PART 2. HEALTH POLICY AND PLANNING [127280. - 127774.]

Part 2 added by Stats. 1995, Ch. 415, Sec. 9.

§§ 127280–127774 · 136 sections

CHAPTER 1. Health Planning §§ 127280–127286 · 4 sections
- § 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…
- § 127280.1 Notwithstanding any other provision of law, up to two hundred thousand dollars ($200,000) of the moneys collected pursuant to Section 127280 may be used by the…
- § 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…
- § 127286 (a) Commencing on January 1, 2027, health facilities, clinics, home health agencies, and hospices shall annually report to the department, on forms supplied by…
CHAPTER 2. Health Policy Research and Evaluation §§ 127340–127376 · 13 sections
1. ARTICLE 2. Hospitals: Community Benefits §§ 127340–127360 · 6 sections
  - § 127340 The Legislature finds and declares all of the following: (a) Private not-for-profit hospitals meet certain needs of their communities through the provision of…
  - § 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…
  - § 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,…
  - § 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…
  - § 127355 The hospital shall include all of the following elements in its community benefits plan: (a) Mechanisms to evaluate the plan’s effectiveness including, but not…
  - § 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…
2. ARTICLE 3. The Medical Equity Disclosure Act §§ 127370–127376 · 7 sections
  - § 127370 The Legislature finds and declares all of the following: (a) The COVID-19 health emergency has thrown into sharp relief longstanding health inequities along…
  - § 127371 As used in this article: (a) “Advisory committee” means the Health Care Equity Measures Advisory Committee established pursuant to Section 127376. (b)…
  - § 127372 (a) A hospital shall prepare an annual equity report. The equity report shall include an analysis of health status and access to care disparities for patients…
  - § 127373 (a) A hospital shall do all of the following with respect to an equity report prepared pursuant to Section 127372: (1) Include in the equity report an…
  - § 127374 (a) The Department of Health Care Access and Information may impose a fine not to exceed five thousand dollars ($5,000) against a hospital that fails to adopt,…
  - § 127375 The Department of Health Care Access and Information shall adopt any rules, regulations, or informal guidance necessary to further the objectives of this…
  - § 127376 (a) The Department of Health Care Access and Information shall convene a Health Care Equity Measures Advisory Committee, composed of at least one academic…
CHAPTER 2.5. Fair Pricing Policies §§ 127400–127471 · 32 sections
1. ARTICLE 1. Hospital Fair Pricing Policies §§ 127400–127446 · 18 sections
  - § 127400 As used in this article, the following terms have the following meanings: (a) “Allowance for financially qualified patient” means, with respect to services…
  - § 127400.5 For purposes of this chapter, the following terms have the following meanings: (a) “Charity care” means free care. (b) “Discounted payment” or “discount…
  - § 127401 (a) The State Department of Public Health shall be responsible for the enforcement of the provisions of this article for violations occurring prior to January…
  - § 127405 (a) (1) (A) Each hospital shall maintain an understandable written policy regarding discount payments for financially qualified patients as well as an…
  - § 127406 (a) For purposes of this section, the following terms shall have the following meanings: (1) “Presumptively determine” means a determination made by a hospital…
  - § 127410 (a) Each hospital shall provide patients with a written notice that shall contain information about availability of the hospital’s discount payment and charity…
  - § 127420 (a) Each hospital shall make all reasonable efforts to obtain from the patient or the patient’s representative information about whether private or public…
  - § 127425 (a) A hospital shall not sell patient debt to a debt buyer, as defined in Section 1788.50 of the Civil Code, unless all of the following apply: (1) The…
  - § 127426 (a) The period described in Section 127425 shall be extended if the patient has a pending appeal for coverage of the services, until a final determination of…
  - § 127430 (a) Prior to commencing collection activities against a patient, the hospital, any assignee of the hospital, or other owner of the patient debt, including a…
  - § 127435 (a) A hospital shall provide to the department a copy of its discount payment policy, charity care policy, eligibility procedures for those policies, review…
  - § 127436 (a) Upon promulgation of regulations as required in subdivisions (b) and (c) no later than January 1, 2024, the Director of the Department of Health Care…
  - § 127437 The Hospital Fair Pricing Penalties Fund is created in the State Treasury. Any moneys collected from administrative penalties pursuant to this article shall be…
  - § 127440 (a) The hospital shall reimburse the patient or patients any amount actually paid in excess of the amount due under this article, including interest. Interest…
  - § 127443 The rights, remedies, and penalties established by this article are cumulative, and shall not supersede the rights, remedies, or penalties established under…
  - § 127444 (a) This article does not prohibit a hospital from uniformly imposing charges from its established charge schedule or published rates or preclude the…
  - § 127445 Notwithstanding any other provision of law, the amounts paid by parties for services resulting from reduced or waived charges under a hospital’s discounted…
  - § 127446 To the extent that any requirement of Section 127400, 127401, or 127405 results in a federal determination that a hospital’s established charge schedule or…
2. ARTICLE 2. Emergency Physician Fair Pricing Policies §§ 127450–127462 · 12 sections
  - § 127450 As used in this article, the following terms have the following meanings: (a) “Allowance for financially qualified patient” means, with respect to emergency…
  - § 127451 A violation of this article shall not constitute a violation of the terms of a physician and surgeon’s licensure.
  - § 127452 (a) Uninsured patients or patients with high medical costs who are at or below 400 percent of the federal poverty level shall be eligible to apply to an…
  - § 127454 (a) Each emergency physician shall make all reasonable efforts to obtain from the patient, or his or her representative, information about whether private or…
  - § 127455 (a) Each emergency physician shall have a written policy about when and under whose authority patient debt is advanced for collection. (b) Each emergency…
  - § 127456 (a) The period described in Section 127455 shall be extended if the patient has a pending appeal for coverage of the services, until a final determination of…
  - § 127457 (a) After the period described in Section 127455, and upon the completion of appeals consistent with Section 127456, prior to commencing further collection…
  - § 127458 The emergency physician shall reimburse the patient or patients any amount actually paid in excess of the amount due under this article, including interest.…
  - § 127459 The rights, remedies, and penalties established by this article are cumulative, and shall not supersede the rights, remedies, or penalties established under…
  - § 127460 Nothing in this article shall be construed to prohibit the emergency physician from uniformly imposing charges from its established charge schedule or…
  - § 127461 Notwithstanding any other provision of law, the amounts paid by parties for services resulting from reduced or waived charges under an emergency physician’s…
  - § 127462 To the extent that any requirement of this article results in a federal determination that an emergency physician’s established charge schedule or published…
3. ARTICLE 3. Prescription Drug Pricing for Covered Entities §§ 127470–127471 · 2 sections
  - § 127470 For purposes of this article: (a) “Covered drug” means a drug purchased by a covered entity that is subject to the federal pricing requirements set forth in…
  - § 127471 (a) A pharmacy benefit manager shall not impose any requirements, conditions, or exclusions that do either of the following: (1) Discriminate against a covered…
CHAPTER 2.6. Health Care Affordability §§ 127500–127507.6 · 24 sections
1. ARTICLE 1. General Provisions and Definitions §§ 127500–127500.5 · 3 sections
  - § 127500 This chapter shall be known, and may be cited, as the California Health Care Quality and Affordability Act.
  - § 127500.2 As used in this chapter, the following definitions apply: (a) (1) “Administrative costs and profits” means the total sum of all expenses not included in the…
  - § 127500.5 (a) The Legislature finds and declares all of the following: (1) It is in the public interest that all Californians receive health care that is accessible,…
2. ARTICLE 2. Office of Health Care Affordability §§ 127501–127501.12 · 11 sections
  - § 127501 (a) There is hereby established, within the Department of Health Care Access and Information, the Office of Health Care Affordability. The Director of the…
  - § 127501.2 (a) Until January 1, 2027, any necessary rules and regulations for the purpose of implementing this chapter may be adopted as emergency regulations in…
  - § 127501.3 (a) The office shall be responsive to requests for additional information from the Legislature, including providing testimony during hearings and commenting on…
  - § 127501.4 (a) (1) Notwithstanding any other state or local law, the office shall collect data and other information it determines necessary from health care entities,…
  - § 127501.5 The office shall, in a manner prescribed by the office, establish requirements for management services organizations to submit data and other information as…
  - § 127501.6 (a) For data submitted to the office under paragraph (1) of subdivision (d) of Section 127501.4, the office shall prepare a report on baseline health care…
  - § 127501.7 (a) (1) Notwithstanding any other law regarding the confidentiality of data submitted by health care service plans or other entities to the Department of…
  - § 127501.8 (a) There is hereby established in the State Treasury the Health Care Affordability Fund for the purpose of receiving and expending revenues collected pursuant…
  - § 127501.10 (a) There is hereby established, within the office, the Health Care Affordability Board. The board shall be composed of eight members, as follows: (1) Four…
  - § 127501.11 (a) After receiving input, including recommendations, from the office and the advisory committee, and receiving public comments, the board shall establish all…
  - § 127501.12 (a) (1) The board shall establish a Health Care Affordability Advisory Committee to provide input, including recommendations, to the board and the office on a…
3. ARTICLE 3. Health Care Cost Targets §§ 127502–127502.5 · 2 sections
  - § 127502 (a) The board shall establish a statewide health care cost target. (b) (1) The board shall establish specific targets by health care sector, including fully…
  - § 127502.5 (a) The director shall enforce the cost targets established by this chapter against health care entities in a manner that ensures compliance with targets,…
4. ARTICLE 4. Quality and Equity Performance § 127503 · 1 section
  - § 127503 (a) (1) The office shall adopt a single set of standard measures for assessing health care quality and equity across payers, fully integrated delivery systems,…
5. ARTICLE 5. Alternative Payment Models § 127504 · 1 section
  - § 127504 (a) The office shall promote the shift from payments based on fee-for-service to alternative payment models that provide financial incentive for equitable…
6. ARTICLE 6. Primary Care and Behavioral Health Investments § 127505 · 1 section
  - § 127505 (a) (1) The office shall measure and promote a sustained systemwide investment in primary care and behavioral health. In furtherance of this goal, the office…
7. ARTICLE 7. Health Care Workforce Stability § 127506 · 1 section
  - § 127506 (a) The intent of this section is to monitor the effects of cost targets on health care workforce stability, high-quality jobs, and training needs of health…
8. ARTICLE 8. Health Care Market Trends §§ 127507–127507.6 · 4 sections
  - § 127507 (a) The office shall monitor cost trends, including conducting research and studies on the health care market, including, but not limited to, the impact of…
  - § 127507.2 (a) (1) If the office finds that a material change noticed pursuant to Section 127507 is likely to have a risk of a significant impact on market competitions,…
  - § 127507.4 In furtherance of this article, the office may do all of the following: (a) Contract with, consult, and receive advice from any state agency on terms and…
  - § 127507.6 In addition to any legal remedies, the office shall be entitled to specific performance, injunctive relief, and other equitable remedies a court deems…
CHAPTER 6. Reproductive Health Equity §§ 127630–127639 · 11 sections
- § 127630 For purposes of this chapter: (a) “Abortion” has the same meaning as defined in Section 123464. (b) “Contraception” means the services and contraceptive…
- § 127631 (a) The California Reproductive Health Equity Fund is hereby established. (b) The primary purpose of the fund is to provide grant funding to safety net…
- § 127631.1 In addition to the California Reproductive Health Equity Fund established in this chapter, the department may also use the money in the Abortion Access Fund…
- § 127632 (a) The California Reproductive and TGI Health Equity Program is hereby established within the department. (b) The purpose of the program is to ensure…
- § 127633 (a) A Medi-Cal enrolled provider, as determined by the State Department of Health Care Services, may apply for a grant, and a continuation award after the…
- § 127634 (a) An application for a grant under this chapter shall be made on a form to be developed by the department. (b) An application shall include both of the…
- § 127635 (a) Within the limits of funds available, the department may award grants that, in the department’s judgment, best promote the purposes described in Section…
- § 127636 (a) An application for a continuation award under this chapter shall be made on a form to be developed by the department. (b) Decisions regarding continuation…
- § 127637 Funds awarded pursuant to this chapter shall be expended solely for the purpose for which the funds were awarded, in accordance with the approved application…
- § 127638 In implementing the program, the department shall consult with interested parties, including the State Department of Health Care Services, the Department of…
- § 127639 The department shall conduct an evaluation of the program and shall report its findings to the Legislature by no later than July 1, 2024, and on an annual…
CHAPTER 6.1. Reproductive Health Protection §§ 127640–127643 · 4 sections
- § 127640 For purposes of this chapter: (a) “Abortion” has the same meaning as defined in Section 123464. (b) “Department” means the Department of Health Care Access and…
- § 127641 (a) The Abortion Access Fund is hereby established in the State Treasury. (b) Notwithstanding any other law, all of the following apply: (1) The fund is a…
- § 127642 (a) The department shall distribute moneys in the fund for the purpose of funding abortion services. (b) The department may carry out the program described in…
- § 127643 This chapter shall become inoperative on July 1, 2029, and, as of January 1, 2030, is repealed.
CHAPTER 7. University of California Assessment on Legislation Proposing Mandated Benefits or Services §§ 127660–127665 · 5 sections
- § 127660 (a) The Legislature hereby requests the University of California to establish the California Health Benefit Review Program to assess legislation proposing to…
- § 127661 A request pursuant to this chapter may be made by an appropriate policy or fiscal committee chairperson, the Speaker of the Assembly, or the President pro…
- § 127662 (a) In order to effectively support the University of California and its work in implementing this chapter, there is hereby established in the State Treasury,…
- § 127663 In order to avoid conflicts of interest, the Legislature requests the University of California to develop and implement conflict-of-interest provisions to…
- § 127665 This chapter shall become inoperative on July 1, 2033, and, as of January 1, 2034, is repealed.
CHAPTER 8.5. Health Care Payments Data Program §§ 127671–127674.1 · 21 sections
- § 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…
- § 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…
- § 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…
- § 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…
- § 127672.9 Until June 30, 2028, for purposes of implementing this chapter, including, but not limited to, hiring staff and consultants, facilitating and conducting…
- § 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…
- § 127673.05 (a) For purposes of this section, “pharmacy benefits manager” or “PBM” means an entity that is required to be licensed pursuant to Section 1385.008. (b)…
- § 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.…
- § 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.…
- § 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…
- § 127673.4 (a) The department shall develop regulations on data quality and improvement processes and shall make these processes publicly available. (b) Data quality…
- § 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…
- § 127673.6 The department shall develop an information security program that uses existing state standards and complies with applicable state and federal laws.
- § 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,…
- § 127673.8 (a) The department shall use the program data to produce publicly available information, including data products, summaries, analyses, studies, and other…
- § 127673.81 (a) (1) All personal consumer information obtained or maintained by the program shall be confidential. (2) Only deidentified aggregate patient or other…
- § 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…
- § 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…
- § 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.…
- § 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…
- § 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…
CHAPTER 9. Prescription Drug Pricing for Purchasers §§ 127675–127685 · 7 sections
- § 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…
- § 127676 (a) The Legislature finds and declares that the State of California has a substantial public interest in the price and cost of prescription drugs. California…
- § 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…
- § 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…
- § 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…
- § 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,…
- § 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…
CHAPTER 10. California Affordable Drug Manufacturing Act of 2020 §§ 127690–127697 · 9 sections
- § 127690 This chapter may be cited as the California Affordable Drug Manufacturing Act of 2020.
- § 127691 For purposes of this chapter, the following definitions apply: (a) “Generic drug” means a drug that is approved pursuant to subdivision (j) of Section 355 of…
- § 127692 (a) The California Health and Human Services Agency (CHHSA) or its departments shall enter into partnerships, consistent with subdivision (b) of Section…
- § 127693 (a) CHHSA shall enter into partnerships resulting in the production, procurement, or distribution of generic prescription drugs, with the intent that these…
- § 127694 (a) On or before December 31, 2023, CHHSA shall submit a report to the Legislature that assesses the feasibility of directly manufacturing generic prescription…
- § 127694.1 Upon appropriation by the Legislature, CHHSA shall develop a California-based manufacturing facility for insulin, with the intent of creating high-skill,…
- § 127695 (a) On or before December 31, 2022, CHHSA shall report to the Legislature on both of the following: (1) A description of the status of all drugs targeted under…
- § 127696 Notwithstanding any other provision of law, all nonpublic information and documents obtained or prepared under this chapter shall not be required to be…
- § 127697 In addition to partnerships authorized pursuant to Sections 127692 and 127693, the California Health and Human Services Agency may, subject to an appropriation…
CHAPTER 11. Health Care Data §§ 127770–127774 · 6 sections
- § 127770 For purposes of this chapter: (a) “Department” means the Department of Health Care Access and Information. (b) “State entities” means all state departments,…
- § 127770.5 It is the intent of the Legislature that the department collect data and publish reports on quality of care and patient experience.
- § 127771 (a) (1) Beginning July 1, 2026, the department shall compile annual publications, to be made publicly available on the department’s internet website, including…
- § 127772 (a) The Legislature finds and declares that the department performs public health activities described in Section 164.512(b) of Title 45 of the Code of Federal…
- § 127773 (a) This section governs the use of the Health Plan Improvement Trust Fund, previously renamed in former Section 130208. (b) The moneys in the Health Plan…
- § 127774 (a) Moneys transferred from the Managed Care Fund and the Insurance Fund for use by the department for purposes described in Section 127773 shall be deposited…