article 2 (commencing with Section 128198) of Chapter 3 of Part 3 of Division 107 of, to repeal Article 2 (commencing with Section 128250) of Chapter 4 of Part 3 of Division 107 of, to repeal Article 3 (commencing with Section 128425) of Chapter 5 of Part 3 of Division 107 of, to repeal Article 6 (commencing with Section 128560) of Chapter 5 of Part 3 of Division 107 of, to repeal Part 4 (commencing with Section 128600) of Division 107, to repeal Chapter 3 (commencing with Section 127575) of Part 2 of Division 107 of, Chapter 4 (commencing with Section 127620) of Part 2 of Division 107 of, and Chapter 8 (commencing with Section 127670) of Part 2 of Division 107 of, to repeal Chapter 2 (commencing with Section 129375) of Part 6 of Division 107 of, and to repeal Chapter 2 of Part 7 of Division 107 of, and to repeal and add Sections 128225 and 128360 of, the Health and Safety Code, to add Section 10144.53 to the Insurance Code, to amend Sections 1370, 1370.01, 1372, and 4011.11 of the Penal Code, to add Section 30130.59 to the Revenue and Taxation Code, to amend Sections 4100, 4122, 4361, 5886, 7275, 7276, 7277.1, 7278, 7282, 14005.18, 14007.8, 14011.10, 14042.1, 14043.15, 14059.5, 14087.46, 14105.075, 14105.192, 14105.22, 14105.48, 14124.12, 14124.89, 14127.6, 14131.10, 14132.968, 14184.10, 14184.30, 14184.40, 14188.1, 14196.2, 14196.4, 14196.5, 14197.4, 14301.1, 15840, and 17601 of, to amend and repeal Sections 14132.275, 14132.276, 14132.277, 14182.16, 14182.17, 14182.18, 14186, 14186.1, 14186.2, 14186.3, and 14186.4 of, to amend, repeal, and add Section 14132 of, to add Chapter 6.7 (commencing with Section 4361.5) to Part 3 of Division 4 of, to add Part 7 (commencing with Section 5960) to Division 5 of, to add Article 5.51 (commencing with Section 14184.100) to Chapter 7 of Part 3 of Division 9 of, to add Sections 4147, 4335.2, 14000.6, 14005.185, 14005.62, 14043.51, 14105.194, 14105.222, 14126.029, 14132.755, 14132.85, 14132.969, and 14197.9 to, to repeal Chapter 1 (commencing with Section 5960) of Part 7 of Division 5 of, to repeal Sections 14021.37 and 14105.485 of, and to repeal and add Sections 14124.90 and 14188.4 of, the Welfare and Institutions Code, to repeal Section 69 of Chapter 12 of the Statutes of 2020, and to amend Items 4265-001-0001 and 4265-111-0001 of Section 2.00 of the Budget Act of 2019 (Chapters 23 and 55 of the Statutes of 2019), relating to health, and making an appropriation therefor, to take effect immediately, bill related to the budget.

[ Approved by Governor  July 27, 2021. Filed with Secretary of State  July 27, 2021. ]

LEGISLATIVE COUNSEL'S DIGEST


AB 133, Committee on Budget. Health.
(1) Existing law establishes the Office of Statewide Health Planning and Development (OSHPD), under the control of an executive officer known as the Director of Statewide Health Planning and Development. The office is vested with all the duties, powers, purposes, and responsibilities of the State Department of Public Health relating to health planning and research development. Existing law creates the health care workforce clearinghouse to serve as the central source of health care workforce and education data in the state to collect data regarding health care workers, including the supply of health care workers and current and forecasted demand for health care workers.
This bill would rename the Office of Statewide Health Planning and Development as the Department of Health Care Access and Information. The bill would repeal numerous duties and programs currently carried out by the OSHPD, including, among others, rural health care transition oversight, the Steven M. Thompson Medical School Scholarship Program, and the Postsurgical Care Demonstration Project.
This bill would eliminate the health care workforce clearinghouse and establish the California Health Workforce Research and Data Center to serve as the state’s central source of health care workforce and education data and to inform state policy regarding health care workforce issues. The bill would establish uniform requirements for the reporting and collection of workforce data from health care-related licensing boards to the data center and make related conforming changes. The bill would require the department to maintain the confidentiality of licensee information collected pursuant to these provisions and would only authorize the department to release the information in aggregate form.
Existing law makes the office responsible for administering various programs with respect to the health care professions. Existing law establishes various programs to facilitate the expansion of the health care workforce in rural and underserved communities, including, but not limited to, the Health Professions Career Opportunity Program and the California Registered Nurse Education Program. Existing law requires the office to establish a nonprofit public benefit corporation known as the Health Professions Education Foundation to perform various duties with respect to implementing health professions scholarship and loan programs. Existing law also establishes the California Healthcare Workforce Policy Commission to, among other things, identify specific areas of the state where unmet priority needs for primary care family physicians and registered nurses exist and to make recommendations to the Director of Statewide Health Planning and Development with regard to the funding of specific programs.
This bill would dissolve the Health Professions Education Foundation, but would authorize the department to continue various foundation programs, such as the California Registered Nurse Education Program. The bill would also eliminate the California Healthcare Workforce Policy Commission and replace it with the California Health Workforce Education and Training Council to plan and coordinate California’s approach to health workforce education and training in order to develop a health workforce to meet statewide health care needs. The bill would change the composition of the membership of the council and would authorize the council, among other things, to make recommendations to the department regarding the use of health care education and training funds and advocate for additional funds and additional sources of funds to stimulate graduate medical education expansion in California. The bill would make related conforming changes to existing provisions.
This bill would require the Health Professions Career Opportunity Program to be implemented at colleges and universities, as specified, with priority given to campuses in medically underserved areas or with students from groups underrepresented in medicine, demonstrated commitment to diversity and associated institutional change, a track record of providing tailored student support, and strong health professions school partnerships, as specified.
Existing law authorizes the office to oversee various aspects of the health care market, including oversight of hospital facilities and community benefit plans. Existing law also requires the office to adopt and enforce regulations prescribing building standards for the adequacy and safety of health facility physical plants.
This bill would make necessary conforming changes to these provisions to reflect the reorganization of the office to the Department of Health Care Access and Information.
(2) 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 makes a willful violation of the act a crime.
This bill would require the department, on or before March 1, 2022, to convene a Health Equity and Quality Committee to make recommendations to the department for standard health equity and quality measures, including annual benchmark standards for assessing equity and quality in health care delivery. The bill would require the department to consider the committee’s recommendations and to establish standard measures and annual benchmarks for equity and quality in health care delivery. The bill would require a health care service plan, including a Medi-Cal managed care plan not licensed by the department, to annually submit to the department a report containing equity and quality data and information. The bill would require the department to review a health care service plan’s equity and quality report to determine the plan’s compliance with the health equity and quality standard measures and annual benchmarks established by the department. The bill would authorize the department to take certain actions against a health care service plan that does not demonstrate compliance with the requirements of the bill, including requiring a health care service plan to implement corrective action to achieve and demonstrate compliance with the standard measures and annual benchmarks, monitoring a corrective action plan, and assessing administrative penalties, as provided. The bill would require the department, commencing in 2025, and annually thereafter, to publish on its internet website a Health Equity and Quality Compliance Report. The bill would authorize the department to implement the bill by means of all-plan letters or similar instructions, without taking regulatory action until January 1, 2027. The bill would require a health care service plan, but not a Medi-Cal managed care plan, to be accredited by the National Committee for Quality Assurance on or before January 1, 2026. Because a willful violation of the bill’s provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program.
(3) Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services pursuant to a schedule of benefits. The Medi-Cal program is, in part, governed by, and funded pursuant to, federal Medicaid program provisions. Under existing law, the schedule of benefits includes the purchase of prescribed drugs, subject to the Medi-Cal List of Contract Drugs and utilization controls. Existing law excludes nonlegend cough, cold, and acetaminophen-containing products from the schedule of benefits, with prescribed exceptions, such as children’s acetaminophen-containing products.
This bill would expand, on July 1, 2021, the Medi-Cal schedule of benefits to include nonlegend cough, cold, and acetaminophen-containing products.
(4) Existing law establishes that the Medi-Cal program covers specified health care services, including substance use disorder treatment, pursuant to a state plan. Under existing law, the Director of Health Care Services has those powers and duties to conform to requirements for securing approval of a state plan under federal law, and, pursuant to this authority, the director secured approval for the state plan to include clinical preventive services that are assigned a grade of A or B by the United States Preventive Services Task Force, including adult Alcohol Misuse Screening and Behavioral Counseling Interventions in Primary Care, such as screening for misuse of opioids and other illicit drugs. Existing law requires the department to seek federal approval to expand the Medi-Cal benefit for adult Alcohol Misuse Screening and Behavioral Counseling Interventions in Primary Care to include screening for misuse of opioids and other illicit drugs, and suspends the implementation of these provisions on December 31, 2021, unless specified circumstances apply.
This bill would repeal obsolete law on the department’s obligation to seek federal approval to expand the above-specified benefit and the suspension of the implementation of those provisions.
(5) Under existing law governing the Medi-Cal program, health care services are rendered by enrolled Medi-Cal providers, who are subject to specified requirements relating to provider enrollment. Existing federal law requires a state Medicaid program to implement electronic visit verification for prescribed Medicaid services, including personal care services and home health services that require an in-home visit by a provider.
This bill would authorize the department to undertake action to implement an electronic visit verification system for purposes of obtaining and maintaining federal approval or ensuring federal financial participation is available or not otherwise jeopardized, and to partner and contract with specified governmental entities, including the State Department of Social Services, to comply with federal requirements on electronic visit verification. If a provider renders Medi-Cal services that are subject to electronic visit verification, the bill would require the provider to comply with requirements on electronic visit verification, as established by the department and its partners, and would authorize the department and its partners to take prescribed action, such as requiring an approved correction action plan, to address a provider’s noncompliance of those requirements. The bill would authorize the department and its partners to enter into contracts to implement these provisions, and to implement these provisions by various means, including provider bulletins.
(6) Under existing federal and state law, Medi-Cal is required to be the payer of last resort if a Medi-Cal beneficiary has other health coverage in addition to Medi-Cal. To assess overlapping or duplicate health coverage, existing law requires specified other health coverage entities to maintain a centralized file with specified information about their subscribers, enrollees, or policyholders, and to make this information available to the department upon reasonable request by the department.
Under existing law, other health coverage entities that are legally responsible for payment of a claim for a health care item or service are required to provide specified information to the department, at the department’s request, upon certification by the department that the information requested is pertaining to an individual that is an applicant for, recipient of, or legally responsible person for an applicant for, or recipient of, Medi-Cal services. Existing law requires the department to enter into cooperative agreements with other health coverage entities to establish mutually agreeable procedures for requesting and furnishing specified information to the department about a beneficiary’s other health coverage and provides for the reimbursement, as specified, of other health coverage entities for complying with these provisions.
This bill would add to the list of other health coverage entities subject to these provisions all health entities licensed by the Department of Insurance, third-party administrators, and union trusts. The bill would also add new categories of information that the other health coverage entities are required to maintain about a subscriber, policyholder, enrollee, or insured. The bill would require other health coverage entities to enter into a cooperative agreement with the department for the provision of specified information, rather than placing this requirement on the department. The bill would require that the information provided pursuant to these cooperative agreements be provided to the department within 90 days of the department’s request for the information, at no cost to the department, eliminating the existing reimbursement provisions.
The bill would require that the subscriber, policyholder, enrollee, or insured information required to be maintained in the centralized file be provided to the department, at least once a month, in a format specified by the department. The bill would also require this information be provided to the department’s agents and Medi-Cal managed care plans upon reasonable request. The bill would require the specified entities to provide the department with real-time, electronic eligibility verification, at no cost, and in a form and manner specified by the department. The bill would also authorize the department to implement these requirements by means of policy letter, information notice, or other similar instruction, without taking any further regulatory action.
(7) Existing law excludes specified optional services from coverage in the Medi-Cal program, including audiology services, optometric services, podiatric services, and incontinence creams and washes, among others. Notwithstanding this exclusion, existing law restores coverage for specified optional benefits, including audiology services, optometric services, podiatric services, and incontinence creams and washes. Existing law suspends these optional benefits on December 31, 2021, unless specified conditions occur.
This bill would delete the provisions suspending these optional benefits.
(8) Under existing law, an individual is eligible for Medi-Cal benefits, to the extent required by federal law, as though the individual was pregnant, for all pregnancy-related and postpartum services for a 60-day period beginning on the last day of pregnancy. Existing law, subject to an appropriation in the annual Budget Act, extends Medi-Cal eligibility for a pregnant individual who receives health care coverage under the Medi-Cal program, or another related program, and who has been diagnosed with a maternal mental health condition, for a period of one year following the last day of the individual’s pregnancy if the individual complies with certain requirements. Existing law suspends implementation of these provisions on December 31, 2021, unless specified circumstances apply.
This bill would remove the conditional suspension of the above Medi-Cal eligibility extension. The bill would make those provisions on eligibility extension inoperative upon implementation of the extended eligibility provisions described below, and would restore their operation if the provisions below are no longer implemented. The bill would require the department to determine the implementation status of the provisions below and to post, on its internet website, notice of its determination.
The bill would instead extend eligibility for full-scope Medi-Cal benefits for a pregnant individual or targeted low-income child who is eligible for and is receiving health care coverage under the Medi-Cal program, or another related program, for the duration of the pregnancy and for a period of one year following the last day of the individual’s pregnancy, without conditioning the extended eligibility to a diagnosis of a maternal mental health condition.
The bill would require the department to seek any necessary federal approvals for these purposes. Coverage under these provisions would commence on April 1, 2022, or the effective date or dates reflected in any necessary federal approvals obtained by the department, whichever is later. The bill would make implementation of these provisions subject to an appropriation, receipt of any necessary federal approvals, except as specified, and the availability of federal financial participation.
The bill would make conforming changes to related provisions.
Because counties are required to make eligibility determinations, and this bill would expand Medi-Cal eligibility, the bill would impose a state-mandated local program.
(9) The California Healthcare, Research and Prevention Tobacco Tax Act of 2016, an initiative measure approved as Proposition 56 at the November 8, 2016, statewide general election, increases taxes imposed on distributors of cigarettes and tobacco products and requires all revenues to be deposited into the California Healthcare, Research and Prevention Tobacco Tax Act of 2016 Fund, a continuously appropriated fund. That act allocates those revenues for specified purposes, including $30,000,000 to provide funding to the State Department of Public Health state dental program for the purpose and goal of educating about, preventing, and treating dental disease, including dental disease caused by the use of cigarettes and other tobacco products. Under existing law, if there is a reduction in revenues resulting from a reduction in the consumption of cigarettes and tobacco products due to the additional taxes imposed on cigarettes, the amount of funds allocated to specified programs, including the state dental program, is required to be reduced proportionally.
This bill would, contingent upon a reduction in allocations to the state dental program, backfill the reduced amount by continuously appropriating moneys from the General Fund in an amount equivalent to the required reduction, so that the total funding for the state dental program remains at $30,000,000 annually. By continuously appropriating moneys from the General Fund, this bill would make an appropriation.
(10) Existing law allocates a specified percentage of those revenues to the department to increase funding for the Medi-Cal program, in a manner that, among other things, ensures timely access, limits specific geographic shortages of services, or ensures quality care. Existing law establishes the Healthcare Treatment Fund for this purpose.
Existing law authorizes the department to use those funds to make supplemental payments or rate increases for specified service categories, including physician services, dental services, and home health providers, and programs, including value-based payment (VBP) programs. Existing law suspends the department’s ability to make those supplemental payments and rate increases after July 1, 2021, unless specified conditions apply, including that the estimates of General Fund revenue and expenditures for the 2021–22 and 2022–23 fiscal years contain estimated annual General Fund revenues that exceed estimated annual General Fund expenditures for those fiscal years by an amount equal to or greater than the sum total of all General Fund appropriations for other specified programs subject to suspension.
This bill would repeal these provisions imposing the suspension.
Existing law requires the department to develop, using moneys appropriated in the Budget Act for this purpose from the Healthcare Treatment Fund, VBP programs that require designated Medi-Cal managed care plans to make incentive payments to qualified network providers in behavioral health integration (BHI), prenatal and postpartum care, and chronic disease management for prescribed purposes. Existing law makes the VBP programs inoperative on July 1, 2021, if the department’s ability to make those supplemental payments and rate increases is suspended, as specified above.
With respect to VBP programs aimed at improving BHI in Medi-Cal managed care, existing law requires designated Medi-Cal managed care plans to make incentive payments to qualified network providers, as prescribed, and authorizes qualified network providers to be eligible for different levels of incentive payments depending on the level of integration.
For VBP programs aimed at improving BHI in Medi-Cal managed care, this bill would instead authorize designated Medi-Cal managed care plans to earn incentive payments for achieving milestones and measures through partnerships with qualified network providers, and would provide that different levels of incentive payments may be available depending on the level of integration. For VBP programs, the bill would delete the provisions making those programs inoperative on July 1, 2021, and would require the department to implement payments under VBP programs for a service period during a state fiscal year subject to appropriation by the Legislature for that state fiscal year.
(11) Existing law, the Medi-Cal 2020 Demonstration Project Act, requires the department to implement specified components of a Medi-Cal demonstration project, including the Global Payment Program (GPP), the Dental Transformation Initiative, and the Whole Person Care pilot program, consistent with the Special Terms and Conditions approved by the federal Centers for Medicare and Medicaid Services. Pursuant to existing law, the department has created a multiyear initiative, the California Advancing and Innovating Medi-Cal (CalAIM) initiative, to build upon the outcomes of various Medi-Cal pilots and demonstration projects, including the Medi-Cal 2020 Demonstration Project Act.
This bill would establish the CalAIM initiative in statute to support the stated goals of identifying and managing the risk and needs of Medi-Cal beneficiaries, transitioning and transforming the Medi-Cal program to a more consistent and seamless system, and improving quality outcomes. The bill would require the department to seek federal approval for the CalAIM initiative, and would condition its implementation on receipt of federal approvals and availability of federal financial participation. For implementation purposes, the bill would authorize the department to enter into exclusive or nonexclusive contracts, or amend existing contracts. The bill would require the department to issue guidance identifying permissible data-sharing arrangements to implement CalAIM. To the extent authorized by the CalAIM Terms and Conditions, the bill would authorize the department to claim federal financial participation for expenditures associated with the designated state health care programs identified in the CalAIM Terms and Conditions for use solely by the department, and would appropriate both federal and General Fund moneys to the Health Care Deposit Fund in an amount equal to the federal financial participation that may be claimed under these provisions.
This bill would authorize the department to make incentive payments, grants, or other financial support available to qualified entities or providers, as specified, under the Providing Access and Transforming Health (PATH) program to support services, infrastructure, and capacity building in advancing and complimenting select goals and components of CalAIM. The bill would require the department to establish the methodologies, parameters, and eligibility criteria for PATH payments.
This bill would require the department to standardize those applicable covered Medi-Cal benefits provided by Medi-Cal managed care plans under comprehensive risk contracts with the department on a statewide basis and across all models of Medi-Cal managed care in accordance with specified requirements and the CalAIM Terms and Conditions.
This bill would authorize the department to standardize those populations that are subject to mandatory enrollment in a Medi-Cal managed care plan across all aid code groups and Medi-Cal managed care models statewide, subject to a Medi-Cal managed care plan readiness, continuity of care transition plan, and disenrollment process developed in consultation with stakeholders, in accordance with specified requirements and the CalAIM Terms and Conditions.
Under the CalAIM initiative, this bill would require the department to implement an enhanced care management (ECM) benefit designed to address the clinical and nonclinical needs on a whole-person-care basis for certain target populations of Medi-Cal beneficiaries enrolled in Medi-Cal managed care plans, as specified. The bill would require Medi-Cal managed care plans to consult and collaborate with county mental health plans for the delivery of ECM services for beneficiaries with certain health conditions, including serious mental illness, to maximize federal reimbursement and minimize duplication of services. The bill would require the department to require those plans to report specified information related to the ECM benefit and would require the department to annually publicly report on the utilization of ECM in a manner that allows for an analysis of demographic populations, as specified.
As part of the CalAIM initiative, and commencing January 1, 2022, this bill would require the department to authorize Medi-Cal managed care plans to elect to cover those services or settings approved by the department as cost effective and medically appropriate in the comprehensive risk contract that are in lieu of applicable Medi-Cal state plan services. The bill would provide that in lieu of services include specified services, such as housing transition navigation services, recuperative care, and asthma remediation. The bill would require the department to establish metrics for, and conduct an annual evaluation of, the utilization and effectiveness of in lieu of services, and to publicly report the evaluation, as specified.
This bill would reorganize or repeal some of those provisions relating to the Medi-Cal 2020 Demonstration Project Act under the CalAIM initiative, and would continue other components of the Medi-Cal 2020 Demonstration Project Act, including the GPP, Medi-Cal dental efforts, such as the state plan dental improvement program, and enhancement of county oversight and monitoring, as components of the CalAIM initiative. Under the CalAIM initiative, the bill would make various changes to the Medi-Cal managed care system, including requiring prescribed accreditation by the National Committee for Quality Assurance or an alternative entity and providing incentive payments to plans.
As part of the CalAIM initiative, this bill would make various changes to the Medi-Cal behavioral health delivery system. The bill would set forth requirements for coverage of certain nonspecialty mental health services by a Medi-Cal managed care plan or the Medi-Cal fee-for-service delivery system, and coverage of specialty mental health services by a county mental health plan, as specified. The bill would prohibit a dispute between a county mental health plan and a Medi-Cal managed care plan from delaying the provision of medically necessary services by either of those plans. The bill would also set forth requirements for covered services provided under a Drug Medi-Cal Treatment Program or a Drug Medi-Cal organized delivery system, including the use of certain professional criteria and coverage of all medically necessary substance use disorder services for an individual under 21 years of age, as specified. The bill would require the department to develop standardized screening tools, statewide transition tools, and documentation standards related to care transitions in the behavioral health delivery system, as specified. The bill would also require the design of an intergovernmental transfer-based reimbursement methodology. The bill would require the department to establish, implement, and administer the Behavioral Health Quality Improvement Program to provide grants to qualified Medi-Cal behavioral health delivery systems to prepare those entities and their contracting health care providers for implementation of CalAIM behavioral health components, and would impose requirements on the department relating to the behavioral health delivery system, such as determining the eligibility criteria. Commencing January 1, 2027, the bill would require 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.
Subject to federal approval, and under the CalAIM initiative, this bill would require the department to implement the State Plan Dental Improvement Program to further improving accessibility of Medi-Cal dental services and oral health outcomes for targeted populations, as specified.
As a component of the CalAIM initiative, on and after July 1, 2022, this bill would require the department, in consultation with representatives of county welfare departments and other affected stakeholders, to develop and make publicly available a dashboard that reflects each county’s performance in meeting existing County Administrative Cost Control Plan measures. During the CalAIM term, the bill would require the department to develop and implement specified initiatives to enhance oversight and monitoring of county administration of the California Children’s Services (CCS) program and would require the department to convene a workgroup consisting of counties and other stakeholders to develop and implement one or more initiatives designed to improve the collection and use of beneficiary demographic and contact information in administering the Medi-Cal program and other public assistance programs.
Commencing January 1, 2023, the bill would require the department to implement the Population Health Management Program under the Medi-Cal managed care delivery system to improve health outcomes, care coordination, and efficiency through application of standardized health management requirements. The bill would require the department to require each Medi-Cal managed care plan to develop and maintain a beneficiary-centered population health management program that meets specified standards, including identifying and mitigating social determinants of health and reducing health disparities or inequities. The bill would require the department to consult with specified stakeholders, including the State Department of Public Health, to establish requirements for the population health management program, as specified, and, beginning January 1, 2024, would require the department to annually post an analysis of the Population Health Management Program on its internet website.
As part of the CalAIM initiative, this bill would authorize the department to establish capitation rates to contracted health plans on a regional basis in lieu of health plan and county-specific rates, and would require the department to consult with and provide a briefing to affected entities and individuals, as specified. Before the implementation of a regional-based capitation rate, the bill would require the department to report to the Legislature on specified matters, including how these rates are to be established. The bill would require the department to publish on its public internet website a description of the rate methodology, data used for rate development, and core actuarial assumptions and adjustments in each year that the department develops these rates. The bill would authorize the department to develop and implement appropriate actuarial methods to prevent significant overpayments or significant underpayments, as specified.
(12) Existing federal law provides for the federal Medicare program, which is a public health insurance program for persons who are 65 years of age or older and specified persons with disabilities who are under 65 years of age. Under existing law, a demonstration project known as the Coordinated Care Initiative (CCI) enables beneficiaries who are dually eligible for the Medi-Cal program and the Medicare Program to receive a continuum of services that maximizes access to, and coordination of, benefits between these programs.
As a component of the CalAIM initiative, this bill would make CCI operative only through December 31, 2022, as specified, and would repeal its provisions on January 1, 2025. The bill would require Medi-Cal managed care plans to operate, or continue to operate, a Medicare Advantage Dual Special Needs Plan, commencing January 1, 2023, in CCI counties, and, commencing January 1, 2026, in all other counties.
(13) Existing law authorizes the department to create the Health Home Program for Medi-Cal enrollees with chronic conditions, subject to federal approval and the availability of federal financial participation. Existing law generally conditions the implementation of the program on no additional General Fund moneys being used to fund the administration and costs of services.
Commencing with the 2021–22 state fiscal year, this bill would authorize program implementation using General Funds moneys upon appropriation by the Legislature. The bill would require the department to cease implementing the program on January 1, 2022, or as specified, and would repeal the program’s provisions on January 1, 2023.
(14) Existing law authorizes the board of supervisors in each county to designate an entity or entities to assist county jail inmates to apply for a health insurance affordability program, as defined, consistent with federal requirements.
Commencing January 1, 2023, this bill would instead require the board of supervisors, in consultation with the county sheriff, to designate an entity or entities to assist both county jail inmates and juvenile inmates with the application process. The bill would make conforming changes to provisions relating to the coordination duties of jail administrators. By creating new duties for local officials, including boards of supervisors and jail administrators, the bill would impose a state-mandated local program.
No sooner than January 1, 2023, the bill would require the department to develop and implement a mandatory process for county jails and county juvenile facilities to coordinate with Medi-Cal managed care plans and Medi-Cal behavioral health delivery systems to facilitate continued behavioral health treatment in the community for inmates. The bill would authorize the sharing of certain information, including health records, with and among counties and other specified entities, as determined necessary by the department.
(15) Existing law provides for the suspension of Medi-Cal benefits to an inmate of a public institution, and requires county welfare departments to notify the department within 10 days of receiving information that an individual who is receiving Medi-Cal is or will be an inmate of a public institution. Existing law generally requires a county to redetermine a Medi-Cal beneficiary’s eligibility to receive Medi-Cal benefits every 12 months and whenever the county receives information about changes in a beneficiary’s circumstances that may affect their eligibility for Medi-Cal benefits.
This bill would, beginning no sooner than January 1, 2023, require that a qualifying inmate of a public institution be eligible to receive targeted Medi-Cal services approved in the CalAIM Terms and Conditions for 90 days, or the number of days approved in the CalAIM Terms and Conditions if fewer than 90 days, prior to the date they are released from a public institution, if otherwise eligible for the services. The bill would, to the extent federal approval is obtained for this purpose, require the department to arrange for an independent, third-party evaluation of the hypotheses and outcomes associated with providing targeted Medi-Cal services to qualifying inmates as described in the CalAIM Terms and Conditions. The bill would require the department to post the evaluation report on its internet website following submission to the federal Centers for Medicare and Medicaid Services. The bill would also, commencing no sooner than July 1, 2021, require the department, in consultation with specified stakeholders, to initiate the planning process to prioritize the automation of Medi-Cal suspensions for incarcerated individuals into the California Healthcare Eligibility, Enrollment, and Retention System, as specified.
(16) For purposes of the programs and services described in paragraphs (11) to (15), inclusive, this bill would make conforming changes to provisions relating to the adoption of regulations or issuance of all-county letters by the department.
(17) Existing law includes coverage for specified pharmacist services under the Medi-Cal program, subject to federal approval, the availability of federal financial participation, department protocols, and utilization controls.
This bill would add medication therapy management (MTM) pharmacist services, provided in conjunction with the dispensing of qualified specialty drugs, to the list of covered pharmacist services under the Medi-Cal program, subject to the above conditions. The bill would define MTM and specialty drugs for purposes of these provisions.
Existing law requires that the rate of reimbursement for pharmacist services be at 85% of the fee schedule for physician services under the Medi-Cal program.
This bill would make an exception for the above MTM pharmacist services and would, subject to an annual appropriation, require the department to implement an MTM reimbursement methodology for covered pharmacist services related to the dispensing of qualified specialty drugs by an eligible pharmacy contracted with the department. The bill would require the department to establish and maintain protocols and utilization controls, a list of covered specialty drug therapy categories, rates of reimbursement, and eligibility criteria and conditions for receipt of MTM pharmacist services reimbursement, as specified.
(18) Existing federal law establishes the Money Follows the Person Rebalancing Demonstration, which is designed to achieve various objectives with respect to institutional and home- and community-based long-term care services provided under state Medicaid programs. Under the Money Follows the Person Rebalancing Demonstration, an eligible individual is required to meet prescribed qualifications, including that they have resided in an inpatient facility for a period of not less than 60 consecutive days.
Existing law requires the department to provide services consistent with the Money Follows the Person Rebalancing Demonstration for transitioning eligible individuals out of an inpatient facility. Existing law defines “eligible individual” for these purposes as a person who meets certain requirements, including the prescribed qualifications set forth under federal law, except that the person is not required to have resided for at least 90 consecutive days in an inpatient facility. Existing law requires the department to cease providing those services on January 1, 2024, and repeals these provisions on January 1, 2025.
This bill would delete the 90 consecutive day residence period, and would instead provide that the eligible individual is not required to have resided for at least 60 consecutive days in an inpatient facility. The bill would make other conforming changes.
(19) Existing law requires, for the duration of the COVID-19 emergency period, the State Department of Health Care Services to implement any federal Medicaid program waiver or flexibility approved by the federal Centers for Medicare and Medicaid Services related to that emergency.
This bill would require the department to seek any federal approvals it deems necessary to extend the approved waiver or flexibility implemented pursuant to those provisions as of July 1, 2021, that are related to the delivery and reimbursement of services via telehealth modalities in the Medi-Cal program, and, subject to approval by the Department of Finance, would require the department to implement those extended waivers or flexibilities for which federal approval is obtained for a specified period of time ending December 31, 2022. The bill would also require the department to convene an advisory group to provide recommendations to inform the department in establishing and adopting billing and utilization management protocols for telehealth modalities to increase access and equity and reduce disparities in the Medi-Cal program. The bill would authorize the department to enter into contracts, or amend existing contracts, for the purposes of implementing these provisions and would exempt those contracts or amendments from specified provisions of law.
(20) The Long-Term Care, Health, Safety, and Security Act of 1973 generally requires the State Department of Public Health to license and regulate long-term health care facilities and to establish an inspection and reporting system to ensure that long-term health care facilities are in compliance with state statutes and regulations. The term “long-term health care facility” includes, among other types of facilities, a skilled nursing facility and intermediate care facility. Existing law provides that it is the intent of the Legislature to expressly set forth fundamental human rights which patients are entitled to in a skilled nursing facility, intermediate care facility, or hospice facility, and to ensure that patients in those facilities are advised of their fundamental human rights, including rights relating to transfers and discharges, and the obligations of the facilities.
Existing law, the Medi-Cal Long-Term Care Reimbursement Act, requires, among other things, the State Department of Health Care Services to implement a facility-specific reimbursement ratesetting system for certain skilled nursing facilities. Under the act, existing law requires nursing facilities to meet the residents’ discharge planning and referral needs, or make referrals to a designated local contact agency, as determined by the department.
This bill would require a long-term health care facility, as defined, to timely comply with a hearing decision, as issued by the department’s Office of Administrative Hearings and Appeals, that finds that the facility improperly transferred, discharged, or refused to readmit a resident. If a facility fails to timely comply with a hearing decision, the bill would authorize the department to assess penalties of $750 for each calendar day the facility fails to comply with the hearing decision. To demonstrate compliance with a hearing decision, the bill would require a facility to file a specified certification of compliance with the department, would require the department to make a certificate of compliance available on its internet website, and would provide that the facility’s failure to provide the certification of compliance would subject the facility to the prescribed penalties, except as specified. The bill would authorize the department to deduct the penalties from Medi-Cal payments to the facility if the department provides prior written notice to the facility and takes into account the financial condition of the facility. If there is a merger, acquisition, or change of ownership involving a facility that has outstanding penalties, the bill would require the successor long-term health care facility to be responsible for paying to the department the amount of outstanding penalties attributable to the facility for which it was assessed. The bill would authorize the department to waive assessed penalties if that facility petitions for a waiver and the department makes a determination that the facility meets certain requirements, including that the facility has taken corrective action to remediate its improper conduct. The bill would provide that the assessed penalties are appealable only to the superior court of the county where the facility is located and would require the department to refund any penalties paid by a long-term health care facility if the hearing decision is reversed on appeal. The bill would require collected penalties to be deposited into the General Fund, and, upon appropriation by the Legislature, to be used for particular purposes, including to improve the quality of long-term care services under the Medi-Cal program, would authorize the department to implement these provisions by various means, including provider bulletins, and would require the department to seek federal approvals, as necessary, to implement these provisions. The bill would condition the implementation of these provisions to the extent that necessary federal approvals are obtained and federal financial participation is not jeopardized.
(21) Existing law requires the State Department of Health Care Services to establish a Medically Tailored Meals Pilot Program in specified counties to provide medically tailored meals, as defined, to Medi-Cal participants with specified health conditions, such as cancer and renal disease. Existing law requires the department to evaluate, at the conclusion of the program, the impact of the pilot program on specified matters related to participants, including hospital readmission and emergency room utilization rates, and to send a report on the evaluation to the Legislature.
For the 2021–22 fiscal year, this bill would require the department to implement the Short-Term Medically Tailored Meals Intervention Services Program to award funds to qualified entities providing medically tailored meals intervention services to eligible Medi-Cal beneficiaries with certain health conditions, such as cancer and congestive heart failure, who reside in specified counties. To the extent funding is available, the bill would require an eligible Medi-Cal beneficiary to receive medically tailored meals intervention services, as prescribed, for a period of 12 to 52 weeks, depending on the medical diagnosis and need. The bill would authorize the department to implement additional eligibility requirements for individuals to receive these services, and to use data from the Medi-Cal program to identify eligible Medi-Cal beneficiaries who may receive services under the Short-Term Medically Tailored Meals Intervention Services Program. The bill would require providers that are awarded funding to monitor and document the impacts of this program, including health outcomes, and to provide that information to the department. The bill would require the department to develop a methodology for reimbursing contractors or other entities for services and would require the department to allocate 5% of the funds allocated for purposes of the program to a nonprofit organization fiscal sponsor to coordinate the program, as specified.
Existing law makes the provisions of the Medically Tailored Meals Pilot Program inoperative on the earlier of the date the department submits its report to the Legislature or 12 months after the end of that program.
This bill would instead make these provisions inoperative on the date the department submits its report to the Legislature or 12 months after the end of the Medically Tailored Meals Pilot Program or the Short-Term Medically Tailored Meals Intervention Services Program, whichever occurs last.
(22) The federal Medicaid program provisions prohibit payment to a state for medical assistance furnished to an alien who is not lawfully admitted for permanent residence or otherwise permanently residing in the United States under color of law.
Existing law requires individuals under 19 years of age enrolled in restricted-scope Medi-Cal benefits at the time the Director of Health Care Services makes a determination that systems have been programmed for implementation of these provisions to be enrolled in the full scope of Medi-Cal benefits, if otherwise eligible, pursuant to an eligibility and enrollment plan, and extends eligibility for full-scope Medi-Cal benefits to individuals who are under 25 years of age, and who are otherwise eligible for those benefits but for their immigration status. Existing law makes the effective date of enrollment for those individuals the same day that systems are operational to begin processing new applications pursuant to the director’s determination. Existing law requires an individual eligible for Medi-Cal under these provisions to enroll in a Medi-Cal managed care health plan. Existing law provides that Medi-Cal benefits for individuals who are 65 years of age or older, and who do not have satisfactory immigration status or are unable to establish satisfactory immigration status, as specified, are to be prioritized in the annual Budget Act for the upcoming fiscal year if the Department of Finance projects a positive ending balance in the Special Fund for Economic Uncertainties for the upcoming fiscal year and each of the ensuing 3 fiscal years that exceeds the cost of providing those individuals with full-scope Medi-Cal benefits.
The bill would delete the above-specified provisions regarding individuals who are under 19 or 25 years of age, or 65 years of age or older, and delay implementation until the director makes the determination described above. The bill would instead make an individual who is 25 years of age or younger, and who does not have satisfactory immigration status or is unable to establish satisfactory immigration status, as specified, eligible for the full scope of Medi-Cal benefits if they are otherwise eligible for those benefits, would delete obsolete provisions, and would make conforming changes.
After the director determines, and communicates that determination in writing to the Department of Finance, that systems have been programmed for implementation of these purposes, but no sooner than May 1, 2022, this bill would extend Medi-Cal eligibility for the full scope of Medi-Cal benefits to an individual who is 50 years of age or older, and who does not have satisfactory immigrant status or is unable to establish satisfactory immigration status, as specified, if they are otherwise eligible for those benefits. The bill would make the effective date of enrollment for those individuals the same day that systems are operational to begin processing new applications pursuant to the director’s determination. The bill would provide that a person enrolled in the Medi-Cal program under these provisions is not required to file a new application for the Medi-Cal program, would require the enrollment to be conducted pursuant to a prescribed eligibility and enrollment plan, and would require the department to provide monthly updates to the Legislature, as specified. Because counties are required to make Medi-Cal eligibility determinations and this bill would expand Medi-Cal eligibility to specified individuals who are 50 years of age and older, the bill would impose a state-mandated local program.
(23) Existing law authorizes the department to provide health care services to beneficiaries through models of managed care, including geographic managed care and prepaid health plans, and requires the department to implement a dental managed care program. Dental services are provided under geographic managed care in the County of Sacramento and prepaid health plans in the County of Los Angeles.
This bill would require the department to extend dental managed care contracts to December 31, 2022, and to secure the extensions on a sole source basis, as specified. The bill would authorize the department to implement provisions on the Medi-Cal dental managed care program by prescribed means, including information notices, without taking any further regulatory action.
(24) Existing federal law provides for the federal Medicare program, which is a public health insurance program for persons who are 65 years of age or older and specified persons with disabilities who are under 65 years of age. Under existing law, a demonstration project known as the Coordinated Care Initiative (CCI) enables beneficiaries who are dually eligible for the Medi-Cal program and the Medicare program to receive a continuum of services that maximizes access to, and coordination of, benefits between these programs.
This bill would establish the Office of Medi-Cal Innovation and Integration in the department. The duties of the department would include, among others, to provide focused leadership and expertise on innovative models for Medicare beneficiaries in California, as specified, and to develop innovative approaches to integrated models of care and coordinated access to long-term services and supports for Medicare-only beneficiaries and dually eligible beneficiaries.
(25) Existing law requires Medi-Cal benefits to be provided to individuals eligible for services pursuant to prescribed standards, including a modified adjusted gross income (MAGI) eligibility standard. Existing law prohibits the use of an asset or resources test for individuals whose financial eligibility for Medi-Cal is determined based on the application of MAGI. Existing federal law authorizes a state to establish a non-MAGI standard for determining the eligibility of specified individuals, and existing law imposes the use of a resources test for establishing Medi-Cal eligibility for prescribed populations.
This bill would require the department to seek federal approval to implement specified disregards in nonexempt property for applicants or beneficiaries whose eligibility is not determined using the MAGI-based financial methods, and would condition the implementation of this provision on the Director of Health Care Services determining that systems have been programmed and they communicate that determination in writing to the Department of Finance, and no sooner than July 1, 2022.
This bill would prohibit the use of resources, including property or other assets, to determine Medi-Cal eligibility for applicants or beneficiaries whose eligibility is not determined using the MAGI-based financial methods, and would require the department to seek federal authority to disregard all resources as authorized by the flexibilities provided pursuant to federal law.
The bill would authorize the department to implement these provisions by various means, including provider bulletins, without taking regulatory authority. The bill would require the department to adopt, amend, or repeal regulations on the prohibition, and to update its notices and forms to delete any reference to limitations on resources or assets, as specified. The bill would condition the implementation of the bill’s provisions to the extent consistent with federal law, upon the department obtaining any necessary federal approvals, and to the extent federal financial participation under the Medi-Cal program is available and not otherwise jeopardized.
Because counties are required to make Medi-Cal eligibility determinations, and this bill would expand Medi-Cal eligibility, the bill would impose a state-mandated local program.
(26) The Budget Act of 2018 appropriates $2,000,000 for the Whole Genome Sequencing Pilot Project, and requires the department to provide a grant to a state nonprofit organization for the execution of a one-time pilot project to investigate the potential clinical and programmatic value of utilizing clinical Whole Genome Sequencing in the Medi-Cal program.
This bill would, no sooner than January 1, 2022, expand the Medi-Cal schedule of benefits to include rapid Whole Genome Sequencing, as specified, for any Medi-Cal beneficiary who is one year of age or younger and is receiving inpatient hospital services in an intensive care unit. The bill would authorize the department to implement this provision by various means without taking regulatory action.
(27) Existing law requires the department to develop, subject to federal approval, reimbursement rates for clinical or laboratory services according to specified standards, including requiring that reimbursement to providers for those services not exceed the lowest of enumerated criteria, including 80% of the lowest maximum allowance established by the federal Medicare program for the same or similar services.
For dates of service on or after July 1, 2022, this bill would raise the above-described standard to 100% of the lowest maximum allowance established by the federal Medicare program for the same or similar services. For dates of service from July 1, 2021, to June 30, 2022, inclusive, the bill would require the department to establish the reimbursement rates for clinical laboratory or laboratory services at the rates in effect and approved in the Medi-Cal State Plan as of December 31, 2019. The bill would prohibit the department from retroactively implementing reimbursement reductions and from recouping overpayments for clinical laboratory or laboratory services, as specified.
(28) Existing law authorizes the department to adopt regulations for the certification of each applicant and each provider in the Medi-Cal program. Existing law requires a provider that is not currently enrolled at a location where the provider intends to provide services, goods, supplies, or merchandise to a Medi-Cal beneficiary to submit a complete application package for enrollment at a new location or a change in location. Existing law exempts an applicant, a provider operated by a licensed primary care clinic, or an affiliated mobile health care unit from this requirement and from a requirement to enroll in the Medi-Cal program as a separate provider, if a licensed primary care clinic operating the applicant, provider clinic, or mobile health care unit notifies the department of its separate locations.
This bill would, to the extent permissible under federal law, authorize a mobile optometric office that meets certain requirements to be enrolled in the Medi-Cal program as either a mobile optometric office or within any other provider category for which the applicant or provider qualifies.
(29) Under existing law, durable medical equipment, which includes custom rehabilitation equipment and custom rehabilitation technology services, is a covered Medi-Cal benefit, subject to utilization controls.
Existing law requires a provider of custom rehabilitation equipment and custom rehabilitation technology services to have a qualified rehabilitation professional on staff, as specified, and requires a medical provider to conduct a physical examination of an individual before prescribing a motorized wheelchair or scooter for a Medi-Cal beneficiary.
This bill would repeal and recast those provisions to apply to complex rehabilitation technology (CRT), defined as items classified within the federal Medicare Program as of January 1, 2021, as durable medical equipment that are individually configured for individuals to meet their specific and unique medical, physical, and functional needs and capacities for basic activities of daily living and instrumental activities of daily living identified as medically necessary. The bill would impose certain accreditation, staffing, supply, and other types of requirements for CRT providers. The bill would maintain the above-described requirement concerning physical examinations by medical providers.
The bill would recast qualified rehabilitation professionals as qualified health care professionals and qualified rehabilitation technology professionals, as defined, with certain changes to certification requirements. The bill would make a conforming change to a related provision. The bill would require both types of professionals to be involved in the evaluation of complex needs patients, as defined, who receive a complex rehabilitation manual wheelchair, power wheelchair, or seating component. The bill would authorize the department to adopt utilization controls, including a specialty evaluation by a qualified health care professional.
The bill would require the department to seek any necessary federal approvals for the implementation of these provisions, and would condition their implementation to the extent that any necessary federal approvals are obtained and federal financial participation is available and is not otherwise jeopardized.
Existing law requires, except as otherwise provided, Medi-Cal provider payments and payments for specified non-Medi-Cal programs to be reduced by 10% for dates of service on and after June 1, 2011, and conditions the implementation of these provisions on the department securing federal approval.
For dates of service on and after January 1, 2022, or the effective date of any necessary federal approvals, whichever is later, this bill would exempt providers of CRT and CRT services from the above-described provider payment reduction.
(30) Existing law authorizes the State Department of Public Health to establish the Office of Suicide Prevention within the department, and requires the office to perform specified duties, including providing information and technical assistance to statewide and regional partners regarding best practices on suicide prevention policies and programs and reporting on progress to reduce rates of suicide, and to authorize the office to apply for and use federal, state, and foundation grants.
This bill would remove the limitation that, should the office be established, all duties and responsibilities of the office be carried out using existing staff and resources.
(31) Existing law authorizes the Director of Public Health to establish and administer a program within the State Department of Public Health’s Office of AIDS to subsidize certain costs of medications for the prevention of human immunodeficiency virus (HIV) infection and other related medical services to residents of California who are at least 18 years of age, who are HIV negative, have been prescribed medications listed on the AIDS Drug Assistance Program (ADAP) formula, and meet specified financial eligibility requirements. Existing law also authorizes the program to subsidize, without regard to eligibility and for the prevention of HIV infection, up to 30 days of pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) medications.
This bill would expand eligibility for subsidized medications under this program to include individuals who have the specified medication dispensed or otherwise furnished.
(32) Existing law authorizes the State Public Health Officer, to the extent allowable under federal law, and upon the availability of funds, to expend money from the AIDS Drug Assistance Program Rebate Fund for the HIV infection prevention program to cover the costs of prescribed ADAP formulary medications for the prevention of HIV infection and other specified costs.
This bill would, to the extent that funds are available for these purposes, authorize the office to allocate funds to local health departments and community-based organizations to support PrEP and PEP navigation and retention coordinators and related services for the purpose of increasing PrEP and PEP initiation and retention among individuals most vulnerable to HIV. The bill would require the office to establish a simple application process for funding to support these PrEP and PEP navigation and retention services. The bill would establish eligibility criteria for applicants to receive these funds. The bill would require funded local health departments and community-based organizations to collaborate with the office to conduct outcome and process evaluation of PrEP and PEP navigation and retention services, and would require the office to establish performance metrics to ensure that funding is used efficiently and to measure program success. The bill would authorize the office to use a portion of funds to contract with a third-party entity to provide training, program technical assistance, and capacity building to funded local health departments and community-based organizations. The bill would, to the extent allowable under federal law, and upon availability of funds, authorize the office to expend funding from the AIDS Drug Assistance Program Rebate Fund, a continuously appropriated fund, for these activities. Because the bill would authorize a new purpose for a continuously appropriated fund, the bill would create an appropriation.
(33) Existing law requires a licensed physician and surgeon or other person attending a newborn infant diagnosed as having had rhesus (Rh) isoimmunization hemolytic disease to report the condition to the State Department of Public Health on report forms prescribed by the department.
This bill would repeal that reporting requirement.
(34) Existing law authorizes the State Department of State Hospitals, subject to appropriation by the Legislature, to solicit proposals from, and to contract with, a county to help fund the development or expansion of pretrial diversion for individuals with serious mental disorders who may otherwise be found incompetent to stand trial and committed to the department for restoration of competency. Existing law requires participants to meet specified criteria, including, among others, that they suffer from certain mental disorders and have felony charges, and that there is a significant relationship between the serious mental disorders and the charged offense or between the individual’s conditions of homelessness and the charged offense.
This bill would, beginning July 1, 2021, and upon appropriation from the Legislature, permit the department to amend a contract with a county to fund the expansion of an existing department-funded pretrial diversion. The bill would permit expansion of existing department-funded pretrial diversion programs for participants that have been found incompetent to stand trial on a felony charge and suffer from a mental disorder, except as specified. The bill would specify that a county expanding its programs under this section will not be required to meet any additional match funding requirements.
(35) Existing law specifies a process for declaring a defendant who is charged with a felony to be mentally incompetent to stand trial. Existing law requires the court to order that the mentally incompetent defendant be delivered by the sheriff to a State Department of State Hospitals facility or to any other available public or private treatment facility that meets stated specifications, or placed on outpatient status.
This bill would authorize the State Department of State Hospitals to conduct a reevaluation, as defined, in person or by video telehealth, of a defendant in county custody if the defendant has been committed to and awaiting admission to the department for 60 days or more, as specified. The bill would require the county jails to provide the department confidential access to the defendant for evaluation, including establishing and maintaining remote access capabilities at the jail for this purpose. By imposing additional duties on county jails, this bill would create a state-mandated local program. The bill would require the department to provide funding at a rate set by the department for reimbursement of information technology support and a portion of staff time used to facilitate telehealth interviews and evaluations of felony defendants.
This bill would also require the California Health and Human Services Agency, along with the State Department of State Hospitals, to convene an Incompetent to Stand Trial Solutions Workgroup to identify solutions to advance alternatives to placing defendants at a State Department of State Hospitals facility who are found incompetent to stand trial. The bill would require the workgroup to submit recommendations to the agency and the Department of Finance on or before November 30, 2021, for short-term, medium-term, and long-term solutions that can be accomplished on or before specified dates. Until December 31, 2024, if the recommendations cannot be completed, as specified, or if other described conditions are not met, the bill would authorize the State Department of State Hospitals, upon specified approval, to discontinue admissions for specified patients, impose patient reduction targets, and charge 150% of the daily bed rate for counties for specified patients that are above the patient reduction targets.
(36) Existing law prohibits a person who is mentally incompetent, as specified, from being tried or sentenced for a criminal offense. Existing law requires the court, upon a finding that a criminal defendant is mentally incompetent to stand trial, to order that defendant to be committed to a facility of the State Department of State Hospitals (DSH), or other available facility, for restoration of competence.
Existing law requires the medical director of the facility, within 90 days after commitment, to make a report of the defendant’s progress to the court, as specified. If that report indicates that there is no substantial likelihood of the defendant regaining mental competence in the foreseeable future, or if, after a specified interval of treatment, the defendant is not restored to mental competence, existing law requires the defendant to be returned to the court for further proceedings.
This bill would prohibit a person from being admitted to a state hospital under these provisions.
This bill would require a mentally incompetent defendant in the custody of a DSH facility, for whom there is no substantial likelihood of restoration of competency or who, after a specified interval of treatment, has not been restored to mental competence, to be returned to the custody of the county, as specified.
The bill would also authorize DSH to charge a county that fails to take custody of such a defendant a daily rate, as specified, for any time that the defendant remains in DSH custody.
The bill would make other conforming changes.
By requiring counties to take, or pay for, the custody of these defendants, this bill would impose a state-mandated local program.
(37) Existing federal law, the Patient Protection and Affordable Care Act (PPACA), requires each state to establish an American Health Benefit Exchange to facilitate the purchase of qualified health benefit plans by qualified individuals and qualified small employers. Existing state 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 PPACA. If a qualified health plan covers abortion services for which federal funding is prohibited, PPACA requires the plan to deposit the premium amounts that equal the actuarial value of the coverage of those services into a separate account. PPACA prohibits the actuarial value of that abortion services coverage from being estimated at a cost of less than $1 per enrollee per month.
This bill would require the Exchange, upon appropriation by the Legislature and beginning on or after January 1, 2022, to make payments to qualified health plan issuers that equal the cost of providing abortion services for which federal funding is prohibited to individuals enrolled in a qualified health plan through the Exchange in the individual market. The bill would prohibit the payments from being less than $1 per enrollee per month.
(38) Under existing state law, Covered California is governed by an executive board that facilitates the enrollment of qualified individuals and qualified small employers in qualified health plans as required under PPACA. Existing law specifies the powers and duties of the board governing the Exchange, and requires the board to facilitate the purchase of qualified health plans by qualified individuals and qualified small employers. Existing law establishes the California Health Trust Fund and continuously appropriates moneys in the fund for these purposes.
This bill would establish the Health Care Affordability Reserve Fund, and would authorize the Controller to use funds in the Health Care Affordability Reserve Fund for cashflow loans to the General Fund. Upon the enactment of the Budget Act of 2021, and upon order of the Director of Finance, the bill would require the Controller to transfer $333,439,000 from the General Fund to the Health Care Affordability Reserve Fund, and, upon appropriation by the Legislature, the bill would require that fund to be utilized for the purpose of health care affordability programs operated by the California Health Benefit Exchange. The bill would also require the Exchange, in consultation with stakeholders and the Legislature, to develop options for providing cost sharing reduction subsidies to reduce cost sharing for low- and middle-income Californians, and would require the Exchange to report the developed options to the Legislature, Governor, and the Healthy California for All Commission for consideration in the 2022–23 budget process and to post the report on its internet website.
(39) Existing law authorizes the executive board of Covered California to adopt necessary rules and regulations by emergency regulations until January 1, 2022, with the exception of regulations implementing prescribed provisions relating to criminal background history checks for persons with access to confidential, personal, or financial information. Existing law authorizes the Office of Administrative Law to approve more than 2 readoptions of emergency regulations until January 1, 2027. Existing law provides that these extensions apply to a regulation adopted before January 1, 2019.
This bill would instead extend the authority of the board to adopt those necessary rules and regulations by emergency regulations to January 1, 2025, and would extend the authority of the Office of Administrative Law to approve more than 2 readoptions of emergency regulations until January 1, 2030. The bill would provide that these prescribed time extensions apply to a regulation adopted before January 1, 2022.
(40) Existing law requires the Office of Statewide Health Planning and Development to be the single state agency designated to collect certain health facility or clinic data for use by all state agencies. Existing law requires hospitals to file with the office certain information regarding patients that is reported through a Hospital Discharge Abstract Data Record, an Emergency Care Data Record, and an Ambulatory Surgery Data Record, as applicable.
Existing law requires that the above-described collected health information be made available to the State Department of Health Care Services and the State Department of Public Health. Existing law requires the departments to ensure that the patient’s rights to confidentiality are not violated in any manner and to comply with all applicable policies and requirements involving review and oversight by the State Committee for the Protection of Human Subjects.
This bill would additionally require that the health information be made available to the California Health Benefit Exchange and would extend the above requirements for the departments to the Exchange. The bill would require the Exchange to report to the Governor and the Legislature on or before August 1, 2023, regarding the impact of these requirements on the Exchange.
(41) Under existing law, a Physician Orders for Life Sustaining Treatment (POLST) form is a request regarding resuscitative measures that directs a health care provider regarding resuscitative and life-sustaining measures. Existing law requires a health care provider to treat an individual in accordance with their POLST form.
Existing law establishes the Advance Health Care Directive Registry, allowing individuals to register a written advance health care directive with the Secretary of State. Existing law distinguishes a request regarding resuscitative measures from an advance health care directive.
The bill would enact the California POLST eRegistry Act, which would require the Emergency Medical Services Authority to establish a statewide electronic POLST registry system for the purpose of collecting a patient’s POLST information and disseminating that information to an authorized user. The bill would require the authority to promulgate regulations necessary for the operation of the POLST eRegistry. The bill would require the agency to incorporate the Advance Health Care Directive Registry into the POLST eRegistry. The bill would appropriate $10,000,000 from the General Fund for the 2021–22 fiscal year to support the planning, development, and implementation of the POLST eRegistry, and would continuously appropriate $750,000 from the General Fund annually thereafter to prepare for and support the POLST eRegistry. By appropriating money from the General Fund, the bill would make an appropriation.
(42) Existing law establishes the Richard Paul Hemann Parkinson’s Disease Program, which, among other things, requires the State Department of Public Health to collect data on the incidence of Parkinson’s disease in California, as specified. Existing law requires a hospital, facility, physician and surgeon, or other health care provider diagnosing or providing treatment to Parkinson’s disease patients to report each case of Parkinson’s disease to the department, as prescribed. Existing law conditions the implementation of the program on the availability of funds and repeals the program on January 1, 2022.
This bill would extend the Richard Paul Hemann Parkinson’s Disease Program indefinitely.
The bill would also create the California Neurodegenerative Disease Registry Program, which would, among other things, require the department to collect data on the incidence of neurodegenerative disease, as defined, in California. The bill would require a hospital, facility, physician and surgeon, or other health care provider diagnosing or providing treatment to a patient for a neurodegenerative disease to report each case of a neurodegenerative disease to the department, as prescribed.
This bill would repeal these provisions on January 1, 2028.
(43) Existing law, the State Department of Health Services Cooperative Agreement Act, provides for the establishment of cooperative agreements between the State Department of Public Health and other public and private entities for the purposes of, among other things, simplifying the administration of public health programs by the department. The act requires cooperative agreements to be subject to review and approval by the Department of General Services with certain exceptions. Existing law requires that cooperative agreements be procured by means of a request for application, as defined, or a request for proposal, unless the amount of the agreement is less than $50,000 annually or less than $200,000 a year and from a program that awards 5 or fewer grants per year.
This bill would additionally authorize a cooperative agreement to be procured without a request for application or a request for proposal if the department is awarding a cooperative agreement under the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) to an entity or organization that currently has an executed agreement with the specific WIC local agency. Under these circumstances, the bill would authorize the cooperative agreement to be procured by means of subvention. The bill would require cooperative agreements for new or additional WIC local agencies to be procured by means of a process that complies with applicable federal and state laws and the department’s state plan for operation of WIC.
(44)   Under existing law, various programs provide behavioral health services to children and youth, such as the School-based Early Mental Health Intervention and Prevention Services for Children Act of 1991, which authorizes the Director of Health Care Services, in consultation with the Superintendent of Public Instruction, to award grants to local educational agencies to pay specified costs of providing school-based early mental health intervention and prevention services to eligible pupils at schoolsites. Existing law also establishes the Mental Health Student Services Act as a mental health partnership competitive grant program for the purpose of establishing mental health partnerships between a county’s mental health or behavioral health departments and school districts, charter schools, and the county office of education within the county, as provided.
This bill would establish the Children and Youth Behavioral Health Initiative (initiative), which would be administered by the California Health and Human Services Agency and its departments. The bill would declare the purpose of the initiative to be to transform the state’s behavioral health system into an innovative ecosystem in which all children and youth 25 years of age and younger, regardless of payer, are screened, supported, and served for emerging and existing behavioral health needs.
The bill would require the State Department of Health Care Services to, among other things, procure and oversee a vendor to establish and maintain a behavioral health services and supports virtual platform to integrate behavioral health screenings, application-based supports, and direct behavioral health services, as specified. The bill would also require the department, or a contracted vendor, to provide competitive grants to qualified entities to build partnerships, capacity, and infrastructure supporting ongoing school-linked behavioral health services for children and youth 25 years of age and younger, among other purposes. The bill would require the Office of Statewide Health Planning and Development to award competitive grants to qualified entities and individuals to expand the supply of behavioral health counselors, coaches, peer supports, and other allied health care providers serving children and youth, including those at schoolsites.
This bill would authorize the State Department of Health Care Services to, subject to an appropriation, establish a Behavioral Health Continuum Infrastructure Program to award grants as specified for the construction, acquisition, and rehabilitation of behavioral health treatment resources, as described.
The bill would require a health care service plan contract or disability insurance policy issued, amended, renewed, or delivered on or after January 1, 2024, that is required to provide coverage for medically necessary treatment of mental health and substance use disorders to cover the provision of specified services when delivered at schoolsites, regardless of the network status of the local educational agency, institution of higher education, or health care provider. The bill would require the plan or insurer to reimburse the entity that provided the services, as specified. The bill would require the services to be provided without prior authorization or cost sharing. Because a violation of these requirements by a health care service plan would be a crime, the bill would impose a state-mandated local program.
The bill would require, no sooner than July 1, 2022, and subject to federal approval, that dyadic behavioral visits be a covered Medi-Cal benefit. The bill would require the dyadic visits to include screening for, among other things, behavioral health problems, interpersonal safety, and social determinants of health, as specified.
(45) Existing law establishes the California Health and Human Services Agency (CHHSA), which includes departments charged with administration of health, social, and human services. Existing law makes legislative findings and declarations on health information technology, including that there is a need to promote secure electronic health data exchange among specified individuals, such as health care providers and consumers of health care.
This bill would require, on or before July 1, 2022, subject to an appropriation in the annual Budget Act, CHHSA, in consultation with stakeholders and local partners, to establish the California Health and Human Services Data Exchange Framework that includes a single data sharing agreement and common set of policies and procedures that will govern and require the exchange of health information among health care entities and government agencies in California. The bill would require specified entities to execute the framework data sharing agreement on or before January 31, 2023. The bill would require, on or before January 31, 2024, that specified entities, including general acute care hospitals and skilled nursing facilities, exchange health information, as defined, in real time. The bill would require other specified entities, including physician practices of fewer than 25 physicians and rehabilitation hospitals, to meet this standard on January 31, 2026. The bill would require CHHSA to convene a stakeholder advisory group no later than September 1, 2021, to advise on the development and implementation of the framework and would require, no later than April 1, 2022, CHHSA to submit an update to the Legislature based on the input received from the stakeholder advisory group. The bill would require, on or before January 31, 2023, that CHHSA work with the California State Association of Counties to encourage the inclusion of county health, public health, and social services in the California Health and Human Services Data Exchange Framework.
(46) Existing law authorizes a public entity, as defined, that receives General Fund money from the State Department of Public Health for human immunodeficiency virus prevention and education to use that money to support clean needle and syringe exchange projects authorized by the public entity. Existing law authorizes the department to purchase and provide to the programs sterile hypodermic needles, syringes, and other supplies.
This bill would additionally authorize the department to support any costs associated with the distribution of those supplies.
(47) Existing law establishes the Mental Health Student Services Act, administered by the Mental Health Services Oversight and Accountability Commission. Existing law requires the commission to award grants to county mental health or behavioral health departments and to fund partnerships between educational and county mental health entities.
This bill, subject to an appropriation and commencing with the 2021–22 fiscal year, would require the commission to award grants to a county mental health or behavioral health department or another lead agency, as identified by the partnership within each county that meets the requirements of the program. The bill would authorize the commission to redistribute those funds to other eligible grantees if the commission is unable to provide a grant to a partnership in a county because of a lack of applicants or because no applicants met the minimum requirements within the established timeframes. The bill, for the 2021–22 fiscal year, would require the commission to take into consideration any previous funding the grantee received under this program.
(48) Existing law requires the State Department of Public Health to develop and review plans and participate in a program for the prevention and control of venereal disease.
This bill would require the department, contingent upon a specific appropriation in the annual Budget Act, to allocate grants to local health jurisdictions for sexually transmitted disease control and prevention activities, as prescribed.
(49)Existing law provides for programs relating to treatment of persons with human immunodeficiency virus (HIV) and the acquired immunodeficiency syndrome (AIDS). Under existing law, the Office of AIDS, in the State Department of Public Health, is the lead agency within the state responsible for coordinating state programs, services, and activities relating to HIV and AIDS and AIDS-related conditions.
This bill would require the department, in consultation with the California Department of Aging, to establish a program for up to 5 demonstration projects to operate for a period of up to 3 years, to allow for innovative, evidence-informed approaches to improve the health and well-being of older people living with HIV, as specified. The bill would require the department to establish a process to request applications, and award funding on a competitive basis, for eligible entities to operate a demonstration project. The bill would require applicants to demonstrate experience and expertise in providing culturally appropriate services to the most vulnerable and underserved older people living with HIV and to demonstrate the capacity to ensure that the multidisciplinary clinical and nonclinical needs of older people living with HIV are assessed and addressed, as specified.
(50)   Existing law, the California Healthcare, Research and Prevention Tobacco Tax Act of 2016, an initiative measure approved as Proposition 56 at the November 8, 2016, statewide general election, increases taxes imposed on distributors of cigarettes and tobacco products and requires all revenues to be deposited into the California Healthcare, Research and Prevention Tobacco Tax Act of 2016 Fund, a continuously appropriated fund. Proposition 56 requires the Controller to transfer 82% of those revenues to the Healthcare Treatment Fund, to be used by the department to increase funding for the Medi-Cal program and other specified health care programs and services in a way that, among other things, ensures timely access, limits geographic shortages of services, and ensures quality care.
For intermediate care facilities for individuals with developmental disabilities, facilities providing continuous skilled nursing care to individuals with developmental disabilities, and freestanding pediatric subacute care units, and for dates of service on or after August 1, 2021, this bill would require the Medi-Cal reimbursement rate to exclude prescribed rate reductions, limitations, or increases. For dates of service on or after August 1, 2021, and for each rate year thereafter, the bill would require the department to calculate and publish the reimbursement rates for these providers. For the 2021–22 fiscal year, and for each fiscal year thereafter, the bill would require the reimbursement rates for these providers to account for, and be inclusive of, Proposition 56 supplemental payments if the Budget Act of that fiscal year appropriates funds from the Healthcare Treatment Fund to the department to make those supplemental payments to these providers. With respect to intermediate care facilities for the developmentally disabled or facilities providing continuous skilled nursing care to developmentally disabled individuals, for dates of service on or after August 1, 2021, to July 31, 2022, inclusive, the rates would be the greater of the amount determined above, or the approved Medi-Cal State Plan reimbursement rate, inclusive of the temporary increased Medicaid payments associated with the COVID-19 Public Health Emergency, plus the Proposition 56 supplemental payment amount, in effect for that facility, as specified.
The bill would require the department to seek federal approvals to implement these provisions, and would condition the implementation of these provisions on the department securing federal approval and the availability of federal financial participation. The bill would authorize the department to implement these provisions by various means, including provider bulletins, and to modify methodology and specified provisions under prescribed circumstances.
(51) Existing law requires the State Department of Public Health to allocate funds to local health jurisdictions to provide hepatitis C virus (HCV) activities, including, but not limited to, monitoring, prevention, testing, and linkage to, and retention in, care activities for the most vulnerable and underserved individuals living with, or at high risk for, HCV infection.
This bill, in order to ensure that the most vulnerable Californians are informed of their HCV status and are linked to care and a cure, would require the State Department of Public Health’s Office of Viral Hepatitis Prevention to purchase HCV test kits and associated materials and supplies for distribution to community-based organizations and local health departments. The bill would also authorize the office to allocate funding to train personnel, as specified, to conduct HCV testing, human immunodeficiency virus (HIV) testing, and sexually transmitted infection (STI) testing and related activities. The bill would authorize the office to use a portion of the funds allocated for purposes of the bill to hire necessary staff to successfully implement and evaluate the activities authorized by the bill.
(52) Existing law establishes state hospitals for the care, treatment, and education of mentally disordered persons, and provides the State Department of State Hospitals with jurisdiction over specified facilities, including state hospitals and county jail treatment facilities under contract with the department to provide competency restoration services.
Existing law authorizes the department to transfer patients of a state institution under its jurisdiction to another institution, and requires the transfer of a conservatee to be made only with the consent of the conservator.
This bill would delete the requirement of consent to the transfer of a conservatee.
Subject to an appropriation by the Legislature, this bill would authorize the department to contract for subacute bed capacity, including institutions for mental disease, mental health rehabilitation centers, skilled nursing facilities, or any other treatment options, such as community-based restoration of competency services, to address the increasing number of patient referrals to the department, and would expand the jurisdiction of the department to include these contracted facilities. The bill would authorize contracted funds to include certain expenses, such as program implementation costs and one-time purchases of patient and staff furnishings. The bill would exempt these contracts from specified contracting requirements, including the State Administrative Manual, and from approval by the Department of General Services. The bill would authorize the department to implement these provisions by specified means, including departmental letters.
(53) Existing law establishes the State Department of State Hospitals within the California Health and Human Services Agency and provides the department with jurisdiction over specified facilities for the care and treatment of persons with mental health disorders. Under existing law, specified relatives of a patient in a state hospital are liable for their costs of care, support, and maintenance of the patient. Existing law requires the department to investigate to determine if a patient has a relative responsible for the patient’s costs and if they are financially able to pay those costs. Under existing law, reports regarding these investigations, and investigations into the patient’s moneys, properties, and interests in property, are records of the department and may be inspected at any time by interested relatives, their agents, or representatives. Existing law authorizes the Director of State Hospitals to reduce, cancel, or remit the amount a relative owes.
This bill would delete the above-described provisions, thus eliminating a relative’s financial liability for a patient in a state hospital and their authorization to inspect specified investigative reports at any time.
(54) The Budget Act of 2019 made appropriations for the support of state government for the 2019–20 fiscal year.
This bill would amend the Budget Act of 2019 by revising items of appropriation.
This bill would declare that it is to take effect immediately as a Budget Bill.
(55) This bill would make its provisions severable and would make other legislative findings and declarations.
(56) This bill would declare that it is to take effect immediately as a bill providing for appropriations related to the Budget Bill.
(57) 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.
(58) 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.
Vote: MAJORITY   Appropriation: YES   Fiscal Committee: YES   Local Program: YES  

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


SECTION 1.

 The Legislature finds and declares all of the following with respect to Division 109.7 (commencing with Section 130290) of the Health and Safety Code, as added by this act:
(a) While parts of California’s health care system rely on coordinated, interoperable electronic systems, other parts rely on decentralized, manual, and siloed systems of clinical and administrative data exchange that is voluntary in many situations. This voluntary patchwork imposes burdens on providers and patients, limits the health care ecosystem from making material advances in equity and quality, and functionally inhibits patient access to personalized, longitudinal health records. Further, a lack of clear policies and requirements to share data between payers, providers, hospitals, and public health systems is a significant hindrance to addressing public health crises, as demonstrated by challenges inherent to the COVID-19 pandemic.
(b) Despite the widespread availability of secure electronic data transfer, a small but important minority of Californians’ medical information is stored or shared on paper. When that medical information is shared between providers, much of it happens by mail, fax, or, most likely, by the patients themselves, who frequently carry their records from appointment to appointment. While electronic health information exchange cannot replace provider-patient communication, it can greatly improve the completeness of patient records, which has a significant effect on health and wellness outcomes, as past history, current medications, and other information are jointly reviewed during appointments.
(c) Social and economic factors distinct from medical care are powerful predictors of health outcomes and disease burden throughout a person’s life. From a population health perspective, this means that evidence-based policies that affect the broader conditions in which people are born, grow, and live can exert a powerful influence on health and well-being. From an operational perspective, data-driven efforts to better coordinate human and social supports with the medical and health care sectors provide opportunities to deliver services that are more client centered, efficient, effective, and tailored.

SEC. 2.

 The Legislature finds and declares all of the following with respect to Part 7 (commencing with Section 5960) of Division 5 of the Welfare and Institutions Code, as added by this act:
(a) The COVID-19 public health emergency has impacted every aspect of life as social distancing became a necessity, businesses closed, schools transitioned to remote education, and millions of Americans lost their jobs. The pandemic’s impacts on behavioral health, including the toll of pandemic-related stress, have increased the need for behavioral health resources.
(b) In particular, the pandemic has exacerbated behavioral health conditions for children and youth. Increases in economic hardship, material insecurity, and parental stress and behavioral health challenges all raise the risk of long-term harm.
(c) The pandemic has also exacerbated the need to build new capacity or expand existing capacity for the continuum of behavioral health treatment resources in less restrictive, community-based, residential settings of care.
(d) It is the intent of the Legislature to establish an innovative and prevention-focused behavioral health system where all children and youth are routinely screened, supported, and served for emerging and existing behavioral health needs due to the pandemic.
(e) It is the intent of the Legislature to provide competitive grants to qualified entities to construct, acquire, and rehabilitate real estate assets to support the community continuum of behavioral health treatment resource needs due to the pandemic.

SEC. 3.

 The Legislature finds and declares all of the following with respect to Section 14000.6 of the Welfare and Institutions Code, as added by this act:
(a) Individuals with multiple chronic conditions or functional limitations, people with disabilities, and residents of nursing facilities are often dually eligible for the Medicare and Medi-Cal programs. These individuals tend to experience high rates of chronic illness, with many having long-term care needs and social risk factors. In addition, dually eligible individuals are more likely to be from systematically and historically disadvantaged populations.
(b) For dually eligible individuals, the Medicare and Medi-Cal programs operate independently and under different funding streams. California has implemented a time-limited federal demonstration and other health care delivery system models to promote integrated care for dually eligible individuals and to improve health care outcomes, quality, and cost effectiveness. Under the California Advancing and Innovating Medi-Cal (CalAIM) Initiative, the number of dually eligible individuals enrolled in integrated care will increase, through aligned enrollment in affiliated Medicare health plans and Medi-Cal managed care plans.
(c) The number of Medicare-only beneficiaries is rapidly growing in California. California’s population of residents over 60 years of age is projected to grow faster than any other age group, and is projected to be one quarter of the state’s population by 2030. This population is also becoming more diverse, with increased numbers of older adults being single or childless and living alone, thus increasing the need for additional external supports.
(d) Long-term services and supports may be unaffordable for some middle-income Medicare-only beneficiaries who are not eligible for the Medi-Cal program. This places them at greater risk of having unmet needs, and may increase the likelihood of unnecessary institutionalization or spending down assets to qualify for the Medi-Cal program.
(e) All older adults, and those with disabilities, should be provided with meaningful choice and access to coordinated and client-friendly services and supports in their communities.
(f) Both paid and unpaid caregivers to Medicare-only and dually eligible beneficiaries should be supported in the provision of their essential care for older adults and those with disabilities, especially with the growing demand for that care.

SEC. 4.

 Section 502 is added to the Business and Professions Code, to read:

502.
 (a) Notwithstanding any other law, both of the following apply:
(1) The Board of Registered Nursing, the Board of Vocational Nursing and Psychiatric Technicians of the State of California, the Physician Assistant Board, and the Respiratory Care Board of California shall collect workforce data from their respective licensees and registrants as specified in subdivision (b) for future workforce planning at least biennially. The data shall be collected at the time of electronic license or registration renewal for those boards that utilize electronic renewals for licensees or registrants.
(2) All other boards that are not listed in paragraph (1) that regulate healing arts licensees or registrants under this division shall request workforce data from their respective licensees and registrants as specified in subdivision (b) for future workforce planning at least biennially. The data shall be requested at the time of electronic license or registration renewal for those boards that utilize electronic renewals for licensees or registrants.
(b) In conformance with specifications under subdivision (d), the workforce data collected or requested by each board about its licensees and registrants shall include, at a minimum, all of the following information:
(1) Anticipated year of retirement.
(2) Area of practice or specialty.
(3) City, county, and ZIP Code of practice.
(4) Date of birth.
(5) Educational background and the highest level attained at time of licensure or registration.
(6) Gender or gender identity.
(7) Hours spent in direct patient care, including telehealth hours as a subcategory, training, research, and administration.
(8) Languages spoken.
(9) National Provider Identifier.
(10) Race or ethnicity.
(11) Type of employer or classification of primary practice site among the types of practice sites specified by the board, including, but not limited to, clinic, hospital, managed care organization, or private practice.
(12) Work hours.
(13) Sexual orientation.
(14) Disability status.
(c) Each board shall maintain the confidentiality of the information it receives from licensees and registrants under this section and shall only release information in an aggregate form that cannot be used to identify an individual other than as specified in subdivision (e).
(d) The Department of Consumer Affairs, in consultation with the Department of Health Care Access and Information, shall specify for each board subject to this section the specific information and data that will be collected or requested pursuant to subdivision (b). The Department of Consumer Affairs’ identification and specification of this information and data shall be exempt until June 30, 2023, from the requirements of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(e) Each board, or the Department of Consumer Affairs on its behalf, shall, beginning on July 1, 2022, and quarterly thereafter, provide the individual licensee and registrant data it collects pursuant to this section to the Department of Health Care Access and Information in a manner directed by the Department of Health Care Access and Information, including license or registration number and associated license or registration information. The Department of Health Care Access and Information shall maintain the confidentiality of the licensee and registrant information it receives and shall only release information in an aggregate form that cannot be used to identify an individual.
(f) A licensee or registrant shall not be required to provide the information listed in subdivision (b) as a condition for license or registration renewal, and licensees or registrants shall not be subject to discipline for not providing the information listed in subdivision (b).
(g) This section does not alter or affect mandatory reporting requirements for licensees or registrants established pursuant to this division, including, but not limited to, Sections 1715.5, 1902.2, 2425.3, and 2455.2.

SEC. 5.

 Section 2717 of the Business and Professions Code is repealed.

SEC. 6.

 Section 2852.5 of the Business and Professions Code is repealed.

SEC. 7.

 Section 3518.1 of the Business and Professions Code is repealed.

SEC. 8.

 Section 3770.1 of the Business and Professions Code is repealed.

SEC. 9.

 Section 4506 of the Business and Professions Code is repealed.

SEC. 10.

 Section 100503.5 is added to the Government Code, to read:

100503.5.
 (a) The Exchange shall provide payments equaling the cost of providing coverage of services described in Section 18023(b)(1)(B)(i) of Title 42 of the United States Code to individuals enrolled in a qualified health plan through the Exchange in the individual market. The payments shall not be less than one dollar ($1) per enrollee per month.
(b) The Exchange shall make the payments required under subdivision (a) directly to the qualified health plan issuers on behalf of the enrollees.
(c) The payments required under subdivision (a) shall be made upon appropriation by the Legislature. The payments shall not be made from the California Health Trust Fund established by Section 100520.
(d) Subject to appropriation, the payments shall be made for months beginning on or after January 1, 2022.
(e) For purposes of this section, “qualified health plan” does not include a qualified dental plan offered through the Exchange.
(f) This section does not create an entitlement program of any kind, appropriate any funds, require the Legislature to appropriate any funds, or increase or decrease taxes owed by a taxpayer.

SEC. 11.

 Section 100504 of the Government Code is amended to read:

100504.
 (a) The board may do the following:
(1) With respect to individual coverage made available in the Exchange, collect premiums and assist in the administration of subsidies.
(2) Enter into contracts.
(3) Sue and be sued.
(4) Receive and accept gifts, grants, or donations of moneys from an agency of the United States, an agency of the state, and a municipality, county, or other political subdivision of the state.
(5) Receive and accept gifts, grants, or donations from individuals, associations, private foundations, and corporations, in compliance with the conflict of interest provisions to be adopted by the board at a public meeting.
(6) (A) Adopt rules and regulations, as necessary. Until January 1, 2025, necessary rules and regulations, except those implementing Section 1043, may be adopted as emergency regulations in accordance with the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2). The adoption of emergency regulations pursuant to this section shall be deemed to be an emergency and necessary for the immediate preservation of the public peace, health and safety, or general welfare. Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2, including subdivisions (e) and (h) of Section 11346.1, an emergency regulation adopted pursuant to this section shall be repealed by operation of law unless the adoption, amendment, or repeal of the regulation is promulgated by the board pursuant to Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 within five years of the initial adoption of the emergency regulation. A rule or regulation adopted pursuant to this section shall be discussed by the board during at least one properly noticed board meeting before the board meeting at which the board adopts the rule or regulation. Notwithstanding subdivision (h) of Section 11346.1, until January 1, 2030, the Office of Administrative Law may approve more than two readoptions of an emergency regulation adopted pursuant to this section.
(B) The amendments made to this paragraph by the act that added this subparagraph also shall apply to a regulation adopted pursuant to this section before January 1, 2022.
(7) Collaborate with the State Department of Health Care Services and the Managed Risk Medical Insurance Board, to the extent possible, to allow an individual the option to remain enrolled with the individual’s carrier and provider network if the individual experiences a loss of eligibility of premium tax credits and becomes eligible for the Medi-Cal program, or loses eligibility for the Medi-Cal program and becomes eligible for premium tax credits through the Exchange.
(8) Share information with relevant state departments, consistent with the confidentiality provisions in Section 1411 of the federal act, necessary for the administration of the Exchange.
(9) Require carriers participating in the Exchange to make available to the Exchange and regularly update an electronic directory of contracting health care providers so that individuals seeking coverage through the Exchange can search by health care provider name to determine which health plans in the Exchange include that health care provider in their network. The board may also require a carrier to provide regularly updated information to the Exchange as to whether a health care provider is accepting new patients for a particular health plan. The Exchange may provide an integrated and uniform consumer directory of health care providers indicating which carriers the providers contract with and whether the providers are currently accepting new patients. The Exchange may also establish methods by which health care providers may transmit relevant information directly to the Exchange, rather than through a carrier.
(10) Make available supplemental coverage for enrollees of the Exchange to the extent permitted by the federal act, provided that General Fund money is not used to pay the cost of that coverage. Supplemental coverage offered in the Exchange shall be subject to the charge imposed under subdivision (n) of Section 100503.
(b) The Exchange shall only collect information from individuals or designees of individuals necessary to administer the Exchange and consistent with the federal act.
(c) (1) The board shall have the authority to standardize products to be offered through the Exchange. A product standardized by the board pursuant to this subdivision shall be discussed by the board during at least one properly noticed board meeting before the board meeting at which the board adopts the standardized products to be offered through the Exchange.
(2) The adoption, amendment, or repeal of a regulation by the board to implement this subdivision is exempt from the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2).

SEC. 12.

 Section 100520.5 is added to the Government Code, immediately following Section 100520, 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 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.

SEC. 13.

 Section 1374.722 is added to the Health and Safety Code, to read:

1374.722.
 (a) (1) A health care service plan contract issued, amended, renewed or delivered on or after January 1, 2024, that is required to provide coverage for medically necessary treatment of mental health and substance use disorders pursuant to Sections 1374.72, 1374.721, and 1374.73 shall cover the provision of the services identified in the fee-for-service reimbursement schedule published by the State Department of Health Care Services, as described in subparagraph (B) of paragraph (5) of subdivision (c), when those services are delivered at schoolsites pursuant to this section, regardless of the network status of the local educational agency, institution of higher education, or health care provider.
(2) This section does not relieve a local educational agency or institution of higher education from requirements to accommodate or provide services to students with disabilities pursuant to any applicable state and federal law, including, but not limited to, the federal Individuals with Disabilities Education Act (20 U.S.C. Sec. 1400 et seq.), Part 30 (commencing with Section 56000) of Division 4 of Title 2 of the Education Code, Chapter 26.5 (commencing with Section 7570) of Division 7 of Title 1 of the Government Code, and Chapter 3 (commencing with Section 3000) of Division 1 of Title 5 of the California Code of Regulations.
(b) The following definitions apply for purposes of this section:
(1) “Health care provider” has the same meaning as defined in paragraph (4) of subdivision (a) of Section 1374.72 and paragraph (5) of subdivision (c) of Section 1374.73.
(2) “Institution of higher education” means the California Community Colleges, the California State University, or the University of California.
(3) “Local educational agency” means a school district, county office of education, charter school, the California Schools for the Deaf, and the California School for the Blind.
(4) “Medically necessary treatment of a mental health or substance use disorder” has the same meaning as defined in paragraph (3) of subdivision (a) of Section 1374.72.
(5) “Mental health and substance use disorder” has the same meaning as defined in paragraph (2) of subdivision (a) of Section 1374.72.
(6) “School site” means a facility or location used for public kindergarten, elementary, secondary, or postsecondary purposes. “School site” also includes a location not owned or operated by a public school, or public school district, if the school or school district provides or arranges for the provision of medically necessary treatment of a mental health or substance use disorder to its students at that location, including off-campus clinics, mobile counseling services, and similar locations.
(7) “Utilization review” has the same meaning as defined in paragraph (3) of subdivision (f) of Section 1374.721.
(c) When a local educational agency or institution of higher education provides or arranges for the provision of treatment of a mental health or substance use disorder services subject to this section by a health care provider for an individual 25 years of age or younger at a school site, the student’s health care service plan shall reimburse the local educational agency or institution of higher education for those services.
(1) A health care service plan shall not require prior authorization for services provided pursuant to this section.
(2) A health care service plan may conduct a postclaim review to determine appropriate payment of the claim. Payment for services subject to this section may be denied only if the health care service plan reasonably determines that the services were provided to a student not enrolled in the health plan, were never performed, or were not provided by a health care provider appropriately licensed or authorized to provide the services.
(3) Notwithstanding paragraph (1), a health plan may require prior authorization for services as authorized by the department pursuant to subdivision (d).
(4) A local educational agency, community college district, the California State University system, or the Regents of the University of California may consolidate claims for purposes of submitting the claims to a health care service plan.
(5) A health care service plan shall provide reimbursement for services provided to students pursuant to this section at the greater of either of the following amounts:
(A) The health plan’s contracted rate with the local educational agency, institution of higher education, or health care provider, if any.
(B) The fee-for-service reimbursement rate published by the State Department of Health Care Services for the same or similar services provided in an outpatient setting, pursuant to Section 5961.4 of the Welfare and Institutions Code.
(6) A health care service plan shall provide reimbursement for services provided pursuant to this section in compliance with the requirements for timely payment of claims, as required by this chapter.
(7) Services provided pursuant to this section shall not be subject to copayment, coinsurance, deductible, or any other form of cost sharing.
(8) An individual or entity shall not bill the enrollee or subscriber, nor seek reimbursement from the enrollee or subscriber, for services provided pursuant to this section.
(d) No later than December 31, 2023, the director shall issue guidance to health care service plans regarding compliance with this section. This guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code). Any guidance issued pursuant to this subdivision shall be effective only until the director adopts regulations pursuant to the Administrative Procedure Act.
(e) This section does not apply to contracts entered into pursuant to Chapter 7 (commencing with Section 14000) or Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code, between the State Department of Health Care Services and a health care service plan for enrolled Medi-Cal beneficiaries.

SEC. 14.

 Article 11.9 (commencing with Section 1399.870) is added to Chapter 2.2 of Division 2 of the Health and Safety Code, to read:
Article  11.9. Health Equity and Quality

1399.870.
 (a) (1) On or before March 1, 2022, the department shall convene a Health Equity and Quality Committee to make recommendations to the department for standard health equity and quality measures, including annual benchmark standards for assessing equity and quality in health care delivery. The department may contract with consultants to assist the committee with the implementation and administration of its duties.
(2) The committee shall provide initial recommendations, as well as recommendations on updating and revising standard health equity and quality measures and annual benchmark standards, consistent with this article. These recommendations shall consider the interaction of multiple characteristics in determining where disparate outcomes exist, including, but not limited to, race, ethnicity, gender, sexual orientation, language, age, income, and disability.
(3) Meetings of the committee shall be subject to the Bagley-Keene Open Meeting Act (Article 9 (commencing with Section 11120) of Chapter 1 of Part 1 of Division 3 of Title 2 of the Government Code).
(4) The department may contract with consultants to assist the committee with the implementation and administration of its duties.
(b) In appointing members to the committee, the director shall consider all of the following:
(1) The expertise of each committee member so that the committee’s composition reflects a diversity of relevant expertise.
(2) The racial, cultural, ethnic, sexual orientation, gender, economic, linguistic, age, disability, and geographical diversity of the state so that the committee’s composition reflects the communities of California.
(3) The expertise of representatives from other state agencies that are engaged in the work of setting quality and equity goals or standards for health care entities.
(4) The representation of consumer stakeholders that serve diverse populations.
(5) Inclusion of experts, researchers, and community members who are engaged in the development of alternative approaches to measuring health equity, consumer experience, and health outcomes.
(c) On or before September 30, 2022, the committee shall provide the recommendations described in subdivision (a), which may consider and may include all of the following:
(1) Quality measures, including, but not limited to, Healthcare Effectiveness Data and Information Set (HEDIS) measures and the federal Centers for Medicare and Medicaid Services Child and Adult Core Set measures.
(2) Surveys or other measures to assess consumer experience and satisfaction, including alternative approaches that take into account cultural competence, health literacy, exposure to discrimination, and social and cultural connectedness, such as connection to community, identity, traditions, and spirituality.
(3) Other child and adult quality or outcome measures that the committee determines are appropriate, including establishing new measures for patient-reported outcomes.
(4) Effective ways to measure health outcomes in the absence of quality measures, including both of the following:
(A) Demographic data or other data related to race, ethnicity, or socioeconomic variables that are currently collected by health care service plans.
(B) Other data sources, including the Health Care Payments Data Program established pursuant to Section 127671.1, the health evidence initiative of Covered California for the individual and small group markets, and other statistically valid and reliable sources of data.
(5) Approaches to stratifying reporting of results by factors, including, but not limited to, age, sex, geographic region, race, ethnicity, language, sexual orientation, gender identity, and income to the extent health plans or public programs have data on these factors and that the results are statistically valid and reliable.
(6) Alternative methods to measure health outcomes that permit sufficient stratification to determine impacts on health equity and quality that are not subject to the methodological limitations of current measurement approaches.
(7) Alternative methods to measure physical and behavioral health outcomes, including, but not limited to, measures to assess social and cultural connectedness, such as connection to community, identity, traditions, and spirituality. The department shall consult with the Office of Health Equity in identifying these alternative methods.
(8) Measures of social determinants of health, such as housing security, food insecurity, caregiving, and other nonmedical determinants of health.
(d) The committee’s recommendations shall include setting annual health equity and quality benchmarks.
(e) The department shall consider the committee’s recommendations in establishing the standard measures and annual benchmarks pursuant to Section 1399.871. The department shall enforce the established set of standard health equity and quality measures and applicable annual benchmarks consistent with Section 1399.872.
(f) The department shall reconvene the committee following the establishment of the standard measures and annual benchmarks pursuant to Section 1399.871 for the purpose of reviewing or revisiting the standard measures and annual benchmarks after the department has received data from health care service plans pursuant to Section 1399.872.
(g) Contracts entered into pursuant to this article are exempt from Part 2 (commencing with Section 10100) of Division 2 of the Public Contract Code, Section 19130 of the Government Code, and Chapter 6 (commencing with Section 14825) of Part 5.5 of Division 3 of Title 2 of the Government Code, and are exempt from the review or approval of any division of the Department of General Services, until January 1, 2024.

1399.871.
 (a) (1) The department shall establish standard measures and annual benchmarks for equity and quality in health care delivery.
(2) A standard measure or annual benchmark shall not be adopted, updated, or revised in any manner without being discussed during at least one public meeting of the Health Equity and Quality Committee before the meeting in which the committee makes recommendations to the director.
(3) Standard measures and annual benchmarks shall sunset at most every five years from the date the department establishes standard measures and annual benchmarks pursuant to paragraph (1). To continue the standard measures and annual benchmarks, the department shall conduct a public assessment, at least one year before the sunset, of whether the measures and benchmarks are improving quality and equity, consistent with this article.
(b) In establishing the standard measures and annual benchmarks pursuant to subdivision (a), the department shall consider the recommendations made by the Health Equity and Quality Committee pursuant to Section 1399.870, as well as stakeholder comments on draft standards and benchmarks.
(c) After the department establishes the standard measures and benchmarks pursuant to subdivision (a), a health care service plan shall comply with the annual benchmarks and shall demonstrate compliance in reports submitted to the department pursuant to Section 1399.872.
(d) (1) On or before January 1, 2026, a health care service plan and its subcontracted health care service plans shall have and maintain National Committee for Quality Assurance (NCQA) accreditation.
(2) This subdivision does not apply to a health care service plan that contracts with the State Department of Health Care Services to provide health care services to Medi-Cal beneficiaries. NCQA accreditation for these plans shall be in accordance with Section 14184.203 of the Welfare and Institutions Code.
(e) Throughout the development, implementation, and updating of the standard measures and annual benchmarks pursuant to this section, the department shall coordinate with the State Department of Health Care Services, the Office of Statewide Health Planning and Development, the California Health Benefit Exchange, CalPERS, and the State Department of Public Health.

1399.872.
 (a) Upon the department’s establishment or updating of standard measures and annual benchmarks pursuant to Section 1399.871, a health care service plan shall annually submit to the department, at the time and in a manner specified by the department, a report containing health equity and quality data and information. A health care service plan shall implement the policies, procedures, and systems necessary for compliance with this article and shall, in a manner specified by the department, disclose substantiating documentation to the department demonstrating how the health care service plan shall achieve that compliance.
(b) The department shall review a health care service plan’s equity and quality report submitted pursuant to this section for compliance with the health equity and quality standard measures and annual benchmarks established pursuant to Section 1399.871. The department may also review and use other credible sources of information and data, including, but not limited to, relevant data provided by other state agencies, to determine a health care service plan’s compliance with the equity and quality standard measures and annual benchmarks.
(c) The department shall determine a health care service plan’s compliance with the health equity and quality standard measures and annual benchmarks and issue a report of its findings to the health care service plan, which shall also be made publicly available on the department’s internet website.
(d) If a health care service plan does not demonstrate compliance with this article, the department may take the following actions, which may be progressive, as appropriate:
(1) Require the health care service plan to implement corrective action to achieve and demonstrate compliance with the health equity and quality standard measures and annual benchmarks.
(2) Monitor a health care service plan’s corrective action plan and improvement efforts.
(3) Investigate and require supplemental reporting by the health care service plan.
(4) Assess an administrative penalty in an amount that is initially commensurate with the failure to meet the requirements of this article, and assess additional penalties, in escalating amounts for repeated or continuing failure to meet the requirements. The director may assess administrative penalties under this paragraph if a health care service plan engages in any of the following conduct:
(A) Fails to report complete and accurate data required by this article.
(B) Neglects to file a required corrective action plan with the department.
(C) Fails to file an acceptable required corrective action plan with the department.
(D) Fails to implement or monitor a required corrective action plan.
(E) Fails to provide information required by this article to the department.
(F) Falsifies information required by this section.
(G) Fails to meet the health equity and quality standard measures and annual benchmarks established pursuant to Section 1399.871.
(5) Take other disciplinary or other enforcement action, as determined necessary and appropriate by the director.
(6) If the department assesses an administrative penalty or takes other disciplinary action, the department shall inform the California Health Benefit Exchange, the Office of Statewide Health Planning and Development, CalPERS, and the State Department of Health Care Services, each of which shall consider appropriate action.
(e) (1) For the measurement years 2023 and 2024, the department’s enforcement activities pursuant to subdivision (d) shall address deficiencies in procedural data collection, reporting, corrective action plan implementation, or monitoring requirements pursuant to this article.
(2) Commencing with measurement year 2025, and for each following measurement year, the department’s enforcement activities shall address deficiencies in meeting the requirements under paragraph (1), compliance with the standard measures and annual benchmarks, and all other requirements pursuant to this article.
(3) For the purpose of this subdivision, “measurement year” means the time period within which a health care service plan shall collect the required information for the report required by this section.
(f) Commencing in 2025, and annually thereafter, the department shall publish on its internet website a Health Equity and Quality Compliance Report.
(g) The department shall coordinate with the State Department of Health Care Services to support the review of, and any compliance action taken with respect to, Medi-Cal managed care plans consistent with this article, to maintain consistency with the applicable federal and state Medicaid requirements governing those plans.

1399.873.
 (a) Except as provided by any other law, the requirements of this article apply to health care service plans that cover hospital, medical, or surgical expenses, including a health care service plan that contracts with the State Department of Health Care Services to provide health care services to Medi-Cal beneficiaries, and specialized health care service plans that provide behavioral health care.
(b) The obligation of a health care service plan to comply with this article is not waived if the health care service plan delegates any services or functions to its medical groups, independent practice associations, or other contracting entities.

1399.874.
 (a) This article does not restrict the director’s enforcement authority under this chapter.
(b) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this article by means of all-plan letters, methodologies, rules, policies, forms, or similar instructions, without taking regulatory action, until January 1, 2027.

SEC. 15.

 Chapter 14 (commencing with Section 1860) is added to Division 2.5 of the Health and Safety Code, to read:
CHAPTER  14. California POLST eRegistry Act

1860.
 This chapter shall be known, and may be cited, as the California POLST eRegistry Act.

1861.
 For purposes of this chapter:
(a) “Authorized user” means a person authorized by the authority to submit information to, or to receive information from, the POLST eRegistry, including health care providers, as defined in Section 4781 of the Probate Code, and their designees.
(b) “CEDRS” means the California Emergency Medical Services Data Resource System.
(c) “POLST” means a Physician Orders for Life Sustaining Treatment form that fulfills the requirements, in any format, of Section 4780 of the Probate Code.
(d) “POLST eRegistry” means the registry established pursuant to this chapter to make electronic, in addition to other modes of submission and transmission, POLST information available to authorized users in conjunction with, and as a part of, CEDRS.

1862.
 (a) The Emergency Medical Services Authority shall establish a POLST eRegistry, in consultation with the Coalition for Compassionate Care of California and other pertinent stakeholders, to operate a statewide electronic registry system for the purpose of collecting a patient’s POLST information received from a physician, nurse practitioner, physician assistant, or the designee of a physician, nurse practitioner, or physician assistant, and disseminating the information to an authorized user.
(b) The authority shall adopt regulations for the operation of the POLST eRegistry and shall hold at least one public hearing regarding the proposed regulations. The regulations shall include, but not be limited to, standards and procedures regarding all of the following:
(1) The means by which initial or subsequent POLST information may be submitted to the POLST eRegistry, which shall include a method for electronic delivery of this information and the use of legally sufficient electronic signatures. Submitted information may include new, modified, updated, or voided POLST information.
(2) Methods by which the information in the POLST eRegistry may be disseminated to an authorized user, including a method for electronic access.
(3) Standards and procedures for verifying the identity of an authorized user.
(4) Standards and procedures to ensure the accuracy of, and to appropriately protect the confidentiality of, POLST information submitted to the POLST eRegistry, consistent with state and federal privacy laws.
(c) The authority shall implement the POLST eRegistry in conjunction with CEDRS. The authority shall ensure all of the following requirements are met and that the timing is consistent with the CEDRS project development timeline:
(1) An authorized user shall ensure that the most current version of all POLST forms they have signed have been submitted to the POLST eRegistry.
(2) An electronic version of a POLST shall be the only acceptable format to submit a form to the POLST eRegistry. This section does not prohibit an authorized user from printing out a paper copy of a POLST form for a patient to have on hand, upon request by a patient or the patient’s legally recognized decisionmaker.
(3) The authority shall incorporate the Advance Health Care Directive Registry, established pursuant to Part 5 (commencing with Section 4800) of Division 4.7 of the Probate Code, into the POLST eRegistry.

1863.
 (a) For the 2021–22 fiscal year, the sum of ten million dollars ($10,000,000) is hereby appropriated from the General Fund to the Emergency Medical Services Authority to support the planning, development, and implementation of a statewide POLST eRegistry to be included with the CEDRS system. The ten million dollars ($10,000,000) for the 2021–22 fiscal year to support these efforts shall not fully fund the POLST eRegistry’s implementation or maintenance and operations costs. These costs will be determined through the California Department of Technology planning process, known as the Project Approval Life Cycle (PAL). The authority shall only utilize funds for development and implementation of the POLST eRegistry after it obtains full PAL approval.
(b) For the 2022–23 fiscal year, and annually thereafter, the sum of seven hundred fifty thousand dollars ($750,000) is hereby appropriated annually from the General Fund to the Emergency Medical Services Authority for state operations to prepare for and support the POLST eRegistry. State operations costs may include, but are not limited to, promotion of POLST quality, such as ongoing education and training of health care professionals, community education, and outreach, and adherence to quality standards. The authority may contract for these activities as necessary.

SEC. 16.

 Section 38074 of the Health and Safety Code is amended to read:

38074.
 (a) Cooperative agreements shall be procured by means of a request for application or a request for proposal, whichever is applicable, as determined by the department.
(b) A procurement by a request for application is one where the department has funds, regardless of the source, that it seeks to distribute to those entities or organizations specified in Section 38072, that meet the criteria and standards stated in the request for application. A distinguishing feature of a request for application is that, unlike a request for proposal, a request for application is a request where multiple awards are to be made based on the information provided in the application and evaluated against the methodology and criteria specified in the request for application.
(c) All request for proposal cooperative agreement awards shall comply with the requirements of Section 10344 of the Public Contract Code.
(d) A cooperative agreement shall be for a period of up to three years.
(e) A cooperative agreement for a one-year period may provide for up to two annual extensions.
(f) A cooperative agreement may be procured without a request for application or a request for proposal under any of the following circumstances:
(1) If the amount of the cooperative agreement is less than fifty thousand dollars ($50,000) annually. A nonprofit organization shall receive only one of these awards during each fiscal year.
(2) If the amount of the cooperative agreement is less than two hundred thousand dollars ($200,000) a year and from a program that awards five or fewer grants per year.
(3) If the department is awarding a cooperative agreement under the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) to an entity or organization that currently has an executed agreement with the specific WIC local agency. A cooperative agreement described in this paragraph may be awarded by means of subvention. Cooperative agreements for new or additional WIC local agencies shall be procured by means of a process that complies with applicable federal and state laws and the department’s state plan for operation of WIC.

SEC. 17.

 Section 102430 of the Health and Safety Code is amended to read:

102430.
 (a) The second section of the certificate of live birth as specified in subdivision (b) of Section 102425, the electronic file of birth information collected pursuant to subparagraphs (B) to (H), inclusive, of paragraph (2) of subdivision (a) of Section 102426, the birth mother linkage collected pursuant to Section 102425.2, and the second section of the certificate of fetal death as specified in Section 103025, are confidential. Access to the confidential portion of any certificate of live birth or fetal death, the electronic file of birth information collected pursuant to subparagraphs (B) to (H), inclusive, of paragraph (2) of subdivision (a) of Section 102426, and the birth mother linkage collected pursuant to Section 102425.2 shall be limited to the following:
(1) Department staff.
(2) Local registrar’s staff and local health department staff when approved by the local registrar or local health officer, respectively.
(3) The county coroner.
(4) Persons with a valid scientific interest as determined by the State Registrar, who are engaged in demographic, epidemiological, or other similar studies related to health, and who agree to maintain confidentiality as prescribed by this part and by regulation of the State Registrar.
(5) The parent who signed the certificate or, if no parent signed the certificate, the mother.
(6) The person named on the certificate.
(7) A person who has petitioned to adopt the person named on the certificate of live birth, subject to Section 102705 of the Health and Safety Code and Sections 9200 and 9203 of the Family Code.
(8) The following state government departments requesting the information for official government business purposes as deemed appropriate by the State Registrar, that agree to maintain confidentiality as prescribed by this part:
(A) The State Department of Public Health.
(B) The State Department of Health Care Services.
(C) The Department of Finance. This section shall not be construed as a limitation of the authority granted to the Department of Finance in Sections 13073 to 13073.5, inclusive, of the Government Code.
(D) The Scholarshare Investment Board, for the purpose of implementing the California Kids Investment and Development Savings Program pursuant to Article 19.5 (commencing with Section 69996) of Chapter 2 of Part 42 of Division 5 of Title 3 of the Education Code, as long as the California Kids Investment and Development Savings Program is operational and actively opening new KIDS accounts, as defined in subdivision (g) of Section 69996.2 of the Education Code, for eligible children.
(E) The Department of Health Care Access and Information.
(9) The birth hospital responsible for preparing and submitting a record of the birth or fetal death for purposes of reviewing and correcting birth or fetal death records. The birth hospital shall not further disclose the information nor use the information for purposes other than allowed by this part.
(b) (1) The department shall maintain an accurate record of all persons who are given access to the confidential portion of the certificates. The record shall include all of the following:
(A) The name of the person authorizing access.
(B) The name, title, and organizational affiliation of persons given access.
(C) The dates of access.
(D) The specific purpose for which the information is to be used.
(2) The record of access shall be open to public inspection during normal operating hours of the department.
(c) All research proposed to be conducted using the confidential medical and social information on the birth certificate or fetal death certificate shall first be reviewed by the appropriate committee constituted for the protection of human subjects that is approved by the federal Department of Health and Human Services and has a general assurance pursuant to Part 46 of Title 45 of the Code of Federal Regulations. Information shall not be released until the request for information has been reviewed by the Vital Statistics Advisory Committee and the committee has recommended to the State Registrar that the information shall be released.

SEC. 18.

 Section 120972 of the Health and Safety Code is amended to read:

120972.
 (a) To the extent that funds are available for these purposes, the director may establish and administer a program within the department’s Office of AIDS to subsidize certain costs of medications for the prevention of HIV infection and other related medical services, as authorized by this section, to persons who meet all of the following requirements:
(1) Are residents of California who are at least 18 years of age, or who may consent to medical care related to the prevention of a sexually transmitted disease consistent with Section 6926 of the Family Code.
(2) Are HIV negative.
(3) Meet the financial eligibility requirements identified in Section 120960. Unemancipated minors between 12 and 17 years of age shall be considered a family size of one for purposes of determining financial eligibility for this program.
(4) Have been prescribed, dispensed, or otherwise furnished medication listed on the AIDS Drug Assistance Program (ADAP) formulary as provided in paragraph (2) of subdivision (a) of Section 120955.
(b) To the extent allowable under federal law, and upon available funds, the director may expend funding for this program from the AIDS Drug Assistance Program Rebate Fund as implemented pursuant to Section 120956.
(c) To the extent that funding is made available for this purpose, the program may subsidize all of the following costs of medication for the prevention of HIV infection and related medical services for eligible individuals:
(1) For uninsured individuals, the costs for both of the following:
(A) HIV pre-exposure prophylaxis (PrEP)-related and post-exposure prophylaxis (PEP)-related medical services for individuals who are enrolled, if eligible, in a drug manufacturer’s medication assistance program.
(B) Medication for the prevention of HIV infection for individuals who are ineligible for a drug manufacturer’s medication assistance program.
(2) For insured individuals, the costs for all of the following:
(A) Medication copays, coinsurance, and deductibles for the prevention of HIV infection after the individual’s insurance is applied and, if eligible, after the drug manufacturer’s medication assistance program’s contributions are applied. Use of the drug manufacturer’s medication assistance program is not required if it is not accepted by the health plan or pharmacy contracted with the health plan.
(B) Medical copays, coinsurance, and deductibles for PrEP-related and PEP-related medical services.
(C) Subsidizing premiums to purchase or maintain health insurance coverage for individuals using PrEP if the director makes a determination that it is feasible and would result in cost savings to the state.
(d) For the purposes of this program, an insured individual on a parent’s or partner’s health plan shall be considered uninsured if the individual is unable to use the individual’s health insurance coverage for confidentiality or safety reasons.
(e) Notwithstanding the eligibility requirements in subdivision (a), the program may subsidize the costs of up to 30 days of PrEP and PEP medications for the prevention of HIV infection.
(f) If the director makes a formal determination that, in any fiscal year, funds appropriated for the program will be insufficient to provide medications for the prevention of HIV infection or related medical costs to existing eligible persons for the fiscal year and that a suspension of the implementation of the program is necessary, the director may suspend either of the following:
(1) The program.
(2) The eligibility determinations and enrollment in the program for the period of time necessary to meet the needs of existing eligible persons in the program.
(g) Reimbursement under the program shall not be made for any drugs or related services that are available to the recipient under any other private, state, or federal programs, or under any other contractual or legal entitlements, except as specified in this section. The director may authorize an exemption from this subdivision if it would result in cost savings to the state.
(h) If the department utilizes a contractor or subcontractor to administer any aspect of the program, the provisions of Section 120970, except subdivision (i) of that section, shall apply.
(i) All types of information, whether written or oral, concerning a client, made or maintained in connection with the administration of this program, shall be confidential, and shall not be used or disclosed except for any of the following:
(1) For purposes directly connected with the administration of the program.
(2) If disclosure is otherwise authorized by law.
(3) Pursuant to a written authorization by the person who is the subject of the record or, if the person is 18 years of age or older, by the person’s guardian or conservator.
(j) For purposes of verifying financial eligibility for the program, the department shall verify the accuracy of the modified adjusted gross income reported by an applicant or recipient of the program, with data, if available, from the Franchise Tax Board. The Franchise Tax Board and the department are authorized to disclose personally identifiable data to one another, solely for this purpose, and in accordance with the data exchange process identified in Section 120962.
(k) Regulations adopted pursuant to subdivision (c), (d), or (e), are exempt from rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).

SEC. 19.

 Section 103870.2 of the Health and Safety Code is repealed.

SEC. 20.

 Chapter 1.7 (commencing with Section 103871) is added to Part 2 of Division 102 of the Health and Safety Code, to read:
CHAPTER  1.7. California Neurodegenerative Disease Registry Program

103871.
 (a) Beginning January 1, 2023, the department shall collect data on the incidence of neurodegenerative disease, as defined in subdivision (i), in California.
(b) The department shall establish a system for the collection of information determining the incidence and prevalence of neurodegenerative diseases. The department shall designate the specified neurodegenerative diseases as a disease required to be reported in the state or any part of the state. All cases of neurodegenerative disease diagnosed or treated in California shall be reported to the department.
(c) The department shall provide notification of the mandatory reporting of neurodegenerative disease on its internet website and shall also provide that information to associations representing physicians and hospitals and directly to the Medical Board of California at least 90 days prior to requiring information be reported.
(d) Beginning July 1, 2023, a hospital, facility, physician and surgeon, or other health care provider diagnosing or providing treatment for a patient with a neurodegenerative disease shall report each case of a neurodegenerative disease to the department in a format prescribed by the department.
(e) If the hospital or other facility fails to report in a format prescribed by the department, the department’s authorized representative may access the information from the hospital or the facility and report it in the appropriate format. In these cases, the hospital or other facility shall reimburse the department or the authorized representative for its costs to access and report the information.
(f) A physician and surgeon, hospital, outpatient clinic, and any other facility, individual, or agency providing diagnostic or treatment services to a patient with a neurodegenerative disease shall grant to the department or the authorized representative access to all records that would identify a case of a neurodegenerative disease or would establish characteristics of a neurodegenerative disease, treatment of a neurodegenerative disease, or medical status of any identified patient with a neurodegenerative disease. Willful failure to grant access to those records shall be punishable by a civil penalty of up to five hundred dollars ($500) each day access is refused. Any civil penalties collected pursuant to this subdivision shall be deposited by the department in the General Fund.
(g) Except as otherwise provided in this chapter, all information collected pursuant to this section shall be confidential. For purposes of this chapter, this information shall be referred to as “confidential information.”
(h) The program shall be under the direction of the director, who may enter into contracts, grants, or other agreements as are necessary for the conduct of the program. The award of these contracts, grants, or funding agreements shall be exempt from Part 2 (commencing with Section 10100) of Division 2 of the Public Contract Code. This chapter shall be implemented only to the extent funds are made available for its purposes.
(i) For the purposes of this section, “neurodegenerative disease” may include, but need not be limited to, Alzheimer’s disease, multiple sclerosis, Huntington’s disease, and amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease.

103871.1.
 (a) A person with a valid scientific interest who is engaged in demographic, epidemiological, or other similar studies related to health who meets qualifications as determined by the department, and who agrees, in writing, to maintain confidentiality, may be authorized access to confidential information collected by the department pursuant to Section 103871.
(b) The department may enter into agreements to furnish confidential information to other states’ neurodegenerative disease registries, federal neurodegenerative disease control agencies, local health officers, or health researchers for the study of neurodegenerative diseases. Before confidential information is disclosed to those agencies, officers, researchers, or out-of-state registries, the requesting entity shall agree in writing to maintain the confidentiality of the information, and in the case of researchers, shall also do both of the following:
(1) Obtain approval of their committee for the protection of human subjects established in accordance with Part 46 (commencing with Section 46.101) of Title 45 of the Code of Federal Regulations.
(2) Provide documentation to the department that demonstrates to the department’s satisfaction that the entity has established the procedures and ability to maintain the confidentiality of the information.
(c) Notwithstanding any other law, a disclosure authorized by this section shall include only the information necessary for the stated purpose of the requested disclosure, used for the approved purpose, and not be further disclosed.
(d) The furnishing of confidential information to the department or its authorized representative in accordance with this section shall not expose any person, agency, or entity furnishing information to liability, and shall not be considered a waiver of any privilege or a violation of a confidential relationship.
(e) (1) The department shall maintain an accurate record of all persons who are given access to confidential information. The record shall include all of the following information:
(A) Name of the person authorizing access.
(B) Name, title, address, and organizational affiliation of persons given access.
(C) Dates of access.
(D) Specific purpose for which information is to be used.
(2) The record of access shall be open to public inspection during normal operating hours of the department.
(f) Notwithstanding any other law, the confidential information shall not be available for subpoena, shall not be disclosed, discoverable, or compelled to be produced in any civil or administrative proceeding, or other similar proceeding. The confidential information shall not be deemed admissible as evidence in any civil or administrative proceeding, or other similar tribunal or court for any reason.
(1) This subdivision does not prohibit the department from publishing reports and statistical compilations that do not identify individual cases or individual sources of information.
(2) Notwithstanding the restrictions in this subdivision, the individual to whom the information pertains shall have access to the individual’s own information in accordance with Chapter 1 (commencing with Section 1798) of Title 1.8 of Part 4 of Division 3 of the Civil Code.
(g) This section does not preempt the authority of a facility or an individual providing diagnostic or treatment services to a patient with a neurodegenerative disease to maintain their own facility-based neurodegenerative disease registry.

103871.2.
 This chapter shall remain in effect only until January 1, 2028, and as of that date is repealed.

SEC. 21.

 Section 120511 of the Health and Safety Code is amended to read:

120511.
 (a) The department shall allocate funds to local health jurisdictions for sexually transmitted disease prevention and control activities in accordance, to the extent possible, with the following:
(1) Local health jurisdictions shall be prioritized based on population and incidence of sexually transmitted diseases.
(2) Funds shall be allocated to prioritized local health jurisdictions in a manner that balances the need to spread funding to as many local health jurisdictions, community-based organizations, and nonprofit health care providers as possible and the need to provide meaningful activities to each recipient. No less than 50 percent of the funds allocated to local health jurisdictions shall be provided to community-based organizations or nonprofit health care providers, provided that there are community-based organizations or nonprofit health care providers in the jurisdiction that can conduct the activities and provide these services consistent with this section.
(3) Each local health jurisdiction shall demonstrate to the department that the community-based organization or nonprofit health care provider that receives funding under this section has done all of the following:
(A) Identified priority target populations.
(B) Satisfactorily described its outreach protocols.
(C) Included community resources for prevention and control activities.
(D) Engaged representatives from impacted communities in the development of outreach activities.
(4) Local health jurisdiction shall use these funds to facilitate expanded access to sexually transmitted infection (STI) clinical services, including, but not limited to, LBGTQ+ populations, including those who face confidentiality barriers in using their health coverage to receive STI testing, treatment, and related care.
(5) The department shall develop measures for each local health jurisdiction funded pursuant to this section to demonstrate accountability.
(b) In awarding funds pursuant to subdivision (a), the department shall authorize local health jurisdictions to include innovative and impactful prevention and control activities, including, but not limited to, the following:
(1) Voluntary screening for sexually transmitted diseases among inmates and wards of county adult and juvenile correctional facilities. The department may provide assistance or guidance to the local health jurisdiction if necessary to secure participation by other county agencies.
(2) Technology, telehealth, and digital platforms and applications to enhance immediate access to screening, testing, and treatment, as well as partner activities in order to speed activities and to reduce administrative costs.
(3) State-of-the-art testing modalities that ensure swift and accurate screening for, and diagnosis of, sexually transmitted diseases.
(4) Community-based testing and disease investigation.
(c) The department shall monitor activities in funded local health jurisdictions, based on the accountability measures required under paragraph (4) of subdivision (a), in order to assess the effectiveness of prevention and control activities efforts.
(d) It is the intent of the Legislature that the activities identified in this section are to enhance the activities that are already provided. Therefore, nothing in this section shall be construed to require the department to replace existing activities with the activities provided for in subdivision (a) or to prevent the department from adding new activities as may be appropriate.
(e) This section shall be operative only if funds are explicitly appropriated in the annual Budget Act specifically for purposes of this section.

SEC. 22.

 Section 120780.2 of the Health and Safety Code is amended to read:

120780.2.
 In order to reduce the spread of HIV, hepatitis C, and other potentially deadly bloodborne pathogens, the State Department of Public Health may purchase sterile hypodermic needles and syringes, and other supplies, for distribution to syringe exchange programs authorized pursuant to law and support any costs associated with distribution of supplies. Supplies provided to programs, including those administered by local health departments, are not subject to the formulas and limits of Section 120780.1.

SEC. 23.

 Section 120956 of the Health and Safety Code is amended to read:

120956.
 (a) The AIDS Drug Assistance Program Rebate Fund is hereby created as a special fund in the State Treasury.
(b) All rebates collected from drug manufacturers on drugs purchased through the AIDS Drugs Assistance Program (ADAP) implemented pursuant to this chapter and, notwithstanding Section 16305.7 of the Government Code, interest earned on these moneys shall be deposited in the fund exclusively to cover costs related to the purchase of drugs and services provided through ADAP and the HIV prevention programs as described in Sections 120972 and 120972.1.
(c) Notwithstanding Section 13340 of the Government Code, moneys in the fund are continuously appropriated without regard to fiscal year to State Department of Public Health and available for expenditure for those purposes specified under this section.

SEC. 24.

 Section 120972.1 is added to the Health and Safety Code, to read:

120972.1.
 (a) To the extent that funds are available for these purposes, the State Department of Public Health, Office of AIDS may allocate funds to local health departments and community-based organizations to support HIV preexposure prophylaxis (PrEP) and postexposure prophylaxis (PEP) navigation and retention coordinators and related services for the purpose of increasing PrEP and PEP initiation and retention among individuals most vulnerable to HIV.
(b) Navigation and retention services may include, but are not limited to, outreach and education, community messaging, assistance with applying for and retaining health coverage, assistance with enrollment in PrEP and PEP financial assistance programs, care coordination and adherence support, financial assistance for transportation costs, and linkage to behavioral health, substance use, housing, and other social service programs.
(c) The Office of AIDS shall establish a simple application process for local health departments and community-based organizations to receive funding to support PrEP and PEP navigation and retention coordinators and related services.
(d) Local health departments and community-based organizations in any county shall be eligible for funding if they meet all of the following requirements:
(1) Provide enrollment or clinical services for the HIV prevention program as outlined in Section 120972.
(2) Describe how funding for PrEP and PEP navigation and retention coordinators and related services will help to improve PrEP initiation and retention in their specific geographic area.
(3) Demonstrate the capacity to provide culturally appropriate PrEP and PEP navigation and retention services to one or more communities vulnerable to HIV, including, but not limited to, all of the following:
(A) Black, indigenous, and people of color.
(B) Lesbian, gay, bisexual, queer, and questioning individuals.
(C) Non-English-speaking individuals.
(D) Other populations that are difficult to reach, including those with transportation or technology challenges.
(E) People experiencing homelessness.
(F) People involved in the carceral system.
(G) People who use drugs.
(H) People engaged in sex work.
(I) Transgender and gender-nonconforming individuals.
(J) Undocumented individuals.
(K) Women.
(L) Youth.
(e) Local health departments and community-based organizations shall be eligible to apply for one or more PrEP navigation and retention coordinators based on need in the specific geographic area and organizational capacity to reach the target population or populations.
(f) Funded local health departments and community-based organizations shall collaborate with the Office of AIDS to conduct outcome and process evaluation of PrEP and PEP navigation and retention services. The Office of AIDS shall establish performance metrics to ensure that funding is used efficiently and measure program success.
(g) The Office of AIDS may use a portion of funds to contract with a third-party entity to provide training, program technical assistance, and capacity building to funded local health departments and community-based organizations.
(h) To the extent allowable under federal law, and upon availability of funds, the Office of AIDS may expend funding for the activities outlined in this section from the AIDS Drug Assistance Program Rebate Fund as implemented pursuant to Section 120956.

SEC. 25.

 Chapter 13.8 (commencing with Section 121295) is added to Part 4 of Division 105 of the Health and Safety Code, to read:
CHAPTER  13.8. HIV and Aging Demonstration Projects

121295.
 (a) The State Department of Public Health, in consultation with the California Department of Aging, shall establish a program for demonstration projects to allow for innovative, evidence-informed approaches to improve the health and well-being of older people living with HIV.
(b) The demonstration projects shall address the multidisciplinary clinical and nonclinical needs of older people living with HIV.
(c) The demonstration projects shall be responsive to the unique needs of older people living with HIV in the specific geographic area.
(d) The demonstration projects shall operate for a period of up to three years. The department shall implement up to five demonstration projects.
(e) The demonstration projects shall include an evaluation component and a plan for disseminating lessons learned in order to develop new programs and strengthen existing programs.
(f) (1) The department shall establish a process to request applications, and award funding on a competitive basis, for an eligible entity to operate a demonstration project pursuant to this chapter.
(2) An application to operate a demonstration project under this chapter shall be evaluated based on need in the geographic area, populations served, competency of the entity applying, and program design.
(g) The department shall determine the funding levels of each demonstration project based on the scope of the project and need in the specific geographic area.
(h) Any entity in any county shall be eligible to operate a demonstration project pursuant to this chapter if it meets both of the following requirements:
(1) Demonstrates experience and expertise in providing culturally appropriate services to the most vulnerable and underserved older people living with HIV, including, but not limited to, older people living with HIV who are Black, Indigenous, and people of color.
(2) Demonstrates the capacity to ensure that the multidisciplinary clinical and nonclinical needs of older people living with HIV are assessed and addressed. Services may be colocated or coordinated across different locations, including through referrals or partnerships with other entities.

SEC. 26.

 Section 122445 is added to the Health and Safety Code, to read:

122445.
 (a) In order to ensure that the most vulnerable Californians are informed of their hepatitis C virus (HCV) status and are linked to care and a cure, the State Department of Public Health’s Office of Viral Hepatitis Prevention may purchase HCV test kits and associated materials and supplies for distribution to community-based organizations and local health departments.
(b) The Office of Viral Hepatitis Prevention may also allocate funding to train personnel associated with community-based organizations and local health departments to conduct HCV testing, human immunodeficiency virus (HIV) testing, and sexually transmitted infection (STI) testing and related activities.
(c) The Office of Viral Hepatitis Prevention may use a portion of the funds allocated for purposes of this section to hire necessary staff to successfully implement and evaluate the activities authorized by this section.
(d) The Office of Viral Hepatitis Prevention shall establish a simple application process for community-based organizations and local health departments to apply to receive HCV test kits and support for the activities authorized by this section.
(e) If the overall requests for HCV test kits and support exceeds the amount of funds allocated for this section, the Office of Viral Hepatitis Prevention may prioritize distribution of HCV test kits and support to community-based organizations and local health departments based on need in the specific geographic area and demonstrated capacity to provide culturally appropriate services to one or more of the communities most vulnerable to HCV.

SEC. 27.

 Section 125075 of the Health and Safety Code is repealed.

SEC. 28.

 The heading of Division 107 (commencing with Section 127000) of the Health and Safety Code is amended to read:

DIVISION 107. HEALTH CARE ACCESS AND INFORMATION

SEC. 29.

 The heading of Part 1 (commencing with Section 127000) of Division 107 of the Health and Safety Code is amended to read:

PART 1. DEPARTMENT OF HEALTH CARE ACCESS AND INFORMATION

SEC. 30.

 Section 127000 of the Health and Safety Code is amended to read:

127000.
 There is in the state government, in the Health and Welfare Agency, the Department of Health Care Access and Information.

SEC. 31.

 Section 127002 is added to the Health and Safety Code, to read:

127002.
 Any reference to the Office of Statewide Health Planning and Development shall be deemed a reference to the Department of Health Care Access and Information.

SEC. 32.

 Section 127005 of the Health and Safety Code is amended to read:

127005.
 The department is under the control of an executive officer known as the Director of the Department of Health Care Access and Information who shall be appointed by the Governor, subject to confirmation by the Senate, and hold office at the pleasure of the Governor. The Director shall receive the annual salary provided by Article 1 (commencing with Section 11550) of Chapter 6 of Part 1 of Division 3 of Title 2 of the Government Code.

SEC. 33.

 Section 127010 of the Health and Safety Code is amended to read:

127010.
 The director of the department shall have the powers of a head of the department pursuant to Chapter 2 (commencing with Section 11150) of Part 1 of Division 3 of Title 2 of the Government Code.

SEC. 34.

 Section 127015 of the Health and Safety Code is repealed.

SEC. 35.

 Section 127020 of the Health and Safety Code is repealed.

SEC. 36.

 Section 127025 of the Health and Safety Code is repealed.

SEC. 37.

 Section 127030 of the Health and Safety Code is repealed.

SEC. 38.

 Section 127035 of the Health and Safety Code is repealed.

SEC. 39.

 Section 127040 of the Health and Safety Code is repealed.

SEC. 40.

 Section 127045 of the Health and Safety Code is repealed.

SEC. 41.

 Section 127050 of the Health and Safety Code is repealed.

SEC. 42.

 Section 127125 of the Health and Safety Code is repealed.

SEC. 43.

 Section 127130 of the Health and Safety Code is repealed.

SEC. 44.

 Section 127135 of the Health and Safety Code is repealed.

SEC. 45.

 Section 127140 of the Health and Safety Code is repealed.

SEC. 46.

 Section 127145 of the Health and Safety Code is repealed.

SEC. 47.

 Section 127150 of the Health and Safety Code is repealed.

SEC. 48.

 Section 127155 of the Health and Safety Code is repealed.

SEC. 49.

 Section 127160 of the Health and Safety Code is repealed.

SEC. 50.

 Section 127165 of the Health and Safety Code is repealed.

SEC. 51.

 Section 127170 of the Health and Safety Code is repealed.

SEC. 52.

 Section 127175 of the Health and Safety Code is repealed.

SEC. 53.

 Section 127180 of the Health and Safety Code is repealed.

SEC. 54.

 Section 127185 of the Health and Safety Code is repealed.

SEC. 55.

 Section 127190 of the Health and Safety Code is repealed.

SEC. 56.

 Section 127195 of the Health and Safety Code is repealed.

SEC. 57.

 Section 127200 of the Health and Safety Code is repealed.

SEC. 58.

 Section 127205 of the Health and Safety Code is repealed.

SEC. 59.

 Section 127210 of the Health and Safety Code is repealed.

SEC. 60.

 Section 127215 of the Health and Safety Code is repealed.

SEC. 61.

 Section 127220 of the Health and Safety Code is repealed.

SEC. 62.

 Section 127225 of the Health and Safety Code is repealed.

SEC. 63.

 Section 127230 of the Health and Safety Code is repealed.

SEC. 64.

 Section 127235 of the Health and Safety Code is repealed.

SEC. 65.

 Section 127240 of the Health and Safety Code is repealed.

SEC. 66.

 Section 127245 of the Health and Safety Code is repealed.

SEC. 67.

 Section 127250 of the Health and Safety Code is repealed.

SEC. 68.

 Section 127255 of the Health and Safety Code is repealed.

SEC. 69.

 Section 127260 of the Health and Safety Code is repealed.

SEC. 70.

 Section 127265 of the Health and Safety Code is repealed.

SEC. 71.

 Section 127270 of the Health and Safety Code is repealed.

SEC. 72.

 Section 127275 of the Health and Safety Code is repealed.

SEC. 73.

 Section 127280 of the Health and Safety Code is amended to read:

127280.
 (a) Every health facility licensed pursuant to Chapter 2 (commencing with Section 1250) of Division 2, except a health facility owned and operated by the state, shall each year be charged a fee established by the department consistent with the requirements of this section.
(b) Commencing in calendar year 2004, every freestanding ambulatory surgery clinic as defined in Section 128700, shall each year be charged a fee established by the department consistent with the requirements of this section.
(c) The fee structure shall be established each year by the department to produce revenues equal to the appropriation made in the annual Budget Act or another statute to pay for the functions required to be performed by the department pursuant to this chapter, Article 2 (commencing with Section 127340) of Chapter 2, or Chapter 1 (commencing with Section 128675) of Part 5, and to pay for any other health-related programs administered by the department. The fee shall be due on July 1 and delinquent on July 31 of each year.
(d) The fee for a health facility that is not a hospital, as defined in subdivision (f) of Section 128700, shall be not more than 0.035 percent of the gross operating cost of the facility for the provision of health care services for its last fiscal year that ended on or before June 30 of the preceding calendar year.
(e) The fee for a hospital, as defined in subdivision (f) of Section 128700, shall be not more than 0.035 percent of the gross operating cost of the facility for the provision of health care services for its last fiscal year that ended on or before June 30 of the preceding calendar year.
(f) (1) The fee for a freestanding ambulatory surgery clinic shall be established at an amount equal to the number of ambulatory surgery data records submitted to the department pursuant to Section 128737 for encounters in the preceding calendar year multiplied by not more than fifty cents ($0.50).
(2) (A) For the calendar year 2004 only, a freestanding ambulatory surgery clinic shall estimate the number of records it will file pursuant to Section 128737 for the calendar year 2004 and shall report that number to the department by March 12, 2004. The estimate shall be as accurate as possible. The fee in the calendar year 2004 shall be established initially at an amount equal to the estimated number of records reported multiplied by fifty cents ($0.50) and shall be due on July 1 and delinquent on July 31, 2004.
(B) The department shall compare the actual number of records filed by each freestanding clinic for the calendar year 2004 pursuant to Section 128737 with the estimated number of records reported pursuant to subparagraph (A). If the actual number reported is less than the estimated number reported, the department shall reduce the fee of the clinic for calendar year 2005 by the amount of the difference multiplied by fifty cents ($0.50). If the actual number reported exceeds the estimated number reported, the department shall increase the fee of the clinic for calendar year 2005 by the amount of the difference multiplied by fifty cents ($0.50) unless the actual number reported is greater than 120 percent of the estimated number reported, in which case the department shall increase the fee of the clinic for calendar year 2005 by the amount of the difference, up to and including 120 percent of the estimated number, multiplied by fifty cents ($0.50), and by the amount of the difference in excess of 120 percent of the estimated number multiplied by one dollar ($1).
(g) There is hereby established the California Health Data and Planning Fund within the department for the purpose of receiving and expending fee revenues collected pursuant to this chapter.
(h) Any amounts raised by the collection of the special fees provided for by subdivisions (d), (e), and (f) that are not required to meet appropriations in the Budget Act for the current fiscal year shall remain in the California Health Data and Planning Fund and shall be available to the department in succeeding years when appropriated by the Legislature in the annual Budget Act or another statute, for expenditure under the provisions of this chapter, Article 2 (commencing with Section 127340) of Chapter 2, and Chapter 1 (commencing with Section 128675) of Part 5, or for any other health-related programs administered by the department, and shall reduce the amount of the special fees that the department is authorized to establish and charge. In no event, however, shall those amounts be used for programs administered by the department pursuant to Sections 127676, 127679, 127681, 127683, and 127685, that become effective on or after January 1, 2019.
(i) (1) No health facility liable for the payment of fees required by this section shall be issued a license or have an existing license renewed unless the fees are paid. A new, previously unlicensed, health facility shall be charged a pro rata fee to be established by the department during the first year of operation.
(2) The license of any health facility, against which the fees required by this section are charged, shall be revoked, after notice and hearing, if it is determined by the department that the fees required were not paid within the time prescribed by subdivision (c).
(j) This section shall become operative on January 1, 2002.

SEC. 74.

 Section 127285 of the Health and Safety Code is amended to read:

127285.
 (a)  Health facilities and clinics, except for chronic dialysis clinics as defined in subdivision (b) of Section 1204, shall annually report to the department all of the following information on forms supplied by the department:
(1)  A current inventory of beds and services.
(2)  Utilization data by bed type and service.
(3)  Acquisitions of diagnostic or therapeutic equipment during the reporting period with a value in excess of five hundred thousand dollars ($500,000).
(4)  Commencement of projects during the reporting period that require a capital expenditure for the facility or clinic in excess of one million dollars ($1,000,000).
(b)  With respect to chronic dialysis clinics, the department may annually obtain this information to the extent it is available from the Federal End Stage Renal Disease Network.

SEC. 75.

 Section 127290 of the Health and Safety Code is repealed.

SEC. 76.

 Section 127295 of the Health and Safety Code is repealed.

SEC. 77.

 Section 127300 of the Health and Safety Code is repealed.

SEC. 78.

 The heading of Article 1 of Chapter 2 of Part 2 of Division 107 of the Health and Safety Code is repealed.

SEC. 79.

 Section 127345 of the Health and Safety Code is amended to read:

127345.
 As used in this article, the following terms have the following meanings:
(a) “Charity care” means free health services provided without expectation of payment to persons who meet the organization’s criteria for financial assistance and are unable to pay for all or a portion of the services. Charity care shall be reported at cost, as reported to the Department of Health Care Access and Information. Charity care does not include bad debt defined as uncollectible charges that the organization recorded as revenue but wrote off due to a patient’s failure to pay.
(b) “Community benefits plan” means the written document prepared for annual submission to the Department of Health Care Access and Information that shall include, but shall not be limited to, a description of the activities that the hospital has undertaken in order to address identified community needs within its mission and financial capacity, and the process by which the hospital developed the plan in consultation with the community.
(c) “Community” means the service areas or patient populations for which the hospital provides health care services.
(d) (1) Solely for the planning and reporting purposes of this article, “community benefit” means a hospital’s activities that are intended to address community needs and priorities primarily through disease prevention and improvement of health status, including, but not limited to, any of the following:
(A) Health care services, rendered to vulnerable populations, including, but not limited to, charity care and the unreimbursed cost of providing services to the uninsured, underinsured, and those eligible for Medi-Cal, Medicare, California Children’s Services Program, or county indigent programs.
(B) The unreimbursed cost of services included in subdivision (d) of Section 127340.
(C) Financial or in-kind support of public health programs.
(D) Donation of funds, property, or other resources that contribute to a community priority.
(E) Health care cost containment.
(F) Enhancement of access to health care or related services that contribute to a healthier community.
(G) Services offered without regard to financial return because they meet a community need in the service area of the hospital, and other services including health promotion, health education, prevention, and social services.
(H) Food, shelter, clothing, education, transportation, and other goods or services that help maintain a person’s health.
(2) “Community benefit” does not mean activities or programs that are provided primarily for marketing purposes or are more beneficial to the organization than to the community.
(e) “Community needs assessment” means the process by which the hospital identifies, for its primary service area as determined by the hospital, unmet community needs.
(f) “Community needs” means those requisites for improvement or maintenance of health status in the community.
(g) “Hospital” means a private not-for-profit acute hospital licensed under subdivision (a), (b), or (f) of Section 1250 and is owned by a corporation that has been determined to be exempt from taxation under the United States Internal Revenue Code. “Hospital” does not mean any of the following:
(1) Hospitals that are dedicated to serving children and that do not receive direct payment for services to any patient.
(2) Small and rural hospitals as defined in Section 124840, unless the hospital is part of a hospital system.
(3) A district hospital organized and governed pursuant to the Local Health Care District Law (Division 23 (commencing with Section 32000)) or a nonprofit corporation that is affiliated with the health care district hospital owner by means of the district’s status as the nonprofit corporation’s sole corporate member pursuant to subparagraph (B) of paragraph (1) of subdivision (h) of Section 14169.31 of the Welfare and Institutions Code.
(h) “Mission statement” means a hospital’s primary objectives for operation as adopted by its governing body.
(i) “Vulnerable populations” means any population that is exposed to medical or financial risk by virtue of being uninsured, underinsured, or eligible for Medi-Cal, Medicare, California Children’s Services Program, or county indigent programs.

SEC. 80.

 Section 127346 of the Health and Safety Code is amended to read:

127346.
 (a) The Department of Healthcare Access and Information may impose a fine not to exceed five thousand dollars ($5,000) on hospitals for failure to adopt, update, or submit community benefit plans consistent with Section 127350.
(b) The department may grant a hospital an automatic 60-day extension for submitting annual community benefit plans.
(c) The department shall annually prepare, and post on its internet website, a report that includes all of the following:
(1) The amount each hospital spent on community benefits.
(2) The amount of community benefit spending attributable to charity care, the unpaid cost of government-sponsored health care programs, and community benefit programs and activities.
(3) A list of all hospitals that failed to report community benefits spending.
(d) The department shall make all community benefit plans submitted by hospitals pursuant to Section 127350 available to the public on its internet website.

SEC. 81.

 Section 127350 of the Health and Safety Code is amended to read:

127350.
 Each hospital shall do all of the following:
(a) By July 1, 1995, reaffirm its mission statement that requires its policies integrate and reflect the public interest in meeting its responsibilities as a not-for-profit organization.
(b) By January 1, 1996, complete, either alone, in conjunction with other health care providers, or through other organizational arrangements, a community needs assessment evaluating the health needs of the community serviced by the hospital, that includes, but is not limited to, a process for consulting with community groups and local government officials in the identification and prioritization of community needs that the hospital can address directly, in collaboration with others, or through other organizational arrangement. The community needs assessment shall be updated at least once every three years.
(c) By April 1, 1996, and annually thereafter adopt and update a community benefits plan for providing community benefits either alone, in conjunction with other health care providers, or through other organizational arrangements.
(d) (1) Annually submit its community benefits plan, including, but not limited to, the activities that the hospital has undertaken in order to address community needs within its mission and financial capacity to the Department of Health Care Access and Information. The hospital shall assign and report the economic value of community benefits provided in furtherance of its plan, and include a description of how needs identified in the assessment are being addressed and which needs are not being addressed, and why. Effective with hospital fiscal years, beginning on or after January 1, 1996, each hospital shall file a copy of the plan with the department not later than 150 days after the hospital’s fiscal year ends.
(2) Hospitals under the common control of a single corporation or another entity may file a consolidated report if the report includes each hospital’s community benefit financial data and describes the benefits provided to the communities in the hospitals’ geographic area. Hospitals on a consolidated license may file a consolidated community benefit plan report if they serve the same geographic area.
(3) Each hospital’s community benefit report shall contain an explanation of the methodology used to determine the hospital’s costs, written in plain English.
(e) Annually post its community benefits plan on its internet website.

SEC. 82.

 Section 127360 of the Health and Safety Code is amended to read:

127360.
 Nothing in this article shall be used to justify the tax-exempt status of a hospital under state law. Nothing in this article shall preclude the department from requiring hospitals to directly report their charity activities.

SEC. 83.

 Section 127400 of the Health and Safety Code is amended to read:

127400.
 As used in this article, the following terms have the following meanings:
(a) “Allowance for financially qualified patient” means, with respect to services rendered to a financially qualified patient, an allowance that is applied after the hospital’s charges are imposed on the patient, due to the patient’s determined financial inability to pay the charges.
(b) “Federal poverty level” means the poverty guidelines updated periodically in the Federal Register by the United States Department of Health and Human Services under authority of subsection (2) of Section 9902 of Title 42 of the United States Code.
(c) “Financially qualified patient” means a patient who is both of the following:
(1) A patient who is a self-pay patient, as defined in subdivision (f), or a patient with high medical costs, as defined in subdivision (g).
(2) A patient who has a family income that does not exceed 350 percent of the federal poverty level.
(d) “Hospital” means a facility that is required to be licensed under subdivision (a), (b), or (f) of Section 1250, except a facility operated by the State Department of State Hospitals or the Department of Corrections and Rehabilitation.
(e) “Department” means the Department of Health Care Access and Information.
(f) “Self-pay patient” means a patient who does not have third-party coverage from a health insurer, health care service plan, Medicare, or Medicaid, and whose injury is not a compensable injury for purposes of workers’ compensation, automobile insurance, or other insurance as determined and documented by the hospital. Self-pay patients may include charity care patients.
(g) “A patient with high medical costs” means a person whose family income does not exceed 350 percent of the federal poverty level, as defined in subdivision (b). For these purposes, “high medical costs” means any of the following:
(1) Annual out-of-pocket costs incurred by the individual at the hospital that exceed 10 percent of the patient’s family income in the prior 12 months.
(2) Annual out-of-pocket expenses that exceed 10 percent of the patient’s family income, if the patient provides documentation of the patient’s medical expenses paid by the patient or the patient’s family in the prior 12 months.
(3) A lower level determined by the hospital in accordance with the hospital’s charity care policy.
(h) “Patient’s family” means the following:
(1) For persons 18 years of age and older, spouse, domestic partner, as defined in Section 297 of the Family Code, and dependent children under 21 years of age, whether living at home or not.
(2) For persons under 18 years of age, parent, caretaker relatives, and other children under 21 years of age of the parent or caretaker relative.
(i) “Reasonable payment plan” means monthly payments that are not more than 10 percent of a patient’s family income for a month, excluding deductions for essential living expenses. “Essential living expenses” means, for purposes of this subdivision, expenses for any of the following: rent or house payment and maintenance, food and household supplies, utilities and telephone, clothing, medical and dental payments, insurance, school or child care, child or spousal support, transportation and auto expenses, including insurance, gas, and repairs, installment payments, laundry and cleaning, and other extraordinary expenses.

SEC. 84.

 Section 127435 of the Health and Safety Code is amended to read:

127435.
 Each hospital shall provide to the department a copy of its discount payment policy, charity care policy, eligibility procedures for those policies, review process, and the application for charity care or discounted payment programs. The department may determine whether the information is to be provided electronically or in some other manner. The information shall be provided at least biennially on January 1, or when a significant change is made. If no significant change has been made by the hospital since the information was previously provided, notifying the department of the lack of change shall meet the requirements of this section. The department shall make this information available to the public.

SEC. 85.

 Section 127450 of the Health and Safety Code is amended to read:

127450.
 As used in this article, the following terms have the following meanings:
(a) “Allowance for financially qualified patient” means, with respect to emergency care rendered to a financially qualified patient, an allowance that is applied after the emergency physician’s charges are imposed on the patient, due to the patient’s determined financial inability to pay the charges.
(b) “Emergency care” means emergency medical services and care, as defined in Section 1317.1, that is provided by an emergency physician in the emergency department of a hospital.
(c) “Emergency physician” means a physician and surgeon licensed pursuant to Chapter 5 (commencing with Section 2000) of Division 2 of the Business and Professions Code who is credentialed by a hospital and either employed or contracted by the hospital to provide emergency medical services in the emergency department of the hospital, except that an “emergency physician” shall not include a physician specialist who is called into the emergency department of a hospital or who is on staff or has privileges at the hospital outside of the emergency department.
(d) “Federal poverty level” means the poverty guidelines updated periodically in the Federal Register by the United States Department of Health and Human Services under authority of subsection (2) of Section 9902 of Title 42 of the United States Code.
(e) “Financially qualified patient” means a patient who is both of the following:
(1) A patient who is a self-pay patient or a patient with high medical costs.
(2) A patient who has a family income that does not exceed 350 percent of the federal poverty level.
(f) “Hospital” means a facility that is required to be licensed under subdivision (a) of Section 1250, except a facility operated by the State Department of State Hospitals or the Department of Corrections and Rehabilitation.
(g) “Department” means the Department of Health Care Access and Information.
(h) “Self-pay patient” means a patient who does not have third-party coverage from a health insurer, health care service plan, Medicare, or Medicaid, and whose injury is not a compensable injury for purposes of workers’ compensation, automobile insurance, or other insurance as determined and documented by the emergency physician. Self-pay patients may include charity care patients.
(i) “A patient with high medical costs” means a person whose family income does not exceed 350 percent of the federal poverty level if that individual does not receive a discounted rate from the emergency physician as a result of their third-party coverage. For these purposes, “high medical costs” means any of the following:
(1) Annual out-of-pocket costs incurred by the individual at the hospital that provided emergency care that exceed 10 percent of the patient’s family income in the prior 12 months.
(2) Annual out-of-pocket expenses that exceed 10 percent of the patient’s family income, if the patient provides documentation of the patient’s medical expenses paid by the patient or the patient’s family in the prior 12 months. The emergency physician may waive the request for documentation.
(3) A lower level determined by the emergency physician in accordance with the emergency physician’s discounted payment policy.
(j) “Patient’s family” means the following:
(1) For persons 18 years of age and older, spouse, domestic partner, as defined in Section 297 of the Family Code, and dependent children under 21 years of age, whether living at home or not.
(2) For persons under 18 years of age, parent, caretaker relatives, and other children under 21 years of age of the parent or caretaker relative.
(k) “Reasonable payment formula” means monthly payments that are not more than 10 percent of a patient’s family income for a month, excluding deductions for essential living expenses. “Essential living expenses” means, for purposes of this subdivision, expenses for all of the following: rent or house payment and maintenance, food and household supplies, utilities and telephone, clothing, medical and dental payments, insurance, school or child care, child or spousal support, transportation and auto expenses, including insurance, gas, and repairs, installment payments, laundry and cleaning, and other extraordinary expenses.

SEC. 86.

 Chapter 3 (commencing with Section 127575) of Part 2 of Division 107 of the Health and Safety Code is repealed.

SEC. 87.

 Chapter 4 (commencing with Section 127620) of Part 2 of Division 107 of the Health and Safety Code is repealed.

SEC. 88.

 Chapter 8 (commencing with Section 127670) of Part 2 of Division 107 of the Health and Safety Code is repealed.

SEC. 89.

 Section 127671 of the Health and Safety Code is amended to read:

127671.
 (a) The Legislature finds and declares that California has a substantial public interest in the price, cost, utilization, equity, and quality of health care services. California is a major purchaser of health coverage through the Public Employees’ Retirement System, the State Department of Health Care Services, the Department of General Services, the Department of Corrections and Rehabilitation, the California Health Benefit Exchange, and other entities acting on behalf of a state purchaser. California also provides major tax expenditures through the tax exclusion of employer-sponsored coverage and tax deductibility of coverage purchased by individuals, as well as tax deductibility of excess health care costs for individuals and families.
(b) It is the intent of the Legislature in enacting this chapter to establish a system to collect information regarding health care costs, utilization, quality, and equity. Health care data is reported and collected through many disparate systems. Creating a process to aggregate and use this data will provide greater transparency regarding health care costs, utilization, quality, and equity, and the information may be used to inform policy decisions regarding the provision of quality health care, improving public health, reducing disparities, advancing health coverage, reducing health care costs, oversight of the health care system and health care companies, and providing public benefit for Californians and the state, while preserving consumer privacy.
(c) It is the intent of the Legislature to improve data transparency to achieve a sustainable health care system with more equitable access to affordable and quality health care for all.
(d) It is the intent of the Legislature in enacting this chapter to encourage state agencies, researchers, health care service plans, health insurers, providers, suppliers, and other stakeholders to use this data to develop innovative approaches, services, and programs that may have the potential to deliver health care that is both cost effective and responsive to the needs of enrollees, including recognizing the diversity of California and the impact of social determinants of health.
(e) It is the intent of the Legislature that the development of a Health Care Payments Data System be substantially completed no later than July 1, 2023, pursuant to this chapter.
(f) For purposes of this chapter:
(1) “Director” means the Director of the Department of Health Care Access and Information.
(2) “Fund” means the Health Care Payments Data Fund established pursuant to Section 127674.
(3) “Department” means the Department of Health Care Access and Information.
(4) “Program” means the Health Care Payments Data Program established pursuant to Section 127671.1.
(5) “Qualified applicants” includes state agencies, mandatory submitters, established nonprofit research institutions, the University of California, nonprofit educational institutions, providers, suppliers, labor unions, self-insured multiemployer plans that submit data to the system, and consumer organizations certified for the Consumer Participation Program administered by the Department of Managed Health Care pursuant to Section 1348.9 that have been awarded reasonable advocacy and witness fees in a proceeding or proceedings of the department.
(6) “Research” has the same meaning as defined in Section 164.501 of Title 45 of the Code of Federal Regulations.
(7) “System” means the Health Care Payments Data System.

SEC. 90.

 Section 127671.1 of the Health and Safety Code is amended to read:

127671.1.
 (a) The department shall establish, implement, and administer the Health Care Payments Data Program to implement and administer the system in accordance with this chapter.
(b) The system shall collect data on all California residents to the extent feasible and permissible subject to the state constitutional right to privacy and any other applicable state or federal law.

SEC. 91.

 Section 127672 of the Health and Safety Code is amended to read:

127672.
 (a) (1) The Department of Health Care Access and Information shall convene a Health Care Payments Data Program advisory committee, composed of health care stakeholders and experts, including, but not limited to, all of the following:
(A) Health care service plans, including specialized health care service plans.
(B) Insurers that have a certificate of authority from the Insurance Commissioner to provide health insurance, as defined in Section 106 of the Insurance Code.
(C) Suppliers, as defined in paragraph (3) of subdivision (b) of Section 1367.50.
(D) Providers, as defined in paragraph (2) of subdivision (b) of Section 1367.50.
(E) Self-insured employers.
(F) Multiemployer self-insured plans that are responsible for paying for health care services provided to beneficiaries or the trust administrator for a multiemployer self-insured plan.
(G) Businesses that purchase health care coverage for their employees.
(H) Organized labor.
(I) Organizations representing consumers.
(2) The advisory committee shall consist of no fewer than nine and no more than 11 persons.
(3) In addition to the members specified by paragraph (2), the director of the department, the director of the State Department of Health Care Services, and the executive director of the California Health Benefit Exchange, or their officially designated representatives, shall be nonvoting ex officio members of the advisory committee.
(4) Each appointed member shall serve a term of two years, except one-half of the initial appointments shall be for one year. Each appointed member shall serve at the discretion of the director and may be removed at any time.
(5) The chairperson of the advisory committee shall be an appointed member and shall be elected by a majority of the appointed members.
(6) The advisory committee shall meet at least quarterly or when requested by the director.
(7) The advisory committee shall assist and advise the director in formulating program policies regarding data collection, management, use, and access, and development of public information to meet the goals of the program. The advisory committee shall, through its meetings, provide a forum for stakeholder and public engagement. Upon request of the director, the advisory committee may assist and advise on the department’s other data programs.
(8) On or before July 1, 2024, the advisory committee shall make recommendations to the department on how existing state public health data functions may be integrated into the system. The advisory committee shall also recommend options for state public health data integration. These recommendations shall be published on the department’s internet website.
(9) The advisory committee shall not have decisionmaking authority related to the administration of the system and shall not have a financial interest, individually or through a family member, in the recommendations made to the department. The advisory committee shall hold public meetings with stakeholders, solicit input, and set its own meeting agendas. Meetings of the advisory committee are subject to the Bagley-Keene Open Meeting Act (Article 9 (commencing with Section 11120) of Chapter 1 of Part 1 of Division 3 of Title 2 of the Government Code).
(10) The members of the advisory committee appointed from outside government shall serve without compensation, but shall receive a per diem for each day’s attendance at an advisory committee meeting. All members shall be reimbursed for any actual and necessary expenses incurred in connection with their duties as members of the committee.
(b) The department may convene other committees or workgroups as necessary to support effective operation of the system. These committees may be standing committees or time-limited workgroups, at the discretion of the director.

SEC. 92.

 Section 127672.8 of the Health and Safety Code is amended to read:

127672.8.
 The department shall ensure that the system can map to other datasets, including public health datasets on morbidity and mortality, and data regarding the social determinants of health.

SEC. 93.

 Section 127672.9 of the Health and Safety Code is amended to read:

127672.9.
 Until January 1, 2026, for purposes of implementing this chapter, including, but not limited to, hiring staff and consultants, facilitating and conducting meetings, conducting research and analysis, and developing the required reports, the department may enter into exclusive or nonexclusive contracts on a bid or negotiated basis. Contracts entered into or amended pursuant to this section are exempt from Chapter 6 (commencing with Section 14825) of Part 5.5 of Division 3 of Title 2 of the Government Code and Part 2 (commencing with Section 10100) of Division 2 of the Public Contract Code, and are exempt from the review or approval of any division of the Department of General Services.

SEC. 94.

 Section 127673 of the Health and Safety Code is amended to read:

127673.
 (a) The department shall develop guidance to require data submission from the entities specified in this chapter. The guidance shall include a methodology for the collection, validation, refinement, analysis, comparison, review, and improvement of health care data to be submitted by entities specified in this chapter, including, but not limited to, data from fee-for-service, capitated, integrated delivery system, and other alternative, value-based, payment sources, and any other form of payment to health care providers and suppliers by health plans, health insurers, or other entities described in this chapter.
(b) Notwithstanding any other state law, for the purpose of providing information for inclusion in the system, mandatory submitters shall, and voluntary submitters may, provide health care data, including claim and encounter, member enrollment, provider and supplier information, nonclaims-based payments, premiums, and pharmacy rebate data, and provide all of the following to the department:
(1) Utilization data from the health care service plans’ and insurers’ medical payments or, in the case of entities that do not use payments data, including, but not limited to, integrated delivery systems, encounter data consistent with the core set of data elements for data submission proposed by the All-Payer Claims Database Council, the University of New Hampshire, and the National Association of Health Data Organizations.
(2) Pricing information for health care items, services, and medical and surgical episodes of care gathered from payments for covered health care items and services, including contracted rates, allowed amounts, fee schedules, and other information regarding the cost of care necessary to determine the amounts paid by health plans, health insurers, and public programs to health care providers, suppliers, and other entities. This shall include nonclaims-based payment information such as deductibles, copayments, and coinsurance and other information as needed to determine the total cost of care.
(3) Personally identifiable information that the mandatory submitter is otherwise required to collect, which may include detailed patient identifiers such as first and last name, address, date of birth, gender or gender identity, and Social Security Number or individual taxpayer identification number, in order to support analyses, including, but not limited to, longitudinal, public health impacts, and social determinants of health analyses. Personally identifiable information shall be subject to the privacy protections of this chapter and shall not be publicly available, except as specified in this chapter.
(4) Personal health information that the mandatory submitter is otherwise required to collect, which may include age, gender, gender identity, race, ethnicity, sexual orientation, health status, health condition, and any other data elements that constitute personal health information in this chapter.
(c) For purposes of this chapter, “mandatory submitters” include all of the following:
(1) A health care service plan, including a specialized health care service plan.
(2) An insurer licensed to provide health insurance, as defined in Section 106 of the Insurance Code, including dental-only insurance.
(3) A self-insured plan subject to Section 1349.2, or a state entity, city, county, or other political subdivision of the state, or a public joint labor management trust, that offers self-insured or multiemployer-insured plans that pay for or reimburse any part of the cost of health care services.
(4) The State Department of Health Care Services, for those enrolled in Medi-Cal and other insurance affordability programs, whether enrolled in Medi-Cal managed care, fee-for-service Medi-Cal, or any other payment arrangement.
(d) The department will accept, at its discretion, voluntarily submitted data. For purposes of this chapter, “voluntary submitters” include, but are not limited to:
(1) A self-insured employer that is not subject to Section 1349.2.
(2) A multiemployer self-insured plan that is responsible for paying for health care services provided to beneficiaries.
(3) The trust administrator for a multiemployer self-insured plan.
(4) A provider, as defined in paragraph (2) of subdivision (b) of Section 1367.50, that is a hospital or clinic.
(5) A supplier, as defined in paragraph (3) of subdivision (b) of Section 1367.50, that has an independent scope of practice and submits claims electronically.
(e) On or before December 31, 2021, the department shall adopt emergency regulations pursuant to Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 to implement this chapter, including on all of the following:
(1) Plan size thresholds for submitters, with consideration given to implementation costs for both the submitter and the department. Thresholds shall not apply to qualified health plans offered by the California Health Benefit Exchange or submitters covering more than a total of 50,000 Californians through both Medicare Advantage plans and the private plans and insurance described in subdivision (b).
(2) Required and exempted lines of business.
(3) Coordination of submission in cases where submitters contract with other entities to administer health care benefits.
(4) The content, file formats, and timelines for data submission, and the methods of data collection. In the development of regulations, the department shall consider national, regional, and other all-payer claims databases’ standards.
(5) Frequency of submission by health plans, insurers, and other mandatory submitters of all core data, including claims, encounters, eligibility, and provider files.
(6) Frequency of submission of nonclaims payment data files.
(f) The initial adoption, by the department, of regulations implementing subdivision (e) shall be deemed to be an emergency and necessary to avoid serious harm to the public peace, health, safety, or general welfare for purposes of Sections 11346.1 and 11349.6 of the Government Code. Any emergency regulation adopted pursuant to this section shall be repealed by operation of law unless the adoption, amendment, or repeal of the regulation is promulgated by the department pursuant to Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code within two years of the initial adoption of the emergency regulation. After the adoption of the emergency regulation pursuant to subdivision (e), the department may thereafter establish regulations pursuant to Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code.
(g) (1) A qualified health plan shall submit information either directly or through the California Health Benefit Exchange, as determined by the exchange.
(2) The State Department of Health Care Services shall submit information for those enrolled in Medi-Cal and other insurance affordability programs, whether enrolled in Medi-Cal managed care, fee-for-service Medi-Cal, or any other payment arrangement.
(h) (1) In its initial implementation, the department shall seek data for the three years prior to the effective date of this chapter.
(2) In ongoing administration of the system, the department shall provide data for no less than three years and may seek data for longer time periods to support the intent of this chapter.
(i) To the extent possible, the department shall incorporate into the system any data collected by the department from providers and suppliers, including hospital discharge abstract data records and emergency care data records provided to the department by health facilities and ambulatory surgery data records provided to the department by ambulatory surgical centers.
(j) The department may accept and incorporate into the system any available information that will further the goals of the program.
(k) (1) On or before March 1, 2024, the department shall submit a report to the Legislature that includes all of the following:
(A) Claims data reported by mandatory submitters.
(B) Claims data reported by voluntary submitters.
(C) Data on the covered lives reported, percentage of the population for which the department has data, the number of self-insured plans, providers and suppliers who have voluntarily submitted data, variation of completeness of data across geographic regions, such as the California Health Benefit Exchange’s rating regions, the extent of data submitted on hospitals, physicians, and physician groups, the extent to which mandatory and voluntary submitters are submitting data specified in subdivision (b), frequency of submission of all core data, including claims, encounters, eligibility, and provider files, frequency of submission of nonclaims payment data files, and any other information that is available to determine if hospital and physician data are captured.
(D) A cost estimate if providers and suppliers become mandatory submitters.
(E) The number of data requests from qualified applicants and their data uses.
(2) The department may request the data release committee established pursuant to Section 127673.84 to assist with the report.
(3) The report shall be submitted in compliance with Section 9795 of the Government Code.
(l) Entities regulated pursuant to Article 4.7 (commencing with Section 742.20) of Part 2 of Division 1 of the Insurance Code are exempt from this chapter.
(m) The program performs public health activities described in subdivision (b) of Section 164.512 of Title 45 of the Code of Federal Regulations. The information collected in accordance with this chapter is necessary to carry out projects with public health purposes.
(n) Article 8 (commencing with Section 1798.30) of Chapter 1 of Title 1.8 of Part 4 of Division 3 of the Civil Code shall not apply to records and personal information collected by the system pursuant to this section.

SEC. 95.

 Section 127673.1 of the Health and Safety Code is amended to read:

127673.1.
 (a) (1) The department shall report the information it receives pursuant to this chapter in a form that allows valid comparisons across care delivery systems.
(2) The department shall develop policies and procedures to outline the format and type of data to be submitted pursuant to this chapter.
(b) All entities submitting health care data are responsible for submitting complete and accurate data directly to the system and facilitating data submissions from data owners, including, but not limited to, data feeds from pharmacy benefit managers, behavioral health organizations, and any subsidiaries, affiliates, or subcontractors that a submitter has contracted with for services covered by this chapter.

SEC. 96.

 Section 127673.2 of the Health and Safety Code is amended to read:

127673.2.
 (a) In the development of the system, the department or its designee shall consult with state and federal entities, as necessary, to implement the program. State entities shall assist and provide to the department access to datasets needed to effectuate the intent of this chapter.
(b) The department shall seek data on Medicare enrollees from the federal Centers for Medicare and Medicaid Services and shall incorporate that data, to the extent possible.
(c) The department shall accept data from voluntary submitters if it is provided in a manner and format specified by the office.

SEC. 97.

 Section 127673.3 of the Health and Safety Code is amended to read:

127673.3.
 (a) The department shall develop and maintain a master person index, a master index of providers and suppliers, and a master payer index that will enable the matching of California residents longitudinally and across coverage sources, and will enable the matching of providers and suppliers across practice arrangements, payment sources, and regulators.
(b) The department shall supplement these indices with data from other public and private sources, such as the following:
(1) Other data maintained by the department.
(2) Vital statistics.
(3) Facility licensure data from the State Department of Public Health.
(4) Health professional licensure data from the Department of Consumer Affairs.
(5) Private sources of valid and reliable data, such as a provider and supplier directory utility if it is demonstrably accurate over time.

SEC. 98.

 Section 127673.4 of the Health and Safety Code is amended to read:

127673.4.
 (a) The department shall develop regulations on data quality and improvement processes and shall make these processes publicly available.
(b) Data quality processes shall be applied to each major phase of the system life cycle, including, but not limited to:
(1) Source data intake.
(2) Data conversion and processing.
(3) Data analysis, reporting, and release.
(4) Other data processes necessary for the system.
(c) The department shall provide, upon request of an interested party, to the interested party, and shall regularly report to the health care data policy advisory committee, information on data quality and data quality improvement processes, including, but not limited to, the following:
(1) Descriptions of processes and methodologies.
(2) Periodic updates on known issues and the implications of the issues for data quality and data availability.
(3) Other impediments to the functioning of the system.

SEC. 99.

 Section 127673.5 of the Health and Safety Code is amended to read:

127673.5.
 (a) (1) The purpose of the system is to learn about and seek to improve public health, population health, social determinants of health, and the health care system, not about individual patients.
(2) All policies and procedures developed in implementing this chapter shall ensure that the privacy, security, and confidentiality of consumers’ individually identifiable health information is protected, consistent with state and federal privacy laws.
(b) The department shall develop policies regarding data aggregation and the protection of individual confidentiality, privacy, and security for individual consumers and patients.

SEC. 100.

 Section 127673.6 of the Health and Safety Code is amended to read:

127673.6.
 The department shall develop an information security program that uses existing state standards and complies with applicable state and federal laws.

SEC. 101.

 Section 127673.7 of the Health and Safety Code is amended to read:

127673.7.
 The department shall include in an annual analysis, such as, but not limited to, the following:
(a) Population and regional level data on prevention, screening, and wellness utilization.
(b) Population and regional level data on chronic conditions, management, and outcomes.
(c) Population and regional level data on trends in utilization of procedures for treatment of similar conditions to evaluate medical appropriateness.
(d) Regional variation in payment level for the treatment of identified chronic conditions.
(e) Data regarding hospital and nonhospital payments, including inpatient, outpatient, and emergency department payments and nonhospital ambulatory service data.

SEC. 102.

 Section 127673.8 of the Health and Safety Code is amended to read:

127673.8.
 (a) The department shall use the program data to produce publicly available information, including data products, summaries, analyses, studies, and other reports, to support the goals of the program. The department shall receive input on priorities for the public information portfolio from the advisory committee. The department may establish a pricing mechanism for data products.
(b) The department may establish a public liaison function through which individuals may submit requests for specific products or analyses. The department may establish a pricing mechanism for custom reports. The department shall maintain copies of custom reports as part of the program public information portfolio.
(c) The department may establish a research program to conduct research, as defined in Section 164.501 of Title 45 of the Code of Federal Regulations, to support program policy goals.
(d) Publicly available data products and reports shall protect patient and consumer privacy.

SEC. 103.

 Section 127673.81 of the Health and Safety Code is amended to read:

127673.81.
 (a) (1) All personal consumer information obtained or maintained by the program shall be confidential.
(2) Only deidentified aggregate patient or other consumer data shall be included in a publicly available analysis, data product, or research.
(b) All policies and procedures developed in implementing this chapter shall ensure that the privacy, security, and confidentiality of consumers’ individually identifiable health information is protected, consistent with state and federal privacy laws, including the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA)(Public Law 104-191) and the Confidentiality of Medical Information Act (Part 2.6 (commencing with Section 56) of Division 1 of the Civil Code), and data shall not be disclosed until the department has developed a policy regarding the release of data.
(c) (1) The system and all program data shall be exempt from the disclosure requirements of the California Public Records Act (Chapter 3.5 (commencing with Section 6250) of Division 7 of Title 1 of the Government Code), and shall not be made available except pursuant to this chapter.
(2) The department shall develop policies and procedures for the disclosure of information described in paragraph (2) of subdivision (a).
(d) Program data shall not be used for determinations regarding individual patient care or treatment and shall not be used for any individual eligibility or coverage decisions or similar purposes.

SEC. 104.

 Section 127673.82 of the Health and Safety Code is amended to read:

127673.82.
 (a) The department shall develop a comprehensive program for data use, access, and release that includes data use agreements that require data users to comply with this chapter. The purpose of the data use, access, and release program is to ensure that only aggregated, deidentified information is publicly accessible.
(b) Access to nonpublic data shall be governed by the data use, access, and release program.
(c) To meet the research and policy goals of the program, controlled access to nonpublic data by outside data analysts, researchers, and other qualified applicants is necessary.
(d) The department shall establish a secure research environment for access to potentially identifiable information. The environment shall include access controls sufficient to ensure that users access only the data specified in an approved data request and that personal information is protected from unapproved use.
(e) The department shall, with the advice of the advisory committee and data release committee, develop criteria, policies, and procedures for access to and release of nonpublic data. The policies shall be designed to recognize a patient’s right of privacy and shall include at least the privacy protection standards specified in Section 127673.83.
(f) The department shall establish a pricing mechanism for the use of nonpublic data.
(g) The department shall maintain information about requests and the disposition of requests, and shall develop processes for the timely consideration and release of nonpublic data.

SEC. 105.

 Section 127673.83 of the Health and Safety Code is amended to read:

127673.83.
 (a) In accessing or obtaining nonpublic data through the secure environment, users shall only have access to the minimum amount of potentially identifiable data necessary for an approved project or access to a dataset designed for an approved purpose. Each person who accesses or obtains nonpublic personal data shall sign a data use agreement. Violation of a data use agreement shall be considered a violation of Section 1798.56 of the Civil Code and, if applicable, Section 1798.57 of the Civil Code.
(b) Access to data in the secure research environment shall be permissible as follows:
(1) If the data does not include any of the direct personal identifiers listed in Section 164.514(e) of Title 45 of the Code of Federal Regulations, access may be provided to qualified applicants for research and analysis purposes consistent with program goals.
(2) If the data includes any of the direct personal identifiers listed in Section 164.514(e) of Title 45 of the Code of Federal Regulations, access may be provided only to qualified applicants for research projects that offer significant opportunities to achieve program goals and meet all of the following criteria:
(A) Project approval has been recommended by the data release committee.
(B) The project has been approved by the Committee for the Protection of Human Subjects pursuant to subdivision (t) of Section 1798.24 of the Civil Code. Pursuant to that section, the department may release data to established nonprofit research institutions, the University of California, and other nonprofit educational institutions.
(C) The requester has documented expertise with privacy protection and with the analysis of large sets of confidential data.
(D) The research shall be made available to the department.
(c) The department’s policies shall limit release or transmittal of personal information outside the secure environment.
(1) The department may develop standardized limited datasets that do not include any of the direct personal identifiers listed in Section 164.514(e) of Title 45 of the Code of Federal Regulations, and have the minimum necessary personal information for types of purposes specified by the department. Standardized datasets may be transmitted to qualified applicants if the requester has documented expertise with privacy protection and with the analysis of large sets of confidential data, data security will meet the standards that the department shall apply to personal data, and project approval has been recommended by the data release committee.
(2) Data described in paragraph (2) of subdivision (b) may be transmitted to an outside researcher only if the researcher meets all the criteria of that paragraph, the researcher has documented expertise with data security and the protection of large sets of confidential data, and data security will meet the standards that the department shall apply to personal data.
(d) Program data, including personal information, may be shared with other state agencies pursuant to subdivision (e) of Section 1798.24 of the Civil Code. For purposes of that section, personal information has been collected for the purposes specified in Section 127671, which include analyzing and improving state programs related to public health and the provision of health care or health care coverage.

SEC. 106.

 Section 127673.84 of the Health and Safety Code is amended to read:

127673.84.
 (a) The department shall establish a data release committee with a membership of at least 7 and no more than 11 members appointed by the director. Notwithstanding any other law, a quorum shall be achieved with one fewer member than one-half of the full membership.
(b) The appointed members shall include representatives of health care payers, providers, suppliers, purchasers, researchers, consumers, and labor. Representatives of program data submitters shall not constitute a majority of members. The members shall have knowledge and experience with health care data, privacy, and security.
(c) Each appointed member shall serve a term of two years, except one-half of the initial appointments shall be for one year. The director may remove a member for cause.
(d) (1) The data release committee shall make recommendations about all applications seeking either program data with direct personal identifiers or the transmission of standardized datasets, except for data requests from other state agencies. Upon request of the director, the data release committee shall also make recommendations about other applications for program data.
(2) In making recommendations about applications seeking program data, except for data requests from other state agencies, the data release committee shall consider whether the use of the data is consistent with the goals of the system, whether it provides greater transparency regarding health care costs, utilization, quality, or equity, or how the information may be used to inform policy decisions regarding the provision of quality health care, improving public health, reducing health disparities, advancing health coverage, or reducing health care costs.
(e) Upon request of the director, the data release committee shall generally advise the director about privacy and security matters related to the program and provide feedback on the program’s data application review processes and other matters.
(f) The chairperson of the data release committee shall be appointed from among the members by the director.
(g) A member of the data release committee appointed from outside state government shall serve without compensation, but shall receive a per diem for each day’s attendance at a data release committee meeting. All members shall be reimbursed for any actual and necessary expenses incurred in connection with their duties as members of the committee.

SEC. 107.

 Section 127674 of the Health and Safety Code is amended to read:

127674.
 (a) The department shall expend the General Fund moneys appropriated in the 2018–19 Budget Act (Chapter 23 of the Statutes of 2019) for the purposes of this chapter and the former Health Care Transparency Database to fund the implementation and operation of the program.
(b) The Health Care Payments Data Program shall not be funded with General Fund moneys beyond moneys appropriated in the 2018–19 Budget Act.
(c) The Health Care Payments Data Fund is hereby established within the department for the purpose of receiving and expending revenues collected pursuant to this chapter.
(d) All revenues collected pursuant to this chapter shall be deposited in the fund. Any amounts raised by the collection of the revenues shall remain in the fund and shall be available in succeeding years upon appropriation by the Legislature.
(e) The department shall seek to maximize federal financial participation from the Medicaid program for the system, working through the sole state agency for Medicaid, the State Department of Health Care Services, and shall do so while relying on moneys appropriated from the General Fund in the 2018–19 Budget Act, and on an ongoing basis using any federally allowed fund source for the state match.
(f) (1) The department may impose a data user fee for an eligible user that is in compliance with this chapter, including, but not limited to, provisions related to consumer privacy and data security.
(2) In establishing the user fee schedule and fee waivers, the department shall work with the advisory committee to make considerations for state agencies, data submitters, and consumer organizations that have been awarded reasonable advocacy and witness fees in a proceeding or proceedings of the Department of Managed Health Care pursuant to Section 1348.9.
(3) The department shall adopt regulations on the fee waiver consistent with subdivisions (e) and (f) of Section 127673.
(g) On or before March 1, 2023, the office shall submit a report to the Legislature on recommendations for funding options for the program pursuant to Section 9795 of the Government Code.
(h) The department may accept foundation funding from foundations not affiliated or controlled by a health care entity.

SEC. 108.

 Section 127674.1 of the Health and Safety Code is amended to read:

127674.1.
 The department shall notify the Department of Managed Health Care or the Department of Insurance, as appropriate, if a health care service plan or health insurer fails to comply with this chapter. The Department of Managed Health Care and the Department of Insurance shall take appropriate action necessary to bring the plan or insurer into compliance.

SEC. 109.

 Section 127675 of the Health and Safety Code is amended to read:

127675.
 (a) This chapter shall apply to a manufacturer of a prescription drug that is purchased or reimbursed by any of the following:
(1) A state purchaser in California, including, but not limited to, the Public Employees’ Retirement System, the State Department of Health Care Services, the Department of General Services, and the Department of Corrections and Rehabilitation, or an entity acting on behalf of a state purchaser.
(2) A licensed health care service plan.
(3) A health insurer holding a valid outstanding certificate of authority from the Insurance Commissioner.
(4) A pharmacy benefit manager as defined in subdivision (j) of Section 4430 of the Business and Professions Code.
(b) For the purposes of this chapter, the term “department” shall mean the Department of Health Care Access and Information.

SEC. 110.

 Section 127677 of the Health and Safety Code is amended to read:

127677.
 (a) A manufacturer of a prescription drug with a wholesale acquisition cost of more than forty dollars ($40) for a course of therapy shall notify each purchaser described in Section 127675 if the increase in the wholesale acquisition cost of a prescription drug is more than 16 percent, including the proposed increase and the cumulative increases that occurred within the previous two calendar years prior to the current year. For purposes of this section, a “course of therapy” is defined as either of the following:
(1) The recommended daily dosage units of a prescription drug pursuant to its prescribing label as approved by the federal Food and Drug Administration for 30 days.
(2) The recommended daily dosage units of a prescription drug pursuant to its prescribing label as approved by the federal Food and Drug Administration for a normal course of treatment that is less than 30 days.
(b) The notice required by subdivision (a) shall be provided in writing at least 60 days prior to the planned effective date of the increase.
(c) (1) The notice required by subdivision (a) shall include the date of the increase, the current wholesale acquisition cost of the prescription drug, and the dollar amount of the future increase in the wholesale acquisition cost of the prescription drug.
(2) The notice required by subdivision (a) shall include a statement regarding whether a change or improvement in the drug necessitates the price increase. If so, the manufacturer shall describe the change or improvement.
(d) The notice required by subdivision (a) shall be provided to each state purchaser and other purchasers described in paragraphs (2) to (4), inclusive, of subdivision (a) of Section 127675 if a purchaser registers with the department for the purpose of this notification. The department shall make available to manufacturers a list of registered purchasers for the purpose of this notification.
(e) If a pharmacy benefit manager receives a notice of an increase in wholesale acquisition cost consistent with subdivision (a), it shall notify its large contracting public and private purchasers of the increase. For the purposes of this section, a “large purchaser” means a purchaser that provides coverage to more than 500 covered lives.

SEC. 111.

 Section 127679 of the Health and Safety Code is amended to read:

127679.
 (a) On a quarterly basis at a time prescribed by the department and in a format prescribed by the department, commencing no earlier than January 1, 2019, a manufacturer shall report to the department all of the following information for each drug for which an increase in wholesale acquisition cost is described in Section 127677:
(1) A description of the specific financial and nonfinancial factors used to make the decision to increase the wholesale acquisition cost of the drug and the amount of the increase, including, but not limited to, an explanation of how these factors explain the increase in the wholesale acquisition cost of the drug.
(2) A schedule of wholesale acquisition cost increases for the drug for the previous five years if the drug was manufactured by the company.
(3) If the drug was acquired by the manufacturer within the previous five years, all of the following information:
(A) The wholesale acquisition cost of the drug at the time of acquisition and in the calendar year prior to acquisition.
(B) The name of the company from which the drug was acquired, the date acquired, and the purchase price.
(C) The year the drug was introduced to market and the wholesale acquisition cost of the drug at the time of introduction.
(4) The patent expiration date of the drug if it is under patent.
(5) If the drug is a multiple source drug, an innovator multiple source drug, a noninnovator multiple source drug, or a single source drug, as defined in subparagraph (A) of paragraph (7) of subdivision (k) of Section 1396r–8 of Title 42 of the United States Code.
(6) A description of the change or improvement in the drug, if any, that necessitates the price increase.
(7) Volume of sales of the manufacturer’s drug in the United States for the previous year.
(b) The manufacturer may limit the information reported pursuant to subdivision (a) to that which is otherwise in the public domain or publicly available.
(c) The department shall publish the information provided to it pursuant to this section on its internet website on no less than a quarterly basis. The information shall be published within 60 days of receipt from a manufacturer. The information shall be published in a manner that identifies the information that is disclosed on a per-drug basis and shall not be aggregated in a manner that would not allow identification of the drug.
(d) The department shall be responsible for the enforcement of this section.
(e) A manufacturer of a prescription drug subject to this chapter that does not report the information required pursuant to this section is liable for a civil penalty of one thousand dollars ($1,000) per day for every day after the reporting period described in this section that the required information is not reported.
(f) A civil penalty shall be assessed and recovered in a civil action brought by the office in the name of the people of the State of California. Assessment of a civil penalty may, at the request of any manufacturer of a prescription drug subject to this section, be reviewed on appeal, and the penalty may be reduced or waived for good cause.
(g) Any money received by the department pursuant to this section shall be paid into the Managed Care Fund.

SEC. 112.

 Section 127681 of the Health and Safety Code is amended to read:

127681.
 (a) A manufacturer of a prescription drug shall notify the department in writing if it is introducing a new prescription drug to market at a wholesale acquisition cost that exceeds the threshold set for a specialty drug under the Medicare Part D program (Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108-173)). The notice shall be provided in writing within three days after the release of the drug in the commercial market. A manufacturer may make this notification pending approval by the federal Food and Drug Administration, if commercial availability is expected within three days of approval.
(b) No later than 30 days after notification pursuant to this section, a manufacturer shall report all of the following information to the department in a format prescribed by the department:
(1) A description of the marketing and pricing plans used in the launch of the new drug in the United States and internationally.
(2) The estimated volume of patients that may be prescribed the drug.
(3) If the drug was granted breakthrough therapy designation or priority review by the federal Food and Drug Administration prior to final approval.
(4) The date and price of acquisition if the drug was not developed by the manufacturer.
(c) The manufacturer may limit the information reported pursuant to subdivision (b) to that which is otherwise in the public domain or publicly available.
(d) The department shall publish the information provided to it pursuant to this section on its internet website on no less than a quarterly basis. The information shall be published in a manner that identifies the information that is disclosed on a per-drug basis and shall not be aggregated in a manner that would not allow identification of the drug.
(e) The department shall be responsible for the enforcement of this section.
(f) A manufacturer of a prescription drug subject to this chapter that does not report the information required pursuant to this section is liable for a civil penalty of one thousand dollars ($1,000) per day for every day after the notification period described in this section that the required information is not reported.
(g) A civil penalty shall be assessed and recovered in a civil action brought by the department in the name of the people of the State of California. Assessment of a civil penalty may, at the request of any manufacturer of a prescription drug subject to this section, be reviewed on appeal, and the penalty may be reduced or waived for good cause.
(h) Any money received by the department pursuant to this section shall be paid into the Managed Care Fund.

SEC. 113.

 Section 127683 of the Health and Safety Code is amended to read:

127683.
 (a) Funding for the actual and necessary expenses of the department to conduct the activities described in this section and in Sections 127676, 127679, 127681, and 127685, shall be provided, subject to appropriation by the Legislature, from transfers of moneys from the Managed Care Fund and the Insurance Fund.
(b) The share of funding from the Managed Care Fund shall be based on the number of covered lives in the state that are covered under plans regulated by the Department of Managed Health Care, including covered lives under Medi-Cal managed care, as determined by the Department of Managed Health Care, in proportion to the total number of all covered lives in the state.
(c) The share of funding to be provided from the Insurance Fund shall be based on the number of covered lives in the state that are covered under health insurance policies and benefit plans regulated by the Department of Insurance, including covered lives under Medicare supplement plans, as determined by the Department of Insurance, in proportion to the total number of all covered lives in the state.

SEC. 114.

 Section 127685 of the Health and Safety Code is amended to read:

127685.
 (a) The department may adopt regulations or issue guidance for the implementation of this chapter. All information that is required to be reported to the department pursuant to this chapter shall be reported in a form prescribed by the department, commencing in the first calendar quarter of 2019.
(b) The department may consult with the Department of Managed Health Care, the Department of Insurance, the California State Board of Pharmacy, and any state purchaser of prescription drugs, or an entity acting on behalf of a state purchaser, in issuing guidance or adopting necessary regulations pursuant to subdivision (a), in posting information on its internet website pursuant to this chapter, and in taking any other action for the purpose of implementing this chapter.

SEC. 115.

 Article 1 (commencing with Section 127750) of Chapter 1 of Part 3 of Division 107 of the Health and Safety Code is repealed.

SEC. 116.

 Chapter 1.5 (commencing with Section 127825) is added to Part 3 of Division 107 of the Health and Safety Code, to read:
CHAPTER  1.5. Behavioral Health Grants

127825.
 (a) As a component of the Children and Youth Behavioral Health Initiative established pursuant to Chapter 2 (commencing with Section 5961) of Part 7 of Division 5 of the Welfare and Institutions Code, the office is hereby authorized to award competitive grants to entities and individuals it deems qualified to expand the supply of behavioral health counselors, coaches, peer supports, and other allied health care providers serving children and youth, including those at schoolsites.
(b) For the purposes of this chapter, “behavioral health coach” means a new category of behavioral health provider trained specifically to help address the unmet mental health and substance use needs of children and youth. Recognizing that unmet mental health and substance use needs create learning barriers, behavioral health coaches shall engage and support children and youth in cultural, linguistic, and age-appropriate services, with the ability to refer and link to higher levels of care, as needed. As members of a care team, behavioral health professionals serving as a coach receive appropriate supervision from licensed staff. Training and qualifications include, but are not limited to, psychoeducation, system navigation, crisis deescalation, safety planning, coping skills, and motivational interviewing.

SEC. 117.

 Section 127885 of the Health and Safety Code is amended to read:

127885.
 (a) The department shall maintain a Health Professions Career Opportunity Program that shall include, but not be limited to, all of the following:
(1) Implementing programs at colleges and universities selected by the department, which may include public and private institutions.
(A) In selecting campuses for the programs, the department shall give priority to campuses in medically underserved areas or with students from groups underrepresented in medicine, demonstrated commitment to diversity and associated institutional change, a track record of providing tailored student support, and strong health professions school partnerships.
(B) The programs shall include one or both of the following:
(i) Pipeline programs that provide comprehensive academic enrichment, career development, mentorship, and advising in order to support students from underrepresented regions and backgrounds to pursue health careers. This may include internships and fellowships to enable students to compete for admission to graduate health professions schools or employment in the health field, including, but not limited to, both of the following:
(I) Paid summer internships for students interning in community health centers, public health departments, public behavioral health settings, and with geriatric providers, as well as community-based initiatives that promote health equity.
(II) One-year postundergraduate fellowships for in-depth, pregraduate school experience in primary care and prevention, behavioral health, and geriatric health.
(ii) Annual postbaccalaureate reapplicant slots and the provision of student scholarships for reapplicant postbaccalaureate students to cover program tuition.
(2) Producing and disseminating a series of publications aimed at informing and motivating minority and disadvantaged students to pursue health professional careers.
(3) Conducting a conference series aimed at informing students of opportunities in health professional training and mechanisms of successfully preparing to enter the training.
(4) Providing support and technical assistance to health professional schools and colleges as well as to student and community organizations active in health professional development of underrepresented groups in medicine.
(5) Conducting relevant health workforce information and data analysis regarding underrepresented groups in medicine.
(6) Providing necessary consultation, recruitment, and counseling through other means.
(7) Supporting and encouraging health professionals in training who are from underrepresented groups to practice in health professional shortage areas of California.
(b) This section shall be implemented only to the extent that funds are appropriated for its purposes in the annual Budget Act or other statute.

SEC. 118.

 Section 127900 of the Health and Safety Code is amended to read:

127900.
 (a)  The Legislature finds and declares that evidence exists to support the development of health promotion and health-risk reduction programs as an effective method of constraining the annual inflation rate for expenditures in the health industry. It is, therefore, the intent of the Legislature that a health manpower education program be developed to demonstrate the health promotion and health-risk reduction concept at educational institutions, with special emphasis on health manpower development in urban areas having a disproportionate share of disadvantaged and indigent persons.
(b)  The department shall establish a contract program for funding allied health manpower training projects related to health promotion and health-risk reduction. The contract program shall provide funds to eligible institutions, as determined by the department, for all of the following purposes:
(1)  Teaching existing and future primary care providers about health-risk reduction through the institutions’ basic curricula.
(2)  Recruiting, remediating, and retaining minority allied health professionals, including, but not limited to, physician assistants, nurse practitioners, nurse-midwives, public health nurses, health educators, dieticians, and nutritionists, especially those who provide in-home patient care.
(3)  Increasing the supply of medical care in underserved urban areas and demonstrating methods which reduce cost through the use of allied health personnel.
(c)  (1) These funds shall be available to institutions which currently operate programs for training family physicians, other primary care physicians, and those health professionals identified in paragraph (2) of subdivision (b).
(2) For purposes of this subdivision, “family physician” means a primary care physician and surgeon who renders continued comprehensive and preventative health care services to individuals and families, and who has received specialized training in an approved family medicine residency for three years after graduation from an accredited medical school.
(d) The recipients of the funds shall provide, but shall not be limited to providing, orientation and training of primary care providers in teaching methods related to patient health education and health promotion, such as educating allied health professionals in the principles of self-care management as it relates to specific health problems in medically underserved communities.
(e) The department shall consult with organizations and experts in the field regarding the establishment of this program, and beginning with the 1986–87 fiscal year, this program shall be implemented to the extent funds are provided in the Budget Act. This program shall be designed to accommodate an appropriation request in the range of forty thousand dollars ($40,000) to eighty thousand dollars ($80,000) per year.
(f) The director of the department may waive any of the requirements of subdivisions (b) and (c) if a potential contractor demonstrates an ability to meet the goals and objectives of the program.

SEC. 119.

 Article 2.5 (commencing with Section 127925) of Chapter 2 of Part 3 of Division 107 of the Health and Safety Code is repealed.

SEC. 120.

 Section 127940 of the Health and Safety Code is amended to read:

127940.
 (a) In administering the National Health Service Corps State Loan Repayment Program in accordance with Section 254q-1 of Title 42 of the United States Code and related federal regulations, the Department of Health Care Access and Information shall strive, whenever feasible, to equitably distribute loan repayment awards between eligible urban and rural program sites, after taking into account the availability of health care services in the communities to be served and the number of individuals to be served in each program site.
(b) The department shall set a reasonable deadline for when all applications are required to be received.
(c) All eligible applications shall be given consideration before any award is granted.
(d) The department shall include all federally qualified health centers located in California in the program’s certified eligible site list.
(e) As part of a program applicant’s initial application, program sites shall agree to provide matching funds.

SEC. 121.

 Section 127985 of the Health and Safety Code is amended to read:

127985.
 A person shall not be awarded a scholarship under subdivision (a) or (b) of Section 127980 unless:
(a) They are a resident of California.
(b) They are licensed as a registered nurse by this state.
(c) They have complied with all the regulations adopted pursuant to this article.
(d) They have agreed that they will continue their education to completion of the bachelor’s degree or a program supplemental to a bachelor’s degree required for admission to master level studies in nursing, and that after completion of the requirements of subdivision (a) or (b) of Section 127980 and within a period of time to be determined by the department, will enroll in an accredited master’s degree program in teaching or supervision in a clinical nursing area.
(e)  They agree that immediately upon completion of their graduate study, either master’s degree or post-master’s program, they will assume an employment obligation in California in teaching or supervision in a clinical nursing area, for not less than one year.

SEC. 122.

 Section 127995 of the Health and Safety Code is amended to read:

127995.
 The department shall administer the program of nursing education scholarships and shall for this purpose, adopt regulations as it determines are necessary to carry out this article.

SEC. 123.

 Section 128000 of the Health and Safety Code is amended to read:

128000.
 Applications for scholarships shall be made to the department, upon forms provided by it, at the times and in the manner prescribed by the regulations adopted by the office.

SEC. 124.

 Section 128005 of the Health and Safety Code is amended to read:

128005.
 The department shall award the scholarships to the applicants that it determines are best fitted to undertake the educational program for which the scholarships are awarded and will be the best qualified to teach or supervise. In awarding the scholarships the department may give a preference to applicants who are willing to be available, upon the completion of their educational program, for a position in any part of the state. The department shall not, however, award any scholarship to an applicant if it determines that the applicant has adequate financial resources to pay the cost of the education necessary to qualify them for teaching or supervision in a clinical area.

SEC. 125.

 Section 128020 of the Health and Safety Code is amended to read:

128020.
 A scholarship shall remain in effect only during the period, as determined by the department, that the person receiving the award achieves satisfactory progress and is regularly enrolled, within the terms of this article, as a full-time student.

SEC. 126.

 Section 128030 of the Health and Safety Code is amended to read:

128030.
 The department, in cooperation with the California Postsecondary Education Commission, shall administer the program established pursuant to this article and shall for this purpose, adopt regulations as it determines are reasonably necessary to carry out this article.

SEC. 127.

 Section 128035 of the Health and Safety Code is amended to read:

128035.
 The department is authorized to make grants, from funds appropriated by the Legislature for this purpose, to assist organizations in meeting the cost of special projects to plan, develop, or establish innovative programs of education in the health professions, or for research in the various fields related to education in the health professions, or to develop training for new types of health professions personnel, or to meet the costs of planning experimental teaching facilities.
In determining priority of project applications, the department shall give the highest priority to:
(1)  Applicants able to obtain commitments for matching planning funds from other governmental and private sources.
(2)  Applicants who develop a preliminary plan that conforms to the criteria stated hereinabove for innovative programs of education in the health sciences.
(3)  Applicants that in its judgment are most able to translate a plan into a feasible program.

SEC. 128.

 Section 128040 of the Health and Safety Code is amended to read:

128040.
 (a)  The Department of Health Care Access and Information shall report to the Legislature on or before June 30, 2002, on the feasibility of establishing a California dental loan forgiveness program utilizing the same general guidelines applicable to the federal National Health Service Corps State Loan Repayment Program (42 U.S.C.A. Sec. 254q-1; 42 C.F.R., Part 62, Subpart C (commencing with Section 62.51)), except as follows:
(1)  A dentist shall be eligible to participate in the loan forgiveness program if they provide full-time or half-time dental services in either of the following:
(A)  A dental health professional shortage area (DHPSA), established pursuant to Section 254e(a) of Title 42 of the United States Code.
(B)  An area of the state where unmet priority needs for dentists exist as determined by the department.
(2)  Matching funds to repay a portion of the dentist’s outstanding loan amount shall be required from the practice site areas or from other private nonprofit sources.
(3)  A qualifying practice site shall include a private dental practice.
(b)  (1)  The report required under subdivision (a) shall include all of the following:
(A)  A projection of the dentist-to-population ratio for California in the next decade.
(B)  A determination of the future need for dentists and dental care in underserved communities. The department shall work collaboratively with organizations that represent providers of dental services to underserved communities in making this determination.
(C)  A report on the utilization by dentists of tuition loan repayment programs at the federal and state level and identify the barriers to full utilization of these loan repayment programs.
(D)  A report on the projected cost increase of dental school education at public and private postsecondary educational institutions.
(E)  A report on the implications of administering an additional program, including a cost analysis.
(2)  The report also shall include recommendations on whether a program described in subdivision (a) should be established and, if so, suggested funding sources. In making its recommendations, the department shall consider the impact of the program on access to dental services in areas of the state that currently have a shortage of dentists.

SEC. 129.

 The heading of Article 5 (commencing with Section 128050) of Chapter 2 of Part 3 of Division 107 of the Health and Safety Code is amended to read:
Article  5. Health Care Workforce Research and Data Center

SEC. 130.

 Section 128050 of the Health and Safety Code is amended to read:

128050.
 The Department of Health Care Access and Information shall establish a health care workforce research and data center to serve as the central source of health care workforce and educational data in the state. The research and data center will serve as the state’s central source of healthcare workforce and education data. The research and data center shall be responsible for the collection, analysis, and distribution of information on the educational and employment trends for health care occupations and distribution in the state. The activities of the research and data center shall be funded by appropriations made from the California Health Data and Planning Fund in accordance with subdivision (h) of Section 127280.

SEC. 131.

 Section 128051 of the Health and Safety Code is amended to read:

128051.
 The Department of Health Care Access and Information shall work with the Employment Development Department’s Labor Market Information Division, state licensing boards, and state higher education entities to collect, to the extent available, all of the following data:
(a) The current supply of health care workers, by specialty.
(b) The geographical distribution of health care workers, by specialty.
(c) The diversity of the health care workforce, by specialty, including, but not necessarily limited to, data on race, ethnicity, and languages spoken.
(d) The current and forecasted demand for health care workers, by specialty.
(e) The educational capacity to produce trained, certified, and licensed health care workers, by specialty and by geographical distribution, including, but not necessarily limited to, the number of educational slots, the number of enrollments, the attrition rate, and wait time to enter the program of study.

SEC. 132.

 Section 128052 of the Health and Safety Code is amended to read:

128052.
 The Department of Health Care Access and Information shall prepare an annual report to the Legislature that does all of the following:
(a) Identifies education and employment trends in the health care profession.
(b) Reports on the current supply and demand for health care workers in California and gaps in the educational pipeline producing workers in specific occupations and geographic areas.
(c) Recommends state policy needed to address issues of workforce shortage and distribution.
(d) Describes the health care workforce program outcomes and effectiveness.

SEC. 133.

 The heading of Article 1 (commencing with Section 128125) of Chapter 3 of Part 3 of Division 107 of the Health and Safety Code is amended to read:
Article  1. Health Workforce Pilot Projects

SEC. 134.

 Section 128130 of the Health and Safety Code is amended to read:

128130.
 For the purposes of this article:
(a)  “Department” means the Department of Health Care Access and Information.
(b)  “Approved project” means an educational or training program approved by the office that does any of the following on a pilot program basis:
(1)  Teaches new skills to existing categories of health care personnel.
(2)  Develops new categories of health care personnel.
(3)  Accelerates the training of existing categories of health care personnel.
(4)  Teaches new health care roles to previously untrained persons, and that has been so designated by the department.
(c)  “Trainee” means a person to be taught health care skills.
(d)  “Supervisor” means a person designated by the project sponsor who already possesses the skills to be taught the trainees and is certified or licensed in California to perform the health care tasks involving the skills.
(e)  “Health care services” means the practice of medicine, dentistry, nursing, including, but not limited to, specialty areas of nursing such as midwifery, pharmacy, optometry, podiatry, and psychology.

SEC. 135.

 Section 128135 of the Health and Safety Code is amended to read:

128135.
 The department may designate experimental health workforce projects as approved projects where the projects are sponsored by community hospitals or clinics, nonprofit educational institutions, or government agencies engaged in health or education activities. Nothing in this section shall preclude approved projects from utilizing the offices of physicians, dentists, pharmacists, and other clinical settings as training sites.

SEC. 136.

 Section 128140 of the Health and Safety Code is amended to read:

128140.
 Notwithstanding any other provision of law, a trainee in an approved project may perform health care services under the supervision of a supervisor where the general scope of the services has been approved by the department.

SEC. 137.

 Section 128155 of the Health and Safety Code is amended to read:

128155.
 The department, after one or more public hearings thereon, shall establish minimum standards, guidelines, and instructions for pilot projects. Advance notice of the hearing shall be sent to all interested parties and shall include a copy of the proposed minimum standards, guidelines, and instructions.
Organizations requesting designation as approved projects shall complete and submit to the department an application, that shall include a description of the project indicating the category of person to be trained, the tasks to be taught, the numbers of trainees and supervisors, a description of the health care agency to be used for training students, and a description of the types of patients likely to be seen or treated. Additionally, the application shall contain a description of all of the following:
(a)  The evaluation process to be used.
(b)  The baseline data and information to be collected.
(c)  The nature of program data that will be collected and the methods for collecting and analyzing the data.
(d)  Provision for protecting the safety of patients seen or treated in the project.
(e)  A statement of previous experience in providing related health care services.

SEC. 138.

 Section 128165 of the Health and Safety Code is amended to read:

128165.
 The department shall carry out periodic onsite visitations of each approved project and shall evaluate each project to determine the following:
(a)  The new health skills taught or extent that existing skills have been reallocated.
(b)  Implication of the project for existing licensure laws with suggestions for changes in the law where appropriate.
(c)  Implications of the project for health services curricula and for the health care delivery systems.
(d)  Teaching methods used in the project.
(e)  The quality of care and patient acceptance in the project.
(f)  The extent that persons with the new skills could find employment in the health care system, assuming laws were changed to incorporate their skill.
(g)  The cost of care provided in the project, the likely cost of this care if performed by the trainees subsequent to the project, and the cost for provision of this care by current providers thereof.
All data collected by the department and by projects approved pursuant to this article shall become public information, with due regard for the confidentiality of individual patient information. The raw data on which projects’ reports are based and the data on which the department’s evaluation is based shall be available on request for review by interested parties. The department shall provide a reasonable opportunity for interested parties to submit dissenting views or challenges to reports to the Legislature and professional licensing boards required by this section. The department shall publish those comments, subject only to nonsubstantive editing, as part of its annual, or any special, reports.

SEC. 139.

 Section 128170 of the Health and Safety Code is amended to read:

128170.
 The department shall approve a sufficient number of projects to provide a basis for testing the validity of the experiment.

SEC. 140.

 Section 128175 of the Health and Safety Code is amended to read:

128175.
 The department shall seek the advice of appropriate professional societies and appropriate healing arts licensing boards prior to designating approved projects. In the case of projects sponsored by a state agency, the following additional procedures shall apply:
(a)  A hearing shall be conducted by a disinterested state government official selected by the director of the department from a state agency other than the department or the proponent of the project. The cost of the services of the disinterested state governmental official shall be paid by the department pursuant to an interagency agreement with the state agency represented by the state governmental official.
(b)  A notice of hearing shall be sent by the department to interested parties, as designated by the director of the department, by registered mail no less than 30 days preceding the date of the hearing. The notice shall include, but not be limited to, the date, time, location, and subject matter of the hearing, and shall include a copy of the application for a pilot project that is the subject of the hearing.
(c)  A verbatim transcript of the hearing shall be prepared and distributed to interested parties upon request.
(d)  Within 60 days of the release of the transcript, the department shall submit a recommendation on the proposal to the director of the department and shall send copies to the interested parties.
(e)  The director of the department shall accept comments on the recommendations, and, on or after 30 days after transmittal of the recommendations, the director of the department shall approve or disapprove the proposed project.

SEC. 141.

 Section 128180 of the Health and Safety Code is amended to read:

128180.
 The department shall not approve a project for a period lasting more than two training cycles plus a preceptorship of more than 24 months, unless the department determines that the project is likely to contribute substantially to the availability of high-quality health services in the state or a region thereof.

SEC. 142.

 Section 128190 of the Health and Safety Code is amended to read:

128190.
 The department may extend the geriatric technician pilot project, known as the Health Manpower Pilot Project No. 152, for a minimum of four additional years, pursuant to reapplication by the sponsoring agency. The project shall continue to meet the applicable requirements established by the department. The number of sponsors authorized to participate in the pilot project may be expanded to a maximum of five.

SEC. 143.

 Section 128195 of the Health and Safety Code is amended to read:

128195.
 (a) The department shall issue followup reports on geriatric technician pilot projects approved by the department following 24 months of implementation of the employment utilization phase of each project. The reports shall contain all of the following information:
(1) A description of the persons trained, including, but not limited to, the following:
(A) The total number of persons who entered training.
(B) The total number of persons who completed training.
(C) The selection method, including descriptions of any nonquantitative criteria used by employers to refer persons to training.
(D) The education and experience of the trainees prior to training.
(E) Demographic characteristics of the trainees, as available.
(2) An analysis of the training completed, including, but not limited to, the following:
(A) Curriculum and core competencies.
(B) Qualifications of the instructor.
(C) Changes in the curriculum during the pilot project or recommended for the future.
(D) The nature of clinical and didactic training, including the ratio of students to instructors.
(3) A summary of the specific services provided by geriatric technicians.
(4) The new health skills taught or the extent to which existing skills have been reallocated.
(5) Implications of the project for existing licensure laws with suggestions for changes in the law where appropriate.
(6) Implications of the project for health services curricula and for health care delivery systems.
(7) Teaching methods used in the project.
(8) The quality of care, including pertinent medication errors, incident reports, and patient acceptance in the project.
(9) The extent to which persons with new skills could find employment in the health care system, assuming laws were changed to incorporate their skills.
(10) The cost of care provided in the project, the likely cost of this care if performed by the trainees subsequent to the project, and the cost for provision of this care by current providers thereof.
(b) Notwithstanding any other provision of law, issuance of the reports described in subdivision (a) shall not require that the department terminate the geriatric technician pilot projects authorized by the department.

SEC. 144.

 Article 2 (commencing with Section 128198) of Chapter 3 of Part 3 of Division 107 of the Health and Safety Code is repealed.

SEC. 145.

 Section 128205 of the Health and Safety Code is amended to read:

128205.
 As used in this article, and Article 2 (commencing with Section 128250), the following terms have the following meanings:
(a) “Family physician” means a primary care physician and surgeon who is prepared to and renders continued comprehensive and preventative health care services to individuals and families and who has received specialized training in an approved family medicine residency for three years after graduation from an accredited medical school.
(b) “Primary care physician” means a physician who is prepared to and renders continued comprehensive and preventative health care services, and has received specialized training in the areas of internal medicine, obstetrics and gynecology, or pediatrics.
(c) “Council” means the California Health Workforce Education and Training Council.
(d) “Graduate medical education” means residency programs for education or training in one or more specialties or subspecialties following graduation from medical school.
(e) “Health professions education and training” means any formal organized education or training undertaken for the purpose of gaining knowledge and skills necessary to practice a specific health profession or to provide a role in a health care setting. Health professions education and training includes any type of health professions training program, including shadowing programs, participating in rotations, affiliation agreements, and accredited or accreditation-eligible programs, at any educational level, including certificate, undergraduate, graduate, professional, or postgraduate, and in any clinical discipline, excluding graduate medical education.
(f) “Programs that train primary care physician’s assistants” means a program that has been approved for the training of primary care physician assistants pursuant to Section 3513 of the Business and Professions Code.
(g) “Programs that train primary care nurse practitioners” means a program that is operated by a California school of medicine or nursing, or that is authorized by the Regents of the University of California or by the Trustees of the California State University, or that is approved by the Board of Registered Nursing.
(h) “Programs that train registered nurses” means a program that is operated by a California school of nursing and approved by the Board of Registered Nursing, or that is authorized by the Regents of the University of California, the Trustees of the California State University, or the Board of Governors of the California Community Colleges, and that is approved by the Board of Registered Nursing.
(i) “Teaching health center” means a community-based ambulatory patient care center that operates a primary care residency program. Community-based ambulatory patient care settings include, but are not limited to, federally qualified health centers, community mental health centers, rural health clinics, health centers operated by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization, and entities receiving funds under Title X of the federal Public Health Service Act (Public Law 91-572).

SEC. 146.

 Section 128207 of the Health and Safety Code is repealed.

SEC. 147.

 Section 128215 of the Health and Safety Code is amended to read:

128215.
 (a) There is hereby created a California Health Workforce Education and Training Council that shall be responsible for helping coordinate California’s health workforce education and training to develop a health workforce that meets California’s health care needs. The council shall be composed of 17 members who, together, represent various graduate medical education and training programs, health professions, including, but not limited to, specialties for primary care and behavioral health, and consumer representatives who shall serve at the pleasure of their appointing authorities, as follows:
(1) Six members appointed by the Governor.
(2) One member who shall be the Director of the Department of Health Care Services, or the director’s designee.
(3) One member who shall be the Director of the Department of Health Care Access and Information, or the director’s designee.
(4) Three members appointed by the Speaker of the Assembly.
(5) Three members appointed by the Chairperson of the Senate Committee on Rules.
(6) One member who shall be the President of the University of California, or the president’s designee.
(7) One member who shall be the Chancellor of the California State University, or the chancellor’s designee.
(8) One member who shall be the Chancellor of the California Community Colleges, or the chancellor’s designee.
(b) Members of the council appointed under paragraphs (1), (4), and (5) of subdivision (a) shall be appointed for a term of four years, except that the term of office of the initial members appointed under paragraph (1) shall expire at the end of two years.

SEC. 148.

 Section 128220 of the Health and Safety Code is amended to read:

128220.
 The members of the council, other than state employees, shall receive compensation of twenty-five dollars ($25) for each day’s attendance at a council meeting, in addition to actual and necessary travel expenses incurred in the course of attendance at a council meeting.

SEC. 149.

 Section 128224 of the Health and Safety Code is repealed.

SEC. 150.

 Section 128225 of the Health and Safety Code is repealed.

SEC. 151.

 Section 128225 is added to the Health and Safety Code, to read:

128225.
 (a) The council shall have the powers and authority necessary to carry out the duties imposed upon it by this chapter, including, but not limited to, the following:
(1) Develop graduate medical education and workforce training and development priorities for the state.
(2) Discuss and make recommendations to the Department of Health Care Access and Information regarding the use of health care education and training funds appropriated by the Legislature for programs administered by the department under this part.
(3) Develop standards and guidelines for residency and health professions education and training programs funded under this part.
(4) Review outcomes data from funded programs, as provided to the council by the department, to reprioritize and reassess the graduate medical education and health professions education and training needs of California’s communities.
(5) Explore options for developing a broad graduate medical education and health professions education and training funding strategy.
(6) Advocate for additional funds and additional sources of funds to stimulate expansion of graduate medical education and health professions education and training in California.
(7) Provide technical assistance and support for establishing new graduate medical education and health professions education and training programs in California.
(8) Review and recommend health professions career pathways or ladders.
(b) The council shall carry out the duties imposed upon it by this chapter with primary consideration given to increasing workforce diversity and furthering improved access, quality, and equity of health care for underserved, underrepresented, and Medi-Cal populations. Further, the council shall carry out the duties imposed upon it by this chapter with a primary focus on primary care, behavioral health, oral health, and allied health.

SEC. 152.

 Section 128230 of the Health and Safety Code is amended to read:

128230.
 When funding primary care and family medicine programs or departments, primary care and family medicine residencies, and programs for the training of primary care physician assistants, primary care nurse practitioners, or registered nurses, the department shall give priority to programs that have demonstrated success in the following areas:
(a) Graduating individuals who practice in medically underserved areas.
(b) Enrolling members of underrepresented groups in medicine to the program.
(c) Locating the program’s main training site in a medically underserved area.
(d) Operating a main training site at which the majority of the patients are Medi-Cal recipients.

SEC. 153.

 Section 128235 of the Health and Safety Code is amended to read:

128235.
 Pursuant to this article and Article 2 (commencing with Section 128250), the Director of the Department of Health Care Access and Information shall do all of the following:
(a) Develop application and contract criteria based on healthcare workforce needs and the priorities of the council.
(b) Determine whether primary care and family medicine, primary care physician’s assistant training program proposals, primary care nurse practitioner training program proposals, and registered nurse training program proposals submitted to the department for participation in the state medical contract program established by this article and Article 2 (commencing with Section 128250) meet the standards established by the council.
(c) Select and contract on behalf of the state with accredited medical schools, teaching health centers, programs that train primary care physician’s assistants, programs that train primary care nurse practitioners, hospitals, and other health care delivery systems for the purpose of training undergraduate medical students and residents in the specialties of internal medicine, obstetrics and gynecology, pediatrics, and family medicine. Contracts shall be awarded to those institutions that best demonstrate the ability to provide quality education and training and to retain students and residents in specific areas of California where there is a recognized unmet priority need for primary care family physicians. Contracts shall be in conformity with the contract criteria developed by the Department of Health Care Access and Information.
(d) Select and contract on behalf of the state with programs that train registered nurses. Contracts shall be awarded to those institutions that best demonstrate the ability to provide quality education and training and to retain students and residents in specific areas of California where there is a recognized unmet priority need for registered nurses. Contracts shall be in conformity with the contract criteria developed by the Department of Health Care Access and Information.
(e) Terminate, upon 30 days’ written notice, the contract of any institution whose program does not meet the standards established by the council or that otherwise does not maintain proper compliance with this part, except as otherwise provided in contracts entered into by the director pursuant to this article and Article 2 (commencing with Section 128250).
(f) Instruct the council to create subcommittees as may be required from time to time in the discretion of the Director of the Department of Health Care Access and Information.

SEC. 154.

 Section 128240 of the Health and Safety Code is repealed.

SEC. 155.

 Section 128240.1 of the Health and Safety Code is repealed.

SEC. 156.

 Section 128241 of the Health and Safety Code is repealed.

SEC. 157.

 Article 2 (commencing with Section 128250) of Chapter 4 of Part 3 of Division 107 of the Health and Safety Code is repealed.

SEC. 158.

 The heading of Article 3 of Chapter 4 of Part 3 of Division 107 of the Health and Safety Code is repealed.

SEC. 159.

 The heading of Chapter 5 (commencing with Section 128330) of Part 3 of Division 107 of the Health and Safety Code is amended to read:
CHAPTER  5.  Health Professions Education Programs

SEC. 160.

 The heading of Article 1 (commencing with Section 128330) of Chapter 5 of Part 3 of Division 107 of the Health and Safety Code is amended to read:
Article  1. Health Professions Education Programs

SEC. 161.

 Section 128330 of the Health and Safety Code is amended to read:

128330.
 As used in this article:
(a) “Board” means the Board of Trustees of the Health Professions Education Foundation.
(b) “Council” means the California Health Workforce Education and Training Council.
(c) “Director” means the Director of the Department of Health Care Access and Information.
(d) “Foundation” means the Health Professions Education Foundation.
(e) “Health professions” or “health professionals” means physicians and surgeons licensed pursuant to Chapter 5 (commencing with Section 2000) of Division 2 of the Business and Professions Code or pursuant to the Osteopathic Act, dentists, registered nurses, and other health professionals determined by the department to be needed in medically underserved areas.
(f) “Department” means the Department of Health Care Access and Information.
(g) “Underrepresented groups” means populations that are underrepresented in medicine, dentistry, nursing, or other health professions as determined by the department. The department, upon a finding that the action is necessary to meet the health care needs of medically underserved areas, may add a group comprising the economically disadvantaged to those groups authorized to receive assistance under this article. The department shall recognize that it is especially important that medical and dental care be provided in a way that is sensitive to the sociocultural variables that affect a person’s health.

SEC. 162.

 Section 128335 of the Health and Safety Code is amended to read:

128335.
 (a) The department shall establish a nonprofit public benefit corporation, to be known as the Health Professions Education Foundation, that shall be governed by a board consisting of nine members appointed by the Governor, one member appointed by the Speaker of the Assembly, one member appointed by the Senate Committee on Rules, and two members appointed by the Medical Board of California. The members of the foundation board appointed by the Governor, Speaker of the Assembly, and Senate Committee on Rules may include representatives of minority groups which are underrepresented in the health professions, persons employed as health professionals, and other appropriate members of health or related professions. All persons considered for appointment shall have an interest in health programs, an interest in health educational opportunities for underrepresented groups, and the ability and desire to solicit funds for the purposes of this article as determined by the appointing power. The chairperson of the council shall also be a nonvoting, ex officio member of the board.
(b) The Governor shall appoint the president of the board of trustees from among those members appointed by the Governor, the Speaker of the Assembly, the Senate Committee on Rules, and the Medical Board of California.
(c) The director, after consultation with the president of the board, may appoint a council of advisers comprised of up to nine members. The council shall advise the director and the board on technical matters and programmatic issues related to the Health Professions Education Foundation Program.
(d) Members of the board and members of the council shall serve without compensation but shall be reimbursed for any actual and necessary expenses incurred in connection with their duties as members of the board or the council. The Medical Board of California shall reimburse the members it appointed to the foundation board for any actual and necessary expenses incurred in connection with their duties as members of the foundation board.
(e) The foundation shall be subject to the Nonprofit Public Benefit Corporation Law (Part 2 (commencing with Section 5110) of Division 2 of Title 2 of the Corporations Code), except that if there is a conflict with this article and the Nonprofit Public Benefit Corporation Law (Part 2 (commencing with Section 5110) of Division 2 of Title 2 of the Corporations Code), this article shall prevail.
(f) This section shall remain in effect only until January 1, 2022, and as of that date is repealed.

SEC. 163.

 Section 128337 is added to the Health and Safety Code, to read:

128337.
 Notwithstanding any other law, on or before October 1, 2021, the nonprofit public benefit corporation known as the Health Professions Education Foundation shall be dissolved. All assets, including records, and any liabilities shall be transferred to the department.

SEC. 164.

 Section 128338 is added to the Health and Safety Code, to read:

128338.
 Effective with the dissolution of the Health Professions Education Foundation, any reference to the Health Professions Education Foundation, or the Foundation, in this chapter shall be deemed a reference to the department.

SEC. 165.

 Section 128340 of the Health and Safety Code is repealed.

SEC. 166.

 Section 128345 of the Health and Safety Code is amended to read:

128345.
 The department may do any of the following:
(a) Solicit and receive funds from business, industry, foundations, and other private or public sources for the purpose of providing financial assistance in the form of scholarships or loans to students from underrepresented groups. These funds shall be expended by the department after transfer to the Health Professions Education Fund, created pursuant to Section 128355.
(b) Disburse private sector moneys deposited in the Health Professions Education Fund to students from underrepresented groups enrolled in or graduated from schools of medicine, dentistry, nursing, or other health professions in the form of loans or scholarships.
(c) Encourage private sector institutions, including hospitals, community clinics, and other health agencies to identify and provide educational experiences to students from underrepresented groups who are potential applicants to schools of medicine, dentistry, nursing, or other health professions.
(d) Implement the Steven M. Thompson Physician Corps Loan Repayment Program and the Volunteer Physician Program, as provided under Article 5 (commencing with Section 128550).

SEC. 167.

 Section 128350 of the Health and Safety Code is amended to read:

128350.
 The department shall do all of the following:
(a)  Provide technical and staff support to the programs in meeting all of its responsibilities.
(b)  Provide financial management for the Health Professions Education Fund.
(c)  Enter into contractual agreements with students from underrepresented groups for the disbursement of scholarships or loans in return for the commitment of these students to practice their profession in an area in California designated as deficient in primary care services.
(d)  Disseminate information regarding the areas in the state that are deficient in primary care services to potential applicants for the scholarships or loans.
(e)  Monitor the practice locations of the recipients of the scholarships or loans.
(f)  Recover funds, in accordance with the terms of the contractual agreements, from recipients of scholarships or loans who fail to begin or complete their obligated service. Funds so recovered shall be redeposited in the Health Professions Education Fund.
(g)  Contract with the institutions that train family practice residents, in order to increase the participation of students from underrepresented groups in entering the specialty of family practice. The director may seek the recommendations of the council as to what programs best demonstrate the ability to meet this objective.
(h)  Contract with training institutions that are involved in osteopathic postgraduate training in general or family practice medicine, in order to increase the participation of students from underrepresented groups participating in the practice of osteopathic medicine. The director may seek the recommendations of the council as to what programs have demonstrated the ability to meet this objective.
(i)  Enter into contractual agreements with graduated health professionals to repay some or all of the debts they incurred in health professional schools in return for practicing their professions in an area in California designated as deficient in primary care services.
(j)  Contract with institutions that award baccalaureate of science degrees in nursing in order to increase the participation of students from underrepresented groups in the nursing profession. The director may seek the recommendations of the council as to what programs have demonstrated the ability to meet this objective.

SEC. 168.

 Section 128355 of the Health and Safety Code is amended to read:

128355.
 There is hereby created within the department a Health Professions Education Fund. The primary purpose of this fund is to provide scholarships and loans to students from underrepresented groups who are accepted to or enrolled in schools of medicine, dentistry, nursing, or other health professions. The fund shall also be used to pay for the cost of administering the program and for any other purpose authorized by this article. The level of expenditure by the department for the administrative support of the program created pursuant to this article shall be subject to review and approval annually through the State Budget process. The department may receive private donations to be deposited into this fund. All money in the fund is continuously appropriated to the department for the purposes of this article. The department shall manage this fund prudently in accordance with other provisions of law.

SEC. 169.

 Section 128360 of the Health and Safety Code is repealed.

SEC. 170.

 Section 128360 is added to the Health and Safety Code, to read:

128360.
 (a) In administering this chapter, the department shall be exempt from the requirements of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code. The department shall provide opportunities for public participation as it administers the Health Professions Education Programs. Information about each type of scholarship or loan repayment opportunity shall be publicly available at least 60 days prior to any application deadline. This information shall include eligibility criteria and the application process, materials, and deadlines, and shall be posted on the department’s internet website and be available directly from the department. All the information shall remain posted and available during the entire application period for a funding cycle.
(b) Regulations that have been adopted to administer this chapter prior to the effective date of this section are repealed as of the effective date of this section.

SEC. 171.

 Section 128365 of the Health and Safety Code is amended to read:

128365.
 Notwithstanding any other provision, applications for financial assistance under this article, or other documents that the department reasonably determines should not be discussed in public due to privacy considerations shall be exempt from the disclosure provisions of the Public Records Act (Chapter 3.5 (commencing with Section 6250) of Division 7 of Title 1 of the Government Code).

SEC. 172.

 Section 128370 of the Health and Safety Code is amended to read:

128370.
 Notwithstanding any other law, the department may exempt from public disclosure any document in the possession of the department that pertains to a donation made pursuant to this article if the donor has requested anonymity.

SEC. 173.

 Section 128371 of the Health and Safety Code is amended to read:

128371.
 (a) The Legislature finds and declares that it is in the best interest of the State of California to provide persons who are not lawfully present in the United States with the state benefits provided by those programs listed in subdivision (d), and therefore, enacts this section pursuant to Section 1621(d) of Title 8 of the United States Code.
(b) A program listed in subdivision (d) shall not deny an application based on the citizenship status or immigration status of the applicant.
(c) For any program listed in subdivision (d), when mandatory disclosure of a social security number is required, an applicant shall provide their social security number, if one has been issued, or an individual tax identification number that has been or will be submitted.
(d) This section applies to all of the following:
(1) Programs supported through the Health Professions Education Fund pursuant to Section 128355.
(2) The Registered Nurse Education Fund created pursuant to Section 128400.
(3) The Mental Health Practitioner Education Fund created pursuant to Section 128458.
(4) The Vocational Nurse Education Fund created pursuant to Section 128500.
(5) The Medically Underserved Account for Physicians created pursuant to Section 128555.
(6) Loan forgiveness and scholarship programs created pursuant to Part 3.1 (commencing with Section 5820) of Division 5 of the Welfare and Institutions Code.
(7) The Song-Brown Health Care Workforce Training Act created pursuant to Article 1 (commencing with Section 128200) of Chapter 4.
(8) To the extent permitted under federal law, the program administered by the department pursuant to the federal National Health Service Corps State Loan Repayment Program (42 U.S.C. Sec. 254q-1), commonly known as the California State Loan Repayment Program.
(9) The programs administered by the department pursuant to the Health Professions Career Opportunity Program (Section 127885), commonly known as the Mini Grants Program, and California’s Student/Resident Experiences and Rotations in Community Health, commonly known as the CalSEARCH program.

SEC. 174.

 Section 128375 of the Health and Safety Code is amended to read:

128375.
 (a)  The Legislature hereby finds and declares that an adequate supply of professional nurses is critical to assuring the health and well-being of the citizens of California, particularly those who live in medically underserved areas.
(b)  The Legislature further finds that changes in the health care system of this state have increased the need for more highly skilled nurses. These changes include advances in medical technology and pharmacology, that necessitate the use of more highly skilled nurses in acute care facilities. Further, the containment of health care costs has led to increased reliance on home health care and outpatient services and to a higher proportion of more acutely ill patients in acute care facilities. Long-term care facilities also need more highly educated nursing personnel. Both shifts require a larger number of skilled nursing personnel.
(c)  The Legislature further finds and declares that in nursing, as in other professions, certain populations are underrepresented. The Legislature also finds and declares that it is especially important that nursing care be provided in a way that is sensitive to the sociocultural variables that affect a person’s health. The Legislature recognizes that the financial burden of obtaining a baccalaureate degree is considerable and that persons from families lacking adequate financial resources may need financial assistance to complete a baccalaureate degree.

SEC. 175.

 Section 128385 of the Health and Safety Code is amended to read:

128385.
 (a) There is hereby created the Registered Nurse Education Program within the department. Persons participating in this program shall be persons who agree in writing prior to graduation to serve in an eligible county health facility, an eligible state-operated health facility, a health workforce shortage area, or a California nursing school, as designated by the director of the department. Persons agreeing to serve in eligible county health facilities, eligible state-operated health facilities, or health workforce shortage areas, and master’s or doctoral students agreeing to serve in a California nursing school may apply for scholarship or loan repayment. The Registered Nurse Education Program shall be administered in accordance with Article 1 (commencing with Section 128330), except that all funds in the Registered Nurse Education Fund shall be used only for the purpose of promoting the education of registered nurses and related administrative costs. The department shall adopt both of the following:
(1) A standard contractual agreement to be signed by the director and any student who has received an award to work in an eligible county health facility, an eligible state-operated health facility, or in a health workforce shortage area that would require a period of obligated professional service in the areas of California designated by the department as deficient in primary care services. The obligated professional service shall be in direct patient care. The agreement shall include a clause entitling the state to recover the funds awarded plus the maximum allowable interest for failure to begin or complete the service obligation.
(2) Maximum allowable amounts for scholarships, educational loans, and loan repayment programs in order to assure the most effective use of these funds.
(b) Applicants may be persons licensed as registered nurses, graduates of associate degree nursing programs prior to entering a program granting a baccalaureate of science degree in nursing, or students entering an entry-level master’s degree program in registered nursing or other registered nurse master’s or doctoral degree program approved by the Board of Registered Nursing. Priority shall be given to applicants who hold associate degrees in nursing.
(c) Registered nurses and students shall commit to teaching nursing in a California nursing school for five years in order to receive a scholarship or loan repayment for a doctoral degree program.
(d) As used in this section, “eligible county health facility” means a county health facility that has been determined by the department to have a nursing vacancy rate greater than noncounty health facilities located in the same health facility planning area.
(e) As used in this section, “eligible state-operated health facility” means a state-operated health facility that has been determined by the department to have a nursing vacancy rate greater than noncounty health facilities located in the same health facility planning area.

SEC. 176.

 Section 128395 of the Health and Safety Code is repealed.

SEC. 177.

 Section 128401 of the Health and Safety Code is amended to read:

128401.
 (a) The Department of Health Care Access and Information shall establish the statewide Associate Degree Nursing (A.D.N.) Scholarship Program.
(b) Scholarships under the program shall be available only to students in counties determined to have the most significant need. Need in a county shall be established based on consideration of all the following factors:
(1) Counties with a registered nurse-to-population ratio equal to or less than 500 registered nurses per 100,000 individuals.
(2) County unemployment rate.
(3) County level of poverty.
(c) A scholarship recipient shall be required to complete, at a minimum, an associate degree in nursing and work in a medically underserved area in California upon obtaining their license from the Board of Registered Nursing.
(d) The department shall consider the following factors when selecting recipients for the A.D.N. Scholarship Program:
(1) An applicant’s economic need, as established by the federal poverty index.
(2) Applicants who demonstrate cultural and linguistic skills and abilities.
(e) The program shall be funded from the Registered Nurse Education Fund established pursuant to Section 128400 and administered by the department within the office. The department shall allocate a portion of the moneys in the fund for the program established pursuant to this section, in addition to moneys otherwise allocated pursuant to this article for scholarships and loans for associate degree nursing students.
(f) No additional staff or General Fund operating costs shall be expended for the program.
(g) The department may accept private or federal funds for purposes of the A.D.N. Scholarship Program.
(h) The department shall post A.D.N. Scholarship Program statistics and updates on its internet website.

SEC. 178.

 Article 3 (commencing with Section 128425) of Chapter 5 of Part 3 of Division 107 of the Health and Safety Code is repealed.

SEC. 179.

 Section 128454 of the Health and Safety Code is amended to read:

128454.
 (a) There is hereby created the Licensed Mental Health Service Provider Education Program within the Department of Health Care Access and Information.
(b) For purposes of this article, the following definitions shall apply:
(1) “Licensed mental health service provider” means a psychologist licensed by the Board of Psychology, registered psychologist, postdoctoral psychological assistant, postdoctoral psychology trainee employed in an exempt setting pursuant to Section 2910 of the Business and Professions Code or employed pursuant to a State Department of Health Care Services waiver pursuant to Section 5751.2 of the Welfare and Institutions Code, marriage and family therapist, associate marriage and family therapist, licensed clinical social worker, associate clinical social worker, licensed professional clinical counselor, and associate professional clinical counselor.
(2) “Mental health professional shortage area” means an area designated as such by the Health Resources and Services Administration (HRSA) of the United States Department of Health and Human Services.
(c) Commencing January 1, 2005, any licensed mental health service provider, including a mental health service provider who is employed at a publicly funded mental health facility or a public or nonprofit private mental health facility that contracts with a county mental health entity or facility to provide mental health services, who provides direct patient care in a publicly funded facility or a mental health professional shortage area may apply for grants under the program to reimburse their educational loans related to a career as a licensed mental health service provider.
(d) The department shall adopt all of the following:
(1) A standard contractual agreement to be signed by the director and any licensed mental health service provider who is serving in a publicly funded facility or a mental health professional shortage area that would require the licensed mental health service provider who receives a grant under the program to work in the publicly funded facility or a mental health professional shortage area for at least one year.
(2) The maximum allowable total grant amount per individual licensed mental health service provider.
(3) The maximum allowable annual grant amount per individual licensed mental health service provider.
(e) The department shall develop the program, which shall comply with all of the following requirements:
(1) The total amount of grants under the program per individual licensed mental health service provider shall not exceed the amount of educational loans related to a career as a licensed mental health service provider incurred by that provider.
(2) The program shall keep the fees from the different licensed providers separate to ensure that all grants are funded by those fees collected from the corresponding licensed provider groups.
(3) A loan forgiveness grant may be provided in installments proportionate to the amount of the service obligation that has been completed.
(4) The number of persons who may be considered for the program shall be limited by the funds made available pursuant to Section 128458.
(f) This section shall become operative on July 1, 2018.

SEC. 180.

 Section 128456 of the Health and Safety Code is repealed.

SEC. 181.

 Section 128458 of the Health and Safety Code is amended to read:

128458.
 There is hereby established in the State Treasury the Mental Health Practitioner Education Fund. The moneys in the fund, upon appropriation by the Legislature, shall be available for expenditure by the Department of Health Care Access and Information for purposes of this article.

SEC. 182.

 Section 128485 of the Health and Safety Code is amended to read:

128485.
 There is hereby created the Vocational Nurse Education Program within the Department of Health Care Access and Information. Persons participating in this program shall be persons who agree in writing prior to completion of vocational nursing school to serve in an eligible county health facility, an eligible state-operated health facility, or a health workforce shortage area, as designated by the director of the department. Persons agreeing to serve in eligible county health facilities, eligible state-operated health facilities, or health workforce shortage areas may apply for scholarship or loan repayment. The Vocational Nurse Education Program shall be administered in accordance with Article 1 (commencing with Section 128330), except that all funds in the Vocational Nurse Education Fund shall be used only for the purpose of promoting the education of vocational nurses and related administrative costs. The department shall adopt both of the following:
(a) A standard contractual agreement to be signed by the director and any student who has received an award to work in an eligible county health facility, an eligible state-operated health facility, or in a health workforce shortage area that would require a period of obligated professional service in the areas of California designated by the department as deficient in primary care services. The obligated professional service shall be in direct patient care. The agreement shall include a clause entitling the state to recover the funds awarded plus the maximum allowable interest for failure to begin or complete the service obligation.
(b) Maximum allowable amounts for scholarships, educational loans, and loan repayment programs in order to assure the most effective use of these funds.
(c) A person who qualifies for admission to a vocational nursing program that is accredited by the board of Vocational Nursing and Psychiatric Technicians may apply for funding under the Vocational Nurse Education Program by establishing a contractual agreement in accordance with subdivision (a).
(d) A person who holds a current valid license as a vocational nurse who wishes to seek an associate of science degree in nursing from an accredited college may apply for funding under the Vocational Nurse Education Program by establishing a contractual agreement in accordance with subdivision (a) unless the person is able to qualify under subdivision (a) of Section 128385 under the Registered Nurse Education Program.

SEC. 183.

 Section 128495 of the Health and Safety Code is repealed.

SEC. 184.

 Section 128550 of the Health and Safety Code is amended to read:

128550.
 (a) There is hereby established within the Department of Health Care Access and Information the California Physician Corps Program.
(b) Commencing July 1, 2006, both of the following programs shall be transferred from the Medical Board of California to the California Physician Corps Program within the department and operated pursuant to this article:
(1) The Steven M. Thompson Physician Corps Loan Repayment Program.
(2) The Physician Volunteer Program developed by the Medical Board of California.
(c) The department may enter into an interagency agreement with the Medical Board of California to implement the transfer of programs as provided under subdivision (b).

SEC. 185.

 Section 128551 of the Health and Safety Code is amended to read:

128551.
 (a) It is the intent of this article that the department provide the ongoing program management of the two programs identified in subdivision (b) of Section 128550 as a part of the California Physician Corps Program.
(b)  For purposes of subdivision (a), the department shall consult with the Medical Board of California and shall establish and consult with an advisory committee of not more than seven members, that shall include two members recommended by the California Medical Association and may include other members of the medical community, including ethnic representatives, medical schools, health advocates representing ethnic communities, primary care clinics, public hospitals, and health systems, statewide agencies administering state and federally funded programs targeting underserved communities, and members of the public with expertise in health care issues.

SEC. 186.

 Section 128552 of the Health and Safety Code is amended to read:

128552.
 For purposes of this article, the following definitions shall apply:
(a) “Account” means the Medically Underserved Account for Physicians established within the Health Professions Education Fund pursuant to this article.
(b) “Fund” means the Health Professions Education Fund.
(c) “Medi-Cal threshold languages” means primary languages spoken by limited-English-proficient (LEP) population groups meeting a numeric threshold of 3,000, eligible LEP Medi-Cal beneficiaries residing in a county, 1,000 Medi-Cal eligible LEP beneficiaries residing in a single ZIP Code, or 1,500 LEP Medi-Cal beneficiaries residing in two contiguous ZIP Codes.
(d) “Medically underserved area” means an area defined as a health professional shortage area in Part 5 of Subchapter A of Chapter 1 of Title 42 of the Code of Federal Regulations or an area of the state where unmet priority needs for physicians exist as determined by the department.
(e) “Medically underserved population” means the Medi-Cal program and uninsured populations.
(f) “Department” means the Department of Health Care Access and Information.
(g) “Physician Volunteer Program” means the Physician Volunteer Registry Program established by the Medical Board of California.
(h) “Practice setting,” for the purposes of this article only, means either of the following:
(1) A community clinic as defined in subdivision (a) of Section 1204 and subdivision (c) of Section 1206, a clinic owned or operated by a public hospital and health system, or a clinic owned and operated by a hospital that maintains the primary contract with a county government to fulfill the county’s role pursuant to Section 17000 of the Welfare and Institutions Code, which is located in a medically underserved area and at least 50 percent of whose patients are from a medically underserved population.
(2) A physician owned and operated medical practice setting that provides primary care located in a medically underserved area and has a minimum of 50 percent of patients who are uninsured, Medi-Cal beneficiaries, or beneficiaries of another publicly funded program that serves patients who earn less than 250 percent of the federal poverty level.
(i) “Primary specialty” means family practice, internal medicine, pediatrics, or obstetrics/gynecology.
(j) “Program” means the Steven M. Thompson Physician Corps Loan Repayment Program.
(k) “Selection committee” means a minimum three-member committee of the board, that includes a member that was appointed by the Medical Board of California.

SEC. 187.

 Section 128553 of the Health and Safety Code is amended to read:

128553.
 (a) Program applicants shall possess a current valid license to practice medicine in this state issued pursuant to Section 2050 of the Business and Professions Code or pursuant to the Osteopathic Act.
(b) The department shall develop guidelines using the criteria specified in subdivision (c) for selection and placement of applicants. The department shall interpret the guidelines to apply to both osteopathic and allopathic physicians and surgeons.
(c) The guidelines shall meet all of the following criteria:
(1) Provide priority consideration to applicants that are best suited to meet the cultural and linguistic needs and demands of patients from medically underserved populations and who meet one or more of the following criteria:
(A) Speak a Medi-Cal threshold language.
(B) Come from an economically disadvantaged background.
(C) Have received significant training in cultural and linguistically appropriate service delivery.
(D) Have three years of experience providing health care services to medically underserved populations or in a medically underserved area, as defined in subdivision (e) of Section 128552.
(E) Have recently obtained a license to practice medicine.
(2) Include a process for determining the needs for physician services identified by the practice setting and for ensuring that the practice setting meets the definition specified in subdivision (h) of Section 128552.
(3) Give preference to applicants who have completed a three-year residency in a primary specialty.
(4) Give preference to applicants who agree to practice in a medically underserved area, as defined in subdivision (e) of Section 128552, and who agree to serve a medically underserved population.
(5) Give priority consideration to applicants from rural communities who agree to practice in a physician owned and operated medical practice setting as defined in paragraph (2) of subdivision (i) of Section 128552.
(6) Include a factor ensuring geographic distribution of placements.
(7) Provide priority consideration to applicants who agree to practice in a geriatric care setting and are trained in geriatrics, and who can meet the cultural and linguistic needs and demands of a diverse population of older Californians. On and after January 1, 2009, up to 15 percent of the funds collected pursuant to Section 2436.5 of the Business and Professions Code shall be dedicated to loan assistance for physicians and surgeons who agree to practice in geriatric care settings or settings that primarily serve adults over the age of 65 years or adults with disabilities.
(d) (1) The department may appoint a selection committee that provides policy direction and guidance over the program and that complies with the requirements of subdivision (l) of Section 128552.
(2) The department may award up to 20 percent of the available positions to program applicants from specialties outside of the primary care specialties.
(e) Program participants shall meet all of the following requirements:
(1) Shall be working in or have a signed agreement with an eligible practice setting.
(2) Shall have full-time status at the practice setting. Full-time status shall be defined by the department and the department may establish exemptions from this requirement on a case-by-case basis.
(3) Shall commit to a minimum of three years of service in a medically underserved area. Leaves of absence shall be permitted for serious illness, pregnancy, or other natural causes. The department shall develop the process for determining the maximum permissible length of an absence and the process for reinstatement. Loan repayment shall be deferred until the physician is back to full-time status.
(f) The department shall adopt a process that applies if a physician is unable to complete their three-year obligation.
(g) The department, in consultation with those identified in subdivision (b) of Section 128551, shall develop a process for outreach to potentially eligible applicants.
(h) The department may adopt any other standards of eligibility, placement, and termination appropriate to achieve the aim of providing competent health care services in approved practice settings.

SEC. 188.

 Section 128554 of the Health and Safety Code is repealed.

SEC. 189.

 Section 128555 of the Health and Safety Code is amended to read:

128555.
 (a) The Medically Underserved Account for Physicians is hereby established within the Health Professions Education Fund. The primary purpose of this account is to provide funding for the ongoing operations of the Steven M. Thompson Physician Corps Loan Repayment Program provided for under this article. This account also may be used to provide funding for the Physician Volunteer Program provided for under this article.
(b) All moneys in the Medically Underserved Account contained within the Contingent Fund of the Medical Board of California shall be transferred to the Medically Underserved Account for Physicians on July 1, 2006.
(c) Funds in the account shall be used to repay loans as follows per agreements made with physicians:
(1) Funds paid out for loan repayment may have a funding match from foundations or other private sources.
(2) Loan repayments may not exceed one hundred five thousand dollars ($105,000) per individual licensed physician.
(3) Loan repayments may not exceed the amount of the educational loans incurred by the physician participant.
(d) Notwithstanding Section 11105 of the Government Code, effective January 1, 2006, the department may seek and receive matching funds from foundations and private sources to be placed in the account. “Matching funds” shall not be construed to be limited to a dollar-for-dollar match of funds.
(e) Funds placed in the account for purposes of this article, including funds received pursuant to subdivision (d), are, notwithstanding Section 13340 of the Government Code, continuously appropriated for the repayment of loans. This subdivision shall not apply to funds placed in the account pursuant to Section 1341.45 and Section 14197.2 of the Welfare and Institutions Code.
(f) The account shall also be used to pay for the cost of administering the program and for any other purpose authorized by this article. The costs for administration of the program may be up to 5 percent of the total state appropriation for the program and shall be subject to review and approval annually through the state budget process. This limitation shall only apply to the state appropriation for the program.
(g) The department shall manage the account established by this section prudently in accordance with the other provisions of law.

SEC. 190.

 Section 128556 of the Health and Safety Code is amended to read:

128556.
 The terms of loan repayment granted under this article shall be established by the department.

SEC. 191.

 Section 128557 of the Health and Safety Code is repealed.

SEC. 192.

 Article 6 (commencing with Section 128560) of Chapter 5 of Part 3 of Division 107 of the Health and Safety Code is repealed.

SEC. 193.

 Part 4 (commencing with Section 128600) of Division 107 of the Health and Safety Code is repealed.

SEC. 194.

 Section 128681 of the Health and Safety Code is repealed.

SEC. 195.

 Section 128690 of the Health and Safety Code is amended to read:

128690.
 Intermediate care facilities/developmentally disabled—nursing, as defined in subdivision (h) of Section 1250, and intermediate care facilities/developmentally disabled-continuous nursing, as defined in subdivision (m) of Section 1250, are not subject to this chapter.

SEC. 196.

 Section 128700 of the Health and Safety Code is amended to read:

128700.
 As used in this chapter, the following terms mean:
(a) “Ambulatory surgery procedures” mean those procedures performed on an outpatient basis in the general operating rooms, ambulatory surgery rooms, endoscopy units, or cardiac catheterization laboratories of a hospital or a freestanding ambulatory surgery clinic.
(b) “Emergency department” means, in a hospital licensed to provide emergency medical services, the location in which those services are provided.
(c) “Encounter” means a face-to-face contact between a patient and the provider who has primary responsibility for assessing and treating the condition of the patient at a given contact and exercises independent judgment in the care of the patient.
(d) “Freestanding ambulatory surgery clinic” means a surgical clinic that is licensed by the state under paragraph (1) of subdivision (b) of Section 1204.
(e) “Health facility” or “health facilities” means all health facilities required to be licensed pursuant to Chapter 2 (commencing with Section 1250) of Division 2.
(f) “Hospital” means all health facilities except skilled nursing, intermediate care, congregate living, and hospice health facilities.
(g) “Department” means the Department of Health Care Access and Information.
(h) “Risk-adjusted outcomes” means the clinical outcomes of patients grouped by diagnoses or procedures that have been adjusted for demographic and clinical factors.

SEC. 197.

 Section 128705 of the Health and Safety Code is amended to read:

128705.
 On and after January 1, 1986, any reference in this code to the Advisory Health Council or the California Health Policy and Data Advisory Commission shall be deemed a reference to the department.

SEC. 198.

 Section 128730 of the Health and Safety Code is amended to read:

128730.
 (a) Effective January 1, 1986, the department shall be the single state agency designated to collect the following health facility or clinic data for use by all state agencies:
(1) Data required by the department pursuant to Section 127285.
(2) Data required in the Medi-Cal cost reports pursuant to Section 14170 of the Welfare and Institutions Code.
(3) Data items formerly required by the California Health Facilities Commission that are listed in Sections 128735 and 128740. Information collected pursuant to subdivision (g) of Section 128735 and Sections 128736 and 128737 shall be made available to the State Department of Health Care Services, the State Department of Public Health, and the California Health Benefit Exchange. The departments and the Exchange shall ensure that the patient’s rights to confidentiality shall not be violated in any manner. The departments and the Exchange shall comply with all applicable policies and requirements involving review and oversight by the State Committee for the Protection of Human Subjects.
(b) The department shall consolidate any and all of the reports listed under this section or Sections 128735 and 128740, to the extent feasible, to minimize the reporting burdens on hospitals, provided, however, that the department shall neither add nor delete data items from the Hospital Discharge Abstract Data Record or the quarterly reports without prior authorizing legislation, unless specifically required by federal law or regulation or judicial decision.
(c) The Exchange shall report to the Governor and the Legislature on or before August 1, 2023, on the impacts to the Exchange associated with paragraph (3) of subdivision (a), including the impacts on premium rates for health plans offered through the Exchange. The report shall be submitted in compliance with Section 9795 of the Government Code.

SEC. 199.

 Section 128734 of the Health and Safety Code is amended to read:

128734.
 (a) Each organization that operates, conducts, owns, or maintains a skilled nursing facility licensed pursuant to subdivision (c) of Section 1250 shall file with the department as part of the information required in subdivisions (a) to (e), inclusive, of Section 128735, whether the licensee, or a general partner, director, or officer of the licensee, has an ownership or control interest of 5 percent or more in a related party that provides any service to the skilled nursing facility. If the licensee, or the general partner, director, or officer of the licensee has such an interest, the licensee shall disclose all services provided to the skilled nursing facility, the number of individuals who provide that service at the skilled nursing facility, and any other information requested by the department. If goods, fees, and services collectively worth ten thousand dollars ($10,000) or more per year are delivered to the skilled nursing facility, the disclosure required pursuant to this subdivision shall include the related party’s profit and loss statement, and the Payroll-Based Journal public use data of the previous quarter for the skilled nursing facility’s direct caregivers.
(b) For purposes of this section, all of the following definitions shall apply:
(1) “Direct caregiver” shall have the same meaning as that term is defined in Section 1276.65.
(2) “Profit and loss statement” means the most recent annual statement on profits and losses finalized by a related party for the most recent year available.
(3) “Related party” means an organization related to the licensee provider or that is under common ownership or control, as defined in Section 413.17(b) of Title 42 of the Code of Federal Regulations.
(c) Current licensees shall provide the information required by this section to the department in a manner prescribed by the department.
(d) The provisions of this section shall become effective on January 1, 2020.

SEC. 200.

 Section 128735 of the Health and Safety Code is amended to read:

128735.
 An organization that operates, conducts, owns, or maintains a health facility, and the officers thereof, shall make and file with the department, at the times as the department shall require, all of the following reports on forms specified by the department that are in accord, if applicable, with the systems of accounting and uniform reporting required by this part, except that the reports required pursuant to subdivision (g) shall be limited to hospitals:
(a) A balance sheet detailing the assets, liabilities, and net worth of the health facility at the end of its fiscal year.
(b) A statement of income, expenses, and operating surplus or deficit for the annual fiscal period, and a statement of ancillary utilization and patient census.
(c) A statement detailing patient revenue by payer, including, but not limited to, Medicare, Medi-Cal, and other payers, and revenue center.
(d) A statement of cashflows, including, but not limited to, ongoing and new capital expenditures and depreciation.
(e) (1) A statement reporting the information required in subdivisions (a), (b), (c), and (d) for each separately licensed health facility operated, conducted, or maintained by the reporting organization.
(2) Notwithstanding paragraph (1), a health facility that receives a preponderance of its revenue from associated comprehensive group practice prepayment health care service plans and that is operated as a unit of a coordinated group of health facilities under common management may report the information required pursuant to subdivisions (a) and (d) for the group and not for each separately licensed health facility.
(f) Data reporting requirements established by the department shall be consistent with national standards, as applicable.
(g) A Hospital Discharge Abstract Data Record that includes all of the following:
(1) Date of birth.
(2) Sex.
(3) Race.
(4) ZIP Code.
(5) Preferred language spoken.
(6) Patient social security number, if it is contained in the patient’s medical record.
(7) Prehospital care and resuscitation, if any, including all of the following:
(A) “Do not resuscitate” (DNR) order on admission.
(B) “Do not resuscitate” (DNR) order after admission.
(8) Admission date.
(9) Source of admission.
(10) Type of admission.
(11) Discharge date.
(12) Principal diagnosis and whether the condition was present on admission.
(13) Other diagnoses and whether the conditions were present on admission.
(14) External causes of morbidity and whether present on admission.
(15) Principal procedure and date.
(16) Other procedures and dates.
(17) Total charges.
(18) Disposition of patient.
(19) Expected source of payment.
(20) Elements added pursuant to Section 128738.
(h) It is the intent of the Legislature that the patient’s rights of confidentiality shall not be violated in any manner. Patient social security numbers and other data elements that the department believes could be used to determine the identity of an individual patient shall be exempt from the disclosure requirements of the California Public Records Act (Chapter 3.5 (commencing with Section 6250) of Division 7 of Title 1 of the Government Code).
(i) A person reporting data pursuant to this section shall not be liable for damages in an action based on the use or misuse of patient-identifiable data that has been mailed or otherwise transmitted to the department pursuant to the requirements of subdivision (g).
(j) A hospital shall use coding from the International Classification of Diseases in reporting diagnoses and procedures.
(k) On or before July 1, 2021, the department shall promulgate regulations as necessary to implement subdivision (e). A health facility that receives a preponderance of its revenue from associated comprehensive group practice prepayment health care service plans and that is operated as a unit of a coordinated group of health facilities under common management shall comply with the reporting requirements of subdivisions (b), (c), and (e) once the department finalizes related regulations.

SEC. 201.

 Section 128736 of the Health and Safety Code is amended to read:

128736.
 (a)  Each hospital shall file an Emergency Care Data Record for each patient encounter in a hospital emergency department. The Emergency Care Data Record shall include all of the following:
(1)  Date of birth.
(2)  Sex.
(3)  Race.
(4)  Ethnicity.
(5)  Preferred language spoken.
(6)  ZIP Code.
(7)  Patient social security number, if it is contained in the patient’s medical record.
(8)  Service date.
(9)  Principal diagnosis.
(10)  Other diagnoses.
(11)  External causes of morbidity.
(12) Principal procedure.
(13) Other procedures.
(14) Disposition of patient.
(15) Expected source of payment.
(16) Elements added pursuant to Section 128738.
(b)  It is the expressed intent of the Legislature that the patient’s rights of confidentiality shall not be violated in any manner. Patient social security numbers and any other data elements that the department believes could be used to determine the identity of an individual patient shall be exempt from the disclosure requirements of the California Public Records Act (Chapter 3.5 (commencing with Section 6250) of Division 7 of Title 1 of the Government Code).
(c)  No person reporting data pursuant to this section shall be liable for damages in any action based on the use or misuse of patient-identifiable data that has been mailed or otherwise transmitted to the department pursuant to the requirements of subdivision (a).
(d)  Data reporting requirements established by the department shall be consistent with national standards as applicable.
(e)  This section shall become operative on January 1, 2004.

SEC. 202.

 Section 128737 of the Health and Safety Code is amended to read:

128737.
 (a) Each general acute care hospital and freestanding ambulatory surgery clinic shall file an Ambulatory Surgery Data Record for each patient encounter during which at least one ambulatory surgery procedure is performed. The Ambulatory Surgery Data Record shall include all of the following:
(1) Date of birth.
(2) Sex.
(3) Race.
(4) Ethnicity.
(5) Preferred language spoken.
(6) ZIP Code.
(7) Patient social security number, if it is contained in the patient’s medical record.
(8) Service date.
(9) Principal diagnosis.
(10) Other diagnoses.
(11) Principal procedure.
(12) Other procedures.
(13) External causes of morbidity.
(14) Disposition of patient.
(15) Expected source of payment.
(16) Elements added pursuant to Section 128738.
(b) It is the expressed intent of the Legislature that the patient’s rights of confidentiality shall not be violated in any manner. Patient social security numbers and any other data elements that the department believes could be used to determine the identity of an individual patient shall be exempt from the disclosure requirements of the California Public Records Act (Chapter 3.5 (commencing with Section 6250) of Division 7 of Title 1 of the Government Code).
(c) No person reporting data pursuant to this section shall be liable for damages in any action based on the use or misuse of patient-identifiable data that has been mailed or otherwise transmitted to the office pursuant to the requirements of subdivision (a).
(d) Data reporting requirements established by the department shall be consistent with national standards as applicable.
(e) This section shall become operative on January 1, 2004.

SEC. 203.

 Section 128738 of the Health and Safety Code is amended to read:

128738.
 (a) The department shall allow and provide for, in accordance with appropriate regulations, additions or deletions to the patient level data elements listed in subdivision (g) of Section 128735, Section 128736, and Section 128737, to meet the purposes of this chapter.
(b) Prior to any additions or deletions, all of the following shall be considered:
(1) Utilization of sampling to the maximum extent possible.
(2) Feasibility of collecting data elements.
(3) Costs and benefits of collection and submission of data.
(4) Exchange of data elements as opposed to addition of data elements.
(c) The department shall add no more than a net of 15 elements to each data set over any five-year period. Elements contained in the uniform claims transaction set or uniform billing form required by the Health Insurance Portability and Accountability Act of 1996 (42 U.S.C. Sec. 300gg) shall be exempt from the 15-element limit.
(d) The department, in order to minimize costs and administrative burdens, shall consider the total number of data elements required from hospitals and freestanding ambulatory surgery clinics, and optimize the use of common data elements.

SEC. 204.

 Section 128740 of the Health and Safety Code is amended to read:

128740.
 (a) The following summary financial and utilization data shall be reported to the department by a hospital within 45 days of the end of a calendar quarter. Adjusted reports reflecting changes as a result of audited financial statements may be filed within four months of the close of the hospital’s fiscal or calendar year. The quarterly summary financial and utilization data shall conform to the uniform description of accounts as contained in the Accounting and Reporting Manual for California Hospitals and shall include all of the following:
(1) Number of licensed beds.
(2) Average number of available beds.
(3) Average number of staffed beds.
(4) Number of discharges.
(5) Number of inpatient days.
(6) Number of outpatient visits.
(7) Total operating expenses.
(8) Total inpatient gross revenues by payer, including Medicare, Medi-Cal, county indigent programs, other third parties, and other payers.
(9) Total outpatient gross revenues by payer, including Medicare, Medi-Cal, county indigent programs, other third parties, and other payers.
(10) Deductions from revenue in total and by component, including the following: Medicare contractual adjustments, Medi-Cal contractual adjustments, and county indigent program contractual adjustments, other contractual adjustments, bad debts, charity care, restricted donations and subsidies for indigents, support for clinical teaching, teaching allowances, and other deductions.
(11) Total capital expenditures.
(12) Total net fixed assets.
(13) Total number of inpatient days, outpatient visits, and discharges by payer, including Medicare, Medi-Cal, county indigent programs, other third parties, self-pay, charity, and other payers.
(14) Total net patient revenues by payer including Medicare, Medi-Cal, county indigent programs, other third parties, and other payers.
(15) Other operating revenue.
(16) Nonoperating revenue net of nonoperating expenses.
(b) The department shall make available at cost, to any person, a hard copy of any hospital report made pursuant to this section and in addition to hard copies, shall make available at cost, a computer tape of all reports made pursuant to this section within 105 days of the end of every calendar quarter.
(c) The department shall adopt by regulation guidelines for the identification, assessment, and reporting of charity care services. In establishing the guidelines, the department shall consider the principles and practices recommended by professional health care industry accounting associations for differentiating between charity services and bad debts. The department shall further conduct the onsite validations of health facility accounting and reporting procedures and records as are necessary to assure that reported data are consistent with regulatory guidelines.

SEC. 205.

 Section 128745 of the Health and Safety Code is amended to read:

128745.
 (a) Commencing July 1993, and annually thereafter, the department shall publish risk-adjusted outcome reports in accordance with the following schedule:
Procedures and
Publication
Period
Conditions
 Date
Covered
Covered
July 1993
1988–90
3
July 1994
1989–91
6
July 1995
1990–92
9
Reports for subsequent years shall include conditions and procedures and cover periods as appropriate.
(b) The procedures and conditions for risk-adjusted outcome reports pursuant to subdivision (a) shall be divided among medical, surgical, and obstetric conditions or procedures and shall be selected by the department. The department shall publish the risk-adjusted outcome reports for selected conditions and procedures by individual hospital, individual medical group, or individual physician as selected by the department in consultation with medical specialists in the relevant area of practice. The selections, under this subdivision, shall be in accordance with all of the following criteria:
(1) The patient discharge abstract contains sufficient data to undertake a valid risk adjustment. The risk adjustment report shall ensure that public hospitals and other hospitals serving primarily low-income patients are not unfairly discriminated against.
(2) The relative importance of the procedure and condition in terms of the cost of cases and the number of cases and the seriousness of the health consequences of the procedure or condition.
(3) Ability to measure outcome and the likelihood that care influences outcome.
(4) Reliability of the diagnostic and procedure data.
(c) (1) In addition to any other established and pending reports, on or before July 1, 2002, the department shall publish a risk-adjusted outcome report for coronary artery bypass graft surgery by hospital for all hospitals opting to participate in the report. This report shall be updated on or before July 1, 2003.
(2) The department shall publish at least one risk-adjusted outcome report for coronary artery bypass graft surgery, transcatheter aortic valve replacement, or any type of interventional cardiovascular procedure for procedures performed in the state. For any type of interventional cardiovascular procedure other than coronary artery bypass graft surgery or transcatheter aortic valve replacement, the department shall only select from interventional cardiovascular procedures recommended by the clinical panel established by Section 128748, not to exceed one additional interventional cardiovascular procedure every three years. In each year, the reports shall compare risk-adjusted outcomes by hospital, medical group, or physician as selected by the department after consultation with the clinical panel. Upon the recommendation of the clinical panel based on statistical and technical considerations, information on individual hospitals, individual medical groups, or individual physicians may be excluded from the reports.
(3) Each hospital shall produce and file with the department, at the times as the department shall require, reports of data the department needs to prepare risk-adjusted outcome reports under this subdivision. Unless otherwise recommended by the clinical panel established by Section 128748, the department shall continue to collect the same data used for the most recent risk-adjusted model developed for the California Coronary Artery Bypass Graft Outcomes Reporting Program. Upon recommendation of the clinical panel, the department may add any clinical data elements included in the Society of Thoracic Surgeons’ database or other relevant databases to be collected from hospitals. Prior to any additions from the Society of Thoracic Surgeons’ database, or other relevant databases, the following factors shall be considered:
(A) Utilization of sampling to the maximum extent possible.
(B) Exchange of data elements as opposed to addition of data elements.
(4) Upon recommendation of the clinical panel, the department may add, delete, or revise clinical data elements to be collected from hospitals for outcome reports under this subdivision. Prior to any additions or deletions, all of the following factors shall be considered:
(A) Utilization of sampling to the maximum extent possible.
(B) Feasibility of collecting data elements.
(C) Costs and benefits of collection and submission of data.
(D) Exchange of data elements as opposed to addition of data elements.
(5) The department shall collect the minimum data necessary for purposes of testing or validating a risk-adjusted model for the outcome reports under this subdivision.
(6) Patient medical record numbers and any other data elements that the department believes could be used to determine the identity of an individual patient shall be exempt from the disclosure requirements of the California Public Records Act (Chapter 3.5 (commencing with Section 6250) of Division 7 of Title 1 of the Government Code).
(d) The annual reports shall compare the risk-adjusted outcomes experienced by all patients treated for the selected conditions and procedures in each California hospital during the period covered by each report, to the outcomes expected. Outcomes shall be reported in at least the following groupings for each hospital, medical group, or physician:
(1) “Higher than average outcomes,” for hospitals with risk-adjusted outcomes higher than the norm.
(2) “Average outcomes,” for hospitals with average risk-adjusted outcomes.
(3) “Lower than average outcomes,” for hospitals with risk-adjusted outcomes lower than the norm.
(e) For outcome reports under this subdivision for which auditing is appropriate, the department shall conduct periodic auditing of data at hospitals.
(f) The department shall either include in the annual reports required under this section, or make separately available at cost to any person requesting it, risk-adjusted outcomes data assessing the statistical significance of hospital, medical group, or physician data at each of the following three levels: 99-percent confidence level (0.01 p-value), 95-percent confidence level (0.05 p-value), and 90-percent confidence level (0.10 p-value). The department shall include any other analysis or comparisons of the data in the annual reports required under this section that the department deems appropriate to further the purposes of this chapter.

SEC. 206.

 Section 128747 of the Health and Safety Code is amended to read:

128747.
 Commencing July 1, 2002, and biennially thereafter, the department shall evaluate the impact of the department’s published risk-adjusted outcome reports required by Section 128745 on mortality rates in California and on any other measure of quality the department deems appropriate. The department shall also coordinate with other state agencies in promoting prevention and educational initiatives on those reported procedures and conditions.

SEC. 207.

 Section 128748 of the Health and Safety Code is amended to read:

128748.
 (a)  This section shall apply to any risk-adjusted outcome report under Section 128745.
(b) This subdivision applies to risk-adjusted outcome reports under subdivision (c) of Section 128745.
(1)  The department shall obtain data necessary to complete a risk-adjusted outcome report from hospitals. If necessary data for an outcome report is available only from the department of a physician and not the hospital where the patient received treatment, then the hospital shall make a reasonable effort to obtain the data from the physician’s office and provide the data to the department. In the event that the department finds any errors, omissions, discrepancies, or other problems with submitted data, the department shall contact either the hospital or physician’s office that maintains the data to resolve the problems.
(2) The department shall collect the minimum data necessary for purposes of testing or validating a risk-adjusted model. Except for data collected for purposes of testing or validating a risk-adjusted model, the department shall not collect data for an outcome report nor issue an outcome report until the clinical panel established pursuant to this section has approved the risk-adjusted model.
(c)  For each risk-adjusted outcome report on a medical, surgical, or obstetric condition or procedure that includes reporting of data by an individual physician or an individual medical group authorized by subdivision (b) of Section 128745, the department director shall appoint a clinical panel, which shall have nine members. Three members shall be appointed from a list of three or more names submitted by the physician specialty society that most represents physicians performing the medical, surgical, and obstetric procedure for which data is collected. Three members shall be appointed from a list of three or more names submitted by the California Medical Association. Three members shall be appointed from lists of names submitted by consumer organizations. At least one-half of the appointees from the lists submitted by the physician specialty society and the California Medical Association, and at least one appointee from the lists submitted by consumer organizations, shall be experts in collecting and reporting outcome measurements for physicians, medical groups, or hospitals. The panel may include physicians from another state. The panel shall review and approve the development of the risk-adjustment model to be used in preparation of the outcome report.
(d)  For risk-adjusted outcome reports authorized by subdivision (c) of Section 128745 the following shall apply:
(1) The California Coronary Artery Bypass Graft Outcomes Reporting Program Clinical Advisory Panel shall become the clinical panel for those outcome reports and this panel shall be renamed by the department.
(2) This clinical panel shall be comprised of at least 9 and no more than 13 members. The department director shall have the authority to appoint the members of the clinical panel. Three members shall be appointed from a list of three or more names submitted by the California Chapter of the American College of Cardiology. Three members shall be appointed from a list of three or more names submitted by the California Medical Association. Three members shall be appointed from lists of names submitted by consumer organizations. Any additional members shall be appointed at the discretion of the department director. If, at the time the department decides to report on a procedure, the panel does not have members with expertise in that procedure, the department shall seek to appoint two new members with expertise in that procedure from a list submitted by the California Chapter of the American College of Cardiology. At least one-half of the appointees from the lists submitted by the California Chapter of the American College of Cardiology, and the California Medical Association, and at least one appointee from the lists submitted by consumer organizations, shall be experts in collecting and reporting outcome measurements. The panel may include physicians from another state.
(3) The panel shall review and approve the development of the risk-adjustment model to be used in preparation of the outcome report.
(e)  Any report that includes reporting by an individual physician shall include, at a minimum, the risk-adjusted outcome data for each physician. The department may also include in the report, after consultation with the clinical panel, any explanatory material, comparisons, groupings, and other information to facilitate consumer comprehension of the data.
(f)  Members of a clinical panel shall serve without compensation, but shall be reimbursed for any actual and necessary expenses incurred in connection with their duties as members of the clinical panel.

SEC. 208.

 Section 128750 of the Health and Safety Code is amended to read:

128750.
 (a) Prior to the public release of the annual outcome reports, the department shall furnish a preliminary report to each hospital that is included in the report. The department shall allow the hospital and chief of staff 60 days to review the outcome scores and compare the scores to other California hospitals. A hospital or its chief of staff that believes that the risk-adjusted outcomes do not accurately reflect the quality of care provided by the hospital may submit a statement to the department, within the 60 days, explaining why the outcomes do not accurately reflect the quality of care provided by the hospital. The statement shall be included in an appendix to the public report, and a notation that the hospital or its chief of staff has submitted a statement shall be displayed wherever the report presents outcome scores for the hospital.
(b) (1) Prior to the public release of any outcome report that includes data by a physician or medical group, the department shall furnish a preliminary report to each physician or medical group that is included in the report. The department shall allow the physician or medical group 30 days from the date the department sends the report to the physician or medical group to review the outcome scores and compare the scores to other California physicians or medical groups, respectively. A physician or medical group that believes that the risk-adjusted outcome does not accurately reflect the quality of care provided by the physician or medical group may submit a statement to the department within the 30 days, explaining why the outcomes do not accurately reflect the quality of care provided by the physician or medical group.
(2) The department shall promptly review the statement and shall respond to the physician or medical group with one of the following conclusions:
(A) The statement reveals a flaw in the accuracy of the reported data relating to the physician or medical group that materially diminishes the validity of the report. If this finding is made, the data for that physician or medical group shall not be included in the report until the flaw in the data is corrected.
(B) The statement reveals a flaw in the risk-adjustment model that materially diminishes the value of the report for all physicians or medical groups. If this finding is made, the report using that risk-adjustment model shall not be issued until the flaw is corrected.
(C) The statement does not reveal a flaw in either the accuracy of the reported data relating to the physician or medical group, or the risk-adjustment model in which case the report shall be used, unless the physician or medical group chooses to use the procedure set forth in paragraph (3).
(3) If a physician or medical group is not satisfied with the conclusion reached by the department, the physician or medical group shall notify the department of that fact. Upon receipt of the notice, the department shall forward the statement to the appropriate clinical panel appointed pursuant to Section 128748. The department shall forward the statement with any information identifying the physician or medical group or the hospital of the physician or medical group redacted, or shall adopt other means to ensure the physician or medical group’s identity is not revealed to the panel. The clinical panel shall promptly review the statement and the conclusion of the office and shall respond by either upholding the conclusion or reaching one of the other conclusions set forth in this subdivision. The panel decision shall be the final determination regarding the statement. The process set forth in this subdivision shall be completed within 60 days from the date the department sends the report to each physician or medical group included in the report. If a decision by either the department or the clinical panel cannot be reached within the 60-day period, then the outcome report may be issued but shall not include data for the physician or medical group submitting the statement.
(c) The department shall, in addition to public reports, provide hospitals and the chiefs of staff of the medical staffs with a report containing additional detailed information derived from data summarized in the public outcome reports as an aid to internal quality assurance.
(d) If, pursuant to the recommendations of the department, the Legislature subsequently amends Section 128735 to authorize the collection of additional discharge data elements, then the outcome reports for conditions and procedures for which sufficient data is not available from the current abstract record will be produced following the collection and analysis of the additional data elements.
(e) The recommendations of the department for the addition of data elements to the discharge abstract should take into consideration the technical feasibility of developing reliable risk-adjustment factors for additional procedures and conditions as determined by the department with the advice of the research community, physicians and surgeons, hospitals, consumer or patient advocacy groups, and medical records personnel.
(f) The department at a minimum shall identify a limited set of core clinical data elements to be collected for all of the selected procedures and conditions and unique clinical variables necessary for risk adjustment of specific conditions and procedures selected for the outcomes report program. In addition, the department should give careful consideration to the costs associated with the additional data collection and the value of the specific information to be collected.
(g) The department shall also engage in a continuing process of data development and refinement applicable to both current and prospective outcome studies.

SEC. 209.

 Section 128755 of the Health and Safety Code is amended to read:

128755.
 (a) (1) Hospitals shall file the reports required by subdivisions (a), (b), (c), and (d) of Section 128735 with the department within four months after the close of the hospital’s fiscal year except as provided in paragraph (2).
(2) If a licensee relinquishes the facility license or puts the facility license in suspense, the last day of active licensure shall be deemed a fiscal year end.
(3) The department shall make the reports filed pursuant to this subdivision available no later than three months after they were filed.
(b) (1) Skilled nursing facilities, intermediate care facilities, intermediate care facilities/developmentally disabled, hospice facilities, and congregate living facilities, including nursing facilities certified by the State Department of Health Care Services to participate in the Medi-Cal program, shall file the reports required by subdivisions (a), (b), (c), and (d) of Section 128735 with the department within four months after the close of the facility’s fiscal year, except as provided in paragraph (2).
(2) (A) If a licensee relinquishes the facility license or puts the facility licensure in suspense, the last day of active licensure shall be deemed a fiscal year end.
(B) If a fiscal year end is created because the facility license is relinquished or put in suspense, the facility shall file the reports required by subdivisions (a), (b), (c), and (d) of Section 128735 within two months after the last day of active licensure.
(3) The department shall make the reports filed pursuant to paragraph (1) available not later than three months after they are filed.
(4) (A) Effective for fiscal years ending on or after December 31, 1991, the reports required by subdivisions (a), (b), (c), and (d) of Section 128735 shall be filed with the department by electronic media, as determined by the department.
(B) Congregate living health facilities are exempt from the electronic media reporting requirements of subparagraph (A).
(c) A hospital shall file the reports required by subdivision (g) of Section 128735 as follows:
(1) For patient discharges on or after January 1, 1999, through December 31, 1999, the reports shall be filed semiannually by each hospital or its designee not later than six months after the end of each semiannual period, and shall be available from the department no later than six months after the date that the report was filed.
(2) For patient discharges on or after January 1, 2000, through December 31, 2000, the reports shall be filed semiannually by each hospital or its designee not later than three months after the end of each semiannual period. The reports shall be filed by electronic tape, diskette, or similar medium as approved by the department. The department shall approve or reject each report within 15 days of receiving it. If a report does not meet the standards established by the department, it shall not be approved as filed and shall be rejected. The report shall be considered not filed as of the date the facility is notified that the report is rejected. A report shall be available from the department no later than 15 days after the date that the report is approved.
(3) For patient discharges on or after January 1, 2001, the reports shall be filed by each hospital or its designee for report periods and at times determined by the department. The reports shall be filed by online transmission in formats consistent with national standards for the exchange of electronic information. The department shall approve or reject each report within 15 days of receiving it. If a report does not meet the standards established by the department, it shall not be approved as filed and shall be rejected. The report shall be considered not filed as of the date the facility is notified that the report is rejected. A report shall be available from the department no later than 15 days after the date that the report is approved.
(d) The reports required by subdivision (a) of Section 128736 shall be filed by each hospital for report periods and at times determined by the department. The reports shall be filed by online transmission in formats consistent with national standards for the exchange of electronic information. The department shall approve or reject each report within 15 days of receiving it. If a report does not meet the standards established by the department, it shall not be approved as filed and shall be rejected. The report shall be considered not filed as of the date the facility is notified that the report is rejected. A report shall be available from the department no later than 15 days after the report is approved.
(e) The reports required by subdivision (a) of Section 128737 shall be filed by each hospital or freestanding ambulatory surgery clinic for report periods and at times determined by the department. The reports shall be filed by online transmission in formats consistent with national standards for the exchange of electronic information. The department shall approve or reject each report within 15 days of receiving it. If a report does not meet the standards established by the department, it shall not be approved as filed and shall be rejected. The report shall be considered not filed as of the date the facility is notified that the report is rejected. A report shall be available from the department no later than 15 days after the report is approved.
(f) Facilities shall not be required to maintain a full-time electronic connection to the office for the purposes of online transmission of reports as specified in subdivisions (c), (d), and (e). The department may grant exemptions to the online transmission of data requirements for limited periods to facilities. An exemption may be granted only to a facility that submits a written request and documents or demonstrates a specific need for an exemption. Exemptions shall be granted for no more than one year at a time, and for no more than a total of five consecutive years.
(g) The reports referred to in paragraph (2) of subdivision (a) of Section 128730 shall be filed with the department on the dates required by applicable law and shall be available from the department no later than six months after the date that the report was filed.
(h) The department shall post on its internet website and make available to any person a copy of any report referred to in subdivision (a), (b), (c), (d), or (g) of Section 128735, subdivision (a) of Section 128736, subdivision (a) of Section 128737, Section 128740, and, in addition, shall make available in electronic formats reports referred to in subdivision (a), (b), (c), (d), or (g) of Section 128735, subdivision (a) of Section 128736, subdivision (a) of Section 128737, Section 128740, and subdivisions (a) and (c) of Section 128745, unless the department determines that an individual patient’s rights of confidentiality would be violated. The department shall make the reports available at cost.

SEC. 210.

 Section 128760 of the Health and Safety Code is amended to read:

128760.
 (a) On and after January 1, 1986, the systems of health facility accounting and auditing formerly approved by the California Health Facilities Commission shall remain in full force and effect for use by health facilities, but shall be maintained by the department.
(b) The department shall allow and provide, in accordance with appropriate regulations, for modifications in the accounting and reporting systems for use by health facilities in meeting the requirements of this chapter if the modifications are necessary to do any of the following:
(1) To correctly reflect differences in size of, provision of, or payment for, services rendered by health facilities.
(2) To correctly reflect differences in scope, type, or method of provision of, or payment for, services rendered by health facilities.
(3) To avoid unduly burdensome costs for those health facilities in meeting the requirements of differences pursuant to paragraphs (1) and (2).
(c) The department shall allow and provide, in accordance with appropriate regulations, for modifications to discharge data reporting format and frequency requirements if these modifications will not impair the department’s ability to process the data or interfere with the purposes of this chapter. This modification authority shall not permit the department to administratively require the reporting of discharge data items not specified pursuant to Section 128735.
(d) The department shall allow and provide, in accordance with appropriate regulations, for modifications to emergency care data reporting format and frequency requirements if these modifications will not impair the department’s ability to process the data or interfere with the purposes of this chapter. This modification authority shall not permit the department to require administratively the reporting of emergency care data items not specified in subdivision (a) of Section 128736.
(e) The department shall allow and provide, in accordance with appropriate regulations, for modifications to ambulatory surgery data reporting format and frequency requirements if these modifications will not impair the department’s ability to process the data or interfere with the purposes of this chapter. The modification authority shall not permit the department to require administratively the reporting of ambulatory surgery data items not specified in subdivision (a) of Section 128737.
(f) The department shall adopt comparable modifications to the financial reporting requirements of this chapter for county hospital systems consistent with the purposes of this chapter.

SEC. 211.

 Section 128765 of the Health and Safety Code is amended to read:

128765.
 (a) The department shall maintain a file of all the reports filed under this chapter at its Sacramento office. Subject to any rules the department may prescribe, these reports shall be produced and made available for inspection upon the demand of any person, and shall also be posted on its internet website with the exception of discharge and encounter data that shall be available for public inspection unless the department determines, pursuant to applicable law, that an individual patient’s rights of confidentiality would be violated.
(b) The reports published pursuant to Section 128745 shall include an executive summary, written in plain English to the maximum extent practicable, that shall include, but not be limited to, a discussion of findings, conclusions, and trends concerning the overall quality of medical outcomes, including a comparison to reports from prior years, for the procedure or condition studied by the report. The department shall disseminate the reports as widely as practical to interested parties, including, but not limited to, hospitals, providers, the media, purchasers of health care, consumer or patient advocacy groups, and individual consumers. The reports shall be posted on the department’s internet website.
(c) Copies certified by the department as being true and correct copies of reports properly filed with the department pursuant to this chapter, together with summaries, compilations, or supplementary reports prepared by the department, shall be introduced as evidence, where relevant, at any hearing, investigation, or other proceeding held, made, or taken by any state, county, or local governmental agency, board, or commission that participates as a purchaser of health facility services pursuant to the provisions of a publicly financed state or federal health care program. Each of these state, county, or local governmental agencies, boards, and commissions shall weigh and consider the reports made available to it pursuant to this subdivision in its formulation and implementation of policies, regulations, or procedures regarding reimbursement methods and rates in the administration of these publicly financed programs.
(d) The department shall compile and publish summaries of individual facility and aggregate data that do not contain patient-specific information for the purpose of public disclosure. Upon request, these shall include summaries of observation services data, in a format prescribed by the department. The summaries shall be posted on the department’s internet website. The department may initiate and conduct studies as it determines will advance the purposes of this chapter.
(e) In order to ensure that accurate and timely data are available to the public in useful formats, the department shall establish a public liaison function. The public liaison shall provide technical assistance to the general public on the uses and applications of individual and aggregate health facility data and shall provide the director with an annual report on changes that can be made to improve the public’s access to data.

SEC. 212.

 Section 128766 of the Health and Safety Code is amended to read:

128766.
 (a) Notwithstanding Section 128765 or any other provision of law, the department, upon request, shall disclose information collected pursuant to subdivision (g) of Section 128735 and Sections 128736 and 128737, to any California hospital and any local health department or local health officer in California as set forth in Part 3 (commencing with Section 101000) of Division 101. The department shall disclose this same information to the United States Department of Health and Human Services or any of its subsidiary agencies, including the National Center for Health Statistics or any other unit of the Centers for Disease Control and Prevention, the Agency for Healthcare Research and Quality, the Centers for Medicare and Medicaid Services, the Health Resources and Services Administration, the Indian Health Service, Tribal Epidemiology Centers, which are defined as public health authorities pursuant to the federal Indian Health Care Improvement Act (25 U.S.C. Sec. 1601 et seq.), the National Institutes of Health, or the National Cancer Institute, or the Veterans Health Care Administration within the United States Department of Veterans Affairs, for the purposes of conducting a statutorily authorized activity. All disclosures made pursuant to this section shall be consistent with the standards and limitations applicable to the disclosure of limited data sets as provided in Section 164.514 of Part 164 of Title 45 of the Code of Federal Regulations, relating to the privacy of health information.
(b) Any hospital that receives information pursuant to this section shall not disclose that information to any person or entity, except in response to a court order, search warrant, or subpoena, or as otherwise required or permitted by the federal medical privacy regulations contained in Parts 160 and 164 of Title 45 of the Code of Federal Regulations. In no case shall a hospital, contractor, or subcontractor reidentify or attempt to reidentify any information received pursuant to this section.
(c) No disclosure shall be made pursuant to this section if the director of the department has determined that the disclosure would create an unreasonable risk to patient privacy. The director shall provide a written explanation of the determination to the requester within 60 days.

SEC. 213.

 Section 128770 of the Health and Safety Code is amended to read:

128770.
 (a) Any health facility or freestanding ambulatory surgery clinic that does not file any report as required by this chapter with the department is liable for a civil penalty of one hundred dollars ($100) a day for each day the filing of any report is delayed. No penalty shall be imposed if an extension is granted in accordance with the guidelines and procedures established by the department.
(b) Any health facility that does not use an approved system of accounting pursuant to the provisions of this chapter for purposes of submitting financial and statistical reports as required by this chapter shall be liable for a civil penalty of not more than five thousand dollars ($5,000).
(c) Civil penalties are to be assessed and recovered in a civil action brought in the name of the people of the State of California by the department. Assessment of a civil penalty may, at the request of any health facility or freestanding ambulatory surgery clinic, be reviewed on appeal, and the penalty may be reduced or waived for good cause.
(d) Any money that is received by the department pursuant to this section shall be paid into the General Fund.

SEC. 214.

 Section 128775 of the Health and Safety Code is amended to read:

128775.
 (a) Any health facility or freestanding ambulatory surgery clinic affected by any determination made under this part by the department may petition the department for review of the decision. This petition shall be filed with the department within 15 business days, or within a greater time as the department may allow, and shall specifically describe the matters which are disputed by the petitioner.
(b) A hearing shall be commenced within 60 calendar days of the date on which the petition was filed. The hearing shall be held before an employee of the department, or an administrative law judge employed by the Office of Administrative Hearings. If held before an employee of the department, the hearing shall be held in accordance with any procedures as the office shall prescribe. If held before an administrative law judge employed by the Office of Administrative Hearings, the hearing shall be held in accordance with Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government Code. The employee or administrative law judge shall prepare a recommended decision including findings of fact and conclusions of law and present it to the department for its adoption. The decision of the department shall be in writing and shall be final. The decision of the department shall be made within 60 calendar days after the conclusion of the hearing and shall be effective upon filing and service upon the petitioner.
(c) Judicial review of any final action, determination, or decision may be had by any party to the proceedings as provided in Section 1094.5 of the Code of Civil Procedure. The decision of the department shall be upheld against a claim that its findings are not supported by the evidence unless the court determines that the findings are not supported by substantial evidence.
(d) The employee of the office, or the administrative law judge employed by the Office of Administrative Hearings or the Office of Administrative Hearings, may issue subpoenas and subpoenas duces tecum in a manner and subject to the conditions established by Article 11 (commencing with Section 11450.10) of Chapter 4.5 of Part 1 of Division 3 of Title 2 of the Government Code.
(e) This section shall become operative on July 1, 1997.

SEC. 215.

 Section 128782 of the Health and Safety Code is amended to read:

128782.
 Notwithstanding any other provision of law, upon the request of a small and rural hospital, as defined in Section 124840, the department shall do all of the following:
(a)  If the hospital did not file financial reports with the department by electronic media as of January 1, 1993, the department shall, on a case-by-case basis, do one of the following:
(1)  Exempt the small and rural hospital from any electronic filing requirements of the department regarding annual or quarterly financial disclosure reports specified in Sections 128735 and 128740.
(2)  Provide a one-time reduction in the fee charged to the small and rural hospital not to exceed the maximum amount assessed pursuant to Section 127280 by an amount equal to the costs incurred by the small and rural hospital to purchase the computer hardware and software necessary to comply with any electronic filing requirements of the department regarding annual or quarterly financial disclosure reports specified in Sections 128735 and 128740.
(b)  The department shall provide a one-time reduction in the fee charged to the small and rural hospital not to exceed the maximum amount assessed pursuant to Section 127280 by an amount equal to the costs incurred by the small and rural hospital to purchase the computer software and hardware necessary to comply with any electronic filing requirements of the department regarding reports specified in Sections 128735, 128736, and 128737.
(c)  The department shall provide the hospital with assistance in meeting the requirements specified in paragraphs (1) and (2) of subdivision (c) of Section 128755 that the reports required by subdivision (g) of Section 128735 be filed by electronic media or by online transmission. The assistance shall include the provision to the hospital by the department of a computer program or computer software to create an electronic file of patient discharge abstract data records. The program or software shall incorporate validity checks and edit standards.
(d)  The department shall provide the hospital with assistance in meeting the requirements specified in subdivision (d) of Section 128755 that the reports required by subdivision (a) of Section 128736 be filed by online transmission. The assistance shall include the provision to the hospital by the department of a computer program or computer software to create an electronic file of emergency care data records. The program or software shall incorporate validity checks and edit standards.
(e)  The department shall provide the hospital with assistance in meeting the requirements specified in subdivision (e) of Section 128755 that the reports required by subdivision (a) of Section 128737 be filed by online transmission. The assistance shall include the provision to the hospital by the department of a computer program or computer software to create an electronic file of ambulatory surgery data records. The program or software shall incorporate validity checks and edit standards.

SEC. 216.

 Section 128785 of the Health and Safety Code is amended to read:

128785.
 On January 1, 1986, all regulations previously adopted by the California Health Facilities Commission that relate to functions vested in the department and that are in effect on that date, shall remain in effect and shall be fully enforceable to the extent that they are consistent with this chapter, as determined by the department, unless and until readopted, amended, or repealed by the department.

SEC. 217.

 Section 128790 of the Health and Safety Code is amended to read:

128790.
 Pursuant to Section 16304.9 of the Government Code, the Controller shall transfer to the department the unexpended balance of funds as of January 1, 1986, in the California Health Facilities Commission Fund, available for use in connection with the performance of the functions of the California Health Facilities Commission to which it has succeeded pursuant to this chapter.

SEC. 218.

 Section 128795 of the Health and Safety Code is amended to read:

128795.
 All officers and employees of the California Health Facilities Commission who, on December 31, 1985, are serving the state civil service, other than as temporary employees, and engaged in the performance of a function vested in the department by this chapter shall be transferred to the department. The status, positions, and rights of persons shall not be affected by the transfer and shall be retained by them as officers and employees of the department, pursuant to the State Civil Service Act except as to positions exempted from civil service.

SEC. 219.

 Section 128800 of the Health and Safety Code is amended to read:

128800.
 The department shall have possession and control of all records, papers, offices, equipment, supplies, moneys, funds, appropriations, land, or other property, real or personal, held for the benefit or use of the California Health Facilities Commission for the performance of functions transferred to the department by this chapter.

SEC. 220.

 Section 128805 of the Health and Safety Code is amended to read:

128805.
 The department may enter into agreements and contracts with any person, department, agency, corporation, or legal entity as are necessary to carry out the functions vested in the department by this chapter or any other law.

SEC. 221.

 Section 128810 of the Health and Safety Code is amended to read:

128810.
 The department shall administer this chapter and shall make all regulations necessary to implement the provisions and achieve the purposes stated herein.

SEC. 222.

 The heading of Chapter 2 of Part 5 of Division 107 of the Health and Safety Code is repealed.

SEC. 223.

 The heading of Chapter 3 of Part 5 of Division 107 of the Health and Safety Code is repealed.

SEC. 224.

 Section 129010 of the Health and Safety Code is amended to read:

129010.
 Unless the context otherwise requires, the definitions in this section govern the construction of this chapter and of Section 32127.2.
(a) “Bondholder” means the legal owner of a bond or other evidence of indebtedness issued by a political subdivision or a nonprofit corporation.
(b) “Borrower” means a political subdivision or nonprofit corporation that has secured or intends to secure a loan for the construction of a health facility.
(c) “Construction, improvement, or expansion” or “construction, improvement, and expansion” includes construction of new buildings, expansion, modernization, renovation, remodeling and alteration of existing buildings, acquisition of existing buildings or health facilities, and initial or additional equipping of any of these buildings.
In connection therewith, “construction, improvement, or expansion” or “construction, improvement, and expansion” includes the cost of construction or acquisition of all structures, including parking facilities, real or personal property, rights, rights-of-way, the cost of demolishing or removing any buildings or structures on land so acquired, including the cost of acquiring any land where the buildings or structures may be moved, the cost of all machinery and equipment, financing charges, interest (prior to, during and for a period after completion of the construction), provisions for working capital, reserves for principal and interest and for extensions, enlargements, additions, replacements, renovations and improvements, cost of engineering, financial and legal services, plans, specifications, studies, surveys, estimates of cost and of revenues, administrative expenses, expenses necessary or incident to determining the feasibility or practicability of constructing or incident to the construction; or the financing of the construction or acquisition.
(d) “Committee” means the Advisory Loan Insurance Committee.
(e) “Debenture” means any form of written evidence of indebtedness issued by the State Treasurer pursuant to this chapter, as authorized by Section 4 of Article XVI of the California Constitution.
(f) “Fund” means the Health Facility Construction Loan Insurance Fund.
(g) “Health facility” means any facility providing or designed to provide services for the acute, convalescent, and chronically ill and impaired, including, but not limited to, public health centers, community mental health centers, facilities for the developmentally disabled, nonprofit community care facilities that provide care, habilitation, rehabilitation or treatment to developmentally disabled persons, facilities for the treatment of chemical dependency, including a community care facility, licensed pursuant to Chapter 3 (commencing with Section 1500) of Division 2, a clinic, as defined pursuant to Chapter 1 (commencing with Section 1200) of Division 2, an alcoholism recovery facility, defined pursuant to former Section 11834.11, and a structure located adjacent or attached to another type of health facility and that is used for storage of materials used in the treatment of chemical dependency, and general tuberculosis, mental, and other types of hospitals and related facilities, such as laboratories, outpatient departments, extended care, nurses’ home and training facilities, offices and central service facilities operated in connection with hospitals, diagnostic or treatment centers, extended care facilities, nursing homes, and rehabilitation facilities. “Health facility” also means an adult day health center and a multilevel facility. Except for facilities for the developmentally disabled, facilities for the treatment of chemical dependency, or a multilevel facility, or as otherwise provided in this subdivision, “health facility” does not include any institution furnishing primarily domiciliary care.
“Health facility” also means accredited nonprofit work activity programs as defined in subdivision (e) of Section 19352 and Section 19355 of the Welfare and Institutions Code, and nonprofit community care facilities as defined in Section 1502, excluding foster family homes, foster family agencies, adoption agencies, and residential care facilities for the elderly.
Unless the context dictates otherwise, “health facility” includes a political subdivision of the state or nonprofit corporation that operates a facility included within the definition set forth in this subdivision.
(h) “Department” means the Department of Health Care Access and Information.
(i) “Lender” means the provider of a loan and its successors and assigns.
(j) “Loan” means money or credit advanced for the costs of construction or expansion of the health facility, and includes both initial loans and loans secured upon refinancing and may include both interim, or short-term loans, and long-term loans. A duly authorized bond or bond issue, or an installment sale agreement, may constitute a “loan.”
(k) “Maturity date” means the date that the loan indebtedness would be extinguished if paid in accordance with periodic payments provided for by the terms of the loan.
(l) “Mortgage” means a first mortgage on real estate. “Mortgage” includes a first deed of trust.
(m) “Mortgagee” includes a lender whose loan is secured by a mortgage. “Mortgagee” includes a beneficiary of a deed of trust.
(n) “Mortgagor” includes a borrower, a loan to whom is secured by a mortgage, and the trustor of a deed of trust.
(o) “Nonprofit corporation” means any corporation formed under or subject to the Nonprofit Public Benefit Corporation Law (Part 2 (commencing with Section 5110) of Division 2 of Title 1 of the Corporations Code) that is organized for the purpose of owning and operating a health facility and that also meets the requirements of Section 501(c)(3) of the Internal Revenue Code.
(p) “Political subdivision” means any city, county, joint powers entity, local hospital district, or the California Health Facilities Authority.
(q) “Project property” means the real property where the health facility is, or is to be, constructed, improved, or expanded, and also means the health facility and the initial equipment in that health facility.
(r) “Public health facility” means any health facility that is or will be constructed for and operated and maintained by any city, county, or local hospital district.
(s) “Adult day health center” means a facility defined under subdivision (b) of Section 1570.7, that provides adult day health care, as defined under subdivision (a) of Section 1570.7.
(t) “Multilevel facility” means an institutional arrangement where a residential facility for the elderly is operated as a part of, or in conjunction with, an intermediate care facility, a skilled nursing facility, or a general acute care hospital. “Elderly,” for the purposes of this subdivision, means a person 60 years of age or older.
(u) “State plan” means the plan described in Section 129020.

SEC. 225.

 Section 129015 of the Health and Safety Code is amended to read:

129015.
 The department shall administer this chapter and shall make all regulations necessary to implement the provisions and achieve the purposes stated herein.

SEC. 226.

 Section 129020 of the Health and Safety Code is amended to read:

129020.
 The department shall implement the loan insurance program for the construction, improvement, and expansion of public and nonprofit corporation health facilities so that, in conjunction with all other existing facilities, the necessary physical facilities for furnishing adequate health facility services will be available to all the people of the state.
Every odd-numbered year the department shall develop a state plan for use under this chapter. The plan shall include an overview of the changes in the health care industry, an overview of the financial status of the fund and the loan insurance program implemented by the department, a statement of the guiding principles of the loan insurance program, an evaluation of the program’s success in meeting its mission as outlined in Section 129005, a discussion of administrative, procedural, or statutory changes that may be needed to improve management of program risks or to ensure the program effectively addresses the health needs of Californians, and the priority needs to be addressed by the loan insurance program.
The health facility construction loan insurance program shall provide for health facility distribution throughout the state in a manner that will make all types of health facility services reasonably accessible to all persons in the state according to the state plan.

SEC. 227.

 Section 129022 of the Health and Safety Code is amended to read:

129022.
 Applications submitted to the department shall be signed under penalty of perjury by the applicant.

SEC. 228.

 Section 129030 of the Health and Safety Code is amended to read:

129030.
 The proceeds of all loans insured pursuant to this chapter shall be disbursed only upon order of the department or its designated agent. The department shall make regulations to insure the security of these proceeds.

SEC. 229.

 Section 129035 of the Health and Safety Code is amended to read:

129035.
 From time to time the department or its designated agent shall inspect each project for which loan insurance was approved, as needed, and if the inspection so warrants, the department or agent shall certify that the work has been performed upon the project, or purchases have been made, in accordance with the approved plans and specifications, and that payment of an installment of the loan proceeds is due to the borrower. The department shall charge the borrower a fee for these inspections and certifications, that in no instance shall exceed four dollars ($4) for each one thousand dollars ($1,000) of the borrower’s loan that is insured. These fees shall be deposited in the fund.

SEC. 230.

 Section 129040 of the Health and Safety Code is amended to read:

129040.
 (a) The department shall establish a premium charge for the insurance of loans under this chapter, and this charge shall be deposited in the fund. A one-time nonrefundable premium charge shall be paid at the time the loan is insured. The premium rate may vary based upon the assessed level of relative financial risk determined pursuant to Section 129051, but shall in no event be greater than 3 percent. The amount of premium shall be computed on the basis of the application of the rate to the total amount of principal and interest payable over the term of the loan.
(b) The department may annually charge a portion of the premium in advance commencing at the time of issuing or extending the commitment until the date the loan is insured or the commitment expires. The amount of the advance premium shall not exceed six dollars ($6) per year for each one thousand dollars ($1,000) of principal of the proposed loan. The total dollar amount of the premium advanced shall be nonrefundable and shall be credited against the amount of the premium charged pursuant to this section, or if the commitment expires and the loan is not insured, the advance shall be retained by the department to offset costs and expenses of the department related to preliminary work, underwriting the loan commitment, and monitoring construction.

SEC. 231.

 Section 129045 of the Health and Safety Code is amended to read:

129045.
 The department shall annually report to the Legislature the financial status of the program and its insured portfolio, including the status of all borrowers in each stage of default and the department’s efforts to collect from borrowers that have defaulted on their debt service payments.

SEC. 232.

 Section 129049 of the Health and Safety Code is amended to read:

129049.
 (a)  The department may, at the request of a hospital, commission an independent study of market need and feasibility, as required by the United States Department of Housing and Urban Development, as part of an application for mortgage insurance for hospitals pursuant to Section 1715z-7 of Title 12 of the United States Code, or any other federal mortgage insurance program for health-related facilities.
(b)  The cost of the feasibility study permitted pursuant to subdivision (a) shall be paid for by the department from reimbursements received from the applicant.
(c)  Notwithstanding any other provision of law, the department may directly retain independent feasibility consultants and require a deposit from the applicant for the entire cost of the services at the time they are requested.
(d)  The department shall charge applicants a fee for the reasonable costs of administering this article.
(e)  The program provided for in this article shall be administered in conformance with the requirements of the United States Department of Housing and Urban Development for feasibility studies authorized by this section and the applicable requirements of state law pertaining to contracts.

SEC. 233.

 Section 129050 of the Health and Safety Code is amended to read:

129050.
 A loan shall be eligible for insurance under this chapter if all of the following conditions are met:
(a) The loan shall be secured by a first mortgage, first deed of trust, or other first priority lien on a fee interest of the borrower or by a leasehold interest of the borrower having a term of at least 20 years, including options to renew for that duration, longer than the term of the insured loan. The security for the loan shall be subject only to those conditions, covenants and restrictions, easements, taxes, and assessments of record approved by the office, and other liens securing debt insured under this chapter. The department may require additional agreements in security of the loan.
(b) The borrower obtains an American Land Title Association title insurance policy with the department designated as beneficiary, with liability equal to the amount of the loan insured under this chapter, and with additional endorsements that the department may reasonably require.
(c) The proceeds of the loan shall be used exclusively for the construction, improvement, or expansion of the health facility, as approved by the department under Section 129020. However, loans insured pursuant to this chapter may include loans to refinance another prior loan, whether or not state insured and without regard to the date of the prior loan, if the department determines that the amount refinanced does not exceed 90 percent of the original total construction costs and is otherwise eligible for insurance under this chapter. The department may not insure a loan for a health facility that the office determines is not needed pursuant to subdivision (k).
(d) The loan shall have a maturity date not exceeding 30 years from the date of the beginning of amortization of the loan, except as authorized by subdivision (e), or 75 percent of the department’s estimate of the economic life of the health facility, whichever is the lesser.
(e) The loan shall contain complete amortization provisions requiring periodic payments by the borrower not in excess of its reasonable ability to pay as determined by the department. The department shall permit a reasonable period of time during which the first payment to amortization may be waived on agreement by the lender and borrower. The department may, however, waive the amortization requirements of this subdivision and of subdivision (g) of this section when a term loan would be in the borrower’s best interest.
(f) The loan shall bear interest on the amount of the principal obligation outstanding at any time at a rate, as negotiated by the borrower and lender, as the department finds necessary to meet the loan money market. As used in this chapter, “interest” does not include premium charges for insurance and service charges if any. Where a loan is evidenced by a bond issue of a political subdivision, the interest thereon may be at any rate the bonds may legally bear.
(g) The loan shall provide for the application of the borrower’s periodic payments to amortization of the principal of the loan.
(h) The loan shall contain those terms and provisions with respect to insurance, repairs, alterations, payment of taxes and assessments, foreclosure proceedings, anticipation of maturity, additional and secondary liens, and other matters the department may in its discretion prescribe.
(i) The loan shall have a principal obligation not in excess of an amount equal to 90 percent of the total construction cost.
(j) The borrower shall offer reasonable assurance that the services of the health facility will be made available to all persons residing or employed in the area served by the facility.
(k) The department has determined that the facility is needed by the community to provide the specified services. In making this determination, the department shall do all of the following:
(1) Require the applicant to describe the community needs the facility will meet and provide data and information to substantiate the stated needs.
(2) Require the applicant, if appropriate, to demonstrate participation in the community needs assessment required by Section 127350.
(3) Survey appropriate local officials and organizations to measure perceived needs and verify the applicant’s needs assessment.
(4) Use any additional available data relating to existing facilities in the community and their capacity.
(5) Contact other state and federal departments that provide funding for the programs proposed by the applicant to obtain those departments’ perspectives regarding the need for the facility. Additionally, the department shall evaluate the potential effect of proposed health care reimbursement changes on the facility’s financial feasibility.
(6) Consider the facility’s consistency with the Cal-Mortgage state plan.
(l) In the case of acquisitions, a project loan shall be guaranteed only for transactions not in excess of the fair market value of the acquisition.
Fair market value shall be determined, for purposes of this subdivision, pursuant to the following procedure, that shall be utilized during the department’s review of a loan guarantee application:
(1) Completion of a property appraisal by an appraisal firm qualified to make appraisals, as determined by the department, before closing a loan on the project.
(2) Evaluation of the appraisal in conjunction with the book value of the acquisition by the department. When acquisitions involve additional construction, the department shall evaluate the proposed construction to determine that the costs are reasonable for the type of construction proposed. In those cases where this procedure reveals that the cost of acquisition exceeds the current value of a facility, including improvements, then the acquisition cost shall be deemed in excess of fair market value.
(m) Notwithstanding subdivision (i), any loan in the amount of ten million dollars ($10,000,000) or less may be insured up to 95 percent of the total construction cost.
In determining financial feasibility of projects of counties pursuant to this section, the department shall take into consideration any assistance for the project to be provided under Section 14085.5 of the Welfare and Institutions Code or from other sources. It is the intent of the Legislature that the department endeavor to assist counties in whatever ways are possible to arrange loans that will meet the requirements for insurance prescribed by this section.
(n) The project’s level of financial risk meets the criteria in Section 129051.

SEC. 234.

 Section 129051 of the Health and Safety Code is amended to read:

129051.
 (a)  The department shall develop and implement a system for assessing the relative financial risk of the applicant. The system shall include, but is not limited to, an assessment of the applicant’s financial strength, credit history, security for the loan, cash-flow, and ability to repay the debt.
(b)  The department shall establish a maximum acceptable level of financial risk for the projects it insures. The department may only approve a project if its risk level is below the established maximum, except as provided in subdivision (c).
(c)  The department may approve a project with a level of insurance risk that exceeds the established maximum if the department determines that the project meets a significant community need or will be a sole community provider.

SEC. 235.

 Section 129052 of the Health and Safety Code is amended to read:

129052.
 A pledge by or to the department of, or the grant to the department of a security interest in, revenues, moneys, accounts, accounts receivable, contract rights, general intangibles, documents, instruments, chattel paper, and other rights to payment of whatever kind made by or to the department pursuant to the authority granted in this chapter shall be valid and binding from the time the pledge is made for the benefit of pledgees and successors thereto. The revenues, moneys, accounts, accounts receivable, contract rights, general intangibles, documents, instruments, chattel paper, and other rights to payment of whatever kind pledged by or to the department or its assignees shall immediately be subject to the lien of the pledge without physical delivery or further act. The lien of such pledge shall be valid and binding against all parties, irrespective of whether the parties have notice of the lien. The indenture, trust agreement, resolution, or another instrument by which such pledge is created need not be recorded or the security interest otherwise perfected.

SEC. 236.

 Section 129055 of the Health and Safety Code is amended to read:

129055.
 In order to comply with subdivision (j) of Section 129050, any borrower that is certified for reimbursement for cost of care under Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of the Welfare and Institutions Code shall demonstrate that its facility is used by persons for whom the cost of care is reimbursed under that chapter, in a proportion that is reasonable based upon the proportion of Medi-Cal patients in the community served by the borrower and by persons for whom the costs of care is reimbursed under Title XVIII of the federal Social Security Act in a proportion that is reasonable based upon the proportion of Medicare patients in the community served by the borrower.
For the purposes of this chapter, the community means the service areas or patient populations for which the health facility provides health care services, unless the department determines that, or the borrower demonstrates to the satisfaction of the office that, a different definition is more appropriate for the borrower’s facility.

SEC. 237.

 Section 129065 of the Health and Safety Code is amended to read:

129065.
 As part of its assurance under subdivision (j) of Section 129050, any borrower that is a general acute care hospital or acute psychiatric hospital shall agree to the following actions:
(a)  To advise each person seeking services at the borrower’s facility as to the person’s potential eligibility for Medi-Cal and Medicare benefits or benefits from other governmental third party payers.
(b)  To make available to the department and to any interested person a list of physicians with staff privileges at the borrower’s facility, that includes:
(1)  Name.
(2)  Speciality.
(3)  Language spoken.
(4)  Whether takes Medi-Cal and Medicare patients.
(5)  Business address and phone number.
(c)  To inform in writing on a periodic basis all practitioners of the healing arts having staff privileges in the borrower’s facility as to the existence of the facility’s community service obligation. The required notice to practitioners shall contain a statement, as follows:
“This hospital has agreed to provide a community service and to accept Medi-Cal and Medicare patients. The administration and enforcement of this agreement is the responsibility of the Department of Health Care Access and Information and this facility.”
(d)  To post notices in the following form, that shall be multilingual where the borrower serves a multilingual community, in appropriate areas within the facility, including but not limited to, admissions offices, emergency rooms, and business offices:

NOTICE OF COMMUNITY SERVICE OBLIGATION

“This facility has agreed to make its services available to all persons residing or employed in this area. This facility is prohibited by law from discriminating against Medi-Cal and Medicare patients. Should you believe you may be eligible for Medi-Cal or Medicare, you should contact our business office (or designated person or office) for assistance in applying. You should also contact our business office (or designated person or office) if you are in need of a physician to provide you with services at this facility. If you believe that you have been refused services at this facility in violation of the community service obligation you should inform (designated person or office) and the Department of Health Care Access and Information.”

The borrower shall provide copies of this notice for posting to all welfare offices in the county where the borrower’s facility is located.

SEC. 238.

 Section 129070 of the Health and Safety Code is amended to read:

129070.
 In the event the borrower cannot demonstrate that it meets the requirement of Section 129055, it may nonetheless be eligible for a loan under this chapter if it presents a plan that is satisfactory to the department that details the reasonable steps and timetables that the borrower agrees to take to bring the facility into compliance with Section 129055.

SEC. 239.

 Section 129075 of the Health and Safety Code is amended to read:

129075.
 (a)  Each borrower shall provide any reports as may be required of it by Part 5 (commencing with Section 128675), from which the department shall determine the borrower’s compliance with subdivision (j) of Section 129050.
(b)  If a report indicates noncompliance with subdivision (j) of Section 129050, Section 129055, or Section 129065, the department shall require the borrower to submit a plan detailing the steps and timetables the borrower will take to bring the facility into compliance.
(c)  The department shall annually report to the Legislature the extent of the borrowers’ compliance with their community service obligations pursuant to subdivision (j) of Section 129050, Section 129055, and Section 129065.

SEC. 240.

 Section 129080 of the Health and Safety Code is amended to read:

129080.
 The department may impose additional appropriate remedies and sanctions against a borrower when any of the following occurs:
(a)  The department determines that the annual compliance report required in Section 129075 indicates that the borrower is out of compliance with subdivision (j) of Section 129050.
(b)  A facility fails to carry out the actions agreed to in a plan approved by the department pursuant to Section 129070.
(c)  The facility fails to submit compliance reports as required by Section 129075. The additional remedies include referring the violation to the office of Attorney General of California for legal action authorized under existing law or other remedy at law or equity.
However, the remedies obtainable by legal action shall not include withdrawal or cancellation of the loan insurance provided under this chapter.

SEC. 241.

 Section 129085 of the Health and Safety Code is amended to read:

129085.
 (a)  If a borrower is unable to comply with subdivision (j) of Section 129050 due to selective provider contracting under the Medi-Cal program, and the department has determined the borrower has negotiated in good faith but was not awarded a contract, the borrower may be eligible for insurance under this chapter as provided in subdivision (b).
(b)  The department may determine that a noncontracting borrower shall be considered as meeting the requirements of subdivision (j) of Section 129050 if the borrower otherwise provides a community service in accordance with regulations adopted by the department. The regulations shall describe alternative methods of meeting the obligation, that may include, but not be limited to, providing free care, charity care, trauma care, community education, or primary care outreach and care to the elderly, in amounts greater than the community average. The regulations shall include a requirement that a general acute care hospital, that is not a small and rural hospital as defined in Section 124840, shall have, and continue to maintain, a 24-hour basic emergency medical service with a physician on duty, if it provided this service on January 1, 1990. The department shall have the authority to waive this requirement upon a determination by the director that this requirement would create a hardship for the hospital, be inconsistent with regionalization of emergency medical services, or not be in the best interest of the population served by the hospital.

SEC. 242.

 Section 129087 of the Health and Safety Code is amended to read:

129087.
 The department shall develop and maintain a formal system of monitoring borrowers, in order to assist the department in detecting at the earliest possible date those borrowers who are experiencing financial difficulties. This system shall include, but shall not be limited to, all of the following:
(a)  A method of tracking the receipt of information that borrowers are required by law and regulatory agreement to submit to the department.
(b)  A process for thoroughly reviewing borrowers’ financial statements, budgets, auditor’s management letters, and health facility utilization trends.
(c)  Timely and structured site visits to insured facilities.

SEC. 243.

 Section 129090 of the Health and Safety Code is amended to read:

129090.
 Pursuant to this chapter, political subdivisions and nonprofit corporations may apply for state insurance of needed construction, improvement, or expansion loans for construction, remodeling, or acquisition of health facilities to be or already owned, established, and operated by them as provided in this chapter. Applications shall be submitted to the department by the nonprofit corporation or political subdivision authorized to construct and operate a health facility. Each application shall conform to the requirements of the department, shall be submitted in the manner and form prescribed by the department, and shall be accompanied by an application fee of one-half of 1 percent of the amount of the loan applied for, but in no case shall the application fee exceed five hundred dollars ($500). The fees shall be deposited by the department in the fund and used to defray the office’s expenditures in the administration of this chapter.

SEC. 244.

 Section 129092 of the Health and Safety Code is amended to read:

129092.
 Notwithstanding any other provision of law, upon the application of a borrower for insurance, the department shall perform a feasibility study relating to the proposed project, the cost of which shall be paid by the applicant. The department may retain independent consultants and require a deposit from the applicant for such services, upon submission of the application. This section shall take effect on January 1, 2001.

SEC. 245.

 Section 129095 of the Health and Safety Code is amended to read:

129095.
 (a)  The department shall not regulate, impose requirements on, or require approval by the department of a professional, or a fee charged by a professional, used by applicants for the initial application for loan insurance. The choice of any professional and the funding source used shall be left entirely to the participants.
(b)  For purposes of this section, “professional” includes, but is not limited to, an underwriter, bond counsel, or consultant.
(c)  Nothing in this section shall prohibit the department, in the event of defaults, from taking any action authorized under this chapter to protect the financial interest of the state.

SEC. 246.

 Section 129100 of the Health and Safety Code is amended to read:

129100.
 Every applicant for insurance shall be afforded an opportunity for a fair hearing before the committee upon 10 days’ written notice to the applicant. If the department, after affording reasonable opportunity for development and presentation of the application and after receiving the advice of the committee, finds that an application complies with the requirements of this article and of Section 129020 and is otherwise in conformity with the state plan, it may approve the application for insurance. The department shall consider and approve applications in the order of relative need set forth in the state plan in accordance with Section 129020. Judicial review of a final decision made under this section may be had by filing a petition for writ of mandate. Any petition shall be filed within 30 days after the date of the final decision of the department.

SEC. 247.

 Section 129105 of the Health and Safety Code is amended to read:

129105.
 The department may upon application of the borrower insure any loan that is eligible for insurance under this chapter, and upon the terms prescribed by the department, may make commitments for the insuring of the loans prior to their date of execution or disbursement thereon. The decision to grant loan insurance upon an application of the borrower is within the discretion of the director of the department. Showing need for the project or meeting the eligibility requirements for loan insurance and establishing financial feasibility of the project or recommendation for approval from the committee does not create any entitlement to loan insurance.

SEC. 248.

 Section 129110 of the Health and Safety Code is amended to read:

129110.
 Any contract of insurance executed by the department under this chapter shall be conclusive evidence of the eligibility of the loan for insurance and the validity of any contract of insurance so executed shall be incontestable from the date of the execution of the contract, except in case of fraud or misrepresentation on the part of the lender.

SEC. 249.

 Section 129125 of the Health and Safety Code is amended to read:

129125.
 In any case when the lender under a loan to a nonprofit corporation insured under this chapter shall have foreclosed and taken possession of the property under a mortgage in accordance with regulations of, and within a period to be determined by the department, or shall, with the consent of the department, have otherwise acquired the property from the borrower after default, the lender shall be entitled to receive the benefit of the insurance as provided in this section, upon (a) the prompt conveyance to the office of title to the property that meets the requirements of the regulations of the department in force at the time the loan was insured, and that is evidenced in the manner prescribed by the regulations, and (b) the assignment to the department of all claims of the lender against the borrower or others arising out of the loan transaction or foreclosure proceedings except claims that may have been released with the consent of the department. Upon the conveyance and assignment, the department shall notify the Treasurer, who shall issue to the lender debentures having a total face value equal to the outstanding value of the loan.
For the purposes of this section, the outstanding value of the loan shall be determined, in accordance with the regulations prescribed by the department, by (a) adding to the amounts of the original principal obligation of the loan and interest that are accrued and unpaid the amount of all payments that have been made by the lender for the following: taxes and assessments, ground rents, water rates, and other liens that are prior to the mortgage; charges for the administration, operation, maintenance and repair of the health facility property; insurance on the project property, loan insurance premiums, and any tax imposed by a city or county upon any deed or other instrument by which the property was acquired by the lender and transferred or conveyed to the office; and the costs of foreclosure or of acquiring the property by other means actually paid by the lender and approved by the department; and by (b) deducting from the total amount any amounts received by the lender after the borrower’s default on account of the loans or as rent or other income from the property.

SEC. 250.

 Section 129130 of the Health and Safety Code is amended to read:

129130.
 In any case when a political subdivision defaults on the payment of interest or principal accrued and due on bonds or other evidences of indebtedness insured under this chapter, debentures in an amount equal to the outstanding original principal obligation and interest on the bonds that were accrued and unpaid on the date of default and bearing interest at a rate equal to and payment schedule identical with those of the bonds shall be issued by the Treasurer upon notification thereof by the department to the bondholders upon the surrender of the bonds to the department.
In any case in which a hospital district defaults on the payment of interest or principal accrued and due on an insured loan secured by a first mortgage, first deed of trust, or other security agreement as authorized by Section 32127.2, debentures in an amount equal to the outstanding original principal obligation and interest on the bonds that were accrued and unpaid on the date of default and bearing interest at a rate equal to and payment schedule identical with those of the bonds shall be issued by the Treasurer upon notification thereof by the department to the bondholders upon surrender of the bonds to the department after the state has enforced its rights under the first mortgage, first deed of trust, or other security agreement.

SEC. 251.

 Section 129135 of the Health and Safety Code is amended to read:

129135.
 Notwithstanding any requirement contained in this chapter relating to acquisition of title and possession of the project property by the lender and its subsequent conveyance and transfer to the department, and for the purpose of avoiding unnecessary conveyance expense in connection with payment of insurance benefits under the provisions of this chapter, the department may, subject to regulations that it may prescribe, permit the lender to tender to the department a satisfactory conveyance of title and transfer of possession direct from the borrower or other appropriate grantor and to pay to the lender the insurance benefits to which it would otherwise be entitled if the conveyance had been made to the lender and from the lender to the department.

SEC. 252.

 Section 129140 of the Health and Safety Code is amended to read:

129140.
 Upon receiving notice of the default of any loan insured under this chapter, the department, in its discretion and for the purpose of avoiding foreclosure under Section 129125 and notwithstanding the fact that it has previously approved a request of the lender for extensions of the time for curing the default and of the time for commencing foreclosure proceedings or for otherwise acquiring title to the project property, or has approved a modification of the loan for the purpose of changing the amortization provisions by recasting the unpaid balance, may acquire the loan and security agreements securing the loans upon the issuance to the lender of debentures in an amount equal to the unpaid principal balance of the loan plus any accrued unpaid loan interest plus reimbursement for the costs and attorney’s fees of the lender enumerated in Section 129125.
After the acquisition of the loan and security interests therefor by the department, the lender shall have no further rights, liabilities, or obligations with respect thereto. The provisions of Section 129125 relating to the issuance of debentures incident to the acquisition of foreclosed properties shall apply with respect to debentures issued under this section, and the provisions of this chapter relating to the rights, liabilities, and obligations of a lender shall apply with respect to the department when it has acquired an insured loan under this section, in accordance with and subject to any regulations prescribed by the department modifying the provisions to the extent necessary to render their application for these purposes appropriate and effective.

SEC. 253.

 Section 129145 of the Health and Safety Code is amended to read:

129145.
 Notwithstanding any other provision of this chapter, after the department determines that the lender and borrower have exhausted all reasonable means of curing any default, the department within its discretion may, when it is in the best interests of the state, the borrower, and the lender, cure the default of the borrower by making payment from the fund directly to the lender of any amounts of the original principal obligation and interest of the loan that are accrued and unpaid. The payment shall be secured by an assignment to the department of a pro rata share of the security agreements made to the lender and, upon the payment, the borrower shall become liable for repayment of the amount thereof to the office over a period and at a rate of interest as shall be determined by the department.

SEC. 254.

 Section 129150 of the Health and Safety Code is amended to read:

129150.
 The department may at any time, under the terms and conditions that it may prescribe, consent to the lender’s release of the borrower from its liability under the loan or the security agreement securing the loan, or consent to the release of parts of the project property from the lien of any security agreement.

SEC. 255.

 Section 129152 of the Health and Safety Code is amended to read:

129152.
 If a borrower fails to submit a required report, or upon any other default of any regulatory or contractual term or covenant, whether or not a default has been declared, the department first shall informally communicate with the borrower. If the borrower fails to submit the required report or otherwise cure the default, the department shall issue a formal demand in writing stating the nature of the default and requiring the borrower to submit a detailed plan of correction that is acceptable to the office. If the borrower fails to either submit a plan, or timely cure the default, the department shall perform an onsite visit. If the department determines the borrower is not making sufficient progress in submitting any required reports or otherwise curing any default, the department may require the borrower, at the borrower’s expense, to employ an independent consultant or professional, acceptable to the department, to conduct a program audit. If the borrower fails to adopt the recommendations of the independent consultant or professional made in the program audit, or if the borrower fails to otherwise timely cure the default, the department shall have all the remedies set forth in the Section 129173.

SEC. 256.

 Section 129155 of the Health and Safety Code is amended to read:

129155.
 Debentures issued under this chapter shall be in the form and denomination, subject to the terms and conditions, and include provisions for redemption, if any, as may be prescribed by the department with the approval of the Treasurer, and may be in coupon or registered form.

SEC. 257.

 Section 129160 of the Health and Safety Code is amended to read:

129160.
 (a)  (1) All debentures issued under this chapter to any lender or bondholder shall be executed in the name of the fund as obligor, shall be signed by the Treasurer, and shall be negotiable. Pursuant to Sections 129125 and 129130, all debentures shall be dated as of the date of the institution of foreclosure proceedings or as of the date of the acquisition of the property after default by other than foreclosure, or as of another date as the department, in its discretion, may establish.
(2) The debentures shall bear interest from that date at a rate equal to the insured loan or bonds, and shall be payable on a payment schedule identical with payments on the insured loan or bonds. The Treasurer shall take appropriate steps to the extent feasible to provide that interest on the debentures is exempt from federal income taxation under Section 103 of the Internal Revenue Code to the extent interest on the insured loan or bonds is exempt from federal income taxation under Section 103 of the Internal Revenue Code on the date the insured loan or bonds is exchanged for debentures. All debentures shall be exempt, both as to principal and interest, from all taxation now or hereafter imposed by the state or local taxing agencies, shall be paid out of the fund, which shall be primarily liable therefor, and shall be, pursuant to Section 4 of Article XVI of the California Constitution, fully and unconditionally guaranteed as to principal and interest by the State of California, which guaranty shall be expressed on the face of the debentures.
(3) If the fund fails to pay upon demand, when due, the principal of, or interest on, any debentures issued under this chapter, the Treasurer shall pay to the holders the amount thereof, which amount, notwithstanding Section 13340 of the Government Code, is hereby continuously appropriated from the General Fund, without regard to fiscal years, and thereupon to the extent of the amount so paid the Treasurer shall succeed to all the rights of the holders of the debentures. The fund shall be liable for repayment to the General Fund of any money paid from the General Fund pursuant to this section in accordance with procedures jointly established by the Treasurer and the department.
(b)  Any debenture issued under this article shall be paid on a par with general obligation bonds issued by the state.

SEC. 258.

 Section 129165 of the Health and Safety Code is amended to read:

129165.
 Notwithstanding any other provision of law relating to the acquisition, management or disposal of real property by the state, the department shall have power to deal with, operate, complete, lease, rent, renovate, modernize, insure, or sell for cash or credit, in its discretion, any properties conveyed to it in exchange for debentures as provided in this chapter; and notwithstanding any other provision of law, the department shall also have power to pursue to final collection by way of compromise or otherwise all claims against borrowers assigned by lenders to the department as provided in this chapter. All income from the operation, rental, or lease of the property and all proceeds from the sale thereof shall be deposited in the fund and all costs incurred by the office in its exercise of powers granted in this section shall be met by the fund.
The power to convey and to execute in the name of the department deeds of conveyance, deeds of release, assignments and satisfactions of loans and mortgages, and any other written instrument relating to real or personal property or any interest therein acquired by the department pursuant to the provisions of this chapter may be exercised by the department or by any officer of the department appointed by it.

SEC. 259.

 Section 129170 of the Health and Safety Code is amended to read:

129170.
 No lender or borrower shall have any right or interest in any property conveyed to the department or in any claim assigned to it, nor shall the department owe any duty to any lender or borrower with respect to the management or disposal of this property.

SEC. 260.

 Section 129172 of the Health and Safety Code is amended to read:

129172.
 Notwithstanding any other provision of law, if, prior to foreclosing on any collateral provided by a borrower, the department institutes a judicial proceeding or takes any action against a borrower to enforce compliance with the obligations set out in the regulatory agreement, the contract of insurance, or any other contractual loan closing document or law, including, but not limited to, Section 129173, that remedy or action shall not constitute an action within the meaning of subdivision (a) of Section 726 of the Code of Civil Procedure, or in any way constitute a violation of the intent or purposes of Section 726 of the Code of Civil Procedure, or constitute a money judgment or a deficiency judgment within the meaning of Sections 580a, 580b, 580d, or subdivision (b) of Section 726 of the Code of Civil Procedure. However, these provisions of the Code of Civil Procedure shall apply to any judicial proceeding instituted, or nonjudicial foreclosure action taken by the department to collect the principal and interest due on the loan with the borrower.

SEC. 261.

 Section 129173 of the Health and Safety Code is amended to read:

129173.
 (a)  In fulfilling the purposes of this article, as set forth in Section 129005, and upon making a determination that the financial status of a borrower may jeopardize a borrower’s ability to fulfill its obligations under any insured loan transaction so as to threaten the economic interest of the department in the borrower or to jeopardize the borrower’s ability to continue to provide needed health care services in its community, including, but not limited to, a declaration of default under any contract related to the transaction, the borrower missing any payment to its lender, or the borrower’s accounts payable exceeding three months, the department may assume or direct managerial or financial control of the borrower in any or all of the following ways:
(1)  The department may supervise and prescribe the activities of the borrower in the manner and under the terms and conditions as the office may stipulate in any contract with the borrower.
(2)  Notwithstanding the provisions of the articles of incorporation or other documents of organization of a nonprofit corporation borrower, this control may be exercised through the removal and appointment by the department of members of the governing body of the borrower sufficient so that the new members constitute a voting majority of the governing body.
(3)  In the event the borrower is a nonprofit corporation or a political subdivision, the department may request the Secretary of the California Health and Human Services Agency to appoint a trustee. The trustee shall have full and complete authority of the borrower over the insured project, including all property on which the department holds a security interest. No trustee shall be appointed unless approved by the department. A trustee appointed by the secretary pursuant to this subdivision may exercise all the powers of the officers and directors of the borrower, including the filing of a petition for bankruptcy. No action at law or in equity may be maintained by any party against the office or a trustee by reason of their exercising the powers of the officers and directors of a borrower pursuant to the direction of, or with the approval of, the secretary.
(4)  The department may institute any action or proceeding, or the department may request the Attorney General to institute any action or proceeding against any borrower, to obtain injunctive or other equitable relief, including the appointment of a receiver for the borrower or the borrower’s assets, in the superior court in and for the county in which the assets or a substantial portion of the assets are located. The proceeding under this section for injunctive relief shall conform with the requirements of Chapter 3 (commencing with Section 525) of Title 7 of Part 2 of the Code of Civil Procedure, except that the department shall not be required to allege facts necessary to show lack of adequate remedy at law, or to show irreparable loss or damage. Injunctive relief may compel the borrower, its officers, agents, or employees to perform each and every provision contained in any regulatory agreement, contract of insurance, or any other loan closing document to which the borrower is a party, or any obligation imposed on the borrower by law, and require the carrying out of any and all covenants and agreements and the fulfillment of all duties imposed on the borrower by law or those documents.
A receiver may be appointed pursuant to Chapter 5 (commencing with Section 564) of Title 7 of Part 2 of the Code of Civil Procedure. In cooperation with the Attorney General, the department shall develop and maintain a list of receivers who have demonstrated experience both in the health care field and as a receiver. Upon a proper showing, the court shall grant the relief provided by law and requested by the department or the Attorney General. No receiver shall be appointed unless approved by the department. The department shall establish reporting requirements for receivers to ensure that the department is fully apprised of all costs incurred and progress made by the receiver. A receiver appointed by the superior court pursuant to this subdivision and Section 564 of the Code of Civil Procedure may, with the approval of the court, exercise all of the powers of the officers and directors of the borrower, including the filing of a petition for bankruptcy. No action at law or in equity may be maintained by any party against the department, the Attorney General, or a receiver by reason of their exercising the powers of the officers and directors of a borrower pursuant to the order of, or with the approval of, the superior court.
(5)  The borrower shall inform the department in advance of all meetings of its governing body. The borrower shall not exclude the department from attending any meeting of the borrower’s governing body.
(b)  Other than the loan insured under this chapter, the department shall not be liable for any debt of a borrower, or to a borrower, as a result of the department asserting its legal remedies against a borrower insured under this chapter.
(c)  It is the intent of the Legislature that this section is remedial in nature, and is applicable retroactively to any health facility construction loans in existence at the time of its enactment, to the extent that the application of this section does not unlawfully impair existing contract rights.

SEC. 262.

 Section 129174 of the Health and Safety Code is amended to read:

129174.
 (a)  In the event a borrower has defaulted in making its payments on the loan insured by the department to the lender or the borrower’s bond trustee, at any time thereafter, the office may do any of the following:
(1)  Decease a portion or all of the bonds or may purchase a portion or all of the bonds at a private or public sale or on the open market. For this purpose, the department may use any funds available, including, but not limited to, funds in the Health Facility Construction Loan Insurance Fund, funds that the department may receive either from settlement or recoveries from lawsuits, funds from the sale of assets of the borrower, or funds held by the borrower’s bond trustee. If requested by the department, the Treasurer shall purchase the bonds on behalf of the office. Upon the purchase of any bonds under this section, the department shall direct the borrower’s bond trustee to cancel the bonds purchased.
(2)  Issue bonds used for the sole purpose of refunding any part or all of the defaulted bonds, provided that, in the opinion of the department, there are adequate present value savings to refund all or part of the defaulted bonds. If requested by the department, the Treasurer shall act as the issuer for this purpose.
(3)  Require the lender or borrower’s bond trustee to accelerate the borrower’s debt and the maturity dates of the bonds, if any. If the bond trustee accelerates the bond debt and maturity dates, the department shall pay from the fund to the lender or borrower’s bond trustee the full amount of the remaining principal of the loan, any interest accrued and unpaid on this amount, and any costs enumerated in Section 129125.
(b)  For the purposes of this section, “bonds” mean bonds, certificate of participation, notes, or other evidence of indebtedness of a loan insured by the department.

SEC. 263.

 Section 129174.1 of the Health and Safety Code is amended to read:

129174.1.
 In the event an obligor on a loan insured by the department is the subject of an order for relief in bankruptcy and that a plan has been proposed for confirmation, upon a certification by the department that the insurance is in place and would be in place if the plan were confirmed, then the department shall have the right to vote whether to accept or reject the plan on behalf of the holders of the loan insured by the department.

SEC. 264.

 Section 129175 of the Health and Safety Code is amended to read:

129175.
 Should a borrower be more than 10 days delinquent in paying the premium charges or inspection fees for insurance under this chapter, the department shall notify the borrower in writing. If that payment remains delinquent more than 30 days after the sending of the department’s notice to the borrower, the department shall make every reasonable effort to notify the lender in writing. If that delinquency continues, on the 31st day after sending of the department’s notice to the lender, the insurance shall be terminated and become null and void.

SEC. 265.

 Section 129180 of the Health and Safety Code is amended to read:

129180.
 The obligation to pay any subsequent premium charge for insurance shall cease, and all rights of the lender and the borrower under this chapter shall terminate as of the date of the notice, as herein provided, in the event that (a) any lender under a loan forecloses on the mortgaged property, or has otherwise acquired the project property from the borrower after default, but does not convey the property to the department in accordance with this chapter, and the department is given written notice thereof, or (b) the borrower pays the obligation under the loan in full prior to the maturity thereof, and the department is given written notice thereof.

SEC. 266.

 Section 129185 of the Health and Safety Code is amended to read:

129185.
 The department is authorized to terminate any insurance contract upon joint request by the borrower and the lender and upon payment of a termination charge that the department determines to be equitable, taking into consideration the necessity of protecting the fund. Upon the termination, borrowers and lenders shall be entitled to the rights, if any, that they would be entitled to under this chapter if the insurance contract were terminated by payment in full of the insured loan.

SEC. 267.

 Section 129200 of the Health and Safety Code is amended to read:

129200.
 There is hereby established a Health Facility Construction Loan Insurance Fund, that shall be used by the department as a revolving fund for carrying out the provisions and administrative costs of this chapter. Notwithstanding Section 13340 of the Government Code, the money in the fund is hereby continuously appropriated to the department without regard to fiscal years for the purposes of this chapter.

SEC. 268.

 Section 129205 of the Health and Safety Code is amended to read:

129205.
 Moneys in the fund not needed for the current operations of the department under this chapter shall be invested pursuant to law. The department may, with the approval of the State Treasurer, purchase the debentures issued under this chapter. Debentures so purchased shall be canceled and not reissued.

SEC. 269.

 Section 129210 of the Health and Safety Code is amended to read:

129210.
 (a)  The department’s authorization to insure health facility construction, improvement, and expansion loans under this chapter shall be limited to a total of not more than three billion dollars ($3,000,000,000).
(b)  Notwithstanding the limitation in subdivision (a), the department may exceed the specific dollar limitation in either of the following instances:
(1)  Refinancing a preexisting loan, if the refinancing results in savings to the health facility and increases the probability that a loan can be repaid.
(2)  The need for financing results from earthquakes or other natural disasters.

SEC. 270.

 Section 129220 of the Health and Safety Code is amended to read:

129220.
 The department shall establish an Advisory Loan Insurance Committee which shall be comprised of nine members, eight of whom shall be appointed by the director of the department. Of the nine members, seven shall be appointed from outside state government and two shall be appointed from inside state government. The Director of Finance shall appoint one of the members chosen from inside state government. The members of the committee shall be qualified in the field of financial analysis, management, operations, or construction, improvement, or expansion of health facilities. Those members appointed from outside state government shall be reimbursed one hundred dollars ($100) for each day spent in the performance of official duties. All members shall be reimbursed for reasonable and necessary expenses.

SEC. 271.

 Section 129221 of the Health and Safety Code is amended to read:

129221.
 The duties of the committee shall include, but not be limited to, the following:
(a)  The committee shall assist the director of the department in formulating policy concerning financial analysis, management, operation, or construction, improvement, or expansion of health facilities, and shall, at the request of the director of the department, provide overall policy advice, guidance, and recommendations. The committee shall also provide the department with advice and comment on the state plan prepared pursuant to Section 129020.
(b)  The committee shall also review and analyze the feasibility, level of financial risk, and community benefit assessments made by the department on applications submitted for approval. The committee shall recommend to the director whether an application should be approved and whether any conditions should be attached to that approval. Loans that are currently insured by the department and subsequently are refinanced to obtain a lower interest rate or emergency working capital loans insured pursuant to Section 129091 shall not require the review of the committee.

SEC. 272.

 Section 129230 of the Health and Safety Code is amended to read:

129230.
 It is the intent of the Legislature in enacting this article to encourage the development of facilities for community-based programs that assist mental health clients living in any institutional setting, including state and local inpatient hospitals, skilled nursing homes, intermediate care facilities, and community care facilities to move to more independent living arrangements. It is further the intent of the Legislature to encourage local programs to seek funding for facility development from private sources and with the assistance provided pursuant to this chapter.
To achieve this purpose in determining eligibility for loan insurance pursuant to this chapter, the following special provisions apply to facilities approved in the local mental health program and meeting the intentions of this article:
(a) Facilities shall not require approval pursuant to Section 129295 by the statewide system of health facility planning, the area health planning agency, or the Health Advisory Council, for the issuance of loan insurance, unless specifically required for the facilities by the facility category of licensure.
(b) Notwithstanding subdivision (i) of Section 129050, any loan of under three hundred thousand dollars ($300,000) for a nonprofit corporation as well as a political subdivision may be fully insured equal to the total construction cost, except a loan to any proprietary corporation that is insured pursuant to subdivision (d) of this section.
(c) The local mental health program may provide all application fees, inspection fees, premiums and other administrative payments required by this chapter, except with respect to any loan to a proprietary corporation that is insured pursuant to subdivision (d) of this section.
(d) The borrower may be a proprietary corporation, provided that the facility is leased to the local mental health program for the duration of the insurance agreement. In these instances, all provisions in this chapter and this article that apply to a nonprofit corporation shall apply to the proprietary corporation, except as provided in subdivisions (b) and (c) of this section.
(e) For the purposes of this article, subdivision (c) of Section 129010 shall include the purchase of existing buildings.
(f) Facilities shall not require approval pursuant to Section 129020 by the statewide system of health facility planning, the area health planning agency, or the Health Advisory Council, for the issuance of loan insurance, until the director of the department determines that the state plan developed pursuant to Section 129020 adequately and comprehensively addresses the need for community mental health facilities and that finding is reported to the appropriate policy committees of the Legislature.

SEC. 273.

 Section 129295 of the Health and Safety Code is amended to read:

129295.
 The department may insure, pursuant to this article, loans to nonprofit borrowers that are not licensed to operate the facilities for which the loans are insured, provided that the borrower has entered into a long-term residency lease agreement with a service provider selected by the applicable regional center to operate that facility. The number of facilities for which loans are insured under this section shall not exceed 100 and the aggregate amount of loans insured under this section shall not exceed one hundred million dollars ($100,000,000).

SEC. 274.

 Section 129330 of the Health and Safety Code is amended to read:

129330.
 In each even-numbered year, the department shall contract for an actuarial study to determine the reserve sufficiency of funds in the Health Facility Construction Loan Insurance Fund. The study shall examine the portfolio of existing insured loans and shall estimate the amount of reserve funds that the department should reasonably have available to be able to respond adequately to potential foreseeable risks, including extraordinary administrative expenses and actual defaults. Actuarial study contracts shall be exempt from Section 10373 of the Public Contract Code and shall be considered sole-source contracts.

SEC. 275.

 Section 129335 of the Health and Safety Code is amended to read:

129335.
 (a)  In each odd-numbered year when the reserve balance in the fund is projected to be in excess of that actuarially needed, the department may, subject to authority in the Budget Act, grant excess reserve funds to rural hospitals.
(b)  Whenever the department administers the grant program, it shall do so by a competitive process where potential grantees have sufficient time to apply. Priority for funds shall be given to alternative rural hospitals and rural hospitals that are sole community providers. Priority shall also be given to applicants that are otherwise financially viable, but request one-time financial assistance for equipment expenditures or other capital outlays. The maximum amount of any grant for a single project in any one grant year shall be two hundred fifty thousand dollars ($250,000).
(c)  For the purposes of this article, “rural hospital” shall have the same meaning as contained in subdivision (a) of Section 124840.

SEC. 276.

 Section 129355 of the Health and Safety Code is amended to read:

129355.
 (a)  “Community health center facilities,” as used in this article, means those licensed, nonprofit primary care clinics as defined in paragraph (1) of subdivision (a) of Section 1204.
(b)  Notwithstanding subdivision (i) of Section 129050, any loan in the amount of five million dollars ($5,000,000) or less for a community health center facility pursuant to this chapter may be insured up to 95 percent of the total construction cost.
(c)  Community health center facilities applying for any loan insurance pursuant to this chapter, may use existing equity in buildings, equipment, and donated assets, including, but not limited to, land and receipts from expenses related to the capital outlay for the project, notwithstanding the date of occurrence to meet the equity requirements of this chapter. In determining the value of the equity in any donated property, the department may use the original purchase price or the current appraised value.
(d)  Any state plan referred to in Section 129020 developed by the department shall include a chapter identifying any impediments that preclude small facilities from utilizing the California Health Facility Construction Loan Insurance Program. The state plan shall also include specific programmatic remedies to enable small projects to utilize the program if impediments are found.

SEC. 277.

 Chapter 2 (commencing with Section 129375) of Part 6 of Division 107 of the Health and Safety Code is repealed.

SEC. 278.

 Section 129680 of the Health and Safety Code is amended to read:

129680.
 (a)  It is the intent of the Legislature that hospital buildings that house patients who have less than the capacity of normally healthy persons to protect themselves, and that must be reasonably capable of providing services to the public after a disaster, shall be designed and constructed to resist, insofar as practical, the forces generated by earthquakes, gravity, and winds. In order to accomplish this purpose, the department shall propose proper building standards for earthquake resistance based upon current knowledge, and provide an independent review of the design and construction of hospital buildings.
(b)  Local jurisdictions are preempted from the enforcement of all building standards published in the California Building Standards Code relating to the regulation of hospital buildings and the enforcement of other regulations adopted pursuant to this chapter, and all other applicable state laws, including plan checking and inspection of the design and details of the architectural, structural, mechanical, plumbing, electrical, and fire and panic safety systems, and the observation of construction. The department shall assume these responsibilities.
(c)  Where local jurisdictions have more restrictive requirements for the enforcement of building standards, other building regulations, and construction supervision, these requirements shall be enforced by the department.
(d)  Each local jurisdiction shall keep the department advised as to the existence of any more restrictive local requirements. Where a reasonable doubt exists as to whether the requirements of the local jurisdiction are more restrictive, the effect of these requirements shall be determined by the Hospital Building Safety Board.
It is further the intent of the Legislature that the department, with the advice of the Hospital Building Safety Board, may conduct or enter into contracts for research regarding the reduction or elimination of seismic or other safety hazards in hospital buildings or research regarding hospital building standards.

SEC. 279.

 Section 129715 of the Health and Safety Code is amended to read:

129715.
 “Director” means the Director of the Department of Health Care Access and Development.

SEC. 280.

 Section 129730 of the Health and Safety Code is amended to read:

129730.
 (a)  Space for the following functions shall be considered “outpatient clinical services,” when provided in a freestanding building that is separated from a hospital building where inpatient hospital services are provided: administrative space; central sterile supply; storage; morgue and autopsy facilities; employee dressing rooms and lockers; janitorial and housekeeping facilities; and laundry.
(b)  The outpatient portions of the following services may also be delivered in a freestanding building and shall be considered “outpatient clinical services:” surgical; chronic dialysis; psychiatry; rehabilitation; occupational therapy; physical therapy; maternity; dentistry; and chemical dependency.
(c)  Services that duplicate basic services, as defined in subdivision (a) of Section 1250, or services that are provided as part of a basic service, but are not required for facility licensure may also be provided in a freestanding building.
(d)  The department shall not approve any plans that propose to locate any function listed in subdivision (a) in a freestanding building until the State Department of Health Services certifies to the department that it has received and approved a plan acceptable to the State Department of Health Services that demonstrates how the health facility will continue to provide all basic services in the event of any emergency when the freestanding building may no longer remain functional.
(e)  Services listed in subdivisions (b) and (c) are subject to the same 25-percent inpatient limitation described in Section 129725.

SEC. 281.

 Section 129740 of the Health and Safety Code is amended to read:

129740.
 “Department” means the Department of Health Care Access and Information.

SEC. 282.

 Section 129750 of the Health and Safety Code is amended to read:

129750.
 The department shall observe the construction of, or addition to, any hospital building or the reconstruction or alteration of any hospital building, as it deems necessary to comply with this chapter for the protection of life and property.

SEC. 283.

 Section 129760 of the Health and Safety Code is amended to read:

129760.
 The governing board of each hospital or other hospital governing authority, before adopting any plans for the hospital building, shall submit the plans to the department for approval and shall pay the fees prescribed in this chapter.

SEC. 284.

 Section 129761 of the Health and Safety Code is amended to read:

129761.
 The department shall use, to the extent possible, information technology to facilitate the timely performance of its duties and responsibilities under this chapter.

SEC. 285.

 Section 129765 of the Health and Safety Code is amended to read:

129765.
 (a) Except as set forth in subdivision (b), the application for approval of the plans shall be accompanied by the plans, including full, complete, and accurate specifications, and structural design computations, which shall comply with the requirements prescribed by the department. The department may permit electronic submission, review, and approval of plans.
(b) Notwithstanding subdivision (a), the department, in its sole discretion, may enter into a written agreement with the hospital governing authority for the phased submittal and approval of plans. The department shall charge a fee for the review and approval of plans submitted pursuant to this subdivision. This fee shall be based on the estimated cost, but shall not exceed the actual cost, of the entire phased review and approval process for those plans. This fee shall be deducted from the application fee pursuant to Section 129785.

SEC. 286.

 Section 129770 of the Health and Safety Code is amended to read:

129770.
 (a)  The department shall pass upon and approve or reject all plans for the construction or the alteration of any hospital building, independently reviewing the design to assure compliance with the requirements of this chapter. The department shall review the structural systems and related details, including the independent review of the geological data. Geological data shall be reviewed by an engineering geologist, and structural design data shall be reviewed by a structural engineer.
(b)  Whenever the department finds a violation of this chapter that requires correction, a citation of the violation shall be issued to the hospital governing board or authority in writing and shall include a proper reference to the regulation or statute being violated.

SEC. 287.

 Section 129775 of the Health and Safety Code is amended to read:

129775.
 (a)  Except as otherwise provided in subdivision (b), plans submitted pursuant to this chapter for work that affects structural elements shall contain an assessment of the nature of the site and potential for earthquake damage, based upon geologic and engineering investigations and reports by competent personnel of the causes of earthquake damage. One-story Type V wood frame or light steel frame, or light steel and wood frame construction of 4,000 square feet or less, shall be exempt from the provisions of this section, unless the project is within a special study zone established pursuant to Section 2622 of the Public Resources Code.
(b)  The requirements of subdivision (a) may be waived by the department when the department determines that these requirements for the proposed hospital project are unnecessary and would not be beneficial to the safety of the public. The department, after consultation with the Building Safety Board, shall adopt regulations defining the criteria upon which the determination of a waiver shall be made.

SEC. 288.

 Section 129785 of the Health and Safety Code is amended to read:

129785.
 (a)  (1)  The department shall determine an application filing fee that will cover the costs of administering this chapter. For a hospital facility, as defined in subdivision (a), (b), or (f) of Section 1250, the fee shall not exceed 2 percent of a project’s estimated construction cost. For a skilled nursing or intermediate care facility, as defined in subdivision (c), (d), (e), or (g) of Section 1250, the fee shall not exceed 1.5 percent of a project’s estimated construction cost. Application filing fees shall be established in accordance with applicable procedures established in Article 5 (commencing with Section 11346) of Chapter 3.5 of Part 1 of Division 3 of Title 2 of the Government Code.
(2)  Notwithstanding paragraph (1), the minimum application filing fee in any case shall be two hundred fifty dollars ($250).
(b)  The department shall issue an annual permit upon submission of an application, pursuant to Section 129765, for one or more projects of a hospital facility, as defined in subdivision (a), (b), or (f) of Section 1250, if the total estimated construction cost is fifty thousand dollars ($50,000) or less per fiscal year. The fee for the annual permit shall be five hundred dollars ($500) and shall be in lieu of an application filing fee. The annual permit shall cover all projects undertaken for a particular hospital facility up to a total estimated construction cost of fifty thousand dollars ($50,000) during the state fiscal year in which the annual permit is issued. If a hospital facility chooses not to apply for an annual permit to cover a project or projects costing fifty thousand dollars ($50,000) or less in total, the hospital facility may instead submit the project or projects for review and approval as otherwise specified in this chapter, including paying the application filing fee determined under subdivision (a).
(c)  The department shall issue an annual permit upon submission of an application, pursuant to Section 129765, for one or more projects of a skilled nursing or intermediate care facility, as defined in subdivision (c), (d), (e), or (g) of Section 1250, if the total estimated construction cost is twenty-five thousand dollars ($25,000) or less per fiscal year. The fee for the annual permit shall be two hundred fifty dollars ($250) and shall be in lieu of an application filing fee. The annual permit shall cover all projects undertaken for a particular skilled nursing or intermediate care facility up to a total estimated construction cost of twenty-five thousand dollars ($25,000) during the state fiscal year in which the annual permit is issued. If a skilled nursing or intermediate care facility chooses not to apply for an annual permit to cover a project or projects costing twenty-five thousand dollars ($25,000) or less in total, the skilled nursing or intermediate care facility may instead submit the project or projects for review and approval as otherwise specified in this chapter, including paying the application filing fee determined under subdivision (a).
(d)  If the actual construction cost exceeds the estimated construction cost by more than 5 percent, a further fee shall be paid to the department, based on the above schedule and computed on the amount that the actual cost exceeds the amount of the estimated cost. If the estimated construction cost exceeds the actual construction cost by more than 5 percent, the department shall refund the excess portion of any paid fees, based on the above schedule and computed on the amount that the estimated cost exceeds the amount of the actual cost. A refund is not required if the applicant did not complete construction or alteration of 75 percent of the square footage included in the project, as contained in the approved drawings and specifications for the project. In addition, the department shall adopt regulations specifying other circumstances when the department shall refund to an applicant all or part of any paid fees for projects submitted under this chapter. The regulations shall include, but not be limited to, refunds of paid fees for a project that is determined by the department to be exempt or otherwise not reviewable under this chapter, and for a project that is withdrawn by the applicant prior to the commencement of review by the department of the drawing and specifications submitted for the project. All refunds pursuant to this section shall be paid from the Hospital Building Account in the Architecture Public Building Fund, as established pursuant to Section 129795.

SEC. 289.

 Section 129787 of the Health and Safety Code is amended to read:

129787.
 (a) The payment of the filing fee described in Section 129785 may be postponed by the department if all of the following conditions are met:
(1) The proposed construction or alteration has been proposed as a result of any event that has been declared to be a disaster by the Governor.
(2) The department determines that the applicant cannot presently afford to pay the filing fee.
(3) The applicant has applied for federal disaster relief from the Federal Emergency Management Agency (FEMA) with respect to the disaster described in paragraph (1).
(4) The applicant is expected to receive disaster assistance within one year from the date of the application.
(b) If the department does not receive full payment of any fee for which payment has been postponed pursuant to subdivision (a) within one year from the date of plan approval, the statewide department may request an offset from the Controller for the unpaid amount against any amount owed by the state to the applicant, and may request additional offsets against amounts owed by the state to the applicant until the fee is paid in full. This subdivision shall not be construed to establish an offset as described in the preceding sentence as the exclusive remedy for the collection of any unpaid fee amount as described in that same sentence.

SEC. 290.

 Section 129790 of the Health and Safety Code is amended to read:

129790.
 The department shall propose specific space, architectural, structural, mechanical, plumbing, and electrical standards for correctional treatment centers in cooperation with the Board of Corrections, the Department of Corrections, and the Department of the Youth Authority.

SEC. 291.

 Section 129795 of the Health and Safety Code is amended to read:

129795.
 All fees shall be paid into the State Treasury and credited to the Hospital Building Fund, that is hereby created and continuously appropriated without regard to fiscal years for the use of the department, subject to approval of the Department of Finance, in carrying out this chapter. Adjustments in the amounts of the fees, as determined by the department and approved by the Department of Finance, shall be made within the limits set in Section 129785 in order to maintain a reasonable working balance in the account. Notwithstanding any other provision of law, any moneys collected pursuant to this chapter contained in the hospital building fund established by the Department of Finance, that are in the fund on January 1, 1994, shall be available for expenditure in accordance with this section.

SEC. 292.

 Section 129800 of the Health and Safety Code is amended to read:

129800.
 The director shall request the Department of Finance or the Auditor General to perform an audit of the uses of fees collected pursuant to Section 129785. This audit shall include, but not be limited to, an accounting of staff resources allocated to hospital plan reviews by the department and by the Office of the State Architect in the Department of General Services since these reviews are funded by fees collected pursuant to Section 129785. If the Department of Finance and the Auditor General indicate that other audit responsibilities will prohibit them from performing and completing the audit within six months of being initially requested to do so, then the department may contract with an independent organization to perform the audit.

SEC. 293.

 Section 129805 of the Health and Safety Code is amended to read:

129805.
 (a) All plans and specifications shall be prepared under the responsible charge of an architect or a structural engineer, or both. A structural engineer shall prepare the structural design and shall sign plans and specifications related thereto. Administration of the work of construction shall be under the responsible charge of the architect and structural engineer, except that where plans and specifications for alterations or repairs do not affect architectural or structural conditions, the plans and specifications may be prepared under the responsible charge of, and work of construction may be administered by, a professional engineer duly qualified to perform the services and holding a valid certificate under Chapter 7 (commencing with Section 6700) of Division 3 of the Business and Professions Code for performance of services in that branch of engineering in which the plans, specifications, and estimates and work of construction are applicable.
(b) The department may exempt projects from the requirements of subdivision (a) where the plans and specifications are not ordinarily, in the standard practice of architecture and engineering, prepared by licensed architects or registered engineers, or both, and are not a component of a project prepared under the responsible charge of a licensed architect or registered engineer, or both. To implement this authority, the department shall adopt regulations, consistent with this section, that specify which projects may be exempted from the requirements of subdivision (a).

SEC. 294.

 Section 129810 of the Health and Safety Code is amended to read:

129810.
 Before commencing any construction or alteration of any hospital building, the written approval of the necessary plans as to safety of design and construction, by the department, shall be obtained.

SEC. 295.

 Section 129812 of the Health and Safety Code is amended to read:

129812.
 Notwithstanding any other provision of law, the department may utilize an over-the-counter plan review process.

SEC. 296.

 Section 129820 of the Health and Safety Code is amended to read:

129820.
 No contract for the construction or alteration of any hospital building, made or executed on or after January 1, 1983, by the governing board or authority of any hospital or other similar public board, body, or officer otherwise vested with authority to make or execute the contract, is valid, and no money shall be paid for any work done under the contract or for any labor or materials furnished in constructing or altering the hospital building, unless all of the following requirements are satisfied:
(a)  The plans and specifications comply with this chapter and the requirements contained in the California Building Standards Code.
(b)  The written approval thereof has first been obtained from the department.
(c)  The hospital building is to be accessible to, and usable by, persons with disabilities.
(d)  The plans and specifications comply with the fire and panic safety requirements of the California Building Standards Code.

SEC. 297.

 Section 129825 of the Health and Safety Code is amended to read:

129825.
 (a)  The hospital governing board or authority shall provide for and require competent and adequate inspection during construction or alteration by an inspector satisfactory to the architect or structural engineer, or both, and the department. Except as otherwise provided in subdivision (b), the inspector shall act under the direction of the architect or structural engineer, or both, and be responsible to the board or authority. Nothing in this section shall be construed to prohibit any licensed architect, structural engineer, mechanical engineer, electrical engineer, or any facility maintenance personnel, if approved by the department, from performing the duties of an inspector.
(b)  If alterations or repairs are to be conducted under the supervision of a professional engineer pursuant to Section 129805, the inspector need only be satisfactory to the department and to the professional engineer, and the inspector shall act under the direction of the professional engineer.
(c)  The department shall make an inspection of the hospital buildings and of the work of construction or alteration as in its judgment is necessary or proper for the enforcement of this chapter and the protection of the safety of the public.
Whenever the department finds a violation of this chapter that requires correction, the citation of the violation shall be issued to the hospital governing board or authority in writing and shall include a proper reference to the regulation or statute being violated.
(d)  The department shall approve inspectors that shall be limited to the following:
(1)  “A” inspectors, who may inspect all areas of construction specialty, including, but not limited to, structural.
(2)  “B” inspectors, who may inspect all areas of construction specialty, except structural.
(3)  “C” inspectors, who may inspect one or more areas of construction specialty, including structural, but may not inspect the scope of construction specialties authorized for “A” or “B” inspectors.
(e)  (1)  As part of its approval process, the department shall initially and periodically examine inspectors by giving either a written examination or a written and oral examination. The department may charge a fee for the examination process calculated to cover its costs. Inspectors who have not passed a written examination shall not be approved by the department until they have successfully passed the written examination. No employee of the department performing field inspections or supervising the field inspections shall be approved as an inspector on any construction project pursuant to this chapter for a period of one year after leaving employment of the department.
(2)  The department shall develop regulations for the testing and approval of inspectors.

SEC. 298.

 Section 129830 of the Health and Safety Code is amended to read:

129830.
 From time to time, as the work of construction or alteration progresses and whenever the department requires, the architect or structural engineer, or both, in charge of construction or registered engineer in charge of other work, the inspector on the work, and the contractor shall each make a report, duly verified by them, upon a form prescribed by the department showing, of their personal knowledge, that the work during the period covered by the report has been performed and materials used and installed are in accordance with the approved plans and specifications, setting forth detailed statements of fact as required by the department.
The term “personal knowledge,” as used in this section and as applied to the architect or registered engineer, or both, means the personal knowledge that is obtained by periodic visits to the project site of reasonable frequency, for the purpose of general observation of the work, and that is also obtained from the reporting of others as to the progress of the work, testing of materials, and inspection and superintendence of the work that is performed between the periodic visits of the architect or the registered engineer. Reasonable diligence shall be exercised in obtaining the facts.
The term “personal knowledge,” as applied to the inspector, means the actual personal knowledge that is obtained from the inspector’s personal continuous inspection of the work of construction in all stages of its progress at the site where the inspector is responsible for inspection, and when work is carried out away from the site, that personal knowledge that is obtained from the reporting of others on the testing or inspection of materials and workmanship, for compliance with plans, specifications, or applicable standards. Reasonable diligence shall be exercised in obtaining the facts.
The term “personal knowledge,” as applied to the contractor, means the personal knowledge that is obtained from the construction of the building. The exercise of reasonable diligence to obtain the facts is required.

SEC. 299.

 Section 129835 of the Health and Safety Code is amended to read:

129835.
 Upon written request to the department by the governing board or authority of any hospital, the department shall make, or cause to be made, an examination and report on the condition of any hospital building subject to the payment by the governing board or authority of the actual expenses incurred by the department.

SEC. 300.

 Section 129840 of the Health and Safety Code is amended to read:

129840.
 Subsequent to the occurrence of any earthquake, the department may make, or cause to be made, studies of health facilities within the area involved.

SEC. 301.

 Section 129850 of the Health and Safety Code is amended to read:

129850.
 Except as provided in Sections 18929 and 18930, the department shall from time to time make any regulations that it deems necessary, proper, or suitable to effectually carry out this chapter. The department shall also propose and submit building standards to the California Building Standards Commission for adoption and approval pursuant to Chapter 4 (commencing with Section 18935) of Part 2.5 of Division 13 relating to seismic safety for hospital buildings.

SEC. 302.

 Section 129851 of the Health and Safety Code is amended to read:

129851.
 Written rules and regulations by the department to clarify the application of the California Building Standards Code pursuant to this chapter shall be made available to the public upon request.

SEC. 303.

 Section 129853 of the Health and Safety Code is amended to read:

129853.
 (a) The person or entity requesting a copy of construction documents maintained by the department shall bear the actual cost of producing the copy of those documents, including staff time spent retrieving, inspecting, and handling the documents, copying costs, and shipping costs.
(b) The department shall provide an estimate of the costs described in subdivision (a) to the requester before the department begins to make those copies.

SEC. 304.

 Section 129855 of the Health and Safety Code is amended to read:

129855.
 The department may enter into any agreements and contracts with any qualified person, department, agency, corporation, or legal entity, as determined by the department, when necessary in order to facilitate the timely performance of the duties and responsibilities relating to the review and inspection of architectural, mechanical, electrical, and plumbing systems of hospital buildings to be constructed or altered or buildings under construction or alteration.
If the department determines that the structural review of plans for a hospital building cannot be completed without undue delay, the department may enter into contractual agreements with private structural engineers or local governments for the purpose of facilitating the timely performance of the duties and responsibilities relating to the review and inspection of plans and specifications of the structural systems of hospital construction projects.
The department, with the advice of the Building Safety Board, shall prepare regulations, containing qualification criteria, for implementing the contractual agreement provisions of this section.

SEC. 305.

 Section 129856 of the Health and Safety Code is amended to read:

129856.
 (a) Contingent on an appropriation in the annual Budget Act, the department shall establish a program for training fire and life safety officers. The goal of this program shall be to provide a sufficient number of qualified persons to facilitate the timely performance of the department’s duties and responsibilities relating to the review of plans and specifications pertaining to the design and observation of construction of hospital buildings and buildings described in paragraphs (2) and (3) of subdivision (b) of Section 129725, in order to ensure compliance with applicable facility design and construction codes and standards.
(b) The department shall prepare a comprehensive report on the training program setting forth its goals, objectives, and structure. The report shall include the number of fire and life safety officers to be trained annually, a timeline for training completion, a process for gathering information to evaluate the training programs efficiency that includes dropout and retention rates, and a mechanism to annually assess the need for the training program to continue. The report shall be submitted to the Joint Legislative Budget Committee by April 1, 2007.
(c) The department may establish other training programs as necessary to ensure that a sufficient number of qualified persons are available to facilitate the timely performance of the department’s duties and responsibilities relating to the review of plans and specifications pertaining to the design and construction of hospital buildings and buildings described in paragraphs (2) and (3) of subdivision (b) of Section 129725, to ensure compliance with applicable safety codes and standards.
(d) If additional training programs are established pursuant to subdivision (c), the department shall prepare a comprehensive report on the training program setting forth its goals, objectives, and structure. The report shall include the number of individuals trained pursuant to subdivision (c) annually, a timeline for training completion, a process for gathering information to evaluate the training programs efficiency that includes dropout and retention rates, and a mechanism to annually assess the need for the training program to continue. The report shall be submitted to the Joint Legislative Budget Committee three years after the training program has been implemented.

SEC. 306.

 Section 129875 of the Health and Safety Code is amended to read:

129875.
 Construction or alterations of buildings specified in paragraphs (2) and (3) of subdivision (b) of Section 129725 shall conform to the latest edition of the California Building Standards Code. The department shall independently review and inspect these buildings. For purposes of this section, “construction or alteration” includes the conversion of a building to a purpose specified in paragraphs (2) and (3) of subdivision (b) of Section 129725. Any construction or alteration of any building subject to this section shall be exempt from any plan review and approval or construction inspection requirement of any city or county.
The department may also exempt from the plan review process or expedite those projects undertaken by an applicant for a hospital building that the department determines do not materially alter the mechanical, electrical, architectural, or structural integrity of the facility. The department shall set forth criteria to expedite projects or to implement any exemptions made pursuant to this paragraph.
The Legislature recognizes the relative safety of single-story, wood-frame, and light steel frame construction for use in housing patients requiring skilled nursing and intermediate care services and it is, therefore, the intent of the Legislature to provide for reasonable flexibility in seismic safety standards for these structures. The department shall be reasonably flexible in the application of seismic standards for other buildings by allowing incidental and minor nonstructural additions or nonstructural alterations to be accomplished with simplified written approval procedures as established by the department, with the advice of the Division of the State Architect and the Office of the State Fire Marshal.
The department shall implement, and modify, as necessary, criteria to exempt from the plan review process or expedite those projects for alterations of hospital buildings, and for those specified in paragraphs (2) and (3) of subdivision (b) of Section 129725 that may include, but are not limited to, renovations, remodeling, or installations of necessary equipment such as hot water heaters, air-conditioning units, dishwashers, laundry equipment, handrails, lights, television brackets, small emergency generators (up to 25 kilowatts), storage shelves, and similar plant operations equipment; and decorative materials such as wall coverings, floor coverings, and paint.
The department shall include provisions for onsite field approvals by available department construction advisers and the preapproval of projects that comply with the requirements for which the department has developed standard architectural or engineering detail, or both standard architectural and engineering detail.

SEC. 307.

 Section 129875.1 of the Health and Safety Code is amended to read:

129875.1.
 (a) Notwithstanding Section 129875, projects for the construction or alterations of buildings specified in paragraph (1) of subdivision (a) of Section 129725 that are single-story, wood-frame or light steel frame construction and buildings specified in paragraphs (2) and (3) of subdivision (b) of Section 129725 shall be exempt from plan review and inspection by the department prior to construction if the facility demonstrates to the department, by written description of the project, that all of the following conditions are met:
(1) The construction or alteration is undertaken to repair existing systems or to keep up the course of normal or routine maintenance.
(2) The construction or alteration either restores the facility to the same operational status, or improves operational status from its operating condition immediately prior to the event, occurrence, or condition that necessitated the alteration.
(3) The scope of the construction or alteration is not ordinarily within the standard of practice of a licensed architect or registered engineer.
(4) The construction or alteration does not degrade the status or condition of the fire and life safety system from the status of the system immediately prior to the event, occurrence, or condition that necessitated the alteration.
(b) Upon completion of construction or alteration of any building subject to this section, and prior to use of the repaired system or other subject of the construction or alteration, the department shall inspect and approve the work. The department may require an interim inspection for code compliance when walls, ceilings, or other materials or finishes will cover the final work.
(c) Upon compliance with subdivision (a), the department shall issue a building permit.

SEC. 308.

 Section 129880 of the Health and Safety Code is amended to read:

129880.
 (a) The department may exempt from its plan review process construction or alteration projects for hospital buildings and buildings described in paragraphs (2) and (3) of subdivision (b) of Section 129725 with estimated construction costs of fifty thousand dollars ($50,000) or less. The criteria for exemption shall include, but not be limited to, plans that have been stamped and signed by the design professionals of record.
(b)  Projects that have been split into a series of smaller projects in order to avoid the qualifying dollar limits shall not be approved. The department shall maintain its construction observation mandate to ensure public safety and California Building Standards Code compliance for approved projects.
(c) A presubmittal meeting between the department and the design professionals shall be required for construction or alteration projects for hospital buildings and buildings described in paragraphs (2) and (3) of subdivision (b) of Section 129725 with estimated construction costs of twenty million dollars ($20,000,000) or more.
(d) The department may adopt regulations for this section to make specific the exemption criteria and processes authorized pursuant to subdivision (a), and the complete plan review process required pursuant to subdivision (c).

SEC. 309.

 Section 129885 of the Health and Safety Code is amended to read:

129885.
 (a) A city or county, as applicable, shall have plan review and building inspection responsibilities for the construction or alteration of buildings described in paragraph (1) of subdivision (b) of Section 129725. The building standards for the construction or alteration of buildings specified in paragraph (1) of subdivision (b) of Section 129725 established or applied by a city or county, shall not be more restrictive or comprehensive than comparable building standards established, or otherwise applied, to clinics licensed pursuant to Chapter 1 (commencing with Section 1200) of Division 2. For chronic dialysis and surgical services buildings, construction or alteration shall include conversion of a building to a purpose specified in paragraph (1) of subdivision (b) of Section 129725.
(b) Upon the initial submittal to a city or county by the governing authority or owner of a hospital for plan review and building inspection services for buildings described in paragraph (1) of subdivision (b) of Section 129725 for chronic dialysis and surgical services, the city or county shall reply in writing to the hospital as to whether or not the plan review by the city or county will include a certification as to whether or not the clinic project submitted for plan review meets the clinic standards propounded by the department in the California Building Standards Code.
If the city or county indicates that its review will include this certification, it shall do all of the following:
(1) Apply the applicable clinic provisions of the latest edition of the California Building Standards Code.
(2) Certify in writing to the applicant within 30 days of completion of construction whether or not the standards have been met.
(c) If, upon initial submittal, the city or county indicates that its plan review will not include this certification, the governing authority or owner shall submit the plans to the Department of Health Care Access and Information and the department shall review the plans for certification to determine whether or not the clinic project meets the standards propounded by the department in the California Building Standards Code.
(d) When the department performs the certification review, the department shall charge a fee in an amount not to exceed its actual cost.
(e) Notwithstanding subdivision (a), the governing authority of a hospital may request the Department of Health Care Access and Information to perform plan review and building inspection services for buildings described in paragraph (1) of subdivision (b) of Section 129725 and Section 129730. The department shall perform these services upon request and shall charge an amount equal to its standard fee for the construction and alteration of hospital buildings. The construction or alteration of these buildings shall conform to the applicable provisions of the latest edition of the California Building Standards Code for purposes of the plan review and building inspection of the department pursuant to this subdivision. The department shall issue the building permit and certificate of occupancy for these facilities.
(f) A building described in paragraph (1) of subdivision (b) of Section 129725 that is subject to the plan review and building inspection of the department pursuant to subdivision (e), may be designated by the governing authority or owner of the hospital as a “hospital building” as long as the building remains under the jurisdiction of the department. This hospital building shall be reviewed and inspected according to the standards and requirements of the Alfred E. Alquist Hospital Facilities Seismic Safety Act of 1983 (Chapter 1 (commencing with Section 129675)).
(g) When a building is accepted for review by the department pursuant to subdivision (e), the governing authority of the hospital shall not request the city or county, as applicable, to conduct plan review and building inspection for any subsequent alteration of the same building, unless written notification is submitted to the department by the governing authority or owner of the hospital.

SEC. 310.

 Section 129890 of the Health and Safety Code is amended to read:

129890.
 (a) Notwithstanding any other provision of law, the department shall, on or before January 1, 1991, set forth and implement criteria for the alteration or construction of buildings specified in subdivision (a) of Section 129725 that provide for onsite field review and approval by construction advisers of the department and provide for preapproval of project plans that comply with the requirements for which the department has developed standard architectural or engineering detail, or both standard architectural and engineering detail.
(b) Onsite field reviews shall be performed by available area construction advisers of the department. The area construction advisers shall have the responsibility to coordinate any approvals required by the State Fire Marshal. The approvals may be obtained prior to the start of construction or on a deferred basis, at the discretion of the area construction adviser.
(c) An annual building permit project classified as a “field review” shall be reviewed and approved by the area construction adviser.
(d) Effective January 1, 1991, all plans submitted for the alteration or construction of buildings specified in subdivision (a) of Section 129725 to the department for plan review shall be evaluated to determine if it is exempt from the plan review process or if it qualifies for an expedited plan review. The evaluation shall give priority to plans that are for minor renovation, remodeling, or installation of equipment.

SEC. 311.

 Section 129895 of the Health and Safety Code is amended to read:

129895.
 (a) The department shall adopt by regulations seismic safety standards for hospital equipment anchorages, as defined by the department, to include, but not be limited to, architectural, mechanical, and electrical components, supports, and attachments. Those regulations shall include criteria for the testing of equipment anchorages.
(b) Any fixed hospital equipment anchorages purchased or acquired on or after either the effective date of the regulations adopted pursuant to subdivision (a) shall not be used or installed in any hospital building unless the equipment anchorages are approved by the department.
(c) Manufacturers, designers, or suppliers of equipment anchorages may submit data sufficient for the office to evaluate equipment anchorages’ seismic safety prior to the selection of equipment anchorages for any specific hospital building.
(d) The department may charge a fee based on the actual costs incurred by it for data review, approvals, and field inspections pursuant to this section.

SEC. 312.

 Section 129900 of the Health and Safety Code is amended to read:

129900.
 Notwithstanding any other provision of law, plans for the construction or alteration of any hospital building, or any building specified in Section 129875, that are prepared by or under the supervision of the Department of General Services shall not require the review and approval of the department. In lieu of review and approval by the department, the Department of General Services shall certify to the department that the plans are in full conformance with all applicable building standards and the requirements of this chapter. The Department of General Services shall also observe all aspects of construction and alteration, including the architectural, structural, mechanical, plumbing and electrical systems.
It is the intent of the Legislature that projects developed by, or under the supervision of, the Department of General Services shall still meet all applicable building standards published in the State Building Standards Code relating to the regulation of hospital projects where applicable, and all regulations adopted pursuant to this chapter and all other applicable state laws.

SEC. 313.

 Section 129905 of the Health and Safety Code is amended to read:

129905.
 Subject to the complete exemption contained in paragraphs (6) and (7) of subdivision (b) of Section 129725, and notwithstanding any other provision of law, plans for the construction or alteration of any hospital building, as defined in Section 1250, or any building specified in Section 129875, that are prepared by or under the supervision of the Department of Corrections or on behalf of the Department of the Youth Authority, shall not require the review and approval of the statewide department. In lieu of review and approval by the statewide department, the Department of Corrections and the Department of the Youth Authority shall certify to the statewide department that their plans and construction are in full conformance with all applicable building standards, including, but not limited to, fire and life and safety standards, and the requirements of this chapter for the architectural, structural, mechanical, plumbing, and electrical systems. The Department of Corrections and the Department of the Youth Authority shall use a secondary peer review procedure to review designs to ensure the adherence to all design standards for all new construction projects, and shall ensure that the construction is inspected by a competent, onsite inspector to ensure the construction is in compliance with the design and plan specifications.
Subject to the complete exemption contained in paragraphs (6) and (7) of subdivision (b) of Section 129725, and notwithstanding any other provision of law, plans for the construction or alteration of any correctional treatment center that are prepared by or under the supervision of a law enforcement agency of a city, county, or city and county shall not require the review and approval of the statewide department. In lieu of review and approval by the statewide department, the law enforcement agency of a city, county, or city and county shall certify to the statewide department that the plans and construction are in full conformance with all applicable building standards, including, but not limited to, fire and life and safety standards, and the requirements of this chapter for the architectural, structural, mechanical, plumbing, and electrical systems.
It is the intent of the Legislature that, except as specified in this section, all hospital buildings as defined by this chapter constructed by or under the supervision of the Department of Corrections or local law enforcement agencies, or constructed on behalf of the Department of the Youth Authority shall at a minimum meet all applicable regulations adopted pursuant to this chapter and all other applicable state laws.

SEC. 314.

 Section 129925 of the Health and Safety Code is amended to read:

129925.
 There is in the department a Hospital Building Safety Board that shall be appointed by the director. The board shall advise the director and, notwithstanding Section 13142.6 and except as provided in Section 18945, shall act as a board of appeals in all matters relating to the administration and enforcement of building standards relating to the design, construction, alteration, and seismic safety of hospital building projects submitted to the department pursuant to this chapter.
Further, notwithstanding Section 13142.6, the board shall act as the board of appeals in matters relating to all fire and panic safety regulations and alternate means of protection determinations for hospital building projects submitted to the department pursuant to this chapter.

SEC. 315.

 Section 129930 of the Health and Safety Code is amended to read:

129930.
 The board shall consist of 16 members appointed by the director of the department. Of the appointive members, two shall be structural engineers, two shall be architects, one shall be an engineering geologist, one shall be a geotechnical engineer, one shall be a mechanical engineer, one shall be an electrical engineer, one shall be a hospital facilities manager, one shall be a local building official, one shall be a general contractor, one shall be a fire and panic safety representative, one shall be a hospital inspector of record, and three shall be members of the general public.

SEC. 316.

 Section 129940 of the Health and Safety Code is amended to read:

129940.
 (a)  There shall be six ex officio members of the board, who shall be the director of the department, the State Fire Marshal, the State Geologist, the Executive Director of the California Building Standards Commission, the State Director of Health Services, and the Deputy Director of the Division of Facilities Development in the department, or their officially designated representatives.
(b)  The director may also appoint up to three additional ex officio members, with the advice of the chair. On January 1, 1994, director-appointed ex officio members may continue to serve until appointment of their successors by the director.

SEC. 317.

 Section 129950 of the Health and Safety Code is amended to read:

129950.
 The board shall be served by an executive director who shall be a member of the department staff.

SEC. 318.

 Section 129975 of the Health and Safety Code is amended to read:

129975.
 The director of the department may conduct studies relating to the implementation of this chapter to ensure that the implementation of its provisions results in the least amount of increases in costs, staffing, and regulation.

SEC. 319.

 Section 129980 of the Health and Safety Code is amended to read:

129980.
 Whenever any construction or alteration of any hospital building is being performed contrary to the provisions of this chapter, the department may order the construction or alteration stopped by written notice served upon any persons engaged in or causing the work to be done. Upon service of the written notice, all construction or alteration shall cease until an authorization to remove the notice is issued by the department. Any person so served shall, upon request made within 15 days of the written notice, be entitled to a hearing pursuant to Section 11506 of the Government Code.

SEC. 320.

 Section 129985 of the Health and Safety Code is amended to read:

129985.
 (a)  Whenever it is necessary to make an inspection to enforce any of the provisions of this chapter or whenever the department or its authorized representatives has reasonable cause to believe that there exists in any building or upon any premises any condition or a violation of any applicable building standards that makes the building or premises unsafe, dangerous, or hazardous, the department or its authorized representatives may enter the building or premises at any reasonable time to make an inspection or to perform any authorized duty. Prior to an entry authorized by this section, the authorized representatives of the department shall first present proper identification and credentials and request entry. In the event that the building or premises are unoccupied, there shall be a reasonable effort made to locate the owner or other person or persons having control or charge of the building or premises in order to request an entry. If a request for entry is refused, the department or its authorized representatives shall have recourse to any remedy prescribed by law to secure entry.
(b)  Whenever the owner, occupant, or other person having control or charge of the building or premises is presented with a proper inspection warrant or other authorization prescribed by law to secure entry and a request for entry is made, the owner, occupant, or other person having control or charge of the building or premises shall promptly permit the entry of the authorized representatives of the department for the purpose of inspection and examination authorized by this chapter.

SEC. 321.

 Section 129990 of the Health and Safety Code is amended to read:

129990.
 The department may order the vacating of any building or structure found to have been in violation of the adopted regulations of the department and may order the use of the building or structure discontinued within the time prescribed by the department upon the service of notice to the owner or other person having control or charge of the building or structure. Any owner or person having control so served shall, upon request made within 15 days of the written notice, be entitled to a hearing pursuant to Section 11506 of the Government Code.

SEC. 322.

 Section 130000 of the Health and Safety Code is amended to read:

130000.
 (a) The Legislature hereby finds and declares the following:
(1) The Alfred E. Alquist Hospital Facilities Seismic Safety Act of 1983 was created because of the loss of life in the collapse of hospitals during the Sylmar earthquake of 1971.
(2) We were reminded of the vulnerability of hospitals in the Northridge earthquake of January 17, 1994.
(3) Several hospitals built prior to the act suffered major damage and had to be evacuated.
(4) Hospitals built to the Alfred E. Alquist Hospital Facilities Seismic Safety Act standards resisted the Northridge earthquakes with very little structural damage demonstrating the value and necessity of this act.
(5) Both pre- and post-act hospitals suffered damage to architecture and to power and water systems that prevented hospitals from being operational, caused the loss of one life, triggered evacuations, unacceptable property losses, and added additional concerns on emergency medical response.
(6) An earthquake survivability inventory of California’s hospitals completed by the Department of Health Care Access and Information in December 1989 indicated that over 83 percent of the state’s hospital beds were in buildings that did not comply with the Alfred E. Alquist Hospital Facilities Seismic Safety Act because they were issued permits prior to the effective date of the act. Furthermore, 26 percent of the beds are in buildings posing significant risks of collapse since they were built before modern earthquake codes. The older hospitals pose significant threats of collapse in major earthquakes and loss of functions in smaller or more distant earthquakes.
(7) The 1989 survey also states: “Of the 490 hospitals surveyed, nine hospitals are in Alquist–Priolo Earthquake Fault Rupture Zones, 31 are in areas subject to soil liquefaction, 14 in areas with landslide potential, 33 in flood zones, and 29 have a possible loss or disruption of access. Two hundred five hospitals had no emergency fuel for their main boilers on hand, 19 had no emergency fuel for their emergency generators. Onsite emergency potable water was available at 273 hospitals and nonpotable water was available at 102 hospitals. Four hundred eighteen hospitals had emergency radios onsite, and 419 hospitals had inadequate or partially adequate equipment anchorage. In terms of available emergency preparedness, inadequate or partially inadequate equipment anchorage is still the most widespread shortcoming.”
(8) This survey identifies many of the shortcomings that caused 23 hospitals to suspend some or all operations after the Northridge earthquake. However, one hospital was rebuilt to comply with the Alfred E. Alquist Hospital Facilities Seismic Safety Act after an older hospital building had partially collapsed in the 1971 Sylmar earthquake. The rebuilt hospital suffered failures in water distribution systems and had to be evacuated.
(9) The state must rely on hospitals to support patients and offer medical aid to earthquake victims.
(b) Therefore, it is the intent of the Legislature, that:
(1) By enacting this article, the state shall take steps to ensure that the expected earthquake performance of hospital buildings housing inpatients and providing primary basic services is disclosed to public agencies that have a need and a right to know, because the medical industry cannot immediately bring all hospital buildings into compliance with the Alfred E. Alquist Hospital Facilities Seismic Safety Act.
(2) The state shall encourage structural retrofits or replacements of hospital buildings housing inpatients and providing primary basic services that place lives at risk because of their potential for collapse during an earthquake.
(3) The state shall also encourage retrofits and enhancements to critical hospital architecture, equipment, and utility and communications systems to improve the ability of hospitals to remain operational for those hospitals that do not pose risk to life.

SEC. 323.

 Section 130005 of the Health and Safety Code is amended to read:

130005.
 By June 30, 1996:
(a) The Department of Health Care Access and Information, hereinafter called the department, shall develop definitions of earthquake performance categories for earthquake ground motions for both new and existing hospitals that are:
(1) Reasonably capable of providing services to the public after a disaster, designed and constructed to resist, insofar as practical, the forces generated by earthquakes, gravity, and winds, and in full compliance with the regulations and standards developed by the department pursuant to the Alfred E. Alquist Hospital Facilities Seismic Safety Act.
(2) In substantial compliance with the pre-1973 California Building Standards Codes, but not in substantial compliance with the regulations and standards developed by the department pursuant to the Alfred E. Alquist Hospital Facilities Seismic Safety Act. These buildings may not be repairable or functional but will not significantly jeopardize life.
(3) Potentially at significant risk of collapse and that represent a danger to the public.
(b) The department may define other earthquake performance categories as it deems necessary to meet the intent of this article and the Alfred E. Alquist Hospital Facilities Seismic Safety Act.
(c) Earthquake performance categories shall also include subgradations for risk to life, structural soundness, building contents, and nonstructural systems that are critical to providing basic services to hospital inpatients and the public after a disaster.
(d) Earthquake performance categories shall, as far as practicable, use language consistent with definitions and concepts as developed in the model codes and other state and federal agencies. Where the department finds that deviations from other’s definitions and concepts are necessary and warranted to comply with the intent of the Alfred E. Alquist Hospital Facilities Seismic Safety Act, the act that added this article, or the specific nature or functions of hospitals, the department shall provide supporting documentation that justifies these differences.
(e) Insofar as practicable, the department shall define rapid seismic evaluation procedures that will allow owners to determine with reasonable certainty the existing applicable earthquake performance categories and the minimum acceptable earthquake performance categories for hospital buildings. These procedures shall allow for abbreviated analysis when known vulnerability is clear and when construction in accordance with post-1973 codes allows for an evaluation focusing on limited structural and nonstructural elements.
(f) The department, in consultation with the Hospital Building Safety Board, shall develop regulations to identify the most critical nonstructural systems and to prioritize the timeframes for upgrading those systems that represent the greatest risk of failure during an earthquake.
(g) The department shall develop regulations as they apply to the administration of seismic standards for retrofit designs, construction, and field reviews for the purposes of this article.
(h) The department shall develop regulations for the purpose of reviewing requests and granting delays to hospitals demonstrating a need for more time to comply with Section 130060.
(i) The department shall submit all information developed pursuant to subdivisions (a) to (f), inclusive, to the California Building Standards Commission by June 30, 1996.
(j) The department shall submit all information developed pursuant to subdivisions (g) and (h) to the California Building Standards Commission by December 31, 1996.
(k) “Hospital building,” as used in Article 8 and Article 9 of this chapter means a hospital building as defined in Section 129725 and that is also licensed pursuant to subdivision (a) of Section 1250, but does not include these buildings if the beds licensed pursuant to subdivision (a) of Section 1250, as of January 1, 1995, comprise 10 percent or less of the total licensed beds of the total physical plant, and does not include facilities owned or operated, or both, by the Department of Corrections.

SEC. 324.

 Section 130010 of the Health and Safety Code is amended to read:

130010.
 The department is responsible for reviewing and approving seismic evaluation reports, compliance schedules and construction documents that are developed by hospital owners, and field review of construction for work done pursuant to this article.

SEC. 325.

 Section 130020 of the Health and Safety Code is amended to read:

130020.
 (a) By December 31, 1996, the California Building Standards Commission shall review, revise as necessary and adopt earthquake performance categories, seismic evaluation procedures, and standards and timeframes for upgrading the most critical nonstructural systems as developed by the department. By June 30, 1997, the California Building Standards Commission shall review, revise as necessary, and adopt seismic retrofit building standards and procedures for reviewing requests and granting delays to hospitals that demonstrate a need for more time to comply with Section 130060.
(b) For purposes of this section all submittals made by the department pursuant to subdivisions (i) and (j) of Section 130005 shall be deemed as emergency regulations and adopted as such.

SEC. 326.

 Section 130025 of the Health and Safety Code is amended to read:

130025.
 (a) In the event of a seismic event, or other natural or manmade calamity that the department believes is of a magnitude so that it may have compromised the structural integrity of a hospital building, or any major system of a hospital building, the department shall send one or more authorized representatives to examine the structure or system. “System” for these purposes shall include, but not be limited to, the electrical, mechanical, plumbing, and fire and life safety system of the hospital building. If, in the opinion of the department, the structural integrity of the hospital building or any system has been compromised and damaged to a degree that the hospital building has been made unsafe to occupy, the department may cause to be placed on the hospital building either a red tag, a yellow tag, or a green tag.
(b) A “red” tag shall mean the hospital building is unsafe and shall be evacuated immediately. Access to red-tagged buildings shall be restricted to persons authorized by the department to enter.
(c) A “yellow” tag shall mean that the hospital building has been authorized for limited occupancy, and the authorized representative of the department shall write directly on the yellow tag that portion of the hospital building that may be entered with or without restriction and those portions that may not.
(d) A “green” tag shall mean the hospital building and all of its systems have been inspected by an authorized agent of the department, and have been found to be safe for use and occupancy.
(e) Any law enforcement or other public safety agency of this state shall grant access to hospital buildings by authorized representatives of the department upon the showing of appropriate credentials.
(f) For purposes of this section, “hospital building” includes the buildings referred to in paragraphs (2) and (3) of subdivision (b) of Section 129725.

SEC. 327.

 Section 130050 of the Health and Safety Code is amended to read:

130050.
 (a)  Within three years after the adoption of the standards described in Section 130020, owners of all general acute care hospitals shall:
(1)  Conduct seismic evaluations in accordance with procedures developed by the department pursuant to subdivision (e) of Section 130005 and submit evaluations to the department for its review and approval.
(2)  Identify the most critical nonstructural systems that represent the greatest risk of failure during an earthquake and submit the timetables for upgrading those systems pursuant to subdivision (f) of Section 130005 to the department for its review and approval.
(3)  With respect to the nonstructural performance evaluation required by this subdivision, the evaluation need not exceed those required by the nonstructural performance category the hospital owner has elected. Additional evaluations shall be obtained if the hospital owner elects to obtain a higher nonstructural performance category at a future date. A hospital owner shall report to the department all deficiencies that are pertinent to the nonstructural performance category the hospital owner has elected to attain. A complete nonstructural evaluation and list of nonstructural deficiencies shall be submitted to the department prior to the hospital owner selling or leasing the hospital to another party.
(b)  Within three years after the adoption of standards described in Section 130020, owners of all general acute care hospitals shall prepare a plan and compliance schedule for each building under the department’s jurisdiction that indicates the steps by which the hospital intends to bring their hospital buildings into substantial compliance with the regulations and standards developed by the department pursuant to the Alfred E. Alquist Hospital Facilities Seismic Safety Act and this act, identifies the phasing out of or retrofit of noncomplying structures and systems, or outlines steps for relocation of acute care services to facilities that comply with the regulations and standards developed by the department pursuant to the Alfred E. Alquist Hospital Facilities Seismic Safety Act and this act, and presents comprehensive plans and compliance schedules to the department for its review and approval, and integrates this schedule into the facility’s master plan.
(c)  Owners of all general acute care hospitals may be granted a one year allowance from the requirements of subdivision (b) by the department if they demonstrate a need for more time to prepare plans and compliance schedules for their buildings.

SEC. 328.

 Section 130055 of the Health and Safety Code is amended to read:

130055.
 Within 60 days following the department’s approval of the report submitted pursuant to subdivision (b) of Section 130050, general acute hospital building owners shall do all of the following:
(a) Inform the local office of emergency services or the equivalent agency, the Office of Emergency Services, and the department, of each building’s expected earthquake performance.
(b) Include all pertinent information regarding the building’s expected earthquake performance in emergency training, response, and recovery plans.
(c) Include all pertinent information regarding the building’s expected earthquake performance in capital outlay plans.

SEC. 329.

 Section 130060 of the Health and Safety Code is amended to read:

130060.
 (a) (1) After January 1, 2008, a general acute care hospital building that is determined to be a potential risk of collapse or pose significant loss of life shall only be used for nonacute care hospital purposes, unless an extension of this deadline has been granted and either of the following occurs before the end of the extension:
(A) A replacement building has been constructed and a certificate of occupancy has been granted by the department for the replacement building.
(B) A retrofit has been performed on the building and a construction final has been obtained by the department.
(2) An extension of the deadline may be granted by the department upon a demonstration by the owner that compliance will result in a loss of health care capacity that may not be provided by other general acute care hospitals within a reasonable proximity. In its request for an extension of the deadline, a hospital shall state why the hospital is unable to comply with the January 1, 2008, deadline requirement.
(3) Prior to granting an extension of the January 1, 2008, deadline pursuant to this section, the department shall do all of the following:
(A) Provide public notice of a hospital’s request for an extension of the deadline. The notice, at a minimum, shall be posted on the department’s internet website, and shall include the facility’s name and identification number, the status of the request, and the beginning and ending dates of the comment period, and shall advise the public of the opportunity to submit public comments pursuant to subparagraph (C). The department shall also provide notice of all requests for the deadline extension directly to interested parties upon request of the interested parties.
(B) Provide copies of extension requests to interested parties within 10 working days to allow interested parties to review and provide comment within the 45-day comment period. The copies shall include those records that are available to the public pursuant to the California Public Records Act (Chapter 3.5 (commencing with Section 6250) of Division 7 of Title 1 of the Government Code).
(C) Allow the public to submit written comments on the extension proposal for a period of not less than 45 days from the date of the public notice.
(b) (1) It is the intent of the Legislature, in enacting this subdivision, to facilitate the process of having more hospital buildings in substantial compliance with this chapter and to take nonconforming general acute care hospital inpatient buildings out of service more quickly.
(2) The functional contiguous grouping of hospital buildings of a general acute care hospital, each of which provides, as the primary source, one or more of the hospital’s eight basic services as specified in subdivision (a) of Section 1250, may receive a five-year extension of the January 1, 2008, deadline specified in subdivision (a) of this section pursuant to this subdivision for both structural and nonstructural requirements. A functional contiguous grouping refers to buildings containing one or more basic hospital services that are either attached or connected in a way that is acceptable to the State Department of Health Care Services. These buildings may be either on the existing site or a new site.
(3) To receive the five-year extension, a single building containing all of the basic services or at least one building within the contiguous grouping of hospital buildings shall have obtained a building permit prior to 1973 and this building shall be evaluated and classified as a nonconforming, Structural Performance Category-1 (SPC-1) building. The classification shall be submitted to and accepted by the Department of Health Care Access and Information. The identified hospital building shall be exempt from the requirement in subdivision (a) until January 1, 2013, if the hospital agrees that the basic service or services that were provided in that building shall be provided, on or before January 1, 2013, as follows:
(A) Moved into an existing conforming Structural Performance Category-3 (SPC-3), Structural Performance Category-4 (SPC-4), or Structural Performance Category-5 (SPC-5) and Non-Structural Performance Category-4 (NPC-4) or Non-Structural Performance Category-5 (NPC-5) building.
(B) Relocated to a newly built compliant SPC-5 and NPC-4 or NPC-5 building.
(C) Continued in the building if the building is retrofitted to an SPC-5 and NPC-4 or NPC-5 building.
(4) A five-year extension is also provided to a post-1973 building if the hospital owner informs the Department of Health Care Access and Information that the building is classified as SPC-1, SPC-3, or SPC-4 and will be closed to general acute care inpatient service use by January 1, 2013. The basic services in the building shall be relocated into an SPC-5 and NPC-4 or NPC-5 building by January 1, 2013.
(5) SPC-1 buildings, other than the building identified in paragraph (3) or (4), in the contiguous grouping of hospital buildings shall also be exempt from the requirement in subdivision (a) until January 1, 2013. However, on or before January 1, 2013, at a minimum, each of these buildings shall be retrofitted to an SPC-2 and NPC-3 building, or no longer be used for general acute care hospital inpatient services.
(c) On or before March 1, 2001, the department shall establish a schedule of interim work progress deadlines that hospitals shall be required to meet to be eligible for the extension specified in subdivision (b). To receive this extension, the hospital building or buildings shall meet the year 2002 nonstructural requirements.
(d) A hospital building that is eligible for an extension pursuant to this section shall meet the January 1, 2030, nonstructural and structural deadline requirements if the building is to be used for general acute care inpatient services after January 1, 2030.
(e) Upon compliance with subdivision (b), the hospital shall be issued a written notice of compliance by the department. The department shall send a written notice of violation to hospital owners that fail to comply with this section. The department shall make copies of these notices available on its internet website.
(f) (1) A hospital that has received an extension of the January 1, 2008, deadline pursuant to subdivision (a) or (b) may request an additional extension of up to two years for a hospital building that it owns or operates and that meets the criteria specified in paragraph (2), (3), or (5).
(2) The department may grant the additional extension if the hospital building subject to the extension meets all of the following criteria:
(A) The hospital building is under construction at the time of the request for extension under this subdivision and the purpose of the construction is to meet the requirements of subdivision (a) to allow the use of the building as a general acute care hospital building after the extension deadline granted by the department pursuant to subdivision (a) or (b).
(B) The hospital building plans were submitted to the department and were deemed ready for review by the department at least four years prior to the applicable deadline for the building. The hospital shall indicate, upon submission of its plans, the SPC-1 building or buildings that will be retrofitted or replaced to meet the requirements of this section as a result of the project.
(C) The hospital received a building permit for the construction described in subparagraph (A) at least two years prior to the applicable deadline for the building.
(D) The hospital submitted a construction timeline at least two years prior to the applicable deadline for the building demonstrating the hospital’s intent to meet the applicable deadline. The timeline shall include all of the following:
(i) The projected construction start date.
(ii) The projected construction completion date.
(iii) Identification of the contractor.
(E) The hospital is making reasonable progress toward meeting the timeline set forth in subparagraph (D), but factors beyond the hospital’s control make it impossible for the hospital to meet the deadline.
(3) The department may grant the additional extension if the hospital building subject to the extension meets all of the following criteria:
(A) The hospital building is owned by a health care district that has, as owner, received the extension of the January 1, 2008, deadline, but where the hospital is operated by an unaffiliated third-party lessee pursuant to a facility lease that extends at least through December 31, 2009. The district shall file a declaration with the department with a request for an extension stating that, as of the date of the filing, the district has lacked, and continues to lack, unrestricted access to the subject hospital building for seismic planning purposes during the term of the lease, and that the district is under contract with the county to maintain hospital services when the hospital comes under district control. The department shall not grant the extension if an unaffiliated third-party lessee will operate the hospital beyond December 31, 2010.
(B) The hospital building plans were submitted to the department and were deemed ready for review by the department at least four years prior to the applicable deadline for the building. The hospital shall indicate, upon submission of its plans, the SPC-1 building or buildings that will be retrofitted or replaced to meet the requirements of this section as a result of the project.
(C) The hospital received a building permit for the construction described in subparagraph (B) by December 31, 2011.
(D) The hospital submitted, by December 31, 2011, a construction timeline for the building demonstrating the hospital’s intent and ability to meet the deadline of December 31, 2014. The timeline shall include all of the following:
(i) The projected construction start date.
(ii) The projected construction completion date.
(iii) Identification of the contractor.
(E) The hospital building is under construction at the time of the request for the extension, the purpose of the construction is to meet the requirements of subdivision (a) to allow the use of the building as a general acute care hospital building after the extension deadline granted by the office pursuant to subdivision (a) or (b), and the hospital is making reasonable progress toward meeting the timeline set forth in subparagraph (D).
(F) The hospital granted an extension pursuant to this paragraph shall submit an additional status report to the department, equivalent to that required by subdivision (c) of Section 130061, no later than June 30, 2013.
(4) An extension granted pursuant to paragraph (3) shall be applicable only to the health care district applicant and its affiliated hospital while the hospital is operated by the district or an entity under the control of the district.
(5) The department may grant the additional extension if the hospital building subject to the extension meets all of the following criteria:
(A) The hospital owner submitted to the department, prior to June 30, 2009, a request for review using current computer modeling utilized by the department and based upon software developed by the Federal Emergency Management Agency (FEMA), referred to as Hazards US, and the building was deemed SPC-1 after that review.
(B) The hospital building plans for the building are submitted to the department and deemed ready for review by the department prior to July 1, 2010. The hospital shall indicate, upon submission of its plans, the SPC-1 building or buildings that shall be retrofitted or replaced to meet the requirements of this section as a result of the project.
(C) The hospital receives a building permit from the department for the construction described in subparagraph (B) prior to January 1, 2012.
(D) The hospital submits, prior to January 1, 2012, a construction timeline for the building demonstrating the hospital’s intent and ability to meet the applicable deadline. The timeline shall include all of the following:
(i) The projected construction start date.
(ii) The projected construction completion date.
(iii) Identification of the contractor.
(E) The hospital building is under construction at the time of the request for the extension, the purpose of the construction is to meet the requirements of subdivision (a) to allow the use of the building as a general acute care hospital building after the extension deadline granted by the department pursuant to subdivision (a) or (b), and the hospital is making reasonable progress toward meeting the timeline set forth in subparagraph (D).
(F) The hospital owner completes construction such that the hospital meets all criteria to enable the department to issue a certificate of occupancy by the applicable deadline for the building.
(6) A hospital located in the County of Sacramento, San Mateo, or Santa Barbara or the City of San Jose or the City of Willits that has received an additional extension pursuant to paragraph (2) or (5) may request an additional extension until September 1, 2015, to obtain either a certificate of occupancy from the department for a replacement building, or a construction final from the department for a building on which a retrofit has been performed.
(7) A hospital denied an extension pursuant to this subdivision may appeal the denial to the Hospital Building Safety Board.
(8) The department may revoke an extension granted pursuant to this subdivision for any hospital building where the work of construction is abandoned or suspended for a period of at least one year, unless the hospital demonstrates in a public document that the abandonment or suspension was caused by factors beyond its control.
(g) (1) Notwithstanding subdivisions (a), (b), (c), and (f), and Sections 130061.5 and 130064, a hospital that has received an extension of the January 1, 2008, deadline pursuant to subdivision (a) or (b) also may request an additional extension of up to seven years for a hospital building that it owns or operates. The department may grant the extension subject to the hospital meeting the milestones set forth in paragraph (2).
(2) The hospital building subject to the extension shall meet all of the following milestones, unless the hospital building is reclassified as SPC-2 or higher as a result of its Hazards US score:
(A) The hospital owner submits to the department, no later than September 30, 2012, a letter of intent stating whether it intends to rebuild, replace, or retrofit the building, or remove all general acute care beds and services from the building, and the amount of time necessary to complete the construction.
(B) The hospital owner submits to the department, no later than September 30, 2012, a schedule detailing why the requested extension is necessary, and specifically how the hospital intends to meet the requested deadline.
(C) The hospital owner submits to the department, no later than September 30, 2012, an application ready for review seeking structural reassessment of each of its SPC-1 buildings using current computer modeling based upon software developed by FEMA, referred to as Hazards US.
(D) The hospital owner submits to the department, no later than January 1, 2015, plans ready for review consistent with the letter of intent submitted pursuant to subparagraph (A) and the schedule submitted pursuant to subparagraph (B).
(E) The hospital owner submits a financial report to the department at the time the plans are submitted pursuant to subparagraph (D). The report shall demonstrate the hospital owner’s financial capacity to implement the construction plans submitted pursuant to subparagraph (D).
(F) The hospital owner receives a building permit consistent with the letter of intent submitted pursuant to subparagraph (A) and the schedule submitted pursuant to subparagraph (B), no later than July 1, 2018.
(3) To evaluate public safety and determine whether to grant an extension of the deadline, the department shall consider the structural integrity of the hospital’s SPC-1 buildings based on its Hazards US scores, community access to essential hospital services, and the hospital owner’s financial capacity to meet the deadline as determined by either a bond rating of BBB or below or the financial report on the hospital owner’s financial capacity submitted pursuant to subparagraph (E) of paragraph (2). The criteria contained in this paragraph shall be considered by the department in its determination of the length of an extension or whether an extension should be granted.
(4) The extension or subsequent adjustments granted pursuant to this subdivision may not exceed the amount of time that is reasonably necessary to complete the construction specified in paragraph (2).
(5) If the circumstances underlying the request for extension submitted to the department pursuant to paragraph (2) change, the hospital owner shall notify the department as soon as practicable, but in no event later than six months after the hospital owner discovered the change of circumstances. The department may adjust the length of the extension granted pursuant to paragraphs (2) and (3) as necessary, but in no event longer than the period specified in paragraph (1).
(6) A hospital denied an extension pursuant to this subdivision may appeal the denial to the Hospital Building Safety Board.
(7) The department may revoke an extension granted pursuant to this subdivision for any hospital building when it is determined that any information submitted pursuant to this section was falsified, or if the hospital failed to meet a milestone set forth in paragraph (2), or where the work of construction is abandoned or suspended for a period of at least six months, unless the hospital demonstrates in a publicly available document that the abandonment or suspension was caused by factors beyond its control.
(8) Regulatory submissions made by the department to the California Building Standards Commission to implement this section shall be deemed to be emergency regulations and shall be adopted as emergency regulations.
(9) The hospital owner that applies for an extension pursuant to this subdivision shall pay the office an additional fee, to be determined by the department, sufficient to cover the additional reasonable costs incurred by the department for maintaining the additional reporting requirements established under this section, including, but not limited to, the costs of reviewing and verifying the extension documentation submitted pursuant to this subdivision. This additional fee shall not include any cost for review of the plans or other duties related to receiving a building or occupancy permit.
(10) This subdivision shall become operative on the date that the State Department of Health Care Services receives all necessary federal approvals for a 2011–12 fiscal year hospital quality assurance fee program that includes three hundred twenty million dollars ($320,000,000) in fee revenue to pay for health care coverage for children, which is made available as a result of the legislative enactment of a 2011–12 fiscal year hospital quality assurance fee program.
(h) A critical access hospital located in the City of Tehachapi may submit a seismic safety extension application pursuant to subdivision (g), notwithstanding deadlines in that subdivision that are earlier than the effective date of the act that added this subdivision. The submitted application shall include a timetable as required pursuant to subdivision (g).
(i) (1) A hospital located in the Tarzana neighborhood of the City of Los Angeles that has received extensions pursuant to subdivisions (b) and (g) may request an additional extension for a single building until October 1, 2022, in order to obtain a certificate of occupancy from the department for a replacement building.
(2) The hospital owner seeking the extension shall submit a written request that includes a timeline specifying how the hospital intends to meet the new deadline, including the construction document submission dates. The following timeline shall be met for construction document submissions:
(A) No later than January 1, 2018, the hospital owner shall submit construction documents, deemed ready for review, related to the first final review of the second increment with information including the building core and shell of the hospital. Failure to submit the construction documents by January 1, 2018, shall result in the assessment of a fine of five thousand dollars ($5,000) per calendar day until the documents are submitted.
(B) No later than March 1, 2018, the hospital owner shall submit construction documents, deemed ready for review, related to the first final review of the first increment with information including the structural foundation, frame, and underslab utilities of the hospital. Failure to submit the construction documents by March 1, 2018, shall result in the assessment of a fine of five thousand dollars ($5,000) per calendar day until the documents are submitted.
(C) No later than September 1, 2018, the hospital owner shall submit construction documents, deemed ready for review, related to the first final review of the third increment with information on the build-out of the hospital. Failure to submit the construction documents by September 1, 2018, shall result in the assessment of a fine of five thousand dollars ($5,000) per calendar day until the documents are submitted.
(D) No later than November 1, 2018, the hospital owner shall submit construction documents, deemed ready for review, related to the first final review of the fourth increment with information on the seismic support and anchorage of the hospital. Failure to submit the construction documents by November 1, 2018, shall result in the assessment of a fine of five thousand dollars ($5,000) per calendar day until the documents are submitted.
(E) The hospital owner may submit a written request to the department seeking an extension of the deadlines set forth in subparagraphs (A), (B), (C), and (D). The written request shall state with specificity the reason for the request and how the reason preventing compliance with the deadlines was outside of the control of the hospital owner. After review of the request for extension, the department may grant the request for a period of time not to exceed 30 calendar days. If the department grants the request for an extension, no fine shall accrue or be imposed during the extension period.
(3) Notwithstanding any other law, any fines assessed pursuant to paragraph (2) shall be deposited into the General Fund following a determination on appeal, if any. A hospital assessed a fine pursuant to this subdivision may appeal the assessment to the Hospital Building Safety Board, provided the hospital posts the funds for any fines to be held by the department pending the resolution of the appeal.
(4) The department shall not issue a certificate of occupancy for the single replacement building until such time as all assessed fines accrued pursuant to paragraph (2) have been paid in full, or, if an appeal is pending, have been posted subject to resolution of an appeal. Fines deposited by the hospital pursuant to paragraph (3) shall be considered paid in full for purposes of issuing a certificate of occupancy pursuant to this paragraph. This paragraph is in addition to, and is not intended to supersede, any other requirements that must be met by the hospital for issuance by the department of a certificate of occupancy.

SEC. 330.

 Section 130061 of the Health and Safety Code is amended to read:

130061.
 (a) An owner of a general acute care hospital building that is classified as a nonconforming Structural Performance Category-1 (SPC-1) building, who has not requested an extension of the deadline described in subdivision (a) or (b) of Section 130060, shall submit a report to the department no later than April 15, 2007, describing the status of each building in complying with the requirements of Section 130060. The report shall identify at least all of the following:
(1) Each building that is subject to subdivision (a) of Section 130060.
(2) The project number or numbers for retrofit or replacement of each building.
(3) The projected construction start date or dates and projected construction completion date or dates.
(4) The building or buildings to be removed from acute care service and the projected date or dates of this action.
(b) An owner of a general acute care hospital building that is classified as a nonconforming, Structural Performance Category-1 (SPC-1) building, who has requested an extension of the deadline described in subdivision (a) or (b) of Section 130060, shall submit a report to the department no later than June 30, 2009, describing the status of each building in complying with the requirements of Section 130060. The report shall identify, at a minimum, all of the following:
(1) Each building that is subject to subdivision (a) of Section 130060.
(2) The project number or numbers for retrofit or replacement of each building.
(3) The projected construction start date or dates and projected construction completion date or dates.
(4) The building or buildings to be removed from acute care service and the projected date or dates of that action.
(c) An owner of a general acute care hospital building that is classified as a nonconforming, Structural Performance Category-1 (SPC-1) building, shall submit a report to the department no later than November 1, 2010, describing the status of each building in complying with the requirements of Section 130060, and annually thereafter shall update the department with any changes or adjustments. The report shall identify at least all of the following:
(1) For each building that is subject to subdivision (a) of Section 130060 that is planned for retrofit or replacement, the report shall identify:
(A)  Whether the hospital owner intends to retrofit or replace the building to SPC-2, SPC-3, SPC-4, or SPC-5.
(B) The deadline, as described in Section 130060 or 130061.5, for retrofit or replacement of the building that the hospital owner intends to meet, and the applicable extension for which the hospital owner has been approved.
(C) The project number or numbers for retrofit or replacement of each building.
(D) The projected construction start date or dates and projected construction completion date or dates.
(E) The most recent project status and approvals.
(F) The number of inpatient beds and patient days, by type of unit and type of service to be provided.
(2) For the building or buildings to be removed from acute care service, the following information shall be included:
(A) The projected date or dates the building will be removed from service.
(B) The planned uses of the building or buildings to be removed from acute care service.
(C) The inpatient services currently delivered in the building or buildings.
(D) The number of inpatient beds and patient days, by type of unit and type of service, for the years 2008, 2009, and 2010.
(E) Whether the general acute care services and beds will be relocated to a new or retrofitted building and any corresponding building sites or project numbers.
(3) Each hospital owner shall also report, for each facility for which any buildings will be removed from acute care service, any net change in the number of inpatient beds, by type of unit and type of service, taking into account beds provided in buildings to be taken out of service, beds provided in buildings to be retrofitted or replaced, and beds provided in any other buildings used for general acute care inpatient services by the facility.
(4) Each hospital owner shall report any general acute care hospital inpatient service that is provided in any general acute care hospital building that is rated SPC-1.
(5) Each hospital owner shall report the final configuration of all buildings on its campus showing how each building will comply with the SPC-5/NPC-4 or 5 requirements, whether by retrofit or by replacement, and the type of services that will be provided in each general acute care hospital building.
(d) The department shall make the information required by subdivisions (a) and (b), available on its internet website within 90 days of receipt of this information.
(e) The department shall make the information required by subdivision (c) available on its internet website within 90 days of receipt of this information. The department shall include the hospital name, hospital owners, and location of the buildings included in the report, and, to the extent possible, for service areas containing buildings for which hospital owners report information pursuant to subdivision (c), include information on the number of inpatient beds, by type of unit and type of service, provided by facilities operating buildings that are classified as SPC-2, SPC-3, SPC-4, and SPC-5.
(f) Hospitals that have not reported pursuant to this section are not eligible for the extension provided in subdivision (f) of Section 130060.
(g) A hospital that has not submitted a report pursuant to this section shall be assessed a fine of ten dollars ($10) per licensed acute care bed per day, but in no case to exceed one thousand dollars ($1,000) per day for each SPC-1 building not in compliance with this section until it has complied with the provisions of this section. These fines shall be deposited into the Hospital Building Fund as specified pursuant to Section 129795. A hospital assessed a fine pursuant to this section may appeal the assessment to the Hospital Building Safety Board.

SEC. 331.

 Section 130061.5 of the Health and Safety Code is amended to read:

130061.5.
 (a) The Legislature finds and declares the following:
(1) By enacting this section, the Legislature reinforces its commitment to ensuring the seismic safety of hospitals in California. In order to meet that commitment, this section provides a mechanism for hospitals that lack the financial capacity to retrofit Structural Performance Category-1 (SPC-1) buildings by 2013 to, instead, redirect available capital and borrowing capacity to replace those building by 2020. The mechanism is intended to allow these hospitals to meet the seismic requirements, and provide state agencies and the public with more timely and detailed information about the progress these hospitals are making toward seismic safety compliance.
(2) This section requires hospitals seeking this assistance to demonstrate that their financial condition does not allow them to retrofit these buildings by 2013, and requires them to meet specified benchmarks in order to be eligible for the extended timelines set forth in this section. Failure to meet any of these benchmarks shall result in the hospital being noncompliant and subject the hospital to loss of licensure.
(3) It is the intent of the Legislature to ensure the continuation of services in medically underserved communities in which the closure of the hospital would have significant negative impacts on access to health care services in the community.
(4) It is also the intent of the Legislature that this section be implemented very narrowly to target only facilities that are essential providers in underserved communities and that lack the financial capacity to retrofit SPC-1 buildings by 2013.
(b) A hospital owner may meet the requirements of subdivision (a) of Section 130060 by replacing all of its buildings subject to that subdivision by January 1, 2020, if it meets all of the following conditions:
(1) The hospital owner has requested an extension of the deadline described in subdivision (a) or (b) of Section 130060.
(2) (A) The department certifies that the hospital owner lacks the financial capacity to meet the requirements of subdivision (a) of Section 130060 for that building. In order to receive the certification, the hospital owner shall file with the department by January 1, 2009, financial information as required by the department. This information shall include a schedule demonstrating that, as of the end of the hospital owner’s most recent fiscal year for which the hospital owner has filed its annual financial data with the department by July 1, 2007, the hospital owner’s annual financial data for that fiscal year show that the hospital owner meets all of the following financial conditions:
(i) The owner’s net long-term debt to capitalization ratio, as measured by the ratio of net long-term debt to net long-term debt plus equity, was above 60 percent.
(ii) The owner’s debt service coverage, as measured by the ratio of net income plus depreciation expense plus interest expense to current maturities on long-term debt plus interest expense, was below 4.5.
(iii) The owner’s cash-to-debt ratio, as measured by the ratio of cash plus marketable securities plus limited use cash plus limited use investments to current maturities on long-term debt plus net long-term debt, was below 90 percent.
(B) The department shall certify that a hospital owner applying for relief under this subdivision meets each of these financial conditions. For the purposes of this subdivision, a hospital owner shall be eligible for certification only if the annual financial data required by this paragraph for the hospital owners and all of its hospital affiliates, considered in total, meets all of these financial conditions. For purposes of this section, “hospital affiliate” means any hospital owned by an entity that controls, is controlled by, or is under the common control of, directly or through intermediate entity, the entity that owns the specified hospital. The applicant hospital owner shall bear all costs for review, but not to exceed the costs of review, of its financial information.
(3) The hospital owner files with the department, by January 1, 2009, a declaration that the hospital for which the hospital owner is seeking relief under this subdivision shall satisfy all of the following conditions:
(A) The hospital shall maintain a contract with the California Medical Assistance Commission (CMAC) under the selective provider contracting program, unless in an open area as established by CMAC.
(B) The hospital shall maintain at least basic emergency medical services if the hospital provided emergency medical services at the basic or higher level as of July 1, 2007.
(C) The hospital meets any of the following criteria:
(i) The hospital is located within a Medically Underserved Area or a Health Professions Shortage Area designated by the federal government pursuant to Sections 330 and 332 of the federal Public Health Service Act (42 U.S.C. Secs. 254b and 254e).
(ii) The department determines, by means of a health impact assessment, that removal of the building or buildings from service may diminish significantly the availability or accessibility of health care services to an underserved community.
(iii) The CMAC determines that the hospital is essential to providing and maintaining Medi-Cal services in the hospital’s service area.
(iv) The hospital demonstrates that, based on annual utilization data submitted to the office for 2006 or later, the hospital had in one year over 30 percent of all discharges for either Medi-Cal or indigent patients in the county in which the hospital is located.
(4) The hospital owner submits, by January 1, 2010, a facility master plan for all the buildings that are subject to subdivision (a) of Section 130060 that the hospital intends to replace by January 1, 2020. The facility master plan shall identify at least all of the following:
(A) Each building that is subject to subdivision (a) of Section 130060.
(B) The plan to replace each building with buildings that would be in compliance with subdivision (a) of Section 130065.
(C) The building or buildings to be removed from acute care service and the projected date or dates of that action.
(D) The location for any new building or buildings, including, but not limited to, whether the owner has received a permit for that location. The replacement buildings shall be planned within the same service area as the buildings to be removed from service.
(E) A copy of the preliminary design for the new building or buildings.
(F) The number of beds available for acute care use in each new building.
(G) The timeline for completed plan submission.
(H) The proposed construction timeline.
(I) The proposed cost at the time of submission.
(J) A copy of any records indicating the hospital governing board’s approval of the facility plan.
(5) By January 1, 2013, the hospital owner submits to the department a building plan that is deemed ready for review by the department, for each building.
(6) By January 1, 2015, the hospital owner receives a building permit to begin construction, for each building that the owner intends to replace pursuant to the master plan.
(7) Within six months of receipt of the building permit, the hospital owner submits a construction timeline that identifies at least all of the following:
(A) Each building that is subject to subdivision (a) of Section 130060.
(B) The project number or numbers for replacement of each building.
(C) The projected construction start date or dates and projected construction completion date or dates.
(D) The building or buildings to be removed from acute care.
(E) The estimated cost of construction.
(F) The name of the contractor.
(8) Every six months thereafter, the hospital owner reports to the department on the status of the project, including any delays or circumstances that could materially affect the estimated completion date.
(9) The hospital owner pays to the department an additional fee, to be determined by the department, sufficient to cover the additional cost incurred by the department for maintaining all reporting requirements established under this section, including, but not limited to, the costs of reviewing and verifying the financial information submitted pursuant to paragraph (2). This additional fee shall not include any cost for review of the plans or other duties related to receiving a building or occupancy permit.
(c) The department may also approve an extension of the deadline described in subdivision (a) or (b) of Section 130060 for a general acute care hospital building that is classified as a nonconforming SPC-1 building and is owned or operated by a county, city, or county and city that has requested an extension of this deadline by June 30, 2009, if the owner files a declaration with the department stating that as of the date of that filing the owner lacks the ability to meet the requirements of subdivision (a) of Section 130060 for that building pursuant to subdivision (b) of that section. The declaration shall state the commitment of the hospital to replace those buildings by January 1, 2020, with other buildings that meet the requirements of Section 130065 and shall meet the requirements of paragraphs (4) to (9), inclusive, of subdivision (b).
(d) A hospital filing a declaration pursuant to this section but failing to meet any of the deadlines set forth in this section shall be deemed in violation of this section and Section 130060, and shall be subject to loss of licensure.

SEC. 332.

 Section 130062 of the Health and Safety Code is amended to read:

130062.
 (a) For the purposes of this section, the following terms have the following meanings:
(1) “Rebuild plan” means a plan to meet seismic standards primarily by constructing a new conforming SPC-5 building for use in lieu of an SPC-1 building.
(2) “Removal plan” means a plan to meet seismic standards primarily by removing acute care services or beds from the hospital’s license.
(3) “Replacement plan” means a plan to meet seismic standards primarily by relocating acute care services or beds from nonconforming buildings into a conforming building.
(4) “Retrofit plan” means a plan to meet seismic standards primarily by modifying the building in a manner that brings the building up to SPC-2, SPC-4D, or SPC-5 standards.
(b) (1) Except as specified in paragraph (2), all hospitals seeking an extension for their SPC-1 buildings shall submit to the department an application, in a manner acceptable to the department, by April 1, 2019.
(2) If Providence Tarzana Medical Center in the City of Los Angeles or UCSF Benioff Children’s Hospital in the City of Oakland seeks an extension for its SPC-1 buildings, it shall submit to the department an application, in a manner acceptable to the department, by September 1, 2019.
(3) At a minimum, an application described in paragraph (1) or (2) shall state which of the seismic compliance methods described in subdivision (a) will be used for each SPC-1 building.
(c) A hospital owner that has been granted an extension pursuant to subdivision (g) of Section 130060 or subdivision (b) of Section 130061.5 may request, and the department shall grant, an additional extension of time as set forth in this section.
(d) (1) For a hospital that seeks an extension for compliance based on a replacement plan or retrofit plan, the owner shall submit a construction schedule, obtain a building permit, and begin construction by April 1, 2020.
(2) Using the construction schedule submitted pursuant to paragraph (1), the hospital and the department shall identify at least two major milestones relating to the compliance plan that will be used as the basis for determining whether the hospital is making adequate progress toward meeting the seismic compliance deadline.
(3) Failure to comply with the requirements described in paragraph (1) or (2), or to meet any milestone agreed to pursuant to paragraph (2), shall result in the assessment of a fine of five thousand dollars ($5,000) per calendar day until the requirements or milestones, respectively, are met.
(4) Final seismic compliance shall be achieved by July 1, 2022.
(e) (1) For a hospital that seeks an extension for compliance based on a rebuild plan, the department shall grant an extension of up to five years. The owner shall submit, in a manner acceptable to the department, no later than July 1, 2020, the rebuild plan, deemed ready for review, and shall submit a construction schedule, obtain a building permit, and begin construction no later than January 1, 2022.
(2) The hospital and the department shall identify at least two major milestones, agreed upon by the hospital and the department, that will be used as the basis for determining whether the hospital is making adequate progress toward meeting the seismic compliance deadline.
(3) Failure to comply with the requirements described in paragraph (1) or (4), or to meet any milestone agreed to pursuant to paragraph (2) or (4), shall result in the assessment of a fine of five thousand dollars ($5,000) per calendar day until the requirements or milestones, respectively, are met.
(4) For a hospital that has previously submitted to the department a rebuild project under construction, the department may accept certification from the hospital that it has obtained appropriate building permits consistent with an approved incremental plan review and that construction thereunder has commenced and is continuing. The previously approved construction schedule shall be amended to reflect the extension being requested, and at least two new major milestones shall be identified. The owner shall not be required to resubmit construction plans previously submitted to the department, and the department may not impose new or different requirements for any increment already approved or building permit already issued by the department as a condition for granting an extension.
(5) Final seismic compliance shall be achieved, and a certificate of occupancy shall be obtained, by January 1, 2025.
(f) The department may grant an adjustment to the requirements described in paragraph (1) or (2) of subdivision (d) or paragraph (1) or (4) of subdivision (e), or the milestones agreed to pursuant to paragraph (2) of subdivision (d) or paragraph (2) or (4) of subdivision (e), as necessary to deal with contractor, labor, or material delays, or with acts of God, or with governmental entitlements, experienced by the hospital. If that adjustment is granted, the hospital shall submit a revised construction schedule, and the hospital and the department shall identify at least two new major milestones consistent with the adjustment. Failure to comply with the revised construction schedule or meet any of the major milestones shall result in penalties as specified in paragraph (3) of subdivision (d) and paragraph (3) of subdivision (e). The adjustment shall not exceed the corresponding final seismic compliance date specified in paragraph (4) of subdivision (d) or paragraph (5) of subdivision (e).
(g) The duration of an extension granted by the department pursuant to this section shall not exceed the maximums permitted by this section. Moreover, within that limit, the department shall not grant an extension that exceeds the amount of time needed by the owner to come into compliance. The determination by the department regarding the length of the extension to be granted shall be based upon a showing by the owner of the facts necessitating the additional time. It shall include a review of the plan and all the documentation submitted in the application for the extension, and shall permit only that additional time necessary to allow the owner to deal with compliance plan issues that cannot be fully met without the extension.
(h) No extension shall be granted pursuant to this section for SPC-1 buildings unless the owner has submitted to the department, by January 1, 2018, a seismic compliance plan.
(i) An extension shall not be granted pursuant to this section for seismic compliance based upon a removal plan.
(j) (1) Except as specified in paragraph (2), in lieu of the reporting requirements described in Section 130061, a hospital granted an extension pursuant to this section shall provide a quarterly status report to the department, with the first report due on July 1, 2019, and every October 1, January 1, April 1, and July 1 thereafter, until seismic compliance is achieved.
(2) In lieu of the reporting requirements described in Section 130061, if Providence Tarzana Medical Center in the City of Los Angeles or UCSF Benioff Children’s Hospital in the City of Oakland is granted an extension pursuant to this section based on an application submitted on or after April 1, 2019, the first quarterly status report shall be due on October 1, 2019, and every January 1, April 1, July 1, and October 1 thereafter, until seismic compliance is achieved.
(3) The office shall post the status reports described in paragraphs (1) and (2) on its internet website.
(k) Before June 1, 2019, the office shall provide the Legislature with an inventory of the SPC category of each hospital building. A report submitted to the Legislature pursuant to this subdivision shall be submitted in compliance with Section 9795 of the Government Code.
(l) (1) The office may revoke an extension granted pursuant to this section for a hospital building where the assessment for a penalty exceeds 60 days.
(2) Notwithstanding any other law, any penalties assessed pursuant to this section shall be deposited into the General Fund within 45 days of assessment or within 45 days following a determination on appeal, if any. A hospital assessed a penalty pursuant to this section may appeal the assessment to the Hospital Building Safety Board, provided the hospital posts the funds for any penalties with the department, to be held pending the resolution of the appeal.
(3) The department shall not issue a construction final or certificate of occupancy for the building until all assessed penalties accrued pursuant to this section have been paid in full or, if an appeal is pending, have been posted subject to resolution of the appeal. Penalties deposited by the hospital pursuant to paragraph (2) shall be considered paid in full for purposes of issuing a construction final or certificate of occupancy. This paragraph is in addition to, and is not intended to supersede, any other requirements that must be met by the hospital for issuance of a construction final or certificate of occupancy.
(m) The department may promulgate emergency regulations as necessary to implement this section.

SEC. 333.

 Section 130063 of the Health and Safety Code is amended to read:

130063.
 (a)  With regard to a general acute care hospital building located in Seismic Zone 3 as indicated in the 1995 edition of the California Building Standards Code, any hospital may request an exemption from Non-Structural Performance Category-3 requirements in Title 24 of the California Code of Regulations if the hospital building complies with the year 2002 nonstructural requirements.
(b)  The department shall determine the maximum allowable level of earthquake ground shaking potential for purposes of this section.
(c)  To qualify for an exemption under this section, a hospital shall provide a site-specific engineering geologic report that demonstrates an earthquake ground shaking potential below the maximum allowable level of earthquake ground shaking potential determined by the department pursuant to subdivision (b).
(d)  (1)  To demonstrate an earthquake ground shaking potential as provided in subdivision (c), a hospital shall submit a site-specific engineering geologic report to the department.
(2)  The department shall forward the report received from a hospital to the Division of Mines and Geology in the Department of Conservation for purposes of a review.
(3)  If, after review of the analysis, the Division of Mines and Geology concurs with the findings of the report, it shall return the report with a statement of concurrence to the office. Upon the receipt of the statement, if the ground shaking potential is below that established pursuant to subdivision (b), the department shall grant the exemption requested.
(e)  A hospital building that is eligible for an exemption under this section shall meet the January 1, 2030, nonstructural requirement deadline if the building is to be used for general acute care inpatient services after January 1, 2030.
(f)  A hospital requesting an exemption pursuant to this section shall pay the actual expenses incurred by the department and the Division of Mines and Geology.
(g)  All regulatory submissions to the California Building Standards Commission made by the department for purposes of this section shall be deemed to be emergency regulations and shall be adopted as emergency regulations. This emergency regulation authority shall remain in effect until January 1, 2004.

SEC. 334.

 Section 130063.1 of the Health and Safety Code is amended to read:

130063.1.
 Notwithstanding Section 130063, a county-owned general acute care hospital building is allowed an extension of the Non-structural Performance Category-2 requirements of Title 24 of the California Code of Regulations if all of the following conditions are met:
(a)  The county submitted the compliance plan on or before January 1, 2001.
(b)  The county submitted the Non-structural Performance Category-2 building plans to the Department of Health Care Access and Information on or before September 1, 2001.
(c)  The county complies with the year 2002 nonstructural requirements established by regulation 12 months after receipt of the building permit approval letter from the Department of Health Care Access and Information.

SEC. 335.

 Section 130064 of the Health and Safety Code is amended to read:

130064.
 (a) In lieu of the extension described in subdivision (f) of Section 130060, the department may grant an extension to a general acute care hospital pursuant to either subdivision (c) or (f) if the hospital building will not meet the seismic safety standards of that section by January 1, 2013, due to a local planning delay.
(b) When applying for an extension under this section, the owner of the general acute care hospital shall submit to the department documentation that includes at least all of the following:
(1) The original schedule of the project or projects as had been originally anticipated.
(2) The schedule of the project or projects as currently projected.
(3) A timeline for the submission of documents to the local planning authority or jurisdiction.
(4) Documentation that the local planning authority for the project and for the enabling phases of the project does not grant approvals prior to November 1, 2010, where the hospital had originally filed the local application prior to January 1, 2008.
(5) A proposed construction timeframe demonstrating the completion of the project once the permit is issued. The construction timeframe shall be approved by the department and shall only include the amount of time that is reasonably necessary to complete the construction required to meet the seismic safety requirements.
(c) The department may grant an extension, in full one-year increments, but no longer than three consecutive years, that compensates for delays determined pursuant to subdivision (d).
(d) The department shall conduct a comprehensive review of the schedule for the project or projects according to criteria specified in this section. This review shall encompass the project or projects under the jurisdiction of the department, as well as other project phases not under the jurisdiction of the department. The department shall consider the cumulative effect of local approval timelines for all elements of the project or projects, inclusive of changes in scope or sequence of the project or projects required by the local planning process. The department may grant extensions based on an evaluation of each of the following circumstances:
(1) Where the local planning authority approvals have delayed or will delay the construction start date of the project or projects.
(2) Where the local conditions of approval on a project or projects extend the duration beyond the originally anticipated construction completion date.
(3) Where the cumulative effect of delays on the project or projects creates additional construction delays due to local seasonal weather impact requirements of the local planning authority.
(4) Construction related to the seismic retrofit or replacement project has begun by January 1, 2013.
(5) The project or projects were submitted for review by the department no later than January 1, 2009.
(6) The project or projects have received a building permit from the department no later than January 1, 2012.
(e) Every six months after the approval of the extension, the hospital owner shall report to the department on the status of the project or projects, demonstrating that it is making reasonable progress toward meeting the construction timeline.
(f) The department may grant an additional extension of up to two years in addition to the extension granted pursuant to subdivisions (c) and (d) only if the project or projects meet all of the following criteria:
(1) A matrix of buildings at the hospital that identifies compliance of each building to the standards required by Section 130065 at the completion of the project or projects.
(2) The construction timelines submitted pursuant to subdivision (a) were determined to go beyond three years from the date the building permit was issued.
(3) Acute care services will not be provided in any SPC-1 building at any time during the extension.
(4) The hospital demonstrates that it has, and maintains throughout the extension, life safety systems in all acute care patient care areas that do not depend on, and are not routed through, an SPC-1 building.
(5) The hospital either demonstrates that the SPC-1 building does not pose a structural risk to an adjoining hospital building that is used for acute care services or mitigates the risk in accordance with a deadline described in subdivision (f) of Section 130060 that the department determines will best protect patient safety.
(g) The department may revoke an extension granted pursuant to this section for any hospital building where the work of construction is abandoned or suspended for a period of at least six months, unless the hospital demonstrates that the abandonment or suspension was caused by factors beyond its control.
(h) The department may revoke an extension granted pursuant to this section if it is determined that any information submitted pursuant to this section was falsified in any manner by the hospital or if the hospital fails to meet any of the criteria or conditions specified in this section.
(i) Regulatory submissions made by the department to the California Building Standards Commission pursuant to this section shall be deemed, and shall be adopted as, emergency regulations.
(j) The hospital owner that applies for an extension pursuant to this section shall pay to the department an additional fee, to be determined by the department, sufficient to cover the additional cost incurred by the office for maintaining all reporting requirements established under this section, including, but not limited to, the costs of reviewing and verifying the extension documentation submitted pursuant to this section. This additional fee shall not include any cost for review of the plans or other duties related to receiving a building or occupancy permit.
(k) A hospital denied an extension pursuant to this section may appeal the denial to the Hospital Building Safety Board.

SEC. 336.

 Section 130065 of the Health and Safety Code is amended to read:

130065.
 In accordance with the compliance schedule approved by the department, but in any case no later than January 1, 2030, owners of all acute care inpatient hospitals shall either:
(a)  Demolish, replace, or change to nonacute care use all hospital buildings not in substantial compliance with the regulations and standards developed by the department pursuant to the Alfred E. Alquist Hospital Facilities Seismic Safety Act and this act.
(b)  Seismically retrofit all acute care inpatient hospital buildings so that they are in substantial compliance with the regulations and standards developed by the department pursuant to the Alfred E. Alquist Hospital Facilities Seismic Safety Act and this act.
Upon compliance with this section, the hospital shall be issued a written notice of compliance by the department. The department shall send a written notice of violation to hospital owners that fail to comply with this section.

SEC. 337.

 Section 130066 of the Health and Safety Code is amended to read:

130066.
 Before January 1, 2020, the owner of an acute care inpatient hospital whose building does not substantially comply with the seismic safety regulations or standards described in Section 130065 shall submit to the department an attestation that the board of directors of that hospital is aware that the hospital building is required to meet the January 1, 2030, deadline for substantial compliance with those regulations and standards.

SEC. 338.

 Section 130070 of the Health and Safety Code is amended to read:

130070.
 The department shall notify the State Department of Public Health of the hospital owners that have received a written notice of violation for failure to comply with either Section 130060 or 130065. Unless the hospital places its license in voluntary suspense, the State Department of Public Health shall suspend or refuse to renew the license of a hospital that has received a notice of violation from the department because of its failure to comply with either Section 130060 or 130065. The license shall be reinstated or renewed upon presentation to the State Department of Public Health of a written notice of compliance issued by the department.

SEC. 339.

 The heading of Chapter 2 of Part 7 of Division 107 of the Health and Safety Code is repealed.

SEC. 340.

 Division 109.7 (commencing with Section 130290) is added to the Health and Safety Code, to read:

DIVISION 109.7. California Health and Human Services Data Exchange Framework

130290.
 (a) On or before July 1, 2022, and subject to an appropriation in the annual Budget Act, the California Health and Human Services Agency, along with its departments and offices and in consultation with stakeholders and local partners, shall establish the California Health and Human Services Data Exchange Framework that shall 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 government agencies in California.
(1) The California Health and Human Services Data Exchange Framework is not intended to be an information technology system or single repository of data, rather it is technology agnostic and is a collection of organizations that are required to share health information using national standards and a common set of policies in order to improve the health outcomes of the individuals they serve.
(2) The California Health and Human Services Data Exchange Framework will be designed to enable and require real-time access to, or exchange of, health information among health care providers and payers through any health information exchange network, health information organization, or technology that adheres to specified standards and policies.
(3) The California Health and Human Services Data Exchange Framework shall align with state and federal data requirements, including the federal Health Insurance Portability and Accountability Act of 1996 (Public Law 104-191), the Confidentiality of Medical Information Act of 1996 (Part 2.6 (commencing with Section 56) of Division 1 of the Civil Code), and other applicable state and federal privacy laws related to the sharing of data among and between providers, payers, and the government, while also streamlining and reducing reporting burden.
(4) For the purposes of this section, “health information” means:
(A) For hospitals, clinics, and physician practices, at a minimum, the United States Core Data for Interoperability Version 1, until October 6, 2022. After that date, it shall include all electronic health information as defined under federal regulation in Section 171.102 of Title 45 of the Code of Federal Regulations and held by the entity.
(B) For health insurers and health care service plans, at a minimum, the data required to be shared under the Centers for Medicare and Medicaid Services Interoperability and Patient Access regulations for public programs as contained in United States Department of Health and Human Services final rule CMS-9115-F, 85 FR 25510.
(b) (1)  On or before January 31, 2024, the entities listed in subdivision (f), except those identified in paragraph (2), shall exchange health information or provide access to health information to and from every other entity in subdivision (f) in real time as specified by the California Health and Human Services Agency pursuant to the California Health and Human Services Data Exchange Framework data sharing agreement for treatment, payment, or health care operations.
(2) The requirement in paragraph (1) shall not apply to physician practices of fewer than 25 physicians, rehabilitation hospitals, long-term acute care hospitals, acute psychiatric hospitals, critical access hospitals, and rural general acute care hospitals with fewer than 100 acute care beds, state-run acute psychiatric hospitals, and any nonprofit clinic with fewer than 10 health care providers until January 31, 2026.
(c) The California Health and Human Services Agency shall convene a stakeholder advisory group no later than September 1, 2021, to advise on the development and implementation of the California Health and Human Services Data Exchange Framework.
(1) The members of the stakeholder advisory group shall be appointed by the Secretary of California Health and Human Services and shall not have a financial interest, individually or through a family member, related to issues the stakeholder advisory group will advise on.
(2) The stakeholder advisory group shall be composed of health care stakeholders and experts, including representatives of all the following:
(A) The State Department of Health Care Services.
(B) The State Department of Social Services.
(C) The Department of Managed Health Care.
(D) The Department of Health Care Access and Information.
(E) The State Department of Public Health.
(F) The Department of Insurance.
(G) The Public Employees’ Retirement System.
(H) The California Health Benefit Exchange.
(I) Health care service plans and health insurers.
(J) Physicians, including those with small practices.
(K) Hospitals, including public, private, rural, and critical access hospitals.
(L) Clinics, long-term care facilities, behavioral health facilities, or substance use disorder facilities.
(M) Consumers.
(N) Organized labor.
(O) Privacy and security professionals.
(P) Health information technology professionals.
(Q) Community health information organizations.
(R) County health, social services, and public health.
(S) Community-based organizations providing social services.
(3) The stakeholder advisory group shall provide information and advice to the California Health and Human Services Agency on health information technology issues, including all of the following:
(A) Identify which data beyond health information as defined in paragraph (4) of subdivision (a), at minimum, should be shared for specified purposes between the entities outlined in this subdivision and subdivision (f).
(B) Identify gaps, and propose solutions to gaps, in the life cycle of health information, including gaps in any of the following:
(i) Health information creation, including the use of national standards in clinical documentation, health plan records, and social services data.
(ii) Translation, mapping, controlled vocabularies, coding, and data classification.
(iii) Storage, maintenance, and management of health information.
(iv) Linking, sharing, exchanging, and providing access to health information.
(C) Identify ways to incorporate data related to social determinants of health, such as housing and food insecurity, into shared health information.
(D) Identify ways to incorporate data related to underserved or underrepresented populations, including, but not limited to, data regarding sexual orientation and gender identity and racial and ethnic minorities.
(E) Identify ways to incorporate relevant data on behavioral health and substance use disorder conditions.
(F) Address the privacy, security, and equity risks of expanding care coordination, health information exchange, access, and telehealth in a dynamic technological, and entrepreneurial environment, where data and network security are under constant threat of attack.
(G) Develop policies and procedures consistent with national standards and federally adopted standards in the exchange of health information and ensure that health information sharing broadly implements national frameworks and agreements consistent with federal rules and programs.
(H) Develop definitions of complete clinical, administrative, and claims data consistent with federal policies and national standards.
(I) Identify how all payers will be required to provide enrollees with electronic access to their health information, consistent with rules applicable to federal payer programs.
(J) Assess governance structures to help guide policy decisions and general oversight.
(K) Identify federal, state, private, or philanthropic sources of funding that could support data access and exchange.
(4) The stakeholder advisory group shall hold public meetings with stakeholders, solicit input, and set its own meeting agendas. Meetings of the stakeholder advisory group are subject to the Bagley-Keene Open Meeting Act (Article 9 (commencing with Section 11120) of Chapter 1 of Part 1 of Division 3 of Title 2 of the Government Code).
(5) The members of the stakeholder advisory group shall serve without compensation, but shall be reimbursed for any actual and necessary expenses incurred in connection with their duties as members of the group.
(d) No later than April 1, 2022, the California Health and Human Services Agency shall submit an update, including written recommendations, to the Legislature based on input from the stakeholder advisory group on the issues identified in paragraph (3) of subdivision (c).
(e) On or before January 31, 2023, the California Health and Human Services Agency shall work with the California State Association of Counties to encourage the inclusion of county health, public health, and social services, to the extent possible, as part of the California Health and Human Services Data Exchange Framework in order to assist both public and private entities to connect through uniform standards and policies. It is the intent of the Legislature that all state and local public health agencies will exchange electronic health information in real time with participating health care entities to protect and improve the health and well-being of Californians.
(f) On or before January 31, 2023, and in alignment with existing federal standards and policies, the following health care organizations shall execute the California Health and Human Services Data Exchange Framework data sharing agreement pursuant to subdivision (a):
(1) General acute care hospitals, as defined by Section 1250.
(2) Physician organizations and medical groups.
(3) Skilled nursing facilities, as defined by Section 1250, that currently maintain electronic records.
(4) Health care service plans and disability insurers that provide hospital, medical, or surgical coverage that are regulated by the Department of Managed Health Care or the Department of Insurance. This section shall also apply to a Medi-Cal managed care plan under a comprehensive risk contract with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) or Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code that is not regulated by the Department of Managed Health Care or the Department of Insurance.
(5) Clinical laboratories, as that term is used in Section 1265 of the Business and Professions Code, and that are regulated by the State Department of Public Health.
(6) Acute psychiatric hospitals, as defined by Section 1250.
(g) The California Health and Human Services Agency shall work with experienced nonprofit organizations and entities represented in the stakeholder advisory group in subdivision (c) to provide technical assistance to the entities outlined in subdivisions (e) and (f).
(h) On or before July 31, 2022, the California Health and Human Services Agency shall develop in consultation with the stakeholder advisory group in subdivision (c) a strategy for unique, secure digital identities capable of supporting master patient indices to be implemented by both private and public organizations in California.
(i) For purposes of implementing this section, including, but not limited to, hiring staff and consultants, facilitating and conducting meetings, conducting research and analysis, and developing the required reports, the California Health and Human Services Agency may enter into exclusive or nonexclusive contracts on a bid or negotiated basis. Contracts entered into or amended pursuant to this section shall be exempt from Chapter 6 (commencing with Section 14825) of Part 5.5 of Division 3 of Title 2 of the Government Code, Section 19130 of the Government Code, and Part 2 (commencing with Section 10100) of Division 2 of the Public Contract Code, and shall be exempt from the review or approval of any division of the Department of General Services. No person hired or otherwise retained pursuant to this subdivision shall be permitted to have any financial interest in the California Health and Human Services Data Exchange Framework or shall be, or be affiliated with, any health care organization required to participate in the California Health and Human Services Data Exchange Framework pursuant to subdivisions (b) and (f). The term “person,” as used in this subdivision, means any individual, partnership, joint venture, association, corporation, or any other organization or any combination thereof.
(j) All actions to implement the California Health and Human Services Data Exchange Framework, including the adoption or development of any data sharing agreement, requirements, policies and procedures, guidelines, subgrantee contract provisions, or reporting requirements, shall be exempt from the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code). The California Health and Human Services Agency, or a designee department or office under its jurisdiction, shall release program notices that detail the requirements of the California Health and Human Services Data Exchange Framework.

SEC. 341.

 Section 131300 of the Health and Safety Code is amended to read:

131300.
 (a) The State Department of Public Health is hereby authorized to establish the Office of Suicide Prevention in the department pursuant to this chapter. The responsibilities of the office, if established, may include all of the following:
(1) Providing information and technical assistance to statewide and regional partners regarding best practices on suicide prevention policies and programs.
(2) Conducting state level assessment of regional and statewide suicide prevention policies and practices, including other states’ suicide prevention policies, and including specific metrics and domains as appropriate.
(3) Monitoring and disseminating data to inform prevention efforts at the state and local levels.
(4) Convening experts and stakeholders, including, but not limited to, stakeholders representing populations with high rates of suicide, to encourage collaboration and coordination of resources for suicide prevention.
(5) Reporting on progress to reduce rates of suicide.
(b) If established, the office may focus activities on groups with the highest risk, including youth, Native American youth, older adults, veterans, and LGBTQ people.

SEC. 342.

 Section 10144.53 is added to the Insurance Code, to read:

10144.53.
 (a) (1) A disability insurance policy issued, amended, renewed, or delivered on or after January 1, 2024, that is required to provide coverage for medically necessary treatment of mental health and substance use disorders pursuant to Sections 10144.5, 10144.51, and 10144.52 shall cover the provision of the services identified in the fee-for-service reimbursement schedule published by the State Department of Health Care Services, as described in subparagraph (B) of paragraph (5) of subdivision (c), when those services are delivered at schoolsites pursuant to this section, regardless of the network status of the local educational agency, institution of higher education, or health care provider.
(2) This section does not relieve a local educational agency or institution of higher education from requirements to accommodate or provide services to students with disabilities pursuant to any applicable state and federal law, including, but not limited to, the federal Individuals with Disabilities Education Act (20 U.S.C. Sec. 1400 et seq.), Part 30 (commencing with Section 56000) of Division 4 of Title 2 of the Education Code, Chapter 26.5 (commencing with Section 7570) of Division 7 of Title 1 of the Government Code, and Chapter 3 (commencing with Section 3000) of Division 1 of Title 5 of the California Code of Regulations.
(b) The following definitions apply for purposes of this section:
(1) “Health care provider” has the same meaning as defined in paragraph (4) of subdivision (a) of Section 10144.5 and paragraph (5) of subdivision (c) of Section 10144.51.
(2) “Institution of higher education” means the California Community Colleges, the California State University, or the University of California.
(3) “Local educational agency” means a school district, county office of education, charter school, the California Schools for the Deaf, and the California School for the Blind.
(4) “Medically necessary treatment of a mental health or substance use disorder” has the same meaning as defined in paragraph (3) of subdivision (a) of Section 10144.5.
(5) “Mental health and substance use disorders” has the same meaning as defined in paragraph (2) of subdivision (a) of Section 10144.5.
(6) “Schoolsite” means a facility or location used for public kindergarten, elementary, secondary, or postsecondary purposes. “Schoolsite” also includes a location not owned or operated by a public school, or public school district if the school or school district provides or arranges for the provision of medically necessary treatment of a mental health or substance use disorder to its students at that location, including off-campus clinics, mobile counseling services, and similar locations.
(7) “Utilization review” has the same meaning as defined in paragraph (3) of subdivision (f) of Section 10144.52.
(c) If a local educational agency or institution of higher education provides or arranges for the provision of treatment of a mental health or substance use disorder services subject to this section by a health care provider at a schoolsite for an individual 25 years of age or younger, the student’s disability insurer shall reimburse the local educational agency or institution of higher education for those services.
(1) A disability insurer shall not require prior authorization for services provided pursuant to this section.
(2) A disability insurer may conduct a postclaim review to determine appropriate payment of the claim. Payment for services subject to this section may be denied only if the disability insurer reasonably determines that the services were provided to a student not covered by the insurer, were never performed, or were not provided by a health care provider appropriately licensed or authorized to provide the services.
(3) Notwithstanding paragraph (1), a disability insurer may require prior authorization for services as authorized by the commissioner, pursuant to subdivision (d).
(4) A local educational agency, community college district, the California State University system, or the Regents of the University of California may consolidate claims for purposes of submission to a disability insurer.
(5) A disability insurer shall provide reimbursement for services provided to students pursuant to this section at the greater of either of the following amounts:
(A) The disability insurer’s contracted rate with the local educational agency, institution of higher education, or health care provider, if any.
(B) The fee-for-service reimbursement rate published by the State Department of Health Care Services for the same or similar services provided in an outpatient setting, pursuant to Section 5961.4 of the Welfare and Institutions Code.
(6) A disability insurer shall provide reimbursement for services provided pursuant to this section in compliance with the requirements for timely payment of claims as required by this chapter.
(7) Services provided pursuant to this section shall not be subject to copayment, coinsurance, deductible, or any other form of cost sharing.
(8) An individual or entity shall not bill the policyholder or insured, nor seek reimbursement from the policyholder or insured, for services provided pursuant to this section.
(d) No later than December 31, 2023, the commissioner shall issue guidance to disability insurers regarding compliance with this section. This guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code). Guidance issued pursuant to this subdivision shall be effective only until the commissioner adopts regulations pursuant to the Administrative Procedure Act.

SEC. 343.

 Section 1370 of the Penal Code is amended to read:

1370.
 (a) (1) (A) If the defendant is found mentally competent, the criminal process shall resume, the trial on the offense charged or hearing on the alleged violation shall proceed, and judgment may be pronounced.
(B) If the defendant is found mentally incompetent, the trial, the hearing on the alleged violation, or the judgment shall be suspended until the person becomes mentally competent.
(i) The court shall order that the mentally incompetent defendant be delivered by the sheriff to a State Department of State Hospitals facility, as defined in Section 4100 of the Welfare and Institutions Code, as directed by the State Department of State Hospitals, or to any other available public or private treatment facility, including a community-based residential treatment system established pursuant to Article 1 (commencing with Section 5670) of Chapter 2.5 of Part 2 of Division 5 of the Welfare and Institutions Code if the facility has a secured perimeter or a locked and controlled treatment facility, approved by the community program director that will promote the defendant’s speedy restoration to mental competence, or placed on outpatient status as specified in Section 1600.
(ii) However, if the action against the defendant who has been found mentally incompetent is on a complaint charging a felony offense specified in Section 290, the prosecutor shall determine whether the defendant previously has been found mentally incompetent to stand trial pursuant to this chapter on a charge of a Section 290 offense, or whether the defendant is currently the subject of a pending Section 1368 proceeding arising out of a charge of a Section 290 offense. If either determination is made, the prosecutor shall notify the court and defendant in writing. After this notification, and opportunity for hearing, the court shall order that the defendant be delivered by the sheriff to a State Department of State Hospitals facility, as directed by the State Department of State Hospitals, or other secure treatment facility for the care and treatment of persons with a mental health disorder, unless the court makes specific findings on the record that an alternative placement would provide more appropriate treatment for the defendant and would not pose a danger to the health and safety of others.
(iii) If the action against the defendant who has been found mentally incompetent is on a complaint charging a felony offense specified in Section 290 and the defendant has been denied bail pursuant to subdivision (b) of Section 12 of Article I of the California Constitution because the court has found, based upon clear and convincing evidence, a substantial likelihood that the person’s release would result in great bodily harm to others, the court shall order that the defendant be delivered by the sheriff to a State Department of State Hospitals facility, as directed by the State Department of State Hospitals, unless the court makes specific findings on the record that an alternative placement would provide more appropriate treatment for the defendant and would not pose a danger to the health and safety of others.
(iv) If, at any time after the court finds that the defendant is mentally incompetent and before the defendant is transported to a facility pursuant to this section, the court is provided with any information that the defendant may benefit from diversion pursuant to Chapter 2.8A (commencing with Section 1001.35) of Title 6, the court may make a finding that the defendant is an appropriate candidate for diversion.
(v) If a defendant is found by the court to be an appropriate candidate for diversion pursuant to clause (iv), the defendant’s eligibility shall be determined pursuant to Section 1001.36. A defendant granted diversion may participate for the lesser of the period specified in paragraph (1) of subdivision (c) or two years. If, during that period, the court determines that criminal proceedings should be reinstated pursuant to subdivision (d) of Section 1001.36, the court shall, pursuant to Section 1369, appoint a psychiatrist, licensed psychologist, or any other expert the court may deem appropriate, to determine the defendant’s competence to stand trial.
(vi) Upon the dismissal of charges at the conclusion of the period of diversion, pursuant to subdivision (e) of Section 1001.36, a defendant shall no longer be deemed incompetent to stand trial pursuant to this section.
(vii) The clerk of the court shall notify the Department of Justice, in writing, of a finding of mental incompetence with respect to a defendant who is subject to clause (ii) or (iii) for inclusion in the defendant’s state summary criminal history information.
(C) Upon the filing of a certificate of restoration to competence, the court shall order that the defendant be returned to court in accordance with Section 1372. The court shall transmit a copy of its order to the community program director or a designee.
(D) A defendant charged with a violent felony may not be delivered to a State Department of State Hospitals facility or treatment facility pursuant to this subdivision unless the State Department of State Hospitals facility or treatment facility has a secured perimeter or a locked and controlled treatment facility, and the judge determines that the public safety will be protected.
(E) For purposes of this paragraph, “violent felony” means an offense specified in subdivision (c) of Section 667.5.
(F) A defendant charged with a violent felony may be placed on outpatient status, as specified in Section 1600, only if the court finds that the placement will not pose a danger to the health or safety of others. If the court places a defendant charged with a violent felony on outpatient status, as specified in Section 1600, the court shall serve copies of the placement order on defense counsel, the sheriff in the county where the defendant will be placed, and the district attorney for the county in which the violent felony charges are pending against the defendant.
(G) If, at any time after the court has declared a defendant incompetent to stand trial pursuant to this section, counsel for the defendant or a jail medical or mental health staff provider provides the court with substantial evidence that the defendant’s psychiatric symptoms have changed to such a degree as to create a doubt in the mind of the judge as to the defendant’s current mental incompetence, the court may appoint a psychiatrist or a licensed psychologist to opine as to whether the defendant has regained competence. If, in the opinion of that expert, the defendant has regained competence, the court shall proceed as if a certificate of restoration of competence has been returned pursuant to paragraph (1) of subdivision (a) of Section 1372, except that a presumption of competency shall not apply and a hearing shall be held to determine whether competency has been restored.
(H) (i) The State Department of State Hospitals may, pursuant to Section 4335.2 of the Welfare and Institutions Code, conduct an evaluation of the defendant in county custody to determine any of the following:
(I) The defendant has regained competence.
(II) There is no substantial likelihood that the defendant will regain competence in the foreseeable future.
(III) The defendant should be referred to the county for further evaluation for potential participation in a county diversion program, if one exists, or to another outpatient treatment program.
(ii) If, in the opinion of the department’s expert, the defendant has regained competence, the court shall proceed as if a certificate of restoration of competence has been returned pursuant to paragraph (1) of subdivision (a) of Section 1372, except that a presumption of competency shall not apply and a hearing shall be held to determine whether competency has been restored.
(iii) If, in the opinion of the department’s expert, there is no substantial likelihood that the defendant will regain mental competence in the foreseeable future, the committing court shall proceed pursuant to paragraph (2) of subdivision (c) no later than 10 days following receipt of the report.
(2) Prior to making the order directing that the defendant be committed to the State Department of State Hospitals or other treatment facility or placed on outpatient status, the court shall proceed as follows:
(A) The court shall order the community program director or a designee to evaluate the defendant and to submit to the court within 15 judicial days of the order a written recommendation as to whether the defendant should be required to undergo outpatient treatment, or be committed to the State Department of State Hospitals or to any other treatment facility. A person shall not be admitted to a State Department of State Hospitals facility or other treatment facility or placed on outpatient status under this section without having been evaluated by the community program director or a designee. The community program director or designee shall evaluate the appropriate placement for the defendant between a State Department of State Hospitals facility or the community-based residential treatment system based upon guidelines provided by the State Department of State Hospitals.
(B) The court shall hear and determine whether the defendant lacks capacity to make decisions regarding the administration of antipsychotic medication. The court shall consider opinions in the reports prepared pursuant to subdivision (a) of Section 1369, as applicable to the issue of whether the defendant lacks capacity to make decisions regarding the administration of antipsychotic medication, and shall proceed as follows:
(i) The court shall hear and determine whether any of the following is true:
(I) The defendant lacks capacity to make decisions regarding antipsychotic medication, the defendant’s mental disorder requires medical treatment with antipsychotic medication, and, if the defendant’s mental disorder is not treated with antipsychotic medication, it is probable that serious harm to the physical or mental health of the defendant will result. Probability of serious harm to the physical or mental health of the defendant requires evidence that the defendant is presently suffering adverse effects to their physical or mental health, or the defendant has previously suffered these effects as a result of a mental disorder and their condition is substantially deteriorating. The fact that a defendant has a diagnosis of a mental disorder does not alone establish probability of serious harm to the physical or mental health of the defendant.
(II) The defendant is a danger to others, in that the defendant has inflicted, attempted to inflict, or made a serious threat of inflicting substantial physical harm on another while in custody, or the defendant had inflicted, attempted to inflict, or made a serious threat of inflicting substantial physical harm on another that resulted in the defendant being taken into custody, and the defendant presents, as a result of mental disorder or mental defect, a demonstrated danger of inflicting substantial physical harm on others. Demonstrated danger may be based on an assessment of the defendant’s present mental condition, including a consideration of past behavior of the defendant within six years prior to the time the defendant last attempted to inflict, inflicted, or threatened to inflict substantial physical harm on another, and other relevant evidence.
(III) The people have charged the defendant with a serious crime against the person or property, involuntary administration of antipsychotic medication is substantially likely to render the defendant competent to stand trial, the medication is unlikely to have side effects that interfere with the defendant’s ability to understand the nature of the criminal proceedings or to assist counsel in the conduct of a defense in a reasonable manner, less intrusive treatments are unlikely to have substantially the same results, and antipsychotic medication is in the defendant’s best medical interest in light of their medical condition.
(ii) If the court finds any of the conditions described in clause (i) to be true, the court shall issue an order authorizing involuntary administration of antipsychotic medication to the defendant when and as prescribed by the defendant’s treating psychiatrist at any facility housing the defendant for purposes of this chapter. The order shall be valid for no more than one year, pursuant to subparagraph (A) of paragraph (7). The court shall not order involuntary administration of psychotropic medication under subclause (III) of clause (i) unless the court has first found that the defendant does not meet the criteria for involuntary administration of psychotropic medication under subclause (I) of clause (i) and does not meet the criteria under subclause (II) of clause (i).
(iii) In all cases, the treating hospital, facility, or program may administer medically appropriate antipsychotic medication prescribed by a psychiatrist in an emergency as described in subdivision (m) of Section 5008 of the Welfare and Institutions Code.
(iv) If the court has determined that the defendant has the capacity to make decisions regarding antipsychotic medication, and if the defendant, with advice of their counsel, consents, the court order of commitment shall include confirmation that antipsychotic medication may be given to the defendant as prescribed by a treating psychiatrist pursuant to the defendant’s consent. The commitment order shall also indicate that, if the defendant withdraws consent for antipsychotic medication, after the treating psychiatrist complies with the provisions of subparagraph (C), the defendant shall be returned to court for a hearing in accordance with subparagraphs (C) and (D) regarding whether antipsychotic medication shall be administered involuntarily.
(v) If the court has determined that the defendant has the capacity to make decisions regarding antipsychotic medication and if the defendant, with advice from their counsel, does not consent, the court order for commitment shall indicate that, after the treating psychiatrist complies with the provisions of subparagraph (C), the defendant shall be returned to court for a hearing in accordance with subparagraphs (C) and (D) regarding whether antipsychotic medication shall be administered involuntarily.
(vi) A report made pursuant to paragraph (1) of subdivision (b) shall include a description of antipsychotic medication administered to the defendant and its effects and side effects, including effects on the defendant’s appearance or behavior that would affect the defendant’s ability to understand the nature of the criminal proceedings or to assist counsel in the conduct of a defense in a reasonable manner. During the time the defendant is confined in a State Department of State Hospitals facility or other treatment facility or placed on outpatient status, either the defendant or the people may request that the court review any order made pursuant to this subdivision. The defendant, to the same extent enjoyed by other patients in the State Department of State Hospitals facility or other treatment facility, shall have the right to contact the patients’ rights advocate regarding the defendant’s rights under this section.
(C) If the defendant consented to antipsychotic medication as described in clause (iv) of subparagraph (B), but subsequently withdraws their consent, or, if involuntary antipsychotic medication was not ordered pursuant to clause (v) of subparagraph (B), and the treating psychiatrist determines that antipsychotic medication has become medically necessary and appropriate, the treating psychiatrist shall make efforts to obtain informed consent from the defendant for antipsychotic medication. If informed consent is not obtained from the defendant, and the treating psychiatrist is of the opinion that the defendant lacks capacity to make decisions regarding antipsychotic medication based on the conditions described in subclause (I) or (II) of clause (i) of subparagraph (B), the treating psychiatrist shall certify whether the lack of capacity and any applicable conditions described above exist. That certification shall contain an assessment of the current mental status of the defendant and the opinion of the treating psychiatrist that involuntary antipsychotic medication has become medically necessary and appropriate.
(D) (i) If the treating psychiatrist certifies that antipsychotic medication has become medically necessary and appropriate pursuant to subparagraph (C), antipsychotic medication may be administered to the defendant for not more than 21 days, provided, however, that, within 72 hours of the certification, the defendant is provided a medication review hearing before an administrative law judge to be conducted at the facility where the defendant is receiving treatment. The treating psychiatrist shall present the case for the certification for involuntary treatment and the defendant shall be represented by an attorney or a patients’ rights advocate. The attorney or patients’ rights advocate shall be appointed to meet with the defendant no later than one day prior to the medication review hearing to review the defendant’s rights at the medication review hearing, discuss the process, answer questions or concerns regarding involuntary medication or the hearing, assist the defendant in preparing for the hearing and advocating for the defendant’s interests at the hearing, review the panel’s final determination following the hearing, advise the defendant of their right to judicial review of the panel’s decision, and provide the defendant with referral information for legal advice on the subject. The defendant shall also have the following rights with respect to the medication review hearing:
(I) To be given timely access to the defendant’s records.
(II) To be present at the hearing, unless the defendant waives that right.
(III) To present evidence at the hearing.
(IV) To question persons presenting evidence supporting involuntary medication.
(V) To make reasonable requests for attendance of witnesses on the defendant’s behalf.
(VI) To a hearing conducted in an impartial and informal manner.
(ii) If the administrative law judge determines that the defendant either meets the criteria specified in subclause (I) of clause (i) of subparagraph (B), or meets the criteria specified in subclause (II) of clause (i) of subparagraph (B), antipsychotic medication may continue to be administered to the defendant for the 21-day certification period. Concurrently with the treating psychiatrist’s certification, the treating psychiatrist shall file a copy of the certification and a petition with the court for issuance of an order to administer antipsychotic medication beyond the 21-day certification period. For purposes of this subparagraph, the treating psychiatrist shall not be required to pay or deposit any fee for the filing of the petition or other document or paper related to the petition.
(iii) If the administrative law judge disagrees with the certification, medication may not be administered involuntarily until the court determines that antipsychotic medication should be administered pursuant to this section.
(iv) The court shall provide notice to the prosecuting attorney and to the attorney representing the defendant, and shall hold a hearing, no later than 18 days from the date of the certification, to determine whether antipsychotic medication should be ordered beyond the certification period.
(v) If, as a result of the hearing, the court determines that antipsychotic medication should be administered beyond the certification period, the court shall issue an order authorizing the administration of that medication.
(vi) The court shall render its decision on the petition and issue its order no later than three calendar days after the hearing and, in any event, no later than the expiration of the 21-day certification period.
(vii) If the administrative law judge upholds the certification pursuant to clause (ii), the court may, for a period not to exceed 14 days, extend the certification and continue the hearing pursuant to stipulation between the parties or upon a finding of good cause. In determining good cause, the court may review the petition filed with the court, the administrative law judge’s order, and any additional testimony needed by the court to determine if it is appropriate to continue medication beyond the 21-day certification and for a period of up to 14 days.
(viii) The district attorney, county counsel, or representative of a facility where a defendant found incompetent to stand trial is committed may petition the court for an order to administer involuntary medication pursuant to the criteria set forth in subclauses (II) and (III) of clause (i) of subparagraph (B). The order is reviewable as provided in paragraph (7).
(3) When the court orders that the defendant be committed to a State Department of State Hospitals facility or other public or private treatment facility, the court shall provide copies of the following documents prior to the admission of the defendant to the State Department of State Hospitals or other treatment facility where the defendant is to be committed:
(A) The commitment order, including a specification of the charges.
(B) A computation or statement setting forth the maximum term of commitment in accordance with subdivision (c).
(C) A computation or statement setting forth the amount of credit for time served, if any, to be deducted from the maximum term of commitment.
(D) State summary criminal history information.
(E) Arrest reports prepared by the police department or other law enforcement agency.
(F) Court-ordered psychiatric examination or evaluation reports.
(G) The community program director’s placement recommendation report.
(H) Records of a finding of mental incompetence pursuant to this chapter arising out of a complaint charging a felony offense specified in Section 290 or a pending Section 1368 proceeding arising out of a charge of a Section 290 offense.
(I) Medical records.
(4) When the defendant is committed to a treatment facility pursuant to clause (i) of subparagraph (B) of paragraph (1) or the court makes the findings specified in clause (ii) or (iii) of subparagraph (B) of paragraph (1) to assign the defendant to a treatment facility other than a State Department of State Hospitals facility or other secure treatment facility, the court shall order that notice be given to the appropriate law enforcement agency or agencies having local jurisdiction at the placement facility of a finding of mental incompetence pursuant to this chapter arising out of a charge of a Section 290 offense.
(5) When directing that the defendant be confined in a State Department of State Hospitals facility pursuant to this subdivision, the court shall commit the defendant to the State Department of State Hospitals.
(6) (A) If the defendant is committed or transferred to the State Department of State Hospitals pursuant to this section, the court may, upon receiving the written recommendation of the medical director of the State Department of State Hospitals facility and the community program director that the defendant be transferred to a public or private treatment facility approved by the community program director, order the defendant transferred to that facility. If the defendant is committed or transferred to a public or private treatment facility approved by the community program director, the court may, upon receiving the written recommendation of the community program director, transfer the defendant to the State Department of State Hospitals or to another public or private treatment facility approved by the community program director. In the event of dismissal of the criminal charges before the defendant recovers competence, the person shall be subject to the applicable provisions of the Lanterman-Petris-Short Act (Part 1 (commencing with Section 5000) of Division 5 of the Welfare and Institutions Code). If either the defendant or the prosecutor chooses to contest either kind of order of transfer, a petition may be filed in the court for a hearing, which shall be held if the court determines that sufficient grounds exist. At the hearing, the prosecuting attorney or the defendant may present evidence bearing on the order of transfer. The court shall use the same standards as are used in conducting probation revocation hearings pursuant to Section 1203.2.
Prior to making an order for transfer under this section, the court shall notify the defendant, the attorney of record for the defendant, the prosecuting attorney, and the community program director or a designee.
(B) If the defendant is initially committed to a State Department of State Hospitals facility or secure treatment facility pursuant to clause (ii) or (iii) of subparagraph (B) of paragraph (1) and is subsequently transferred to any other facility, copies of the documents specified in paragraph (3) shall be electronically transferred or taken with the defendant to each subsequent facility to which the defendant is transferred. The transferring facility shall also notify the appropriate law enforcement agency or agencies having local jurisdiction at the site of the new facility that the defendant is a person subject to clause (ii) or (iii) of subparagraph (B) of paragraph (1).
(7) (A) An order by the court authorizing involuntary medication of the defendant shall be valid for no more than one year. The court shall review the order at the time of the review of the initial report and the six-month progress reports pursuant to paragraph (1) of subdivision (b) to determine if the grounds for the authorization remain. In the review, the court shall consider the reports of the treating psychiatrist or psychiatrists and the defendant’s patients’ rights advocate or attorney. The court may require testimony from the treating psychiatrist and the patients’ rights advocate or attorney, if necessary. The court may continue the order authorizing involuntary medication for up to another six months, or vacate the order, or make any other appropriate order.
(B) Within 60 days before the expiration of the one-year involuntary medication order, the district attorney, county counsel, or representative of any facility where a defendant found incompetent to stand trial is committed may petition the committing court for a renewal, subject to the same conditions and requirements as in subparagraph (A). The petition shall include the basis for involuntary medication set forth in clause (i) of subparagraph (B) of paragraph (2). Notice of the petition shall be provided to the defendant, the defendant’s attorney, and the district attorney. The court shall hear and determine whether the defendant continues to meet the criteria set forth in clause (i) of subparagraph (B) of paragraph (2). The hearing on a petition to renew an order for involuntary medication shall be conducted prior to the expiration of the current order.
(8) For purposes of subparagraph (D) of paragraph (2) and paragraph (7), if the treating psychiatrist determines that there is a need, based on preserving their rapport with the defendant or preventing harm, the treating psychiatrist may request that the facility medical director designate another psychiatrist to act in the place of the treating psychiatrist. If the medical director of the facility designates another psychiatrist to act pursuant to this paragraph, the treating psychiatrist shall brief the acting psychiatrist of the relevant facts of the case and the acting psychiatrist shall examine the defendant prior to the hearing.
(b) (1) Within 90 days after a commitment made pursuant to subdivision (a), the medical director of the State Department of State Hospitals facility or other treatment facility to which the defendant is confined shall make a written report to the court and the community program director for the county or region of commitment, or a designee, concerning the defendant’s progress toward recovery of mental competence and whether the administration of antipsychotic medication remains necessary.
If the defendant is in county custody, the county jail shall provide access to the defendant for purposes of the State Department of State Hospitals conducting an evaluation of the defendant pursuant to Section 4335.2 of the Welfare and Institutions Code. Based upon this evaluation, the State Department of State Hospitals may make a written report to the court within 90 days of a commitment made pursuant to subdivision (a) concerning the defendant’s progress toward recovery of mental incompetence and whether the administration of antipsychotic medication is necessary. If the defendant remains in county custody after the initial 90-day report, the State Department of State Hospitals may conduct an evaluation of the defendant pursuant to Section 4335.2 of the Welfare and Institutions Code and make a written report to the court concerning the defendant’s progress toward recovery of mental incompetence and whether the administration of antipsychotic medication is necessary.
If the defendant is on outpatient status, the outpatient treatment staff shall make a written report to the community program director concerning the defendant’s progress toward recovery of mental competence. Within 90 days of placement on outpatient status, the community program director shall report to the court on this matter. If the defendant has not recovered mental competence, but the report discloses a substantial likelihood that the defendant will regain mental competence in the foreseeable future, the defendant shall remain in the State Department of State Hospitals facility or other treatment facility or on outpatient status. Thereafter, at six-month intervals or until the defendant becomes mentally competent, if the defendant is confined in a treatment facility, the medical director of the State Department of State Hospitals facility or person in charge of the facility shall report, in writing, to the court and the community program director or a designee regarding the defendant’s progress toward recovery of mental competence and whether the administration of antipsychotic medication remains necessary. If the defendant is on outpatient status, after the initial 90-day report, the outpatient treatment staff shall report to the community program director on the defendant’s progress toward recovery, and the community program director shall report to the court on this matter at six-month intervals. A copy of these reports shall be provided to the prosecutor and defense counsel by the court.
(A) If the report indicates that there is no substantial likelihood that the defendant will regain mental competence in the foreseeable future, custody of the defendant shall be transferred without delay to the committing county and shall remain with the county until further order of the court. The defendant shall be returned to the court for proceedings pursuant to paragraph (2) of subdivision (c) no later than 10 days following receipt of the report. The court shall not order the defendant returned to the custody of the State Department of State Hospitals under the same commitment. The court shall transmit a copy of its order to the community program director or a designee.
(B) If the report indicates that there is no substantial likelihood that the defendant will regain mental competence in the foreseeable future, the medical director of the State Department of State Hospitals facility or other treatment facility to which the defendant is confined shall do both of the following:
(i) Promptly notify and provide a copy of the report to the defense counsel and the district attorney.
(ii) Provide a separate notification, in compliance with applicable privacy laws, to the committing county’s sheriff that immediate transportation will be needed for the defendant pursuant to subparagraph (A).
(C) If a county does not take custody of a defendant committed to the State Department of State Hospitals within 10 calendar days following notification made pursuant to clause (ii) of subparagraph (B), the county shall be charged the daily rate for a state hospital bed, as established by the State Department of State Hospitals.
(2) If the court has issued an order authorizing the treating facility to involuntarily administer antipsychotic medication to the defendant, the reports made pursuant to paragraph (1) concerning the defendant’s progress toward regaining competency shall also consider the issue of involuntary medication. Each report shall include, but not be limited to, all of the following:
(A) Whether or not the defendant has the capacity to make decisions concerning antipsychotic medication.
(B) If the defendant lacks capacity to make decisions concerning antipsychotic medication, whether the defendant risks serious harm to their physical or mental health if not treated with antipsychotic medication.
(C) Whether or not the defendant presents a danger to others if the defendant is not treated with antipsychotic medication.
(D) Whether the defendant has a mental disorder for which medications are the only effective treatment.
(E) Whether there are any side effects from the medication currently being experienced by the defendant that would interfere with the defendant’s ability to collaborate with counsel.
(F) Whether there are any effective alternatives to medication.
(G) How quickly the medication is likely to bring the defendant to competency.
(H) Whether the treatment plan includes methods other than medication to restore the defendant to competency.
(I) A statement, if applicable, that no medication is likely to restore the defendant to competency.
(3) After reviewing the reports, the court shall determine whether or not grounds for the order authorizing involuntary administration of antipsychotic medication still exist and shall do one of the following:
(A) If the original grounds for involuntary medication still exist, the order authorizing the treating facility to involuntarily administer antipsychotic medication to the defendant shall remain in effect.
(B) If the original grounds for involuntary medication no longer exist, and there is no other basis for involuntary administration of antipsychotic medication, the order for the involuntary administration of antipsychotic medication shall be vacated.
(C) If the original grounds for involuntary medication no longer exist, and the report states that there is another basis for involuntary administration of antipsychotic medication, the court shall set a hearing within 21 days to determine whether the order for the involuntary administration of antipsychotic medication shall be vacated or whether a new order for the involuntary administration of antipsychotic medication shall be issued. The hearing shall proceed as set forth in subparagraph (B) of paragraph (2) of subdivision (a).
(4) If it is determined by the court that treatment for the defendant’s mental impairment is not being conducted, the defendant shall be returned to the committing court, and, if the defendant is not in county custody, returned to the custody of the county. The court shall transmit a copy of its order to the community program director or a designee.
(5) At each review by the court specified in this subdivision, the court shall determine if the security level of housing and treatment is appropriate and may make an order in accordance with its determination. If the court determines that the defendant shall continue to be treated in the State Department of State Hospitals facility or on an outpatient basis, the court shall determine issues concerning administration of antipsychotic medication, as set forth in subparagraph (B) of paragraph (2) of subdivision (a).
(c) (1) At the end of two years from the date of commitment or a period of commitment equal to the maximum term of imprisonment provided by law for the most serious offense charged in the information, indictment, or misdemeanor complaint, or the maximum term of imprisonment provided by law for a violation of probation or mandatory supervision, whichever is shorter, but no later than 90 days prior to the expiration of the defendant’s term of commitment, a defendant who has not recovered mental competence shall be returned to the committing court, and custody of the defendant shall be transferred without delay to the committing county and shall remain with the county until further order of the court. The court shall not order the defendant returned to the custody of the State Department of State Hospitals under the same commitment. The court shall notify the community program director or a designee of the return and of any resulting court orders.
(2) (A) The medical director of the State Department of State Hospitals facility or other treatment facility to which the defendant is confined shall provide notification, in compliance with applicable privacy laws, to the committing county’s sheriff that immediate transportation will be needed for the defendant pursuant to paragraph (1).
(B) If a county does not take custody of a defendant committed to the State Department of State Hospitals within 10 calendar days following notification pursuant to subparagraph (A), the county shall be charged the daily rate for a state hospital bed, as established by the State Department of State Hospitals.
(3) Whenever a defendant is returned to the court pursuant to paragraph (1) or (4) of subdivision (b) or paragraph (1) of this subdivision and it appears to the court that the defendant is gravely disabled, as defined in subparagraph (A) or (B) of paragraph (1) of subdivision (h) of Section 5008 of the Welfare and Institutions Code, the court shall order the conservatorship investigator of the county of commitment of the defendant to initiate conservatorship proceedings for the defendant pursuant to Chapter 3 (commencing with Section 5350) of Part 1 of Division 5 of the Welfare and Institutions Code. Hearings required in the conservatorship proceedings shall be held in the superior court in the county that ordered the commitment. The court shall transmit a copy of the order directing initiation of conservatorship proceedings to the community program director or a designee, the sheriff and the district attorney of the county in which criminal charges are pending, and the defendant’s counsel of record. The court shall notify the community program director or a designee, the sheriff and district attorney of the county in which criminal charges are pending, and the defendant’s counsel of record of the outcome of the conservatorship proceedings.
(4) If a change in placement is proposed for a defendant who is committed pursuant to subparagraph (A) or (B) of paragraph (1) of subdivision (h) of Section 5008 of the Welfare and Institutions Code, the court shall provide notice and an opportunity to be heard with respect to the proposed placement of the defendant to the sheriff and the district attorney of the county in which the criminal charges or revocation proceedings are pending.
(5) If the defendant is confined in a treatment facility, a copy of any report to the committing court regarding the defendant’s progress toward recovery of mental competence shall be provided by the committing court to the prosecutor and to the defense counsel.
(d) With the exception of proceedings alleging a violation of mandatory supervision, the criminal action remains subject to dismissal pursuant to Section 1385. If the criminal action is dismissed, the court shall transmit a copy of the order of dismissal to the community program director or a designee. In a proceeding alleging a violation of mandatory supervision, if the person is not placed under a conservatorship as described in paragraph (3) of subdivision (c), or if a conservatorship is terminated, the court shall reinstate mandatory supervision and may modify the terms and conditions of supervision to include appropriate mental health treatment or refer the matter to a local mental health court, reentry court, or other collaborative justice court available for improving the mental health of the defendant.
(e) If the criminal action against the defendant is dismissed, the defendant shall be released from commitment ordered under this section, but without prejudice to the initiation of proceedings that may be appropriate under the Lanterman-Petris-Short Act (Part 1 (commencing with Section 5000) of Division 5 of the Welfare and Institutions Code).
(f) As used in this chapter, “community program director” means the person, agency, or entity designated by the State Department of State Hospitals pursuant to Section 1605 of this code and Section 4360 of the Welfare and Institutions Code.
(g) For the purpose of this section, “secure treatment facility” does not include, except for State Department of State Hospitals facilities, state developmental centers, and correctional treatment facilities, any facility licensed pursuant to Chapter 2 (commencing with Section 1250) of, Chapter 3 (commencing with Section 1500) of, or Chapter 3.2 (commencing with Section 1569) of, Division 2 of the Health and Safety Code, or any community board and care facility.
(h) This section does not preclude a defendant from filing a petition for habeas corpus to challenge the continuing validity of an order authorizing a treatment facility or outpatient program to involuntarily administer antipsychotic medication to a person being treated as incompetent to stand trial.

SEC. 344.

 Section 1370.01 of the Penal Code is amended to read:

1370.01.
 (a) (1) If the defendant is found mentally competent, the criminal process shall resume, the trial on the offense charged shall proceed, and judgment may be pronounced. If the defendant is found mentally incompetent, the trial, judgment, or hearing on the alleged violation shall be suspended until the person becomes mentally competent, and the court shall order that (A) in the meantime, the defendant be delivered by the sheriff to an available public or private treatment facility approved by the county mental health director that will promote the defendant’s speedy restoration to mental competence, or placed on outpatient status as specified in this section, and (B) upon the filing of a certificate of restoration to competence, the defendant be returned to court in accordance with Section 1372. The court shall transmit a copy of its order to the county mental health director or the director’s designee.
(2) If the defendant is found mentally incompetent, the court may make a finding that the defendant is an appropriate candidate for diversion pursuant to Chapter 2.8A (commencing with Section 1001.35) of Title 6, and may, if the defendant is eligible pursuant to Section 1001.36, grant diversion for a period not to exceed that set forth in paragraph (1) of subdivision (c). Upon the dismissal of charges at the conclusion of the period of diversion, pursuant to subdivision (e) of Section 1001.36, a defendant shall no longer be deemed incompetent to stand trial pursuant to this section.
(3) Prior to making the order directing that the defendant be confined in a treatment facility or placed on outpatient status, the court shall proceed as follows:
(A) The court shall order the county mental health director or the director’s designee to evaluate the defendant and to submit to the court within 15 judicial days of the order a written recommendation as to whether the defendant should be required to undergo outpatient treatment, or committed to a treatment facility. No person shall be admitted to a treatment facility or placed on outpatient status under this section without having been evaluated by the county mental health director or the director’s designee. No person shall be admitted to a state hospital under this section.
(B) The court shall hear and determine whether the defendant, with advice of their counsel, consents to the administration of antipsychotic medication, and shall proceed as follows:
(i) If the defendant, with advice of their counsel, consents, the court order of commitment shall include confirmation that antipsychotic medication may be given to the defendant as prescribed by a treating psychiatrist pursuant to the defendant’s consent. The commitment order shall also indicate that, if the defendant withdraws consent for antipsychotic medication, after the treating psychiatrist complies with the provisions of subparagraph (C), the defendant shall be returned to court for a hearing in accordance with this subdivision regarding whether antipsychotic medication shall be administered involuntarily.
(ii) If the defendant does not consent to the administration of medication, the court shall hear and determine whether any of the following is true:
(I) The defendant lacks capacity to make decisions regarding antipsychotic medication, the defendant’s mental disorder requires medical treatment with antipsychotic medication, and, if the defendant’s mental disorder is not treated with antipsychotic medication, it is probable that serious harm to the physical or mental health of the patient will result. Probability of serious harm to the physical or mental health of the defendant requires evidence that the defendant is presently suffering adverse effects to their physical or mental health, or the defendant has previously suffered these effects as a result of a mental disorder and their condition is substantially deteriorating. The fact that a defendant has a diagnosis of a mental disorder does not alone establish probability of serious harm to the physical or mental health of the defendant.
(II) The defendant is a danger to others, in that the defendant has inflicted, attempted to inflict, or made a serious threat of inflicting substantial physical harm on another while in custody, or the defendant had inflicted, attempted to inflict, or made a serious threat of inflicting substantial physical harm on another that resulted in the defendant being taken into custody, and the defendant presents, as a result of mental disorder or mental defect, a demonstrated danger of inflicting substantial physical harm on others. Demonstrated danger may be based on an assessment of the defendant’s present mental condition, including a consideration of past behavior of the defendant within six years prior to the time the defendant last attempted to inflict, inflicted, or threatened to inflict substantial physical harm on another, and other relevant evidence.
(III) The people have charged the defendant with a serious crime against the person or property; involuntary administration of antipsychotic medication is substantially likely to render the defendant competent to stand trial; the medication is unlikely to have side effects that interfere with the defendant’s ability to understand the nature of the criminal proceedings or to assist counsel in the conduct of a defense in a reasonable manner; less intrusive treatments are unlikely to have substantially the same results; and antipsychotic medication is in the patient’s best medical interest in light of their medical condition.
(iii) If the court finds any of the conditions described in clause (ii) to be true, the court shall issue an order authorizing the treatment facility to involuntarily administer antipsychotic medication to the defendant when and as prescribed by the defendant’s treating psychiatrist. The court shall not order involuntary administration of psychotropic medication under subclause (III) of clause (ii) unless the court has first found that the defendant does not meet the criteria for involuntary administration of psychotropic medication under subclause (I) of clause (ii) and does not meet the criteria under subclause (II) of clause (ii).
(iv) In all cases, the treating hospital, facility, or program may administer medically appropriate antipsychotic medication prescribed by a psychiatrist in an emergency as described in subdivision (m) of Section 5008 of the Welfare and Institutions Code.
(v) Any report made pursuant to subdivision (b) shall include a description of any antipsychotic medication administered to the defendant and its effects and side effects, including effects on the defendant’s appearance or behavior that would affect the defendant’s ability to understand the nature of the criminal proceedings or to assist counsel in the conduct of a defense in a reasonable manner. During the time the defendant is confined in a treatment facility or placed on outpatient status, either the defendant or the people may request that the court review any order made pursuant to this subdivision. The defendant, to the same extent enjoyed by other patients in the treatment facility, shall have the right to contact the patients’ rights advocate regarding the defendant’s rights under this section.
(C) If the defendant consented to antipsychotic medication as described in clause (i) of subparagraph (B), but subsequently withdraws their consent, or, if involuntary antipsychotic medication was not ordered pursuant to clause (ii) of subparagraph (B), and the treating psychiatrist determines that antipsychotic medication has become medically necessary and appropriate, the treating psychiatrist shall make efforts to obtain informed consent from the defendant for antipsychotic medication. If informed consent is not obtained from the defendant, and the treating psychiatrist is of the opinion that the defendant lacks capacity to make decisions regarding antipsychotic medication as specified in subclause (I) of clause (ii) of subparagraph (B), or that the defendant is a danger to others as specified in subclause (II) of clause (ii) of subparagraph (B), the committing court shall be notified of this, including an assessment of the current mental status of the defendant and the opinion of the treating psychiatrist that involuntary antipsychotic medication has become medically necessary and appropriate. The court shall provide copies of the report to the prosecuting attorney and to the attorney representing the defendant and shall set a hearing to determine whether involuntary antipsychotic medication should be ordered in the manner described in subparagraph (B).
(4) When the court, after considering the placement recommendation of the county mental health director required in paragraph (3), orders that the defendant be confined in a public or private treatment facility, the court shall provide copies of the following documents which shall be taken with the defendant to the treatment facility where the defendant is to be confined:
(A) The commitment order, including a specification of the charges.
(B) A computation or statement setting forth the maximum term of commitment in accordance with subdivision (c).
(C) A computation or statement setting forth the amount of credit for time served, if any, to be deducted from the maximum term of commitment.
(D) State summary criminal history information.
(E) Any arrest reports prepared by the police department or other law enforcement agency.
(F) Any court-ordered psychiatric examination or evaluation reports.
(G) The county mental health director’s placement recommendation report.
(5) A person subject to commitment under this section may be placed on outpatient status under the supervision of the county mental health director or the director’s designee by order of the court in accordance with the procedures contained in Title 15 (commencing with Section 1600) except that where the term “community program director” appears the term “county mental health director” shall be substituted.
(6) (A) If the defendant is committed or transferred to a public or private treatment facility approved by the county mental health director, the court may, upon receiving the written recommendation of the county mental health director, transfer the defendant to another public or private treatment facility approved by the county mental health director. In the event of dismissal of the criminal charges before the defendant recovers competence, the person shall be subject to the applicable provisions of Part 1 (commencing with Section 5000) of Division 5 of the Welfare and Institutions Code. Where either the defendant or the prosecutor chooses to contest the order of transfer, a petition may be filed in the court for a hearing, which shall be held if the court determines that sufficient grounds exist. At the hearing, the prosecuting attorney or the defendant may present evidence bearing on the order of transfer. The court shall use the same standards as are used in conducting probation revocation hearings pursuant to Section 1203.2.
(B) Prior to making an order for transfer under this section, the court shall notify the defendant, the attorney of record for the defendant, the prosecuting attorney, and the county mental health director or the director’s designee.
(7) If, at any time after the court has declared a defendant incompetent to stand trial pursuant to this section, counsel for the defendant or a jail medical or mental health staff provider provides the court with substantial evidence that the defendant’s psychiatric symptoms have changed to such a degree as to create a doubt in the mind of the judge as to the defendant’s current mental incompetence, the court may appoint a psychiatrist or a licensed psychologist to opine as to whether the defendant has regained competence. The State Department of State Hospitals may conduct an evaluation of the defendant in county custody pursuant to Section 4335.2 of the Welfare and Institutions Code. If, in the opinion of an expert, the defendant has regained competence, the court shall proceed as if a certificate of restoration of competence has been returned pursuant to paragraph (1) of subdivision (a) of Section 1372, except that a presumption of competency shall not apply and a hearing shall be held to determine whether competency has been restored.
(b) Within 90 days of a commitment made pursuant to subdivision (a), the medical director of the treatment facility to which the defendant is confined shall make a written report to the court and the county mental health director or the director’s designee, concerning the defendant’s progress toward recovery of mental competence and whether the administration of antipsychotic medication remains necessary. If the defendant is in county custody, the State Department of State Hospitals may conduct a remote telehealth evaluation of the defendant pursuant to Section 4335.2 of the Welfare and Institutions Code and make a written report to the court concerning the defendant’s progress toward recovery of mental competence and whether the administration of antipsychotic medication is necessary. Where the defendant is on outpatient status, the outpatient treatment staff shall make a written report to the county mental health director concerning the defendant’s progress toward recovery of mental competence. Within 90 days of placement on outpatient status, the county mental health director shall report to the court on this matter. If the defendant has not recovered mental competence, but the report discloses a substantial likelihood that the defendant will regain mental competence in the foreseeable future, the defendant shall remain in the treatment facility or on outpatient status. Thereafter, at six-month intervals or until the defendant becomes mentally competent, where the defendant is confined in a treatment facility, the medical director of the hospital or person in charge of the facility shall report in writing to the court and the county mental health director or a designee regarding the defendant’s progress toward recovery of mental competence and whether the administration of antipsychotic medication remains necessary. If the defendant remains in county custody after the initial 90-day report, the State Department of State Hospitals may conduct a remote telehealth evaluation of the defendant pursuant to Section 4335.2 of the Welfare and Institutions Code and make a written report to the court concerning the defendant’s progress toward recovery of mental competence and whether the administration of antipsychotic medication is necessary. Where the defendant is on outpatient status, after the initial 90-day report, the outpatient treatment staff shall report to the county mental health director on the defendant’s progress toward recovery, and the county mental health director shall report to the court on this matter at six-month intervals. A copy of these reports shall be provided to the prosecutor and defense counsel by the court. If the report indicates that there is no substantial likelihood that the defendant will regain mental competence in the foreseeable future, the committing court shall order the defendant to be returned to the court for proceedings pursuant to paragraph (2) of subdivision (c). The court shall transmit a copy of its order to the county mental health director or the director’s designee.
(c) (1) If, at the end of one year from the date of commitment or a period of commitment equal to the maximum term of imprisonment provided by law for the most serious offense charged in the misdemeanor complaint, whichever is shorter, the defendant has not recovered mental competence, the defendant shall be returned to the committing court. The court shall notify the county mental health director or the director’s designee of the return and of any resulting court orders.
(2) Whenever any defendant is returned to the court pursuant to subdivision (b) or paragraph (1) of this subdivision and it appears to the court that the defendant is gravely disabled, as defined in subparagraph (A) of paragraph (1) of subdivision (h) of Section 5008 of the Welfare and Institutions Code, the court shall order the conservatorship investigator of the county of commitment of the defendant to initiate conservatorship proceedings for the defendant pursuant to Chapter 3 (commencing with Section 5350) of Part 1 of Division 5 of the Welfare and Institutions Code. Any hearings required in the conservatorship proceedings shall be held in the superior court in the county that ordered the commitment. The court shall transmit a copy of the order directing initiation of conservatorship proceedings to the county mental health director or the director’s designee and shall notify the county mental health director or the director’s designee of the outcome of the proceedings.
(d) The criminal action remains subject to dismissal pursuant to Section 1385. If the criminal action is dismissed, the court shall transmit a copy of the order of dismissal to the county mental health director or the director’s designee.
(e) If the criminal charge against the defendant is dismissed, the defendant shall be released from any commitment ordered under this section, but without prejudice to the initiation of any proceedings which may be appropriate under Part 1 (commencing with Section 5000) of Division 5 of the Welfare and Institutions Code.

SEC. 345.

 Section 1372 of the Penal Code is amended to read:

1372.
 (a) (1) If the medical director of a state hospital, a person designated by the State Department of State Hospitals at an entity contracted by the department to provide services to a defendant prior to placement in a treatment program or other facility to which the defendant is committed, or the community program director, county mental health director, or regional center director providing outpatient services, determines that the defendant has regained mental competence, the director or designee shall immediately certify that fact to the court by filing a certificate of restoration with the court by certified mail, return receipt requested, or by confidential electronic transmission. This shall include any certificate of restoration filed by the State Department of State Hospitals based on an evaluation conducted pursuant to Section 4335.2 of the Welfare and Institutions Code. For purposes of this section, the date of filing shall be the date on the return receipt.
(2) The court’s order committing an individual to a State Department of State Hospitals facility or other treatment facility pursuant to Section 1370 shall include direction that the sheriff shall redeliver the patient to the court without any further order from the court upon receiving from the state hospital or treatment facility a copy of the certificate of restoration.
(3) The defendant shall be returned to the committing court in the following manner, except that a defendant in county custody that the State Department of State Hospitals has evaluated pursuant to Section 4335.2 of the Welfare and Institutions Code and filed a certificate of restoration with the court shall remain in county custody:
(A) A patient who remains confined in a state hospital or other treatment facility shall be redelivered to the sheriff of the county from which the patient was committed. The sheriff shall immediately return the person from the state hospital or other treatment facility to the court for further proceedings.
(B) The patient who is on outpatient status shall be returned by the sheriff to court through arrangements made by the outpatient treatment supervisor.
(C) In all cases, the patient shall be returned to the committing court no later than 10 days following the filing of a certificate of restoration. The state shall only pay for 10 hospital days for patients following the filing of a certificate of restoration of competency. The State Department of State Hospitals shall report to the fiscal and appropriate policy committees of the Legislature on an annual basis in February, on the number of days that exceed the 10-day limit prescribed in this subparagraph. This report shall include, but not be limited to, a data sheet that itemizes by county the number of days that exceed this 10-day limit during the preceding year.
(b) If the defendant becomes mentally competent after a conservatorship has been established pursuant to the applicable provisions of the Lanterman-Petris-Short Act, Part 1 (commencing with Section 5000) of Division 5 of the Welfare and Institutions Code, and Section 1370, the conservator shall certify that fact to the sheriff and district attorney of the county in which the defendant’s case is pending, defendant’s attorney of record, and the committing court.
(c) When a defendant is returned to court with a certification that competence has been regained, the court shall notify either the community program director, the county mental health director, or the regional center director and the Director of Developmental Services, as appropriate, of the date of any hearing on the defendant’s competence and whether or not the defendant was found by the court to have recovered competence.
(d) If the committing court approves the certificate of restoration to competence as to a person in custody, the court shall hold a hearing to determine whether the person is entitled to be admitted to bail or released on own recognizance status pending conclusion of the proceedings. If the superior court approves the certificate of restoration to competence regarding a person on outpatient status, unless it appears that the person has refused to come to court, that person shall remain released either on own recognizance status, or, in the case of a developmentally disabled person, either on the defendant’s promise or on the promise of a responsible adult to secure the person’s appearance in court for further proceedings. If the person has refused to come to court, the court shall set bail and may place the person in custody until bail is posted.
(e) A defendant subject to either subdivision (a) or (b) who is not admitted to bail or released under subdivision (d) may, at the discretion of the court, upon recommendation of the director of the facility where the defendant is receiving treatment, be returned to the hospital or facility of their original commitment or other appropriate secure facility approved by the community program director, the county mental health director, or the regional center director. The recommendation submitted to the court shall be based on the opinion that the person will need continued treatment in a hospital or treatment facility in order to maintain competence to stand trial or that placing the person in a jail environment would create a substantial risk that the person would again become incompetent to stand trial before criminal proceedings could be resumed.
(f) Notwithstanding subdivision (e), if a defendant is returned by the court to a hospital or other facility for the purpose of maintaining competency to stand trial and that defendant is already under civil commitment to that hospital or facility from another county pursuant to the Lanterman-Petris-Short Act (Part 1 (commencing with Section 5000) of Division 5 of the Welfare and Institutions Code) or as a developmentally disabled person committed pursuant to Article 2 (commencing with Section 6500) of Chapter 2 of Part 2 of Division 6 of the Welfare and Institutions Code, the costs of housing and treating the defendant in that facility following return pursuant to subdivision (e) shall be the responsibility of the original county of civil commitment.

SEC. 346.

 Section 4011.11 of the Penal Code is amended to read:

4011.11.
 (a) (1) Through December 31, 2022, the board of supervisors in each county, in consultation with the county sheriff, may designate an entity or entities to assist county jail inmates with submitting an application for a health insurance affordability program consistent with federal requirements.
(2) The board of supervisors shall not designate the county sheriff as an entity to assist with submitting an application for a health insurance affordability program for county jail inmates unless the county sheriff agrees to perform this function.
(3) If the board of supervisors designates a community-based organization as an entity to assist with submitting an application for a health insurance affordability program for county jail inmates, the designation shall be subject to approval by the jail administrator or their designee.
(b) (1) The jail administrator, or their designee, may coordinate with an entity designated pursuant to subdivision (a), through December 31, 2022.
(2) Commencing January 1, 2023, the jail administrator, or their designee, shall coordinate with an entity designated pursuant to subdivision (h), as applicable.
(c) Consistent with federal law, a county jail inmate who is currently enrolled in the Medi-Cal program shall remain eligible for, and shall not be terminated from, the program due to their incarceration unless required by federal law, they become otherwise ineligible, or the inmate’s suspension of benefits has ended pursuant to Section 14011.10 of the Welfare and Institutions Code.
(d) Notwithstanding any other state law, and only to the extent federal law allows and federal financial participation is available, an entity designated pursuant to subdivision (a) or (h) is authorized to act on behalf of a county jail inmate for the purpose of applying for, or determinations of, Medi-Cal eligibility for acute inpatient hospital services authorized by Section 14053.7 of the Welfare and Institutions Code. An entity designated pursuant to subdivision (a) or (h) shall not determine Medi-Cal eligibility or redetermine Medi-Cal eligibility, unless the entity is the county human services agency.
(e) The fact that an applicant is an inmate shall not, in and of itself, preclude a county human services agency from processing an application for the Medi-Cal program submitted to it by, or on behalf of, that inmate.
(f) For purposes of this section, “health insurance affordability program” means a program that is one of the following:
(1) The state’s Medi-Cal program under Title XIX of the federal Social Security Act.
(2) The state’s children’s health insurance program (CHIP) under Title XXI of the federal Social Security Act.
(3) A program that makes coverage in a qualified health plan through the California Health Benefit Exchange established pursuant to Section 100500 of the Government Code with advance payment of the premium tax credit established under Section 36B of the Internal Revenue Code available to qualified individuals.
(4) A program that makes available coverage in a qualified health plan through the California Health Benefit Exchange established pursuant to Section 100500 of the Government Code with cost-sharing reductions established under Section 1402 of the federal Patient Protection and Affordable Care Act (Public Law 111-148) and any subsequent amendments to that act.
(g) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the State Department of Health Care Services may implement this section, in whole or in part, by means of all-county letters or similar instructions, without taking any further regulatory action.
(h) (1) Notwithstanding any other law, commencing January 1, 2023, the board of supervisors in each county, in consultation with the county sheriff, shall designate an entity or entities to assist county jail inmates with submitting an application for, or otherwise assisting their enrollment in, a health insurance affordability program consistent with federal requirements. The board of supervisors in each county, in consultation with the chief probation officer, shall designate an entity or entities to assist juvenile inmates in county juvenile facilities with submitting an application for, or otherwise assisting with an application for enrollment in, a health insurance affordability program consistent with federal requirements.
(2) The board of supervisors shall not designate the county sheriff as an entity to assist with submitting an application for a health insurance affordability program for county jail inmates unless the county sheriff agrees to perform this function, and shall not designate the chief probation officer as an entity to assist with submitting an application for a health insurance affordability program for juvenile inmates unless the chief probation officer agrees to perform this function.
(3) If the board of supervisors designates a community-based organization as an entity to assist with submitting an application for a health insurance affordability program for county jail inmates, the designation for county jail inmates shall be subject to approval by the jail administrator or their designee, and the designation for juvenile inmates shall be subject to approval by the chief probation officer or their designee.
(4) (A) The department shall develop the data elements required to implement this section, in consultation with interested stakeholders that include representatives of counties, county sheriffs, county probation agencies, and whole person care pilot lead entities with experience working with incarcerated individuals.
(B) Notwithstanding any other law, the department, counties, county sheriffs, and county probation agencies shall share the information and data necessary to facilitate the enrollment of inmates in health insurance affordability programs on or before their date of release and to appropriately suspend and unsuspend Medi-Cal coverage for beneficiaries.
(5) (A) No sooner than January 1, 2023, the State Department of Health Care Services, in consultation with counties, county sheriffs, probation departments, Medi-Cal managed care plans, and Medi-Cal behavioral health delivery systems, shall develop and implement a mandatory process by which county jails and county juvenile facilities coordinate with Medi-Cal managed care plans and Medi-Cal behavioral health delivery systems to facilitate continued behavioral health treatment in the community for county jail inmates and juvenile inmates that were receiving behavioral health services before their release.
(B) Notwithstanding any other law, including, but not limited to, Sections 11812 and 11845.5 of the Health and Safety Code and Section 5328 of the Welfare and Institutions Code, the sharing of health information, records, and other data with and among counties, Medi-Cal managed care plans, Medi-Cal behavioral health delivery systems, and other authorized providers or plan entities shall be permitted to the extent necessary to implement this paragraph. The department shall issue guidance identifying permissible data-sharing arrangements.
(C) For purposes of this paragraph, the following definitions shall apply:
(i) “Medi-Cal behavioral health delivery system” has the same meaning as set forth in subdivision (i) of Section 14184.101 of the Welfare and Institutions Code.
(ii) “Medi-Cal managed care plan” has the same meaning as set forth in subdivision (j) of Section 14184.101 of the Welfare and Institutions Code.

SEC. 347.

 Section 30130.59 is added to the Revenue and Taxation Code, to read:

30130.59.
 Notwithstanding Section 13340 of the Government Code, if the board, pursuant to subdivision (h) of Section 30130.57, reduces the allocation to the State Department of Public Health state dental program due to a reduction in revenues, there is hereby continuously appropriated from the state General Fund an amount equivalent to the required reduction so that the total funding for the state dental program is maintained at thirty million dollars ($30,000,000) annually.

SEC. 348.

 Section 4100 of the Welfare and Institutions Code is amended to read:

4100.
 The department has jurisdiction over the following facilities:
(a) Atascadero State Hospital.
(b) Coalinga State Hospital.
(c) Metropolitan State Hospital.
(d) Napa State Hospital.
(e) Patton State Hospital.
(f) (1) The Admission, Evaluation, and Stabilization (AES) Center in the County of Kern, and other AES Centers as defined by regulation.
(2) The Director of State Hospitals may adopt emergency regulations in accordance with the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division of 3 of Title 2 of the Government Code) to implement this subdivision. The adoption of emergency regulations under this paragraph is deemed to address an emergency, for purposes of Sections 11346.1 and 11349.6 of the Government Code, and the Director of State Hospitals is hereby exempted for this purpose from the requirements of subdivision (b) of Section 11346.1 of the Government Code.
(g) A county jail treatment facility under contract with the State Department of State Hospitals to provide competency restoration services.
(h) A facility under contract with the State Department of State Hospitals pursuant to Section 4361.6, excluding community-based restoration of competency services that are operated by the county.
(i) Any other State Department of State Hospitals facility subject to available funding by the Legislature.

SEC. 349.

 Section 4122 of the Welfare and Institutions Code is amended to read:

4122.
 The State Department of State Hospitals, when it deems it necessary, may, under conditions prescribed by the director, transfer any patients of a state institution under its jurisdiction to another institution. Transfers of patients of state hospitals shall be made in accordance with Section 7300.
The expense of any transfer shall be paid from the moneys available by law for the support of the department or for the support of the institution from which the patient is transferred. Liability for the care, support, and maintenance of the transferred patient in the institution to which they have been transferred shall be the same as if they had originally been committed to the institution. The State Department of State Hospitals shall present to the county, not more frequently than monthly, a claim for the amount due the state for care, support, and maintenance of those patients and which the county shall process and pay pursuant to Chapter 4 (commencing with Section 29700) of Division 3 of Title 3 of the Government Code.

SEC. 350.

 Section 4147 is added to the Welfare and Institutions Code, to read:

4147.
 (a) To confront the crisis of individuals found incompetent to stand trial (IST) and in recognition of the importance of these defendants who are committed to the State Department of State Hospitals to begin receiving competency treatment as soon as practicable, the California Health and Human Services Agency along with the State Department of State Hospitals shall convene an Incompetent to Stand Trial Solutions Workgroup to identify short, medium, and long-term solutions to advance alternatives to placement at the State Department of State Hospitals.
(b) Workgroup members shall be appointed by the Secretary of California Health and Human Services and the workgroup shall be chaired by the Director of the State Department of State Hospitals. Members of the workgroup shall serve without compensation. Members may include, but are not limited to, representatives from the following entities and interested parties:
(1) California Health and Human Services Agency.
(2) State Department of Health Care Services.
(3) State Department of Developmental Services.
(4) Department of Corrections and Rehabilitation.
(5) Department of Finance.
(6) Other state agencies, as needed.
(7) Judicial Council.
(8) Other partners, including local government and justice system representatives of entities involved in the commitment of IST defendants to the State Department of State Hospitals and representatives of patients and their family members, as needed.
(c) The workgroup shall submit recommendations to the California Health and Human Services Agency and the Department of Finance no later than November 30, 2021, outlining short-term solutions that can be accomplished by April 1, 2022, medium-term solutions that can be accomplished by January 10, 2023, and long-term solutions that can be accomplished by January 10, 2024, and January 10, 2025, to support the State Department of State Hospitals in serving individuals with the most intensive behavioral health treatment needs and providing timely access to treatment for individuals found IST on felony charges.
(d) The workgroup may meet as often as bi-weekly until the workgroup is disbanded by the Secretary of California Health and Human Services.
(e) The workgroup may consider, but is not limited to, recommendations that accomplish any of the following:
(1) Reduce the total number of felony defendants determined to be IST.
(2) Reduce the lengths of stay for felony IST patients.
(3) Support felony IST defendants to receive early access to treatment before transfer to a restoration of competency treatment program to achieve stabilization and restoration of competency sooner.
(4) Support increased access to felony IST diversion options.
(5) Expand treatment options for felony IST individuals, such as community-based restoration programs, jail-based competency treatment programs, and state hospital beds.
(6) Create new options for treatment of felony IST defendants including community based, locked and unlocked facilities.
(7) Establish partnerships to facilitate admissions and discharges to reduce recidivism and ensure that the most acute, high-risk, and at need patients receive access to State Department of State Hospitals beds, while patients with lower risk or acuity are treated in appropriate community settings.
(f) (1)   Until December 31, 2024, if the Secretary of California Health and Human Services determines that either of the conditions stated in subparagraphs (A) or all of the conditions stated in subparagraph (B) have occurred, the State Department of State Hospitals may take the actions described in paragraph (2), if authorized by the Secretary of California Health and Human Services and the Department of Finance, and after Department of Finance has provided no less than a 30-day notification to the Joint Legislative Budget Committee and the State Department of State Hospitals has provided notification to the county public guardian and county behavioral agencies.
(A) The recommendations required to be completed by subdivision (c) cannot be completed due to reasons outside of the control of the California Health and Human Services Agency or the State Department of State Hospitals.
(B)(i) Insufficient progress has been made in implementing the recommendations in a timely manner to provide timely access to competency treatment for IST defendants committed to the State Department of State Hospitals.
(ii) IST commitments to the State Department of State Hospitals continues to exceed the capacity available, in facilities the department has jurisdiction over pursuant to Section 4100, to provide restoration of competency treatment.
(iii) The State Department of State Hospitals continues to maintain an IST admission waitlist that exceeds the capacity of the facilities within its jurisdiction pursuant to Section 4100 to admit IST commitments.
(iv) As a result of the conditions described in clauses (i) through (iii), inclusive, IST defendants committed to the State Department of State Hospitals are not able to receive timely access to restoration of competency treatment and no reasonable state solutions are available, including timely solutions to increase capacity within the facilities within its jurisdiction pursuant to Section 4100 that may admit IST commitments.
(2) If the requirements of paragraph (1) are met, the State Department of State Hospitals may take the following actions:
(A) The State Department of State Hospitals may discontinue admissions for new patients committed to a state hospital pursuant to Section 5358.
(B) The State Department of State Hospitals may, following the determination by the Secretary of California Health and Human Services pursuant to paragraph (1), impose patient reduction targets over the next three fiscal years for patients committed to a state hospital pursuant to Section 5358. Reduction targets shall only be to the minimum level necessary to achieve timely access to treatment for IST commitments, as determined by the State Department of State Hospitals and the Secretary of California Health and Human Services and will allow no less than a minimum of six months for the first reduction target to be achieved.
(C) The State Department of State Hospitals may charge 150 percent of the daily bed rate for counties, pursuant to Section 4330, that exceed the bed usage for patients admitted pursuant to Section 5358 and that are above the specified patient reduction targets made pursuant to subparagraph (B).
(g) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the State Department of State Hospitals may implement, interpret, or make specific this section by means of a departmental letter or other similar instruction, as necessary.
(h) Contracts awarded pursuant to this section, including contracts to implement solutions developed by the Incompetent to Stand Trial Solutions Workgroup, shall be exempt from the requirements contained in the Public Contract Code, Section 19130 of the Government Code, Section 4101.5, and the State Administrative Manual and shall not be subject to approval by the Department of General Services.

SEC. 351.

 Section 4335.2 is added to the Welfare and Institutions Code, to read:

4335.2.
 (a) As used in this section, “department” means the State Department of State Hospitals.
(b) The Legislature finds and declares that the purpose of this section is to establish a program for the department to perform reevaluations primarily through telehealth evaluations for felony incompetent to stand trial (IST) individuals in jail who have been waiting for admission to the department 60 days or more from the date of commitment. The goals of this program are:
(1) To permit the department to conduct reevaluations of IST defendants committed to the department and awaiting admission to department facilities.
(2) To reduce the growing list of IST defendants awaiting placement to a department facility for competency restoration treatment.
(3) To help address the significant impacts of the COVID-19 pandemic on the IST waitlist through identification of individuals on the waitlist who have restored to competency in jail, are nonrestorable, are malingering, may be divertible, or have stabilized and are appropriate for outpatient treatment.
(4) To reduce the timeframe for a competency evaluation for IST defendants in jail and reduce unnecessary costly hospitalizations.
(5) To offer expert forensic mental health consultation to assist in identifying ISTs who may be appropriate for community placement. This supports the principles of deinstitutionalization for individuals who can best be supported in the least restrictive setting in the community.
(6) To offer expert medication consultation and technical assistance to local sheriffs to support effective use of psychotropic medications and stabilization of IST defendants awaiting placement to a department facility.
(7) To require courts and local county jails to provide to the department all relevant medical, behavioral, and court records of IST defendants committed to the department for evaluation purposes.
(8) To require local county jails to provide the department access to IST defendants in county jails and for local county jails to ensure the department the ability to provide reevaluations for IST defendants remotely.
(c) Beginning July 1, 2021, the department, or its designee, shall have the authority and sole discretion to consider and conduct reevaluations for IST defendants committed to and awaiting admission to the department for 60 days or more. A reevaluation shall involve a review by a department clinician or contracted clinician of an IST defendant’s relevant medical and mental health records, including prior mental health evaluations and an evaluation of the IST defendant by that department clinician or contracted clinician. If not already provided, the court shall provide the department with all IST defendant records pursuant to paragraph (3) of subdivision (a) of Section 1370 of the Penal Code and paragraph (4) of subdivision (a) of Section 1370.01 of the Penal Code, including any updated medical and behavioral health records requested by the department. At the sole discretion of the department, the department clinician or contracted clinician may conduct in person, or video telehealth, evaluations of IST defendants at the local jail for those IST patients awaiting admission more than 60 days since their commitment to the department. The local jail shall provide the department confidential access to the IST defendant for reevaluation, including establishing and maintaining remote access capabilities at the jail for the department to remotely access the IST defendant. Reevaluations provided by the department clinician or contracted clinician shall include, but are not limited to, the following:
(1) Evaluations, including assessment of malingering, pursuant to paragraph (1) of subdivision (b) of Section 1370 of the Penal Code, subdivision (b) of Section 1370.01 of the Penal Code, or paragraph (1) of subdivision (a) of Section 1372 of the Penal Code.
(2) Assessments to determine whether the IST defendant should be referred to the county for further evaluation for potential participation in the county diversion program, if one exists, pursuant to clause (v) of subparagraph (B) of paragraph (1) of subdivision (a) of Section 1370 of the Penal Code or paragraph (2) of subdivision (a) of Section 1370.01 of the Penal Code, or other outpatient treatment program.
(3) Evaluations on whether the IST defendant is substantially unlikely to be restored to competence in the foreseeable future pursuant to paragraph (1) of subdivision (b) of Section 1370 of the Penal Code or subdivision (b) of Section 1370.01 of the Penal Code.
(4) Psychopharmacology evaluations in which a department clinician will identify IST defendants who may need psychotropic medications, a psychopharmacology consultation, or an involuntary medication order.
(5) A written report from the department clinician or contracted clinician of their evaluations of the IST defendant, as well as any conclusions of mental health status and recommendations the clinician may have of placement of the IST defendant.
(d) Written reports shall be filed with the court in the committing county. That report shall be accepted by courts, either pursuant to paragraph (1) of subdivision (b) of Section 1370 of the Penal Code, subdivision (b) of Section 1370.01 of the Penal Code, or paragraph (1) of subdivision (a) of Section 1372 of the Penal Code.
(e) The department shall provide funding based on a flat rate set by the department to local county jails for reimbursement of information technology support and a portion of staff time utilized to facilitate telehealth interviews and evaluations of felony IST defendants in the jail. One-time funding based on a flat rate set by the department will be made available for reimbursement to the county sheriff upon agreement to facilitate telehealth evaluations in the jail. In addition, a flat rate, set by the department, for reimbursement of each telehealth evaluation conducted by the department for an IST defendant and facilitated by the jail will be paid on a quarterly basis in arrears following conclusion of the telehealth evaluation.
(f) Any contracts awarded to implement this chapter shall be exempt from the requirements contained in the Public Contract Code and the State Administrative Manual and shall not be subject to approval by the Department of General Services.
(g) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the state hospitals and the department may implement, interpret, or make specific this section by means of a departmental letter or other similar instruction, as necessary.
(h) The department and any of the designated evaluators shall be provided access to the defendant’s medical records, including mental health records for purposes of conducting a reevaluation of the competency status of the defendant.

SEC. 352.

 Section 4361 of the Welfare and Institutions Code is amended to read:

4361.
 (a) As used in this section, “department” means the State Department of State Hospitals.
(b) The purpose of this chapter is to, subject to appropriation by the Legislature, promote the diversion of individuals with serious mental disorders as prescribed in Chapter 2.8A (commencing with Section 1001.35) of Title 6 of Part 2 of the Penal Code, and to assist counties in providing diversion for individuals with serious mental illnesses who may otherwise be found incompetent to stand trial and committed to the State Department of State Hospitals for restoration of competency. In implementing this chapter, the department shall consider local discretion and flexibility in diversion activities that meet the community’s needs and provide for the safe and effective treatment of individuals with serious mental disorders across a continuum of care.
(c) (1) Subject to appropriation by the Legislature, the department may solicit proposals from, and may contract with, a county to help fund the development or expansion of pretrial diversion described in Chapter 2.8A (commencing with Section 1001.35) of Title 6 of Part 2 of the Penal Code, for the population described in subdivision (b) and that meets all of the following criteria:
(A) Participants are individuals diagnosed with schizophrenia, schizoaffective disorder, or bipolar disorder, who have the potential to be found incompetent to stand trial for felony charges, pursuant to Section 1368 of the Penal Code, or who have been found incompetent to stand trial pursuant to clause (iv) of subparagraph (B) of paragraph (1) of subdivision (a) of Section 1370 of the Penal Code.
(B) There is a significant relationship between the individual’s serious mental disorder and the charged offense, or between the individual’s conditions of homelessness and the charged offense.
(C) The individual does not pose an unreasonable risk of danger to public safety, as defined in Section 1170.18 of the Penal Code, if treated in the community.
(2) A county submitting a proposal for funding under this chapter shall designate a lead entity to apply for the funds. This lead entity shall show in its proposal that it has support from other county entities or other relevant entities, including courts, that are necessary to provide successful diversion of individuals under the contract.
(d) When evaluating proposals from the county, the department, in consultation with the Council on Criminal Justice and Behavioral Health within the Department of Corrections and Rehabilitation, shall prioritize proposals that demonstrate the potential to reduce referrals to the department of felony defendants who are likely to be found incompetent to stand trial, and that demonstrate all of the following:
(1) Provision of clinically appropriate or evidence-based mental health treatment and wraparound services across a continuum of care, as appropriate, to meet the individual needs of the diversion participant. For purposes of this section, “wraparound services” means services provided in addition to the mental health treatment necessary to meet the individual’s needs for successfully managing the individual’s mental health symptoms and to successfully live in the community. Wraparound services provided by the diversion program may include, but are not limited to, forensic assertive community treatment teams, crisis residential services, intensive case management, criminal justice coordination, peer support, supportive housing, substance use disorder treatment, and vocational support.
(2) Collaboration between community stakeholders and other partner government agencies in the diversion of individuals with serious mental disorders.
(3) Connection of individuals to services in the community after they have completed diversion as provided in this chapter.
(e) The department may also provide funding in the contract with the county, subject to appropriation by the Legislature, to cover the cost of providing postbooking assessment of defendants who are likely to be found incompetent to stand trial on felony charges to determine whether the defendant would benefit from diversion as included in the contract.
(f) The department may also provide funding in the contract with the county, subject to appropriation by the Legislature, to cover the cost of in-jail treatment prior to the placement in the community for up to an average of 15 days for defendants who have been approved by the court for diversion as included in the contract.
(g) A county contracted pursuant to this chapter shall report data and outcomes to the department, within 90 days of the end of each quarter, regarding those individuals targeted by the contract and in the program. This subdivision does not preclude the department from specifying reporting formats or from modifying, reducing, or adding data elements or outcome measures from a contracting county, as needed to provide for reporting of effective data and outcome measures. Notwithstanding any other law, but only to the extent not prohibited by federal law, the county shall provide specific patient information to the department for reporting purposes. The patient information is confidential and is not open to public inspection. A contracting county shall, at a minimum, report all of the following:
(1) The number of individuals that the court ordered to postbooking diversion and the length of time for which the defendant has been ordered to diversion.
(2) The number of individuals originally declared incompetent to stand trial on felony charges that the court ultimately ordered to diversion.
(3) The number of individuals participating in diversion.
(4) The name, social security number, date of birth, and demographics of each individual participating in the program. This information is confidential and is not open to public inspection.
(5) The length of time in diversion for each participating individual. This information is confidential and is not open to public inspection.
(6) The types of services and supports provided to each individual participating in diversion. This information is confidential and is not open to public inspection.
(7) The number of days each individual was in jail prior to placement in diversion. This information is confidential and is not open to public inspection.
(8) The number of days that each individual spent in each level of care facility. This information is confidential and is not open to public inspection.
(9) The diagnoses of each individual participating in diversion. This information is confidential and is not open to public inspection.
(10) The nature of the charges for each individual participating in diversion. This information is confidential and is not open to public inspection.
(11) The number of individuals who completed diversion.
(12) The name, social security number, and birth date of each individual who did not complete diversion and the reasons for not completing. This information is confidential and is not open to public inspection.
(h) Contracts awarded pursuant to this chapter are exempt from the requirements contained in the Public Contract Code and the State Administrative Manual and are not subject to approval by the Department of General Services.
(i) (1) In order to receive funds pursuant to this chapter, a county’s proposal shall demonstrate a 20-percent match of county funds toward the total cost of diversion to be funded through the contract.
(2) Notwithstanding paragraph (1), a proposal from a small county shall demonstrate a 10-percent match of county funds toward the total cost of diversion to be funded through the contract. For purposes of this paragraph, “small county” means a county with a population of 200,000 or less based on the most recent available estimates of population data determined by the Demographic Research Unit of the Department of Finance.
(3) The funds shall not be used to supplant existing services or services reimbursable from an available source but rather to expand upon them or support new services for which existing reimbursement may be limited. Up to 5 percent of the required county match may be met through county administrative costs associated with development and evaluation activities for diversion.
(j) (1) Beginning July 1, 2021, subject to appropriation by the Legislature, the department may amend contracts with a county to fund the expansion of an existing department-funded pretrial diversion as described in Chapter 2.8A (commencing with Section 1001.35) of Title 6 of Part 2 of the Penal Code, for the population described in subdivision (b) and that meets both of the following criteria:
(A) All participants identified for potential diversion are found incompetent to stand trial on a felony charge.
(B) Participants diverted through a program expansion suffer from a mental disorder as identified in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, excluding antisocial personality disorder, borderline personality disorder, and pedophilia.
(2) Counties expanding their programs under this section will not be required to meet any additional match funding requirements.
(k) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the state hospitals and the department may implement, interpret, or make specific this section by means of a departmental letter or other similar instruction, as necessary.
(l) The department shall have access to the arrest records and state summary of criminal history of defendants who are participating or have participated in the diversion program. The information may be used solely for the purpose of looking at the recidivism rate for those patients.

SEC. 353.

 Chapter 6.7 (commencing with Section 4361.5) is added to Part 3 of Division 4 of the Welfare and Institutions Code, to read:
CHAPTER  6.7. State Department of State Hospitals: Contracting Facilities

4361.5.
 For purposes of this chapter, “department” means the State Department of State Hospitals.

4361.6.
 (a) Subject to an appropriation by the Legislature for this express purpose, the department may contract as follows:
(1) For subacute bed capacity, including, but not limited to, institutions for mental disease, mental health rehabilitation centers, skilled nursing facilities, or any other treatment options, such as community-based restoration of competency services, to address the increasing number of patient referrals to the department.
(2) With private or public entities to house and treat individuals committed to the department pursuant to Sections 1026, 1370, and 2972 of the Penal Code or Section 5358 of this code. Contracted funds may include any of the following:
(A) Program implementation costs, including funds for projects to modify, expand, or retrofit a space.
(B) One-time purchases of patient and staff furnishings and minor equipment.
(C) Activities related to recruitment and training of staff before program activation.
(D) Operating expenses.
(b) Contracts awarded pursuant to this chapter shall be exempt from the requirements contained in Section 19130 of the Government Code, the Public Contract Code, Section 4101.5 of this code, and the State Administrative Manual. These contracts shall not be subject to approval by the Department of General Services.
(c) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this section by means of a departmental letter or other similar instruction, as necessary.

SEC. 354.

 Section 5886 of the Welfare and Institutions Code is amended to read:

5886.
 (a) The Mental Health Student Services Act is hereby established as a mental health partnership grant program for the purpose of establishing mental health partnerships between a county’s mental health or behavioral health departments and school districts, charter schools, and the county office of education within the county.
(b) The Mental Health Services Oversight and Accountability Commission shall award grants to county mental health or behavioral health departments to fund partnerships between educational and county mental health entities. Subject to an appropriation for this purpose, commencing with the 2021–22 fiscal year, the commission shall award a grant under this section to a county mental health or behavioral health department or another lead agency, as identified by the partnership within each county that meets the requirements of this section.
(1) County, city, or multicounty mental health or behavioral health departments, or a consortium of those entities, including multicounty partnerships, may, in partnership with one or more school districts and at least one of the following educational entities located within the county, apply for a grant to fund activities of the partnership:
(A) The county office of education.
(B) A charter school.
(2) An educational entity may be designated as the lead agency at the request of the county, city, or multicounty department, or consortium, and authorized to submit the application. The county, city, or multicounty department, or consortium, shall be the grantee and receive any grant funds awarded pursuant to this section even if an educational entity is designated as the lead agency and submits the application pursuant to this paragraph.
(c) The commission shall establish criteria for awarding funds under the grant program, including the allocation of grant funds pursuant to this section, and shall require that applicants comply with, at a minimum, all of the following requirements:
(1) That all school districts, charter schools, and the county office of education have been invited to participate in the partnership, to the extent possible.
(2) That applicants include with their application a plan developed and approved in collaboration with participating educational entity partners and that include a letter of intent, a memorandum of understanding, or other evidence of support or approval by the governing boards of all partners.
(3) That plans address all of the following goals:
(A) Preventing mental illnesses from becoming severe and disabling.
(B) Improving timely access to services for underserved populations.
(C) Providing outreach to families, employers, primary care health care providers, and others to recognize the early signs of potentially severe and disabling mental illnesses.
(D) Reducing the stigma associated with the diagnosis of a mental illness or seeking mental health services.
(E) Reducing discrimination against people with mental illness.
(F) Preventing negative outcomes in the targeted population, including, but not limited to:
(i) Suicide and attempted suicide.
(ii) Incarceration.
(iii) School failure or dropout.
(iv) Unemployment.
(v) Prolonged suffering.
(vi) Homelessness.
(vii) Removal of children from their homes.
(viii) Involuntary mental health detentions.
(4) That the plan includes a description of the following:
(A) The need for mental health services for children and youth, including campus-based mental health services, as well as potential gaps in local service connections.
(B) The proposed use of funds, which shall include, at a minimum, that funds will be used to provide personnel or peer support.
(C) How the funds will be used to facilitate linkage and access to ongoing and sustained services, including, but not limited to, objectives and anticipated outcomes.
(D) How the partnership will collaborate with preschool and childcare providers, or other early childhood service organizations, to ensure the mental health needs of children are met before and after they transition to a school setting.
(E) The partnership’s ability to do all of the following:
(i) Obtain federal Medicaid or other reimbursement, including Early and Periodic Screening, Diagnostic, and Treatment funds, when applicable, or to leverage other funds, when feasible.
(ii) Collect information on the health insurance carrier for each child or youth, with the permission of the child or youth’s parent, to allow the partnership to seek reimbursement for mental health services provided to children and youth, where applicable.
(iii) Engage a health care service plan or a health insurer in the mental health partnership, when applicable, and to the extent mutually agreed to by the partnership and the plan or insurer.
(iv) Administer an effective service program and the degree to which mental health providers and educational entities will support and collaborate to accomplish the goals of the effort.
(v) Connect children and youth to a source of ongoing mental health services, including, but not limited to, through Medi-Cal, specialty mental health plans, county mental health programs, or private health coverage.
(vi) Continue to provide services and activities under this program after grant funding has been expended.
(d) Grants awarded pursuant to this section shall be used to provide support services that include, at a minimum, all of the following:
(1) Services provided on school campuses, to the extent practicable.
(2) Suicide prevention services.
(3) Drop-out prevention services.
(4) Outreach to high-risk youth and young adults, including, but not limited to, foster youth, youth who identify as lesbian, gay, bisexual, transgender, or queer, and youth who have been expelled or suspended from school.
(5) Placement assistance and development of a service plan that can be sustained over time for students in need of ongoing services.
(e) Funding may also be used to provide other prevention, early intervention, and direct services, including, but not limited to, hiring qualified mental health personnel, professional development for school staff on trauma-informed and evidence-based mental health practices, and other strategies that respond to the mental health needs of children and youth, as determined by the commission.
(f) The commission shall determine the amount of grants and shall take into consideration the level of need and the number of schoolage youth in participating educational entities when determining grant amounts. In determining the distribution of funds appropriated in the 2021–22 fiscal year, the commission shall take into consideration any previous funding the grantee received under this section.
(g) The commission may establish incentives to provide matching funds by awarding additional grant funds to partnerships that do so.
(h) If the commission is unable to provide a grant to a partnership in a county because of a lack of applicants or because no applicants met the minimum requirements within the timeframes established by the commission, the commission may redistribute those funds to other eligible grantees.
(i) Partnerships currently receiving grants from the Investment in Mental Health Wellness Act of 2013 (Part 3.8 (commencing with Section 5848.5)) are eligible to receive a grant under this section for the expansion of services funded by that grant or for the inclusion of additional educational entity partners within the mental health partnership.
(j) Grants awarded pursuant to this section may be used to supplement, but not supplant, existing financial and resource commitments of the county, city, or multi-county mental health or behavioral health departments, or a consortium of those entities, or educational entities that receive a grant.
(k) (1) The commission shall develop metrics and a system to measure and publicly report on the performance outcomes of services provided using the grants.
(2) (A) The commission shall provide a status report to the fiscal and policy committees of the Legislature on the progress of implementation of this section no later than March 1, 2022, and provide an updated report no later than March 1, 2024. The reports shall address, at a minimum, all of the following:
(i) Successful strategies.
(ii) Identified needs for additional services.
(iii) Lessons learned.
(iv) Numbers of, and demographic information for, the schoolage children and youth served.
(v) Available data on outcomes, including, but not limited to, linkages to ongoing services and success in meeting the goals identified in paragraph (3) of subdivision (c).
(B) The reports to be submitted pursuant to this paragraph shall be submitted in compliance with Section 9795 of the Government Code.
(l) This section does not require the use of funds allocated for the purpose of satisfying the minimum funding obligation under Section 8 of Article XVI of the California Constitution for the partnerships established by this section.
(m) The commission may enter into exclusive or nonexclusive contracts, or amend existing contracts, on a bid or negotiated basis in order to implement this section. Contracts entered into or amended pursuant to this subdivision are exempt from Chapter 6 (commencing with Section 14825) of Part 5.5 of Division 3 of Title 2 of the Government Code, Section 19130 of the Government Code, and Part 2 (commencing with Section 10100) of Division 2 of the Public Contract Code, and shall be exempt from the review or approval of any division of the Department of General Services.
(n) This section shall be implemented only to the extent moneys are appropriated in the annual Budget Act or another statute for purposes of this section.

SEC. 355.

 Part 7 (commencing with Section 5960) is added to Division 5 of the Welfare and Institutions Code, to read:

PART 7. Behavioral Health Services and Supports

CHAPTER  1. Behavioral health continuum infrastructure program

5960.
 The department may establish the Behavioral Health Continuum Infrastructure Program pursuant to this chapter if the Legislature appropriates funds for this purpose.

5960.05.
 If the department establishes the program pursuant to this chapter, the department may award competitive grants to qualified entities to construct, acquire, and rehabilitate real estate assets or to invest in needed mobile crisis infrastructure to expand the community continuum of behavioral health treatment resources to build new capacity or expand existing capacity for short-term crisis stabilization, acute and subacute care, crisis residential, community-based mental health residential, substance use disorder residential, peer respite, mobile crisis, community and outpatient behavioral health services, and other clinically enriched longer term treatment and rehabilitation options for persons with behavioral health disorders in the least restrictive and least costly setting.

5960.1.
 Except as provided in Section 5960.15, the department shall determine the methodology and distribution of the grant funds appropriated for the program pursuant to Section 5960.05 to those entities it deems qualified.

5960.15.
 An entity shall meet all of the following conditions in order to receive grant funds pursuant to Section 5960.05, to the extent applicable and as required by the department:
(a) Provide matching funds or real property.
(b) Expend funds to supplement and not supplant existing funds to construct, acquire, and rehabilitate real estate assets.
(c) Report data to the department within 90 days of the end of each quarter for the first five years.
(d) Operate services in the financed facility for the intended purpose for a minimum of 30 years.

5960.2.
 (a) This chapter shall be implemented only if, and to the extent that, the department determines that federal financial participation under the Medi-Cal program, including but not limited to the increased federal funding available pursuant to Section 9813 of the federal American Rescue Plan Act of 2021 (Pub. Law 117-2), is not jeopardized.
(b) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this chapter, in whole or in part, by means of information notices or other similar instructions, without taking any further regulatory action.

5960.25.
 For purposes of implementing this chapter, the department may enter into exclusive or nonexclusive contracts, or amend existing contracts, on a bid or negotiated basis. Contracts entered into or amended pursuant to this section shall be exempt from Chapter 6 (commencing with section 14825) of Part 5.5 of Division 3 of Title 2 of the Government Code, Section 19130 of the Government Code, Part 2 (commencing with Section 10100) of Division 2 of the Public Contract Code, and the State Administrative Manual, and shall be exempt from the review or approval of any division of the Department of General Services.

5960.3.
 (a) Notwithstanding any other law, a facility project funded by a grant pursuant to this chapter shall be deemed consistent and in conformity with any applicable local plan, standard, or requirement, and allowed as a permitted use, within the zone in which the structure is located, and shall not be subject to a conditional use permit, discretionary permit, or to any other discretionary reviews or approvals.
(b) Notwithstanding any other law, the California Environmental Quality Act (Division 13 (commencing with Section 21000) of the Public Resources Code) shall not apply to a project, including a phased project, funded by a grant pursuant to this chapter if, where applicable, all of the following applicable requirements are satisfied:
(1) The project is not acquired by eminent domain.
(2) The project applicant demonstrates that the project is, and will continue to be, licensed by and in good standing with the department or other state licensing entity at the time of, and for the duration of, occupancy. The project shall be in decent, safe, and sanitary condition at the time of occupancy.
(3) The project applicant requires all contractors and subcontractors performing work on the facility project to pay prevailing wages for any proposed rehabilitation, construction, or major alterations in accordance with Chapter 1 (commencing with Section 1720) of Part 7 of Division 2 of the Labor Code.
(4) The project applicant obtains an enforceable commitment that all contractors and subcontractors performing work on the project will use a skilled and trained workforce for any proposed rehabilitation, construction, or major alterations in accordance with Chapter 2.9 (commencing with Section 2600) of Part 1 of Division 2 of the Public Contract Code.
(5) The project applicant submits to the lead agency a letter of support, or other durable documentary proof for the project, from a county, city, or other local public entity for any new proposed construction, major alteration work, or rehabilitation.
(6) The project applicant demonstrates that not less than ninety-five percent of the total cost of any new construction, facility acquisition, or rehabilitation project is paid for with public funds, private non-profit funds, or philanthropic funds.
(7) The project applicant demonstrates that the project expands the availability of behavioral health treatment services in the subject jurisdiction.
(8) The project applicant demonstrates that there are long-term covenants and restrictions that require the project to be used to provide behavioral health treatment for no less than 30 years, and those covenants and restrictions may not be amended or extinguished by a subsequent title holder, owner, or operator.
(9) The project does not result in any increase in the existing onsite development footprint of structures or improvements.
(c) If a project applicant determines that a project is not subject to the California Environmental Quality Act pursuant to this section, and the lead agency for the project publicly concurs in that determination, the project applicant shall file a notice of exemption with the Office of Planning and Research and the county clerk of the county in which the project is located in the manner specified in subdivisions (b) and (c) of Section 21152 of the Public Resources Code.

5960.35.
 (a) The following definitions shall apply to this chapter:
(1) “Department” means the State Department of Health Care Services.
(2) “Program” means the Behavioral Health Continuum Infrastructure Program authorized by this chapter.
(b) The following provisions shall apply to the implementation of this chapter:
(1) “Low-rent housing project,” as defined in Section 1 of Article XXXIV of the California Constitution, does not apply to any facility project pursuant to this section that meets any one of the following criteria:
(A) The development is privately owned housing, receiving no ad valorem property tax exemption, other than exemptions granted pursuant to subdivision (f) or (g) of Section 214 of the Revenue and Taxation Code, not fully reimbursed to all taxing entities, and not more than 49 percent of the dwellings, apartments, or other living accommodations of the development may be occupied by persons of low income.
(B) The development is privately owned housing, is not exempt from ad valorem taxation by reason of any public ownership, and is not financed with direct long-term financing from a public body.
(C) The development is intended for owner-occupancy, which may include a limited-equity housing cooperative as defined in Section 50076.5 of the Health and Safety Code, or cooperative or condominium ownership, rather than for rental-occupancy.
(D) The development consists of newly constructed, privately owned, one-to-four family dwellings not located on adjoining sites.
(E) The development consists of existing dwelling units leased by the state public body from the private owner of these dwelling units.
(F) The development consists of the rehabilitation, reconstruction, improvement or addition to, or replacement of, dwelling units of a previously existing low-rent housing project, or a project previously or currently occupied by lower income households, as defined in Section 50079.5 of the Health and Safety Code.
(G) The development consists of the acquisition, rehabilitation, reconstruction, improvement, or any combination thereof, of a development which, prior to the date of the transaction to acquire, rehabilitate, reconstruct, improve, or any combination thereof, was subject to a contract for federal or state public body assistance for the purpose of providing affordable housing for low-income households and maintains, or enters into, a contract for federal or state public body assistance for the purpose of providing affordable housing for low-income households.
(2) “Tribal entity” shall mean a federally recognized Indian tribe, tribal organization, or urban Indian organization, as defined in Section 1603 of Title 25 of the United States Code.

5960.4.
 The provisions of this chapter are severable. If any provision of this chapter or its application is held invalid, that invalidity shall not affect other provisions or applications that can be given effect without the invalid provision or application.

5960.45.
 This chapter shall remain in effect only until January, 1, 2027, and as of that date is repealed.

CHAPTER  2. Children and youth behavioral health initiative act
CHAPTER  2. 

5961.
 (a) This chapter shall be known, and may be cited, as the Children and Youth Behavioral Health Initiative Act.
(b) The Children and Youth Behavioral Health Initiative shall be administered by the California Health and Human Services Agency and its departments, as applicable.
(c) The initiative is intended to transform California’s behavioral health system into an innovative ecosystem in which all children and youth 25 years of age and younger, regardless of payer, are screened, supported, and served for emerging and existing behavioral health needs.
(d) Subject to an appropriation by the Legislature for this purpose, the initiative shall include, but need not be limited to, all of the following components:
(1) A behavioral health services and supports virtual platform, as described in Section 5961.1.
(2) School-linked partnership, capacity, and infrastructure grants to qualified entities to support implementation of the initiative for behavioral health services in schools and school-linked settings, as described in Section 5961.2.
(3) Incentive payments to qualifying Medi-Cal managed care plans to implement interventions that increase access to preventive, early intervention, and behavioral health services by school-affiliated behavioral health providers for children in publicly funded childcare and preschool and TK-12 children in public schools, as described in Section 5961.3.
(4) Development and maintenance of a statewide fee schedule for school-linked outpatient mental health and substance use disorder treatment, as described in Section 5961.4.
(5) Development and expansion of evidence-based behavioral health programs, as described in Section 5961.5.
(6) Funding targeted to qualified entities serving individuals 25 years of age and younger through the Behavioral Health Continuum Infrastructure Program, as described in Chapter 1 (commencing with Section 5960).
(7) A comprehensive, and culturally and linguistically proficient, public education and social change campaign in support of the initiative.
(8) Investments for behavioral health workforce, education, and training to foster broad behavioral health capacity in support of the initiative, including a multiyear plan to launch and implement a statewide school behavioral health counselor system pursuant to Chapter 1.5 (commencing with Section 127825) of Part 3 of Division 107 of the Health and Safety Code.
(9) Funding targeted to qualified entities serving individuals 25 years of age and younger through the Mental Health Student Services Act, as described in Chapter 3 (commencing with Section 5886) of Part 4.
(e) Each component of the initiative shall be implemented only if, and to the extent that, the State Department of Health Care Services determines that federal financial participation under the Medi-Cal program is not jeopardized.
(f) For purposes of implementing this chapter, the California Health and Human Services Agency, the State Department of Health Care Services, and the Office of Statewide Health Planning and Development may enter into exclusive or nonexclusive contracts, or amend existing contracts, on a bid or negotiated basis. Contracts entered into or amended pursuant to this chapter shall be exempt from Chapter 6 (commencing with Section 14825) of Part 5.5 of Division 3 of Title 2 of the Government Code, Section 19130 of the Government Code, Part 2 (commencing with Section 10100) of Division 2 of the Public Contract Code, and the State Administrative Manual, and shall be exempt from the review or approval of any division of the Department of General Services.
(g) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the State Department of Health Care Services and the Office of Statewide Health Planning and Development may implement, interpret, or make specific this chapter, in whole or in part, by means of plan letters, information notices, provider bulletins, or other similar instructions, without taking any further regulatory action.
(h) The Legislature finds and declares that this chapter is a state law within the meaning of Section 1621(d) of Title 8 of the United States Code.

5961.1.
 (a) As a component of the initiative, the State Department of Health Care Services shall procure and oversee a vendor to establish and maintain a behavioral health services and supports virtual platform that integrates behavioral health screenings, application-based supports, and direct behavioral health services to children and youth 25 years of age and younger, regardless of payer.
(b) Any virtual platform established or procured shall include access in all Medi-Cal threshold languages and shall be culturally appropriate to accommodate the diversity of the population and shall be accessible by telephone.
(c) The virtual platform may provide behavioral health services and supports, including, but not limited to, the following:
(1) Regular, automated behavioral health screenings.
(2) Short-term individual counseling, group counseling, and behavioral health peer and coaching supports.
(3) Interactive education, self-monitoring tools, application-based games, video and book suggestions, automated cognitive behavioral therapy, and mindful exercises designed to build skills and enhance wellbeing.
(4) Access to behavioral health peers, coaches, and licensed clinicians.
(5) Referrals to an individual’s commercial health insurance, Medi-Cal managed care plan, county behavioral health, school-linked counselor, or community-based organizations, or other resources for higher-level behavioral health services.
(6) Statewide e-consult service to allow primary care pediatric and family practice providers to receive asynchronous support and consultation to manage behavioral health conditions for their patients.

5961.2.
 (a) As a component of the initiative, the State Department of Health Care Services, or its contracted vendor, may award competitive grants to entities it deems qualified for the following purposes:
(1) To build partnerships, capacity, and infrastructure supporting ongoing school-linked behavioral health services for children and youth 25 years of age and younger.
(2) To expand access to licensed medical and behavioral health professionals, counselors, peer support specialists, community health workers, and behavioral health coaches serving children and youth.
(3) To build a statewide, community-based organization provider network for behavioral health prevention and treatment services for children and youth, including those attending institutions of higher education.
(4) To enhance coordination and partnerships with respect to behavioral health prevention and treatment services for children and youth via appropriate data sharing systems.
(b) Subject to subdivision (c), entities eligible to receive grants pursuant to this section may include counties, city mental health authorities, tribal entities, local educational agencies, institutions of higher education, publicly funded childcare and preschools, health care service plans, community-based organizations, and behavioral health providers.
(c) The department shall determine the eligibility criteria, grant application process, and methodology for the distribution of funds appropriated for the purposes described in this section to those entities it deems qualified.
(d) The department shall ensure that grant distribution includes, but is not limited to, rural, urban, and suburban regions and geographic distribution among different age cohorts. Allowable activities shall include, but not be limited to, the following:
(1) Addressing behavioral health disparities while providing linguistically and culturally competent services for children and youth who lack access to adequate behavioral health services or otherwise are difficult to reach.
(2) Supporting administrative costs, including planning, project management, training, and technical assistance.
(3) Linking plans, counties, and school districts with local social services and community-based organizations.
(4) Implementing telehealth equipment and virtual systems in schools or near schools.
(5) Implementing data-sharing tools, information technology interfaces, or other technology investments designed to connect to behavioral health services.
(e) Of the funds appropriated for purposes of this section to institutions of higher education, at least two-thirds shall be reserved for California Community Colleges.
(f) For purposes of this section, the following definitions shall apply:
(1) “Comprehensive risk contract” has the same meaning as set forth in Section 438.2 of Title 42 of the Code of Federal Regulations.
(2) “Health care service plan” has the same meaning as described in subdivision (f) of Section 1345 of the Health and Safety Code.
(3) “Institution of higher education” means the California Community Colleges, the California State University, or the University of California.
(4) “Local educational agency” means a school district, county office of education, charter school, the California Schools for the Deaf, and the California School for the Blind.
(5) “Tribal entity” means a federally recognized Indian tribe, tribal organization, or urban Indian organization.

5961.3.
 (a) As a component of the initiative, the State Department of Health Care Services shall make incentive payments to qualifying Medi-Cal managed care plans that meet predefined goals and metrics developed pursuant to subdivision (b) associated with targeted interventions that increase access to preventive, early intervention and behavioral health services by school-affiliated behavioral health providers for K-12 children in schools.
(b) The department, in consultation with the State Department of Education, Medi-Cal managed care plans, county behavioral health departments, local educational agencies, and other affected stakeholders, shall develop the interventions, goals, and metrics used to determine a Medi-Cal managed care plan’s eligibility to receive the incentive payments described in this section. Higher incentive payments may be made for activities that increase Medi-Cal reimbursable services provided to children and youth, to reduce health equity gaps, and for services provided to children and youth living in transition, are homeless, or are involved in the child welfare system. Interventions, goals, and metrics include, but are not limited to, the following:
(1) Local planning efforts to review existing plans and documents that articulate children and youth needs in the area; compile data; map existing behavioral health providers and resources; identify gaps, disparities, and inequities; and convene stakeholders and develop a framework for a robust and coordinated system of social, emotional, and behavioral health supports for children and youth.
(2) Providing technical assistance to increase coordination and partnerships between schools and health care plans to build an integrated continuum of behavioral health services using contracts, a memorandum of understanding, or other agreements.
(3) Developing or piloting behavioral health wellness programs to expand greater prevention and early intervention practices in school settings, such as Mental Health First Aid and Social and Emotional Learning.
(4) Expanding the workforce by using community health workers or peers to expand the surveillance and early intervention of behavioral health issues in school-age children 0 to 25 years of age, inclusive.
(5) Increasing telehealth in schools and ensure students have access to technological equipment.
(6) Implementing school-based suicide prevention strategies.
(7) Improving performance and outcomes-based accountability for behavioral health access and quality measures through local student behavioral health dashboards or public reporting.
(8) Increasing access to substance use disorder prevention, early intervention, and treatment.
(c) (1) For each Medi-Cal managed care rating period, as defined in paragraph (3) of subdivision (a) of Section 14105.945, that the department implements this section, the department shall determine the amount of incentive payment earned by each qualifying Medi-Cal managed care plan.
(2) Any incentive payments that are eligible for federal financial participation pursuant to subdivision (e) shall be made in accordance with the requirements for incentive arrangements in Section 438.6(b)(2) of Title 42 of the Code of Federal Regulations and any associated federal guidance.
(d) Incentive payments made pursuant to this section shall be used to supplement and not supplant existing payments to Medi-Cal managed care plans. In addition to developing new collaborative initiatives, incentive payments shall be used to build on existing school-based partnerships between schools and applicable Medi-Cal plans, including Medi-Cal behavioral health delivery systems.
(e) The department shall seek any necessary federal approvals to claim federal financial participation for the incentive payments to qualifying Medi-Cal managed care plans described in this section. If federal approval is obtained for one or more Medi-Cal managed care rating periods, the department shall implement this section only to the extent that federal financial participation is available in that applicable rating period. If federal approval is not obtained for one or more Medi-Cal managed care rating periods, the department may make incentive payments to qualifying Medi-Cal managed care plans as described in this section on a state-only funding basis during the applicable rating period, but only to the extent sufficient funds are appropriated to the department for this purpose and the department determines that federal financial participation for the Medi-Cal program is not otherwise jeopardized as a result.
(f) (1) The department may modify any requirement specified in this section to the extent that it deems the modification necessary to meet the requirements of federal law or regulations, to obtain or maintain federal approval, or to ensure that federal financial participation is available or not otherwise jeopardized. The department shall not propose any modification pursuant to this subdivision until the Department of Finance has reviewed and approved a fiscal impact statement.
(2) If the department, after consulting with the State Department of Education, Medi-Cal managed care plans, county behavioral health departments, local educational agencies, and other affected stakeholder entities, determines that the potential modification would be consistent with the goals of this section, the modification may be made in consultation with the Department of Finance and the department shall execute a declaration stating that this determination has been made. The department shall post the declaration on its internet website.
(3) The department shall notify entities consulted in paragraph (2), the Joint Legislative Budget Committee, the Senate Committees on Appropriations, Budget and Fiscal Review, and Health, and the Assembly Committees on Appropriations, Budget, and Health, within 10 business days of that modification or adjustment.
(4) The department shall work with the affected entities and the Legislature to make the necessary statutory changes.
(g) For purposes of this section, the following definitions apply:
(1) “Comprehensive risk contract” has the same meaning as set forth in Section 438.2 of Title 42 of the Code of Federal Regulations.
(2) “Local educational agency” means a school district, county office of education, charter school, the California Schools for the Deaf, and the California School for the Blind.
(3) “Medi-Cal managed care plan” means an individual, organization, or entity that enters into a comprehensive risk contract with the department to provide covered full-scope health care services to enrolled Medi-Cal beneficiaries pursuant to any provision of Chapter 7 (commencing with Section 14000) or Chapter 8 (commencing with Section 14200) of Part 3 of Division 9.
(4) “Medi-Cal behavioral health delivery system” has the meaning described in subdivision (i) of Section 14184.101.

5961.4.
 (a) As a component of the initiative, the State Department of Health Care Services shall develop and maintain a school-linked statewide fee schedule for outpatient mental health or substance use disorder treatment provided to a student 25 years of age or younger at a schoolsite.
(b) The department shall develop and maintain a school-linked statewide provider network of schoolsite behavioral health counselors.
(c) (1) Commencing January 1, 2024, and subject to subdivision (d), each Medi-Cal managed care plan and Medi-Cal behavioral health delivery system, as applicable, shall reimburse providers of medically necessary outpatient mental health or substance use disorder treatment provided at a schoolsite to a student 25 years of age or younger who is an enrollee of the plan or delivery system, in accordance with paragraph (2), but only to the extent the Medi-Cal managed care plan or Medi-Cal behavioral delivery system is financially responsible for those schoolsite services under its approved managed care contract with the department.
(2) Providers of medically necessary schoolsite services described in this section shall be reimbursed, at a minimum, at the fee schedule rate or rates developed pursuant to subdivision (a), regardless of network provider status.
(d) This section shall be implemented only to the extent that the department obtains any necessary federal approvals, and federal financial participation under the Medi-Cal program is available and not otherwise jeopardized.
(e) This section does not relieve a local educational agency or institution of higher education from requirements to accommodate or provide services to students with disabilities pursuant to any applicable state and federal law, including, but not limited to, the federal Individuals with Disabilities Education Act (20 U.S.C. Sec. 1400 et seq.), Part 30 (commencing with Section 56000) of Division 4 of Title 2 of the Education Code, Chapter 26.5 (commencing with Section 7570) of Division 7 of Title 1 of the Government Code, and Chapter 3 (commencing with Section 3000) of Division 1 of Title 5 of the California Code of Regulations.
(f) For purposes of this section, the following definitions shall apply:
(1) “Comprehensive risk contract” has the same meaning as set forth in Section 438.2 of Title 42 of the Code of Federal Regulations.
(2) “Institution of higher education” means the California Community Colleges, the California State University, or the University of California.
(3) Local educational agency” means a school district, county office of education, charter school, the California Schools for the Deaf, and the California School for the Blind.
(4) “Medi-Cal behavioral health delivery system” has the meaning described in subdivision (i) of Section 14184.101.
(5) “Medi-Cal managed care plan” means any individual, organization, or entity that enters into a comprehensive risk contract with the department to provide covered full-scope health care services to enrolled Medi-Cal beneficiaries pursuant to any provision of Chapter 7 (commencing with Section 14000) or Chapter 8 (commencing with Section 14200) of Part 3 of Division 9.
(6) “Schoolsite” has the meaning described in paragraph (6) of subdivision (b) of Section 1374.722 of the Health and Safety Code.

5961.5.
 (a) As a component of the initiative, the State Department of Health Care Services shall develop and select evidence-based interventions and community-defined promising practices to improve outcomes for children and youth with or at high risk for behavioral health conditions.
(b) Prior to selecting the evidence-based interventions, as described in subdivision (a), the department shall establish a workgroup comprised of subject matter experts and affected stakeholders to consider evidence-based interventions based on robust evidence for effectiveness, impact on racial equity, and sustainability.
(c) The department, or its contracted vendor, shall provide competitive grants to entities it deems qualified to support the implementation of the evidence-based interventions and community-defined promising practices developed pursuant to subdivision (a).
(d) Subject to subdivision (e), entities eligible to receive grants pursuant to this section may include Medi-Cal behavioral health delivery systems, city mental health authorities, tribal entities, health care service plans, Medi-Cal managed care plans, community-based organizations, and behavioral health providers. Grants for Medi-Cal behavioral health delivery systems for the purposes described in this section shall be administered through the Behavioral Health Quality Improvement Program pursuant to Section 14184.405.
(e) The department shall determine the eligibility criteria, grant application process, and methodology for the distribution of funds appropriated for the purposes described in this section and in Section 14184.405 to those entities it deems qualified.
(f) As a condition of funding, grant recipients shall share standardized data, in a manner and form determined by the department.
(g) For purposes of this section, “Medi-Cal behavioral health delivery system” shall have the same meaning as specified in subdivision (i) of Section 14184.101.

SEC. 356.

 Section 7275 of the Welfare and Institutions Code is amended to read:

7275.
 (a) A patient in a state hospital, their estate, and the guardian or conservator and administrator of the estate of the patient shall cause the patient to be properly and suitably cared for and maintained, and shall pay the costs and charges for transportation to a state institution. The patient in a state hospital and the administrators of their estate, and the estate of the person shall be liable for their care, support, and maintenance in a state institution of which they are a patient. The liability shall exist whether the person has become a patient of a state institution pursuant to the provisions of this code or pursuant to the provisions of Sections 1026, 1368, 1369, 1370, and 1372 of the Penal Code.
(b) This section does not impose liability for the care of persons with intellectual disabilities in state hospitals.

SEC. 357.

 Section 7276 of the Welfare and Institutions Code is amended to read:

7276.
 (a) The charge for the care and treatment of all persons who have mental health disorders at state hospitals for whom there is liability to pay therefor shall be determined pursuant to Section 4025. The Director of State Hospitals may reduce, cancel, or remit the amount to be paid by the estate liable for the care and treatment of a person who is an alcoholic or who has a mental health disorder and who is a patient at a state hospital, on satisfactory proof that the estate is unable to pay the cost of that care and treatment or that the amount is uncollectible. If there has been a payment under this section, and the payment or any part thereof is refunded because of the death, leave of absence, or discharge of a patient of the hospital, that amount shall be paid by the hospital or the State Department of State Hospitals to the person who made the payment upon demand, and in the statement to the Controller the amounts refunded shall be itemized and the aggregate deducted from the amount to be paid into the State Treasury, as provided by law. If a person dies at any time while their estate is liable for their care and treatment at a state hospital, the claim for the amount due may be presented to the executor or administrator of their estate, and paid as a preferred claim, with the same rank in order of preference, as claims for expenses of last illness.
(b) If the Director of State Hospitals delegates to the county the responsibility for determining the ability of a minor child and their parents to pay for state hospital services, the requirements of Sections 5710 and 7275.1 and the policies and procedures established and maintained by the director, including those relating to the collection and accounting of revenue, shall be followed by each county to which that responsibility is delegated.

SEC. 358.

 Section 7277.1 of the Welfare and Institutions Code is amended to read:

7277.1.
 In the case of liability for care arising under Section 7275 during the lifetime of a decedent, in which the decedent has been a patient in a state hospital preceding the date of decedent’s death, a claim for costs and charges shall be mailed within four months after written request therefor, in the form required by the department, by the fiduciary of the estate or trust or by any other person liable for the claim or any portion thereof.

SEC. 359.

 Section 7278 of the Welfare and Institutions Code is amended to read:

7278.
 The State Department of State Hospitals shall, following the admission of a patient into a state hospital, cause an investigation to be made to determine the moneys, property, or interest in property, if any, the patient has, and whether the patient has a duly appointed and acting guardian to protect their property and their property interests.

SEC. 360.

 Section 7282 of the Welfare and Institutions Code is amended to read:

7282.
 The State Department of State Hospitals with respect to a state hospital under its jurisdiction, or the State Department of Developmental Services with respect to a state hospital under its jurisdiction, may, in its own name, bring an action to enforce payment for the cost and charges of transportation of a person to a state hospital against any person, guardian, or conservator liable for transportation. The department also may, in its own name, bring an action to recover for the use and benefit of any state hospital or for the state the amount due for the care, support, maintenance, and expenses of any patient therein, against any county, or officer thereof, or against any person, guardian, or conservator liable for the care, support, maintenance, or expenses.

SEC. 361.

 Section 14000.6 is added to the Welfare and Institutions Code, to read:

14000.6.
 (a) The Office of Medicare Innovation and Integration is hereby established within the department.
(b) The office shall do all of the following:
(1) Provide focused leadership and expertise on innovative models for Medicare beneficiaries in California, including Medicare-only beneficiaries, and individuals dually eligible for the Medicare and Medi-Cal programs.
(2) Support new and existing models and strategies to benefit Medicare-only beneficiaries in California, in collaboration with local, state, and federal partners and other stakeholders.
(3) Consider and develop strategies for Medicare and Medi-Cal enrollment, benefits, health care delivery systems, and data sharing and reporting, to improve health outcomes, quality, equity, and cost effectiveness.
(4) Develop innovative approaches to integrated models of care and coordinated access to long-term services and supports for Medicare-only beneficiaries and dually eligible beneficiaries.

SEC. 362.

 Section 14005.18 of the Welfare and Institutions Code is amended to read:

14005.18.
 (a) (1) An individual is eligible, to the extent required by federal law, as though the individual was pregnant, for all pregnancy-related and postpartum services for a 60-day period beginning on the last day of pregnancy.
(2) For purposes of paragraph (1), “postpartum services” means those services provided after childbirth, child delivery, or miscarriage.
(b) (1) Notwithstanding subdivision (a), Section 15840, the income eligibility requirements specified in Section 15832, and the annual redetermination requirements described in Section 14005.37, a pregnant individual who is receiving health care coverage under a program identified in subdivision (d) and who is diagnosed with a maternal mental health condition shall remain eligible for the Medi-Cal program under their current eligibility category for a period of one year following the last day of the individual’s pregnancy if the individual complies with the requirements specified in subdivision (c) and is otherwise eligible for the Medi-Cal program.
(2) For purposes of this section, “maternal mental health condition” means a mental health condition that occurs during pregnancy or during the postpartum period and, includes, but is not limited to, postpartum depression.
(c) (1) An individual, or a designee of the individual, who seeks to extend Medi-Cal program coverage pursuant to this section shall submit to a county eligibility worker a note from that individual’s treating health care provider stating that the health care provider has diagnosed the individual with a maternal mental health condition within 60 days following the last day of the individual’s pregnancy.
(2) Notwithstanding paragraph (1), an individual who has had Medi-Cal coverage discontinued within the 60-day period beginning on the last day of pregnancy, but who is diagnosed with a maternal mental health condition more than 60 days following the last day of pregnancy and within the time limit described in subdivision (i) of Section 14005.37, may be reinstated to their previous Medi-Cal eligibility pursuant to subdivision (i) of Section 14005.37 by submitting a note, as described in paragraph (1), from the individual’s treating health care provider within the timeframe described in that subdivision.
(d) For purposes of this section, “Medi-Cal program” refers to any of the following programs:
(1) The Medi-Cal Access Program, as described in Chapter 2 (commencing with Section 15810) of Part 3.3.
(2) The Medi-Cal program, as described in this article.
(3) The Perinatal Services Program, as described in Article 4.7 (commencing with Section 14148).
(e) This section does not limit the ability of a qualified individual to apply for and purchase a qualified health plan in Covered California pursuant to Title 22 (commencing with Section 100500) of the Government Code if the qualified individual is otherwise eligible for coverage pursuant to that title.
(f) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this section by means of all-county letters, provider bulletins, or similar instructions, without taking regulatory action.
(g) Implementation of this section is subject to an appropriation in the annual Budget Act for these purposes.
(h) This section shall become inoperative commencing on the date that Section 14005.185 is implemented. If made inoperative, this section shall become operative again if, and upon the date that, Section 14005.185 is no longer implemented. The department shall determine the implementation status of Section 14005.185 and shall post, on the department’s internet website, notice of its determination.

SEC. 363.

 Section 14005.185 is added to the Welfare and Institutions Code, to read:

14005.185.
 (a) Notwithstanding Section 15840, the income eligibility requirements specified in Section 15832, and the annual redetermination requirements described in Section 14005.37, a pregnant individual or targeted low-income child who is eligible for and is receiving health care coverage under a Medi-Cal program identified in subdivision (b) shall be eligible for full-scope Medi-Cal benefits for the duration of the pregnancy and for a period of one year following the last day of the individual’s pregnancy.
(b) For purposes of this section, “Medi-Cal program” refers to any of the following programs:
(1) The Medi-Cal Access Program, as described in Chapter 2 (commencing with Section 15810) of Part 3.3.
(2) The Medi-Cal program, as described in this article.
(3) The Perinatal Services Program, as described in Article 4.7 (commencing with Section 14148).
(c) The department shall seek any federal approvals, including under Titles XIX and XXI of the federal Social Security Act (42 U.S.C. Sec. 1396 et seq.), that it determines are necessary to extend coverage for eligible pregnant and postpartum individuals or targeted low-income children as described in this section.
(d) (1) Except as provided in paragraph (2), coverage described in this section shall commence on April 1, 2022, or the effective date or dates reflected in any necessary federal approvals obtained by the department pursuant to subdivision (c), whichever is later.
(2) Notwithstanding paragraph (1), coverage described in this section for populations authorized under Title XXI of the federal Social Security Act (42 U.S.C. Sec. 1397aa) shall be effective on the date reflected in any necessary federal approvals obtained by the department pursuant to subdivision (c).
(e) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this section by means of all-county letters, provider bulletins, or similar instructions, without taking any further regulatory action.
(f) Implementation of this section is subject to an appropriation in the annual Budget Act, or any other act approved by the Legislature, for the purposes described in this section.
(g) (1) Except as provided in paragraph (2), this section shall be implemented only to the extent that any necessary federal approvals are obtained and federal financial participation is available and not otherwise jeopardized.
(2) With respect to coverage described in the section for populations authorized under Title XXI of the federal Social Security Act (42 U.S.C. Sec. 1397aa), the department may implement this section prior to receipt of all necessary federal approvals, so long as the department determines that federal financial participation under the Medi-Cal program is not otherwise jeopardized.

SEC. 364.

 Section 14005.62 is added to the Welfare and Institutions Code, to read:

14005.62.
 (a) (1) Notwithstanding any other law, for an applicant or beneficiary whose eligibility is not determined using the modified adjusted gross income (MAGI)-based financial methods, as specified in Section 1396a(e)(14) of Title 42 of the United States Code, the department shall seek federal approval to implement a disregard of one hundred thirty thousand dollars ($130,000) in nonexempt property for a case with one member and sixty five thousand dollars ($65,000) for each additional household member, up to a maximum of ten members.
(2) This subdivision shall be implemented only after the director determines that systems have been programmed for the disregards specified in paragraph (1) and they communicate that determination in writing to the Department of Finance, and no sooner than July 1, 2022.
(b) (1) Notwithstanding any other law, for an applicant or beneficiary described in subdivision (a), resources, including property or other assets, shall not be used to determine eligibility under the Medi-Cal program to the extent permitted by federal law. The department shall seek federal authority to disregard all resources as authorized by the flexibilities provided under Section 1396a(r)(2) of Title 42 of the United States Code or other available authorities.
(2) This subdivision shall be implemented only after the director determines that systems have been programmed for these disregards and they communicate that determination in writing to the Department of Finance, and no sooner than January 1, 2024.
(c) (1)   Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement this section by means of county letters, provider bulletins or notices, policy letters, or other similar instructions, without taking regulatory action.
(2) Within two years of implementing the requirements set forth in subdivision (b), the department shall do both of the following:
(A) Adopt, amend, or repeal regulations in accordance with the requirements of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code and this section.
(B) Update its notices and forms to delete any reference to limitations on resources or assets.
(d) This section shall only be implemented to the extent consistent with federal law, upon the department obtaining any necessary federal approvals, and to the extent federal financial participation under the Medi-Cal program is available and not otherwise jeopardized.

SEC. 365.

 Section 14007.8 of the Welfare and Institutions Code is amended to read:

14007.8.
 (a) (1) An individual who is 25 years of age or younger, and who does not have satisfactory immigration status or is unable to establish satisfactory immigration status as required by Section 14011.2, shall be eligible for the full scope of Medi-Cal benefits, if they are otherwise eligible for benefits under this chapter.
(2) (A) After the director determines, and communicates that determination in writing to the Department of Finance, that systems have been programmed for implementation of this paragraph, but no sooner than May 1, 2022, an individual who is 50 years of age or older, and who does not have satisfactory immigrant status or is unable to establish satisfactory immigration status as required by Section 14011.2, shall be eligible for the full scope of Medi-Cal benefits, if they are otherwise eligible for benefits under this chapter.
(B) The effective date of enrollment into the Medi-Cal program for an individual described in this paragraph, and enrolled in the Medi-Cal program pursuant to subdivision (d) of Section 14007.5, shall be on the same day on which the systems are operational to begin processing new applications pursuant to the director’s determination described in subparagraph (A).
(3) (A) An individual enrolled in the Medi-Cal program pursuant to this section and subdivision (d) of Section 14007.5 shall not be required to file a new application for the Medi-Cal program.
(B) The enrollment specified in subparagraph (A) shall be conducted pursuant to an eligibility and enrollment plan, and shall include outreach strategies developed by the department in consultation with interested stakeholders, including, but not limited to, counties, health care service plans, health care providers, consumer advocates, and the Legislature.
(C) The department shall provide monthly updates to the appropriate policy and fiscal committees of the Legislature on the status of the implementation of this section.
(b) To the extent permitted by state and federal law, an individual eligible under this section shall be required to enroll in a Medi-Cal managed care health plan. Enrollment in a Medi-Cal managed care health plan shall not preclude a beneficiary from being enrolled in any other children’s Medi-Cal specialty program that they would otherwise be eligible for.
(c) (1) The department shall maximize federal financial participation in implementing this section to the extent allowable. For purposes of implementing this section, the department shall claim federal financial participation to the extent that the department determines it is available.
(2) To the extent that federal financial participation is unavailable, the department shall implement this section using state funds appropriated for this purpose.
(d) This section shall be implemented only to the extent it is in compliance with Section 1621(d) of Title 8 of the United States Code.
(e) (1) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department, without taking any further regulatory action, shall implement, interpret, or make specific this section by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions until the time any necessary regulations are adopted. Thereafter, the department shall adopt regulations in accordance with the requirements of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code.
(2) Notwithstanding Section 10231.5 of the Government Code, the department shall provide a status report to the Legislature on a semiannual basis, in compliance with Section 9795 of the Government Code, until regulations have been adopted.
(f) In implementing this section, the department may contract, as necessary, on a bid or nonbid basis. This subdivision establishes an accelerated process for issuing contracts pursuant to this section. Those contracts, and any other contracts entered into pursuant to this subdivision, may be on a noncompetitive bid basis and shall be exempt from both of the following:
(1) Part 2 (commencing with Section 10100) of Division 2 of the Public Contract Code and any policies, procedures, or regulations authorized by that part.
(2) Review or approval of contracts by the Department of General Services.

SEC. 366.

 Section 14011.10 of the Welfare and Institutions Code is amended to read:

14011.10.
 (a) Except as provided in Sections 14053.7, 14053.8, and 14184.800, benefits provided under this chapter to an individual who is an inmate of a public institution shall be suspended in accordance with Section 1396d(a)(29)(A) of Title 42 of the United States Code as provided in subdivisions (c) and (d).
(b) A county welfare department shall notify the department within 10 days of receiving information that an individual on Medi-Cal in the county is or will be an inmate of a public institution.
(c) Until October 1, 2020, if an individual is a Medi-Cal beneficiary on the date they become an inmate of a public institution, their benefits under this chapter and under Chapter 8 (commencing with Section 14200) shall be suspended effective the date they become an inmate of a public institution. The suspension shall end on the date they are no longer an inmate of a public institution or one year from the date they become an inmate of a public institution, whichever is sooner.
(d) Commencing October 1, 2020, if an individual is a Medi-Cal beneficiary on the date they become an inmate of a public institution, their benefits under this chapter and under Chapter 8 (commencing with Section 14200) shall be suspended effective the date they become an inmate of a public institution. The suspension shall end according to the following:
(1) For an individual who is not defined as a juvenile under Section 1396a(nn)(1)(A) or 1396a(nn)(1)(B) of Title 42 of the United States Code, the suspension shall end on the date the individual is no longer an inmate of a public institution or one year from the date the individual becomes an inmate of a public institution, whichever is sooner.
(2) For an individual who is defined as a juvenile under Section 1396a(nn)(1)(A) or 1396a(nn)(1)(B) of Title 42 of the United States Code, the suspension shall end in accordance with Section 1396a(a)(84) of Title 42 of the United States Code, or one year from the date the individual becomes an inmate of a public institution, whichever is later.
(e) The department, in consultation with stakeholders, including the County Welfare Directors Association of California and advocates, shall develop and implement a redetermination of eligibility, to the extent required by federal law, pursuant to Section 14005.37, for individuals referenced in paragraph (2) of subdivision (d) whose eligibility is suspended pursuant to this section.
(f) This section does not create a state-funded benefit or program. Health care services under this chapter and Chapter 8 (commencing with Section 14200) shall not be available to inmates of public institutions whose Medi-Cal benefits have been suspended under this section.
(g) This section shall be implemented only if and to the extent allowed by federal law. This section shall be implemented only if and to the extent that federal financial participation is available and any necessary federal approval of state plan amendments or other federal approvals have been obtained.
(h) This section shall be implemented on January 1, 2010, or the date when all necessary federal approvals are obtained, whichever is later.
(i) By January 1, 2010, or the date when all necessary federal approvals are obtained, whichever is later, the department, in consultation with the Chief Probation Officers of California and the County Welfare Directors Association of California, shall establish the protocols and procedures necessary to implement this section, including any needed changes to the protocols and procedures previously established to implement Section 14029.5.
(j) The department shall determine whether federal financial participation will be jeopardized by implementing this section and shall implement this section only if and to the extent that federal financial participation is not jeopardized.
(k) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department shall implement this section by means of all-county letters or similar instructions without taking regulatory action. Thereafter, the department shall adopt regulations in accordance with the requirements of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code.
(l) Notwithstanding any other law, commencing no sooner than July 1, 2021, the department, in consultation with representatives of county welfare departments, the Statewide Automated Welfare Systems, and other interested stakeholders, shall initiate the planning process to prioritize the automation of Medi-Cal suspensions for incarcerated individuals into the California Healthcare Eligibility, Enrollment, and Retention System, as set forth in this section. This change shall be reflected in both the California Healthcare Eligibility, Enrollment, and Retention System 24-Month Roadmap Initiatives and the County Eligibility Worker Dashboard.

SEC. 367.

 Section 14021.37 of the Welfare and Institutions Code is repealed.

SEC. 368.

 Section 14042.1 of the Welfare and Institutions Code is amended to read:

14042.1.
 (a) No earlier than January 1, 2018, the State Department of Health Care Services shall establish a Medically Tailored Meals Pilot Program to operate for a period of four years from the date the program is established, or until funding is no longer available for the program, whichever date is earlier.
(1) The department shall determine the number of eligible participants and providers in the program and shall use data from the Medi-Cal program to identify eligible beneficiaries for participation in the program.
(2) The program shall provide medically tailored meal intervention services to Medi-Cal participants with one or more of the following health conditions: congestive heart failure, cancer, diabetes, chronic obstructive pulmonary disease, or renal disease.
(3) The department may establish additional eligibility requirements based on acuity and other selection criteria. Each participant in the program shall receive a standard intervention, as determined by the department, of up to 21 meals per week for 12 to 24 weeks. The provided meals shall be medically tailored and designed to meet the specific nutritional needs of the participant’s specific illness.
(4) The program shall be conducted in the Counties of Alameda, Los Angeles, Marin, San Diego, San Francisco, San Mateo, Santa Clara, and Sonoma.
(5) (A) At the conclusion of the program, the department shall use the data from the Medi-Cal program on the program participants to evaluate what impact, to the extent it can be determined, the program had on hospital readmissions, decreased admissions to long-term care facilities, and emergency room utilization.
(B) The department shall send a report containing its evaluation to the Legislature within 12 months after the end of the four-year program.
(C) The legislative report submitted pursuant to subparagraph (B) shall be submitted in compliance with Section 9795 of the Government Code.
(b) For the purposes of this section, “medically tailored meals” means a specifically tailored diet to address the participant’s specific medical condition and associated symptoms.
(c) The department shall develop a methodology for reimbursing contractors, or other entities, as applicable, for services or activities provided pursuant to this section based on, and not to exceed, the aggregate amount of funds allocated per year for purposes of the program. The department may use up to 20 percent of the funds allocated per year for the program to support its administration and evaluation.
(d) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this section, in whole or in part, by means of policy letters, all-county letters, plan letters, or other similar instructions, without taking regulatory action.
(e) For purposes of implementing this section, the department may enter into exclusive or nonexclusive contracts, or amend existing contracts, on a bid or negotiated basis. Contracts entered into or amended pursuant to this section shall be exempt from Chapter 6 (commencing with Section 14825) of Part 5.5 of Division 3 of Title 2 of the Government Code, Section 19130 of the Government Code, and Part 2 (commencing with Section 10100) of Division 2 of the Public Contract Code, and shall be exempt from the review or approval of any division of the Department of General Services.
(f) The department shall seek any federal approvals necessary to implement this section, including any waivers it deems necessary to obtain federal financial participation for the program, and shall claim federal financial participation to the full extent permitted by law. If federal financial participation is unavailable, the department shall implement the program using available state-only funds, subject to annual appropriation by the Legislature.
(g) (1)  For the 2021–2022 fiscal year, in addition to the Medically Tailored Meals Pilot Program specified under subdivisions (a) to (f), inclusive, the department shall implement the Short-Term Medically Tailored Meals Intervention Services Program to award funds to qualified entities providing medically tailored meals intervention services to eligible Medi-Cal beneficiaries who reside in a county identified in paragraph (4) with one or more of the following health conditions described in subparagraphs (A) to (H), inclusive, when meal services are unavailable under the Medically Tailored Meals Pilot Program:
(A)  Diabetes.
(B) Chronic obstructive pulmonary disease.
(C) Renal disease.
(D) Chronic kidney disease.
(E) Cancer.
(F) Malnutrition.
(G) Human immunodeficiency virus or acquired immune deficiency syndrome.
(H) Congestive heart failure.
(2) The Short-Term Medically Tailored Meals Intervention Services Program shall cease to be operative when the funding allocated under the Budget Act of 2021 has been exhausted, or on June 30, 2022, whichever is sooner.
(3) (A) To the extent funding is available, an eligible Medi-Cal beneficiary shall receive medically tailored meals intervention services as specified in subparagraph (B).
(B) (i) For the 2021–2022 fiscal year, medically tailored meals intervention services shall be available to an eligible Medi-Cal beneficiary, and they shall receive up to 21 meals per week for 12 to 52