2019 - 2020 Legislation
The COVID-19 pandemic and projected 2020-21 state budget deficits have significantly affected, and decreased, the number of legislative bills of every member of the Legislature. Here is a list of my legislative efforts for 2020. You can click on the bill number for detailed information including bill text, status and analyses.
AB 890-Nurse Practitioners. This bill will allow nationally certified nurse practitioners, after completing specific transition requirements, to practice to the full scope of their license independent of physician oversight. California is one of 28 states — and the only western state — that restricts NPs by requiring them to work with physician oversight. Twenty-two other states allow full practice authority of nurse practitioners. The number of primary care physicians is on the decline in California and although I support increasing the number of residency slots and funding medical student loan repayment grants, it is not enough to meet the need. Increasing the number of primary care health care practitioners, including nurse practitioners, will increase access to care for many more people in California especially in underserved and rural areas. This bill was signed by the Governor. You can read the press release here.
AB 910-Medi-Cal Mental Health Care. California’s Medi-Cal mental health delivery is complex. Fifty-six county mental health plans provide a broad range of specialty mental health services to individuals with more severe mental illnesses, while Medi-Cal managed care plans cover less severe mental illnesses. This bill would strengthen the dispute resolution process between Medi-Cal managed plans and county mental health plans when there is disagreement about which plan is responsible for providing mental health services to a Medi-Cal enrollee. This bill has been held this year.
AB 1387-Fishing Licenses. Since 1980, annual resident sport fishing license sales have declined 55 percent while the state’s population has increased more than 60 percent. California has one of the country’s longest coastlines, more than 3,000 lakes and thousands of rivers and streams, but has the lowest fishing participation rate per capita in the country and continues to decline. A leading contributor to declining fishing participation rates is that licenses are only valid until December 31 of each year, regardless of the date of purchase. To address this downward trend, the Department of Fish and Wildlife initiated a Recruitment, Retention and Reactivation, or “R-3” Action Plan. That plan resulted in recommendations including creating a fishing license valid for 365 days from the date of purchase and implementing a digital license that can be stored on a mobile device. This bill has been held this year.
AB 1710-Pharmacists. Existing law authorizes a pharmacist to independently initiate and administer vaccines listed on the routine immunization schedules recommended by the federal Advisory Committee on Immunization Practices (ACIP) in compliance with individual ACIP vaccine recommendations, and published by the federal Centers for Disease Control and Prevention for persons 3 years of age or older. This bill would also authorize a pharmacist to independently initiate and administer vaccines approved by the federal Food and Drug Administration under the same circumstances. This bill was signed by the Governor. You can read the press release here.
AB 2100-Medi-Cal Pharmacy Benefits. This bill will address several issues resulting from changes to the Medi-Cal pharmacy benefit program. A new method of paying pharmacies in Medi-Cal fee-for-service (FFS) was approved in August 2017, but not implemented until February 2019, has resulted in reduced pharmacy reimbursement amounts for certain high-cost drugs used to treat mental illness and prevent and treat HIV. In some cases, this new reimbursement amount is less than the amount some community pharmacies paid to acquire the drugs, challenging the financial viability of these pharmacies and threatening access for patients needing these specialty drugs. In addition, this bill would address issues associated with the transition of pharmacy services proposed by Governor Newsom as part of his Medi-CalRx, which shifts outpatient prescription drug coverage from Medi-Cal managed care plans to FFS Medi-Cal. This bill would end the arbitrary six-prescription-per-month limit in FFS Medi-Cal, provide a 180-day continuity of care of period so beneficiaries have adequate time to remain on their current medications during the transition to FFS, and require additional data reporting elements as part of Medi-Cal budget documents to ensure transparency, fiscal and performance oversight and monitoring of the Medi-Cal Rx program. This bill was vetoed by the Governor. Although disappointing, the veto message directs the department to convene stakeholders to look at options and approaches. The veto message can be read here.
AB 2157-Surprise Billing Independent Dispute Resolution Process. The independent dispute resolution process (IDRP) for surprise balance billing health insurance claims has been in place for several years and this bill addresses concerns regarding how the IDRP organization reviews claims. A prior bill, AB 72, dealt with balance billing scenarios in which a patient receives services at a contracted facility but from a non-contracted provider resulting in a “surprise bill” to the patient. That law removed the patient from the dispute process and automatically deems the service as being in-network for purposes of patient cost sharing. This bill will improve the IDRP by requiring procedures established by the Department of Managed Health Care and California Department of Insurance to include a process for each party to submit information that will be kept confidential from the other party, in order to preserve the confidentiality of the source contract. It also requires the independent organization to conduct a new review of the claim dispute and assign reviewers to each case based on their relevant education, background and medical claims payment and clinical experience. This bill was signed by the Governor.
AB 2347-Health Care Coverage Financial Assistance. This bill, contingent upon an appropriation by the Legislature, would reduce premiums to zero for program participants with household incomes at or below 138 percent of the federal poverty level and would scale the premium assistance subsidy amount for program participants with household incomes of 139 percent to 600 percent of the federal poverty level according to the program design adopted by Covered California. This bill was held in the Assembly Appropriations Committee and will not move forward.
AB 2519-Conservation Projects: Advance Payments for Grants. The Natural Resources Agency, the State Coastal Conservancy, the Department of Water Resources, and the Water Resources Control Board have programs that award grants to local nonprofit and government entities to carry out projects that further the state’s goals. These funds are usually dispersed to the grantee after project completion, often months later. Some grantees cannot benefit from these grants because they cannot cover the upfront costs needed to get the project off the ground. This disadvantages small and lower income communities. This bill would require the entities to provide an advance payment of up to 25 percent of the total grant award if requested by a grant recipient. This bill has been held this year.
AB 2644-Skilled nursing facilities: deaths: reporting. In the event of a declared emergency related to a communicable disease, this bill would require a skilled nursing facility to report each disease-related death to the Department of Public Health within 24 hours of that death. The bill would require the State Department of Public Health to report certain information related to those deaths on its internet website on a weekly basis. This bill was signed by the Governor.
AB 2830-Health Care Payments Data Program. Health care spending continues to increase. In California, per-capita spending for all types of health care programs has grown steadily over time for all sources of coverage: employer-sponsored, Medi-Cal, Medicare and private insurance. As California evaluates efforts to control the growth of health care spending, it is important for the state to have a comprehensive picture of what we pay for in health care. The requirement for The Office of Statewide Health Planning and Development (OSHPD) to develop a state all payer claims database was established in 2018. The database will represent the single most important data source to understand health care spending that can eventually lead to cost containment. OSHPD established a review committee to advise the office on establishing and implementing a database and AB 2830 codifies those recommendations. This bill has been held this year.
AB 3012-Residential Property Insurance. Over the past several years, insurance companies have adjusted to catastrophic wildfires by reducing the number of properties they insure in areas at higher risk of fire. As the definition of a fire-prone community has evolved, the changing insurance climate has impacted property owners across the state. More property owners are being non-renewed by their insurance company and are being forced on to the significantly more expensive FAIR Plan (California Fair Access to Insurance Requirements) often referred to as the insurance plan of last resort.
This bill would prohibit insurers from deducting the land value of the insured property if insureds choose to rebuild or replace the insured dwelling in a different location; extend coverage for additional living expenses if the home is not inhabitable or usable due to insufficient infrastructure (such as the local water system); create a process and minimum ratio (30 percent of coverage A limits) for contents replacement value insureds can collect without submitting an itemized claim if the loss occurred due to an event that triggered a declaration of emergency; require the FAIR Plan, by July 1 2021, to develop a clearinghouse to help reduce the number of insureds on the FAIR Plan; and strengthen provisions surrounding the California Home Insurance Finder which was established pursuant to AB 1875 (Wood-2018). This bill was signed by the Governor. You can read the press release here.
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Here is the status of legislation from the first year of the 2019-20 legislative session. To see the legislative text or status of the bills, click on the bill number.
Health Care Legislation:
AB 174-Health care affordability. This bill originally was designed to make health care coverage more affordable for people who are purchasing coverage through Covered California by expanding subsidies/tax credits for people earning up to 800 percent of the federal poverty level (FPL), rather than the existing 400 percent of FPL. The final state budget expanded subsidies for people earning up to 600 percent of FPL, and although not the 800 percent I was seeking, is an improvement. AB 174 has been modified to track data regarding these increased subsidies to see if they are improving enrollment in health plans. This bill was signed by the Governor on October 12.
AB 204-Hospital community benefit reporting. This bill will standardize how hospitals report the value of their "community benefits." The current reporting requirements do not require hospital systems to break out the value of their community benefits by hospital site and, as a result, individual communities do not have accurate information about how a local hospital is supporting their community. This bill will provide relevant information to local communities.This bill was signed by the Governor on October 7.
AB 290-Dialysis third-party payments. Virtually all patients requiring dialysis, after a specified waiting period, qualify for Medicare, regardless of age. In those cases, dialysis is reimbursed at the Medicare rate. Dialysis companies use a practice of making donations to the American Kidney Fund (AKF) and, in turn, AKF uses those donations to pay for all or portions of a patient's commercial health care coverage and/or treatment which results in the dialysis clinic receiving a higher reimbursement for the treatment. Patients receive the same care, whether they are covered by Medicare/Medi-Cal or commercial insurance and this practice unnecessarily inflates the cost of care and only benefits the dialysis clinics and their corporations which reap billions in profits at the expense of patients and the health care system. This bill was signed by the Governor on October 13.
AB 714-Co-prescribing naloxone. Last year, AB 2760, which was signed into law, requires prescribers to offer a prescription for naloxone to patients at high risk of overdose. This bill will exclude prescribers when they are prescribing, ordering or administering medications to a patient in an inpatient health facility or prescribing to a patient in outpatient-based hospice care. This bill was signed by the Governor on September 5, and because it was an urgency measure, it takes effect immediately.
AB 824-This bill prohibits delaying production of generic drugs and improves access to affordable drugs by making it unlawful for generic and brand name drug manufacturers to enter into pay-for-delay agreements. "Pay for delay" is a practice by which pharmaceutical firms with brand name drugs engage in contracts with generic manufacturers and, sometimes, other entities to delay the production of a generic version of a drug's brand name, usually in exchange for some value, which could include a monetary payment or other type of value. This bill will accomplish this by making these agreements presumptively anti-competitive. This bill was signed by the Governor on October 7.
AB 890-This bill will allow nationally certified nurse practitioners, after completing specific transition requirements, to practice to the full scope of their license independent of physician oversight. Twenty-two other states allow full practice authority of nurse practitioners. Increasing the number of primary care health care practitioners will increase access to care for many more people in California, especially in underserved and rural areas. This bill is a two-year bill; see list of 2020 bills above.
AB 899-This bill would authorize a licensed primary care clinic with a license in good standing for the preceding 5 years by the Department of Public Health to acquire ownership or control of an outpatient setting or a previously licensed primary care clinic and would provide that a facility acquired by a licensed primary care clinic be deemed compliant with the minimum standards of adequacy and safety required for the acquiring primary care clinic.This bill was vetoed by the Governor on October 11. His veto message can be found here.
AB 954-Sometimes, to expand network size, a dental plan or insurer will lease a dentist network from a third party (either another dental plan or insurer or a company that aggregates dental networks). Dentists who signed contracts with one dental plan or insurer are sometimes surprised to find out that they were contracted with other plans or don’t know what plans they have been leased to. Leased networks may also confuse dentists about which fee schedules are in effect. Confusion can lead to patient concerns if the wrong coinsurance or copay is charged. Dentists and patients are caught in between with the different dental plans on one side. This bill will increase transparency so that both dentists and patients have more clarity over benefits and co-pays. This bill was signed by the Governor on October 7.
AB 1042-There are nearly 1.2 million low-income seniors enrolled in the state’s Medi-Cal program. Some of these seniors who are temporary residents of skilled nursing facilities are eligible for a Medi-Cal deduction called the “Home Upkeep Allowance.” This allowance allows a person to keep $209 every month, for up to 6 months, for the maintenance of their home while they’re temporarily residing in one of these facilities. Vulnerable seniors may be at risk of losing their homes in these circumstances and this woefully low allowance has not been increased in 40 years. This bill would, first, increase upkeep allowance so seniors can return to their home; the current amount is woefully inadequate to maintain a home in California. Second, it would establish a new “transitional needs fund” for people who want to leave a nursing home but who can’t move out because they don’t have a place to go. This legislation was postponed in 2020 due to state budget deficits created by COVID-19.
AB 1088-This bill is intended to prevent seniors and people with disabilities who are dually enrolled in Medicare and Medi-Cal from losing their Medi-Cal coverage when the state begins paying their Medicare Part B premiums, which covers physician services. This amount, which is $135.50 per month (or $271 for a couple) can be just enough to increase their countable income for purposes of determining their Medi-Cal eligibility and can cause them to be dropped from no-cost Medi-Cal and placed on a share-of-cost Medi-Cal where they would be required to pay hundreds of dollars more for their care. This bill will prevent this unfair process, or "senior penalty," by disregarding the state’s payment for their Medicare premium as income and allowing them to maintain consistent coverage.This bill was signed by the Governor on October 2.
AB 1174-A law passed in 2016, AB 72, prevents consumers from "surprise billing" when their medical care was provided in a network facility but the provider was not a member of their network. That law also requires facilities to maintain a network that has an adequate number of each of the right types of providers to deliver the volume of health care services needed. This legislation will ensure that health plans and health insurers have a contractual relationship with an adequate number of anesthesiologists so that enrollees and insureds will have access to these types of providers at contracted facilities. This bill became AB 2157 in 2020; see above for details.
AB 1175-Medi-Cal mental health benefits are delivered to beneficiaries through separate delivery systems. Because these systems are funded and administered separately, there are patients who move between the two systems if their mental health condition improves or worsens. This can result in patients having to switch mental health providers and contact a different plan with a different network of mental health providers while receiving mental health services. This bill is intended to facilitate an easier transition for the patients to protect the continuity of their care. This bill was vetoed by the Governor on October 13. His veto message can be found here and it's important to note that, in it, the Governor said "I support the author's goal of improving care coordination for consumers who receive treatment from multiple delivery systems. As such, I am directing DHCS to exercise its administrative authority over MCPs and MHPs and identify and implement the most efficient and effective method for ensuring these entities coordinate care for Medi-Cal beneficiaries receiving these critically important services." This bill became AB 910 in 2020; see details above.
AB 1642-Medi-Cal managed care plans. This bill would allow Medi-Cal managed care plans to add the use of clinically appropriate telecommunications technology in order to meet the state's required timely access to health care standards. This bill was signed by the Governor on October 2.
AB 1723-Intermittent clinics. Recent changes in state law allow intermittent clinics to be open up to 40 hours per week; however, these laws did not change the 20-hour limit in the Pharmacy Law, which would prevent these clinics from purchasing drugs at wholesale prices.This bill will change that section of the Pharmacy Law to align with 40 hours per week. This bill was signed by the Governor on September 20.
Other important legislation:
AB 38-This bill would establish defensible space and home hardening retrofit standards for buildings in very high fire hazard severity zones. It will also establish the State Fire Preparedness Council with the goal of improving the scale and effectiveness of the state’s fire preparedness, including the creation of regional community fire preparedness councils. This bill would establish the Fire Hardened Homes Revolving Loan Fund in the State Treasury, and although there is currently no funding established for this, ultimately it will be used to distribute funding for no- or low-interest loans to owners of eligible buildings to pay for eligible costs of fire hardening. This bill was signed by the Governor on October 2.
AB 437-This bill would establish the Move-In Loan Program for the purpose of providing grants to eligible nonprofit organizations to be used to provide no-interest loans to eligible applicants to afford the security deposit and first month’s rent for a rental dwelling. Eligibility requirements for loan recipients would include a requirement that the income of the loan recipient is no greater than the area median income in which the rental dwelling is located. This is a two-year bill and cannot be taken up until January 2020. This legislation was postponed in 2020 due to state budget deficits created by COVID-19.
AB 557-Existing law establishes the Atmospheric Rivers Research, Mitigation, and Climate Forecasting Program in the Department of Water Resources. It requires the department, once funds are available, to research climate forecasting and the causes and impacts that climate change has on atmospheric rivers, to operate reservoirs in a manner that improves flood protection and to operate flood control and water storage facilities to capture water generated by atmospheric rivers. This bill did not move forward because we successfully advocated funding of $9.25 million which was placed into the state budget.
AB 746-Existing law generally prohibits a person from manufacturing, packing, or holding processed food in this state unless the person has a valid registration from the State Department of Public Health. Existing law exempts those holding a valid winegrower’s license or wine blender’s license. This bill would exempt the holder of a valid beer manufacturer’s license from the registration requirements of the law. This bill was signed by the Governor on September 9.
AB 867-This bill was introduced to allow credit cards and installment payments at Department of Motor Vehicles (DMV) offices. Although a person can pay using a credit card through DMV online services, you could not walk into a DMV and pay fees with a credit card. The use of credit cards has been implemented as part of the state budget, with pilot projects to begin in fall 2019. Due to infrastructure and software limitations within DMV, the requirement to allow installment payments could not move forward.
AB 1026-This bill seeks to streamline the process, especially rebuilding areas hit by disaster, by establishing the same level of clarity in the design and construction of utility line extensions as currently exists for the fire and life safety building standards that apply to the design and construction of our buildings in the state. This bill makes it clear that once an electrical or gas corporation initially approves the construction, design and specifications, they have officially determined the rules to which the construction must comply. This bill was signed by the Governor on October 1.
AB 1387-The current "annual" fishing license is only valid until December 31, regardless of the purchase date. California has the lowest fishing participation rate per capita in the country -- there has been a 55 percent decrease since 1980. In addition, our antiquated system prevents many people from purchasing a license later in the year because the expense does not make sense for a shortened period of time. This bill was introduced to provide a 365-day license from the date of purchase and would require the California Department of Fish and Wildlife (DFW) to develop an app that can display your license on your mobile device as well as an auto-renewal feature. Because the CDFW has recently published a plan to recruit, retain and reactivate (R3) hunting anf fishing licenses, and stakeholders are currently discussing how to implement the plan, I will wait for those recommendations (fall 2019) and consider incorporating them into this bill in 2020. This bill is currrently moving; see details above.
AB 1710-Cannabis. This bill would authorize the Elk Valley Rancheria and the County of Del Norte to enter into an agreement that would establish local authorization for cannabis related activity on the Elk Valley Rancheria. Additionally, the bill would require the licensee to comply with all the requirements of the Medicinal and Adult-Use Cannabis Regulation and Safety Act (MAUCRSA). This bill is currrently moving; see details above.