SB 302 (Stern, D-Calabasas)

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Signed by the governor on Oct. 8

Currently, “Ryan’s Law” requires health care facilities — including hospitals, skilled-nursing facilities, and assisted living centers — to allow terminally ill patients to use medicinal cannabis within the facility, subject to specified requirements. SB 302 adds patients who are over 65 years of age with a chronic disease to the list of those who can use medicinal cannabis within these facilities. It also includes home health in the definition of a health care facility, for most purposes. These patients are subject to the same requirements that are applicable to terminally ill patients. The bill adds additional requirements for patients over age 65 seeking to use medicinal cannabis and requires health facilities to train their staff on the facility’s written guidelines for the use and disposal of medicinal cannabis within the facility. The bill also authorizes a health care facility to suspend compliance with “Ryan’s Law” if a regulatory agency, the U.S. Department of Justice, or the Centers for Medicare & Medicaid Services makes an inquiry about the health care facility’s activities under this law or issues a notice to suspend funding.

2023-24 State Budget Summary

In late June, the Legislature and governor approved the 2023-24 state budget authorizing $310 billion in spending, including $226 billion from the General Fund. While refinements to the budget will continue to be made through the rest of the summer, the action resolves the bulk of the budgetary issues that state policymakers faced this year.

Despite a nearly $32 billion budget deficit entering the fiscal year, state policymakers approved a budget with a commitment of historic proportions to improve access to Medi-Cal by increasing payment levels for providers, no ongoing cuts to core programs, and no major tax increases outside of the reauthorized managed care organization (MCO) tax.

Assembly Bill (AB) 102 houses the main provisions of the budget agreement, while the statutory changes implementing the health care-related components of the budget can be found in AB 118 (general provisions) and AB 119 (MCO tax reauthorization).

Here’s a look at some of the major health care-related provisions in the 2023-24 budget:

The MCO Tax – A Historic Commitment. The approved budget reauthorizes the state’s MCO tax and, for the first time, dedicates most of the revenues to addressing longstanding shortfalls in Medi-Cal payments. Pending federal approval (which appears likely), the tax will be in place from April 2023 through the end of 2026. Over its lifespan, it will generate $19.4 billion in revenues available for state purposes. While the MCO tax will be in place for nearly four years, the revenues will be spent over six years, with most of the provider payment increases beginning in 2025. Of the total resources generated, $11.1 billion will support provider payment increases and the remaining $8.3 billion will be used to address the state deficit.

In 2024, $275 million in MCO tax funding will support hospitals in the form of a one-time $150 million allocation to the Distressed Hospital Loan Program, $75 million for graduate medical education (GME) —a portion of which likely will go to clinics — and $50 million to help small and rural hospitals prepare to comply with the state’s seismic standards. Primary care, maternity care, and non-specialty mental health providers will also receive a rate increase in 2024, at a total cost of around $500 million (including federal matching funds).

Starting in 2025, we estimate that hospital payments will increase by about $1.7 billion annually. This estimate includes the federal Medicaid matching funds that will support the provider payment increases, and specifically includes:

• $640 million for hospital emergency departments (EDs)
• $610 million for outpatient services
• $380 million for public hospitals
• $75 million in continued funding for GME

In addition, we estimate that nearly $5 billion in total funds will support other provider payment increases, including for primary and specialty care, ground ambulance providers, family planning services, and workforce for health care entities with labor management committees. Finally, $750 million of the nearly $5 billion will be dedicated to addressing throughput issues for patients in a behavioral health crisis, a portion of which is intended for hospital EDs.

Over the next year, the state will work to develop detailed payment methodologies for the provider payment increases that begin in 2025. Throughout this process, CHA will work with state policymakers to ensure the funding goes where it is intended and protect it from delay or diversion in case the state budget situation worsens. For more information, please see CHA’s FAQs on the MCO tax.

Expands Whole Child Model (WCM) to Additional Counties. Under WCM, California Children’s Services are delivered through county-operated Medi-Cal managed care plans, rather than fee for service, in 21 counties. Earlier this year, the governor proposed to expand WCM to 15 new counties. However, under the final budget, the expansion was limited to 12 additional counties with county-operated health plans: Butte, Colusa, Glenn, Mariposa, Nevada, Placer, Plumas, San Benito, Sierra, Sutter, Tehama, and Yuba.

Establishes New Reporting Timelines for Newborns. The budget includes statutory changes requiring providers that participate in Medi-Cal presumptive eligibility programs to report on the birth of a Medi-Cal eligible newborn within 72 hours after birth, or one business day after discharge, whichever is sooner. This change applies regardless of birth setting and is intended to prevent coverage gaps and delays in care.

Maintains and Builds Upon Recent Progress in Bolstering the State’s Health Care Programs. Despite a nearly $32 billion deficit, the budget protects commitments made in the last several years to expand health care coverage and make that coverage more meaningful. 

• Maintains Comprehensive Medi-Cal Coverage Expansion for Undocumented Adults. Last year’s budget authorized the expansion of comprehensive Medi-Cal coverage to undocumented adults ages 26 through 49 — the last age group of undocumented immigrants without such coverage. The approved budget maintains the expansion as scheduled, with an implementation date of January 2024.
• Supports Continued CalAIM Implementation. California Advancing and Innovating Medi-Cal (CalAIM), is a multi-year Medi-Cal reform effort aimed at improving access to health care and supportive services, particularly for Medi-Cal’s highest-risk, highest-need beneficiaries, and streamlining how care is arranged and paid for. The budget maintains CalAIM implementation as scheduled and provides new funding to implement the Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment (BH-CONNECT) demonstration, assist county behavioral health plans convert to a new payment methodology, and — starting next year — add transitional rent services as a Community Supports benefit.
• Funding for Behavioral Health Modernization Planning. Earlier this year, the governor and legislative leaders announced a $6.38 billion bond and proposal to transform the Mental Health Services Act (MHSA) for the March 2024 ballot. The proposal includes five solutions to transform California’s behavioral health system: reform the MHSA funding structure —which brings in over $3 billion per year — to focus on populations that are most vulnerable and allow funding for substance use disorder treatment; increase the focus on outcomes, accountability, and equity; build a workforce that reflects the state’s diversity; expand housing and treatment in community-based settings; and provide housing for veterans experiencing behavioral health challenges. While the legislation — Senate Bill 326 (Eggman, D-Stockton) and Assembly Bill 531 (Irwin, D-Thousand Oaks) — placing these reforms on the March 2024 ballot continues to work its way through the legislative process, the budget provided $40 million in resources for the Department of Health Care Services to continue the state’s planning efforts related to these reforms. See governor’s fact sheet.
• Furthers Investment in Reproductive Health with New Grant Opportunity. The budget includes $200 million in 2024-25 to fund capacity and access-supporting grants to qualified safety-net providers of reproductive health services. The state is currently seeking federal approval for the grant program, California’s Reproductive Health Demonstration, as a Section 1115 Medicaid demonstration project. As proposed, eligible grant applicants include clinics affiliated with disproportionate share hospital facilities, rural hospitals, small hospitals (less than 50 beds), and critical access hospitals that are not part of a larger system that provide a broad spectrum of sexual and reproductive health services.     
• Improves Affordability in Covered California. The budget provides $165 million in annual ongoing funding to create a new state cost-sharing subsidy program for Covered California consumers. Starting in 2024, deductibles will be eliminated and copays will be reduced for enrollees in the affected Covered California plans. The program will be funded with revenues from the state’s Individual Shared Responsibility Penalty, California’s individual health insurance mandate established after the federal mandate was effectively eliminated in 2019.
• Avoids Most Funding Delays for Health Care Workforce Programs. Last year’s budget included $1.5 billion in new health care workforce funding, around $1 billion of which was scheduled for expenditure across 2022-23 and 2023-24.In January, the governor proposed to delay nearly $400 million of the funding from the first two years to subsequent years. The final budget restores most of this funding. As a result, the only delay beyond 2023-24 that remains is a deferral of $115 million for the community health worker workforce to 2024-25 and 2025-26. This leaves only $15 million to be spent in 2023-24 for this purpose.

Imposes Several Limited Budget Solutions Within the Health Care Space. While health care spending was largely spared from the chopping block, the budget does include several health care-related budget deficit solutions. These include:

• The $8.3 billion from the MCO tax discussed earlier will be used to address the budget deficit (of this amount, $3.6 billion will be used in 2023-24).
• Delaying the elimination of the two-week checkwrite hold that had been scheduled for 2022-23, saving the state $378 million in the General Fund. This is now scheduled for 2024-25.
• Delays of $481 million for the Behavioral Health Continuum Infrastructure Program and $235 million for the Behavioral Health Bridge Housing Program to beyond 2023-24.
• A shift of $196 million from the state General Fund to the Mental Health Services Fund, which allowed the state to avoid the health care workforce funding delays described above.
• Loans totaling $230 million to the General Fund from the Hospital Building Fund (which supports the state’s seismic compliance efforts) and the California Health Data and Planning Fund (which supports the Department of Health Care Access and Information’s health care data collection, analysis, and reporting efforts).

Although painful budget cuts were largely avoided in the health care space this year, without an upturn in the state’s economic performance, budget deficits appear likely in future. Should a significant budget shortfall materialize as predicted, hospitals and other stakeholders will have to be vigilant in defending the important progress that has been made or promised to help protect access to health care for all Californians.

Distressed Hospital Loan Program Budget Trailer Bill

Support

The Legislature took early budget action on AB 112, which establishes a distressed hospital loan program substantially similar to AB 412. The trailer bill immediately appropriated $150 million to provide loans to distressed hospitals meeting specified criteria. The governor signed AB 112 on May 15. Subsequent budget action added an additional $150 million to the fund, for a total of $300 million. The Department of Health Care Access and Information announced close to $300 million in awards to 17 hospitals on Aug. 24.

AB 315 (Bauer-Kahan, D-San Ramon)

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Two-year bill

AB 315 would prohibit and make an unfair business practice of making false or misleading advertisements or statements about the provision, or lack of provision, of abortion or pregnancy-related services.

SB 487 (Atkins, D-San Diego)

Support

Signed by the governor on Sept. 27.

SB 487 prevents health plans and insurers — and the Medi-Cal program, conditional upon federal approval — from penalizing providers who deliver reproductive health care services.

SB 253 (Wiener, D-San Francisco)

Oppose Through Coalition

Signed by the governor on Oct. 7

SB 253 requires businesses, including hospitals and health care providers, with annual revenue in excess of $1 billion to publicly disclose their direct greenhouse gas emissions and indirect emissions related to electricity, heating, and cooling annually to the California Air Resources Board starting in 2026. Other upstream and downstream indirect emissions need to be reported starting in 2027.

AB 403/AB 666 (Arambula, D-Fresno)

Oppose

Neither bill will move forward this year; AB 666 is a two-year bill.

AB 403/AB 666 would set forth new or expanded requirements for community benefits. They would require the Department of Health Care Access and Information to define “community,” redefine the term “community benefit,” and expand the definition of “vulnerable populations.” The bills would also require that a community health needs assessment include the needs of the vulnerable populations and include a description of which vulnerable populations are low or moderate income. Community health needs assessments would have to be updated at least once every two years, and hospitals would be required to coordinate with a local health department. AB 403/AB 666 would also increase the fine for not submitting a community benefit plan from $5,000 to $25,000.

AB 1094 (Wicks, D-Oakland)

Oppose Unless Amended

Two-year bill

AB 1094 would, except in an emergency, require hospitals and other healthcare providers to obtain verbal and written informed consent before testing a pregnant woman or newborn for drugs or alcohol. 

AB 48 (Aguiar-Curry, D-Winters)

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Signed by the governor on Oct. 13

AB 48 establishes new rights and procedures for obtaining informed consent from skilled-nursing facility residents before administering treatments or procedures involving psychotherapeutic drugs, except in an emergency. As part of this new process, before treatment is initiated, skilled-nursing facilities must verify that a consent form has been completed to ensure specified information has been shared with the patient prior to providing consent. The California Department of Public Health (CDPH) is charged with developing the consent form. CDPH has until Dec. 31, 2024, to develop and disseminate the standardized consent form, and facilities are not required to comply until then. AB 48 is a reintroduction of AB 1809, a 2022 bill by the same author that was vetoed. CHA, along with the California Association of Health Facilities, successfully worked with the author’s office to secure amendments in AB 1809 to remove language that could have led to additional criminal or civil penalties for skilled-nursing facilities.

AB 1005 (Alvarez, D-Chula Vista)

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Two-year bill

AB 1005 would set a framework for how hospital discharge planners would provide in-home supportive services (IHSS) information to qualified Medi-Cal beneficiaries with a terminal condition. CHA worked closely with the author’s office to secure amendments to ensure this process reflects current practice while keeping the author’s intent to ensure IHSS information is provided as appropriate.

AB 40 (Rodriguez, D-Pomona)

Oppose

Signrd by the governor on Oct. 13

AB 40 requires local emergency medical services (EMS) agencies, by July 1, 2024, to establish an ambulance patient offload time (APOT) standard of no more than 30 minutes 90% of the time. The bill also requires general acute care hospitals with an emergency department (ED) to develop, in consultation with their exclusive employee representatives, if any, an APOT reduction protocol. Beginning Dec. 31, 2024, when a general acute care hospital with an ED exceeds the local EMS standard for the preceding month, the hospital will be required to participate in, at minimum, biweekly calls with its local EMS agency and EMS providers. These calls will discuss the implementation of the APOT reduction protocol, among other requirements for EMSA. See APOT Advocacy Materials.

AB 296 (Rodriguez, D-Pomona)

Support

2-year bill

AB 296 would establish the 911 Public Education Campaign to educate the public on when it is appropriate to call 911. Some of the goals of the campaign would include reducing the number of unnecessary calls to 911 and reducing delays in the 911 system caused by nonemergency calls.

AB 482 (Wilson, D-Suisun City)

Support

Two-year bill

AB 482 would require the Department of Transportation to transfer $8 million annually from the Aeronautics Account in the State Transportation Fund to the Emergency Medical Air Transportation and Children’s Coverage Fund, enabling the Department of Health Care Services to continue to augment Medi-Cal reimbursement for emergency medical air transportation services.

AB 767 (Gipson, D-Gardena)

Support

Signed by the governor on Sept. 30

AB 767 extends the Community Paramedicine or Triage to Alternate Destination Act of 2020 pilot program to Jan. 1, 2031. It was set to expire on Jan. 1, 2024.

AB 977 (Rodriguez, D-Pomona)

Support

Two-year bill

AB 977 would extend the penalties for violence committed against first responders to all health care workers who provide services within emergency departments. The bill defines “health care worker” as all staff, employees, or volunteers who provide services and treatment in the emergency department. AB 977 would also allow emergency departments to post a notice stating that an assault and battery against hospital staff is a crime and may result in a felony conviction.

AB 1036 (Bryan, D-Culver City)

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Two-year bill

AB 1036 would require a physician, upon an individual’s arrival at a hospital’s emergency department, to certify in the treatment record whether an emergency medical condition existed and required emergency medical transportation services. If a physician certifies that emergency medical transportation was needed, a health care service plan, disability insurance policy, or Medi-Cal managed care plan would be required to provide coverage for emergency medical transport, consistent with an individual’s plan or policy. The bill would specify that the indication by a physician pursuant to these provisions is limited to an assessment of the medical necessity of the emergency medical transport services. It would not apply or otherwise impact provisions regarding coverage for care provided following completion of the emergency medical transport. For Medi-Cal benefits, the bill would specify that these conditions do not apply to various specified provisions related to nonemergency transport services. Additionally, for Medi-Cal benefits, it would also not apply to any other law or regulation related to reimbursement or authorization requirements for services provided for emergencies and care.

AB 1164 (Lowenthal, D-Long Beach)

Oppose

Two-year bill

AB 1164 would require hospitals to create a protocol for emergency department crowding. Hospitals would be required to determine the range of crowding scores that constitute each category of the crowding scale and — with some exceptions — calculate and record a crowding score every four hours, at a minimum. The bill would require implementation and filing of the protocol with the Department of Health Care Access and Information by Jan. 1, 2025.

AB 1731 (Santiago, D-Los Angeles)

Support

Signed by the governor on Sept. 1

AB 1731 removes the requirement for a health care practitioner to consult the Controlled Substance Utilization Review and Evaluation System (CURES) database before prescribing more than a seven-day supply of buprenorphine in an emergency department (ED) setting. Providing a buprenorphine exemption from CURES lookup requirements for health care practitioners in the ED will save time and will enable patients who require treatment for opioid overdose or addiction to receive timely treatment.

AB 311 (Santiago, D-Los Angeles)

Support

Two-year bill

AB 311 would ensure undocumented immigrants are eligible to receive food assistance benefits.

AB 1057 (Weber, D-La Mesa)

Support

Vetoed on Oct. 8

AB 1057 would have codified the existing California Home Visiting Program to support pregnant people and parents with young children who live in communities that face greater risks and barriers to achieving positive maternal and child health outcomes.

AB 1202 (Lackey, R-Palmdale)

Support

Vetoed on Oct. 8

AB 1202 would have required the Department of Health Care Services to prepare a report that includes an analysis of the adequacy of each Medi-Cal managed care plan’s network for pediatric primary care. The report would have also included data on the number of children and pregnant or postpartum persons who are Medi-Cal beneficiaries who received certain health care services during the 2021-22, 2022-23, and 2023-24 fiscal years.

SB 37 (Caballero, D-Merced)

Follow

Two-year bill

SB 37 would require the Department of Housing and Community Development to begin developing the Older Adults and Adults with Disabilities Housing Stability Program.

AB 412 (Soria, D-Merced)

Support

Two-year bill

AB 412 would create the Distressed Hospital Loan Program, until Jan. 1, 2032, for the purpose of providing loans to not-for-profit hospitals and public hospitals in significant financial distress, to prevent the closure or facilitate the reopening of a closed hospital.

AB 1131 (Garcia, D-Coachella)

Support

Two-year bill

AB 1131 would establish the Hospitals First Revolving Fund to offer grants and low-cost loans to hospitals in rural and medically underserved communities to prevent the closure of a hospital or facilitate the reopening of a closed hospital.

SB 870 (Caballero, D-Merced)

Support

Two-year bill

SB 870 would extend the managed care organization (MCO) tax to an unspecified date and would reorganize the taxing tiers of the MCO tax to fund the nonfederal share of Medi-Cal managed care rates.

AB 4 (Arambula, D-Fresno)

Follow

Two-year bill

AB 4 would require Covered California to administer a program to allow persons not otherwise able to obtain coverage because of immigration status to enroll in health insurance coverage similar to other Californians, to the extent feasible under federal law and regulation.

AB 1085 (Maienschein, D-San Diego)

Support

Vetoed on Oct. 7

AB 1085 would have made housing support services a covered Medi-Cal benefit for those experiencing homelessness or at risk of homelessness when:

• The Department of Health Care Services has begun a specified evaluation required under the CalAIM Waiver Special Terms and Conditions
• The Legislature has made an appropriation for purposes of the housing support services

The bill would have also required the department to seek federal approval for the housing support services benefit.

AB 1481 (Boerner Horvath, D-Carlsbad)

Support

Signed by the governor on Oct. 7

AB 1481 ensures beneficiaries enrolled in Medi-Cal’s pregnancy-related presumptive eligibility program can remain enrolled in the program while they await their full eligibility determination and enrollment into the standard Medi-Cal program.

AB 1690 (Kalra, D-San Jose)

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Two-year bill

AB 1690 states the intent of the Legislature to create a universal single-payer health care program.

AB 2680 (Arambula, D-Fresno)

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Placed on the Senate inactive file on Aug. 23.

AB 2680 would create the Community Health Navigator Program to make direct grants to community-based organizations to conduct targeted outreach, enrollment, retention, and access activities for Medi-Cal-eligible individuals and families. The bill would establish the framework for the program.

AB 1392 (Rodriguez, D-Pomona)

Oppose

Signed by the governor on Oct. 13

AB 1392 requires hospitals with operating expenses of $50 million or more and hospitals that are part of a system with operating expenses of $25 million or more to submit annual plans to the Department of Health Care Access and Information (HCAI) detailing how the hospital plans to increase procurement from minority, women, LGBT, and disabled veteran businesses. The plans will be posted on HCAI’s website for public access.Failure to submit the plan will result in a civil penalty of $100 per day.

SB 59 (Skinner, D-Oakland)

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Two-year bill

SB 59 would require any building owned by the state, including a hospital that receives state funds, to provide menstrual products free of charge in all women’s and all-gender restrooms, as well as at least one men’s restroom. 

AB 236 (Holden, D-Pasadena)

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Two-year bill

AB 236 would require a health plan or insurer to annually audit and delete inaccurate listings from its provider directories, including deleting a provider from its directory if the plan or insurer has not financially compensated a provider in the prior year.

AB 616 (Rodriguez, D-Pomona)

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Vetoed on Oct. 13

AB 616, the Medical Group Financial Transparency Act, would have authorized the disclosure of audited financial reports of providers and physician organizations collected by the Office of Health Care Affordability. See veto message.

SB 598 (Skinner, D-Oakland)

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Held on the Assembly Appropriations Committee suspense file on Sept. 1.

SB 598 would prohibit a health care service plan or health insurer from requiring prior authorization by a health professional for a health care service if the plan or insurer approved or would have approved not less than 90% of the prior authorization requests they received in the most recent completed one-year contracted period. The bill also requires plans and insurers to establish an electronic prior authorization process.

AB 1331 (Wood, D-Healdsburg)

Concerns

Two-year bill

AB 1331 would require the Center for Data Insights and Innovation (Center) to take over the establishment, implementation, and all functions related to the California Health and Human Services Agency (CalHHS) Data Exchange Framework (Framework). It would also require the Center to establish the CalHHS Data Exchange Board to develop recommendations and to review, modify, and approve any changes to the Framework Data Sharing Agreement.

AB 1091 (Wood, D-Healdsburg)

Oppose

Two-year bill

AB 1091 would give the attorney general the authority to approve, reject, or impose conditions on any transaction of assets or change in governance worth $15 million or more and that involve hospitals, health systems, health plans, health insurers, medical groups, or pharmacy benefit managers.

AB 1092 (Wood, D-Healdsburg)

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Held in Senate Appropriations Committee on Sept. 1.

AB 1092 would require a health care service plan that intends to acquire or obtain control of an entity to give notice to and secure prior approval from the director of the Department of Managed Health Care. Recent amendments include reviewing transactions related to an affiliate of a health care service plan if the agreement or transaction will impact enrollees. An affiliate includes a hospital that offers a health plan.

SB 774 (Jones, R-Escondido)

Support

Two-year bill

SB 774 would prohibit the California attorney general from putting conditions on nonprofit hospital transactions (such as mergers and acquisitions). The conditions include those that would limit those hospitals from freely entering into contracts and negotiating rates, have an adverse financial or operational impact on the seller, or are different from the conditions that other similar corporations must comply with.

AB 1007 (Ortega, D-Hayward)

Oppose

Signed by the governor on Oct. 7

AB 1007 requires Cal/OSHA to submit a proposed regulation requiring hospitals to evacuate or use a plume scavenging system in any setting where techniques are used that create plume.

AB 1359 (Schiavo, D-Santa Clarita)

Oppose Unless Amended

Two-year bill

AB 1359 would require four days of unpaid sick leave for health care workers, in addition to paid sick leave available under existing law.

ACA 6 (Haney, D-San Francisco)

Oppose

Failed in Senate Elections and Constitutional Amendments Committee on Sept. 11. Reconsideration granted.

ACA 6 would require the University of California (UC) system to submit all service contracts to the State Personnel Board, creating a de facto ban on the use of registry nurses and temporary staff by the UC Health System.

SB 27 (Durazo, D-Los Angeles)

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Signed by the governor on Oct. 8

SB 27 requires vendors to provide their employees with the total compensation rate in the vendor’s contract, as well as make other payroll information available to employees upon request. It requires that vendors provide payroll information to the University of California (UC) and UC employee unions that perform similar services. SB 27 also prohibits vendors from contracting with the UC if they are supplying employees for services at a lower compensation rate than the UC’s policy on wages and benefits.

SB 525 (Durazo, D-Los Angeles)

Support

Signed by the governor on Oct. 13

SB 525 rolls out a $25 minimum wage for health care workers pursuant to these parameters:

• Organizations with 10,000 full-time equivalent workers or more will pay a minimum wage of $23 in June 2024, $24 in June 2025, and $25 in June 2026. Minimum wage after 2026 wll be indexed to the lower of inflation or 3.5%.
• Organizations that qualify for the longest step up in wages include: 1) the 31 hospitals in the state that are not part of a health system and are rural; 2) the 39 hospitals in the state that are not part of a health system and have a government payer mix of 75% or more, where government payer mix is determined by the share of utilization attributed to Medi-Cal and Medicare; and 3) the seven hospitals in the state that are part of a health system where both the hospital and the health system have a government payer mix of 90% or more, where government payer mix is determined by the share of utilization attributed to Medi-Cal and Medicare. Starting in June 2024, these hospitals will have to pay workers $18 an hour. The minimum wage after 2024 will be increased by 3.5% annually until it reaches $25 in June 2033; it is indexed thereafter to the lower of inflation or 3.5%.
• For hospitals that do not fall into one of the other two categories, they will pay workers $21 in June 2024, $23 in June 2026, and $25 in June 2028. The minimum wage after 2028 will be indexed to the lower of inflation or 3.5%.

In addition, local governments are prohibited from enacting local laws relating to wages or compensation for health care facility employees.

SB 616 (Gonzalez, D-Long Beach)

Oppose Through Coalition

Signed by the governor on Oct. 4

SB 616 requires employers to provide at least 40 hours or five days of accrued sick leave or paid time off by the 280th calendar day of employment. It also requires that time to be allowed to be carried over into the following year. Additionally, the bill also increases the amount of paid sick leave or paid time off an employee can accrue from 48 hours or six days to 112 hours or 14 days.

SB 799 (Portantino, D-Glendale)

Oppose Through Coalition

Vetoed on Sept. 30

SB 799 would have expanded unemployment insurance eligibility to employees who have been out of work due to a strike for at least 2 weeks.  

AB 242 (Wood, D-Healdsburg)

Support

Signed by the governor on Oct. 10

AB 242 makes the authority permanent for critical access hospitals to hire physicians directly by eliminating the sunset to the pilot program that was set to expire this year.

SB 784 (Becker, D-San Mateo)

Support

Two-year bill

SB 784 would authorize health care districts, as well as nonprofit corporations with a health care district as its sole corporate member, that own or control a general acute care hospital to directly employ physicians and surgeons.

AB 1001 (Haney, D-San Francisco)

Oppose

Two-year bill

AB 1001 would require general acute care hospitals to adopt behavioral health emergency service policies related to minimum staffing requirements, response times, and data management and reporting. This bill would establish the Behavioral Health Emergency Response and Training Fund to support staffing increases in public and non-profit general acute care hospitals.

AB 1316 (Irwin, D-Thousand Oaks)

Sponsor

Two-year bill

AB 1316 would require that Medi-Cal managed care plans pay hospital emergency departments for serving Medi-Cal beneficiaries experiencing a mental health crisis. It would also ensure people who need access to a mental health inpatient bed are transferred promptly to the care they need.

AB 1451 (Jackson, D-Perris)

Support

Vetoed on Oct. 7

AB 1451 would have required health plans and insurers to cover and pay for treatment for urgent and emergency mental health and substance use disorders. The bill would have prohibited plans and insurers from requiring prior authorization for these services.

Bill Package for 2024 Ballot includes Infrastructure Bond and Modernization of MHSA

Support

Signed by the governor on Oct. 12

Gov. Newsom and legislative leaders announced a $6.38 billion bond and transformation of the Mental Health Services Act (MHSA) for the March 2024 ballot. The bills, SB 326 (Eggman, D-Stockton) and AB 531 (Irwin, D-Thousand Oaks), focus on five solutions to transform California’s behavioral health system:  

1. Reforming the MHSA, which brings in over $3 billion per year, to allow funding for substance use disorder treatment  
2. Building a workforce that reflects the state’s diversity 
3. Focusing on outcomes, accountability, and equity 
4. Supporting housing and treatment in community-based settings 
5. Assisting with housing for veterans experiencing behavioral health challenges 

The bill package aims to build 10,000 new beds within community treatment facilities to support Californians with serious mental illness and substance use disorders. The outcome of these investments could reduce hospital emergency department visits, improve access to behavioral health care, support housing needs, and create additional jobs within California.

SB 43 (Eggman, D-Stockton)

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Signed by the governor on Oct. 10

SB 43 expands the definition of “gravely disabled” for purposes of either placing a person on an involuntary psychiatric hold or conservatorship. The new definition of “gravely disabled” includes individuals with either a severe substance use disorder or a co-occurring mental health disorder and a severe substance use disorder, and individuals who, due to a mental health disorder or one of the two above conditions, are unable to provide for their personal safety or necessary medical care.

SB 45 (Roth, D-Riverside)

Support

Held on the Assembly Appropriations Committee suspense file on Sept. 1.

SB 45 would establish the California Acute Care Psychiatric Hospital Loan Fund. The fund would provide zero-interest loans to counties and cities for the purposes of constructing or renovating acute care psychiatric hospitals and psychiatric health facilities. Funds also would be provided for renovating or expanding general acute care hospitals to add or expand an inpatient psychiatric unit.

SB 363 (Eggman, D-Stockton)

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Held on the Assembly Appropriations Committee suspense file on Sept. 1.

SB 363 would require the Department of Health Care Services to develop — by 2026 — an online database showing real-time availability of beds within behavioral health facilities. This bill would require facilities to submit accurate and timely information to the database or face plans of correction or monetary penalties from the state. CHA is among the stakeholders the bill would require the department to consult in developing the database.

AB 1063 (Gabriel, D-Woodland Hills)

Oppose

Vetoed on Oct. 8

AB 1063 would have required the California Department of Public Health (CDPH) to conduct an annual review of its enforcement of regulations related to nurse-to-patient staffing ratios and submit a report to the Legislature. The report would have included data regarding the number of complaints received, the investigative steps that were taken in response to the complaints, and whether the complaints were found to be substantiated or unsubstantiated. CDPH would also have been required to hold a public hearing at least once every two years and in advance of the first report — due Jan. 1, 2025 — to receive input from stakeholders regarding the efficacy of the department’s enforcement of the regulations. The input received during the hearing would have been required to be summarized and included in the annual report. The report would have also included a plan to implement the suggestions received during the hearing or an explanation as to why those suggestions were rejected.  

AB 1577 (Low, D-Cupertino)

Concerns

Two-year bill

AB 1577 would require health care facilities, including hospitals, to annually submit to the Department of Health Care Access and Information (HCAI) the number of clinical placement slots available for community college nursing students. Community colleges with nursing programs would be required to annually notify HCAI and the Bureau of Registered Nursing (BRN) of the number of clinical placement slots required for the next academic year and the number of slots that they have been unable to fill. HCAI would be required to post the information reported by the hospitals and nursing schools/programs on its website. If there are no hospitals to meet the needs of the community colleges, the bill would authorize the BRN to meet with general acute care hospitals in an attempt to match available clinical placement slots with needed slots. The bill would also establish a process for departmental review and a plan of correction or a potential fine if the hospital is not able to offer any additional slots. CHA is continuing to work with the author and sponsor — the United Nurses Associations of California — to address remaining concerns. 

AB 317 (Weber, D-La Mesa)

Support

Signed by the governor on Oct. 7

AB 317 improves access to preventive health care by ensuring that pharmacists are paid for the care they deliver. Specifically, AB 317 requires a health plan to pay or reimburse the cost of services authorized by law that are performed by a pharmacist.

AB 1557 (Flora, R-Ripon)

Support

Signed by the governor on Sept.1.

AB 1557 makes permanent the authority for a California-licensed pharmacist located in California to conduct medication chart order reviews outside of a licensed California hospital. The waiver that allows hospitals to remotely process prescriptions expired on Aug. 9, 2023. The waiver will be reinstated as soon as the governor signs the bill.

SB 786 (Portantino, D-Glendale)

Support

Signed by the governor on Oct. 7

SB 786 prohibits pharmacy benefit managers from imposing requirements, conditions, or exclusions that prevent 340B-covered entities from retaining the benefit of discounted pricing because of their 340B status.

SB 816 (Roth, D-Riverside)

Concerns

Signed by the governor on Oct. 10

SB 816 raises several types of licensing fees (effective Jan. 1, 2025) imposed by various state boards within the Department of Consumer Affairs. The bill includes numerous Board of Pharmacy (BoP) fee increases for both pharmacists and pharmacy facilities and equipment. The last fee increase occurred July 1, 2017. Based on an independent fee audit performed for the BoP, these new fees are intended to cover the board’s operating costs.

SB 625 (Nguyen, R-Huntington Beach)

Oppose

Two-year bill

SB 625 would make significant changes to California’s nationally recognized Newborn Screening Program (NBS), which tests all newborn babies for life-threatening and seriously disabling diseases. Specifically, SB 625 would require every Californian giving birth to fill out a new California Department of Public Health (CDPH)-developed form consenting to the NBS. The form would also include four different signatures lines for parents to opt out of the screening, storage and/or research components of the program. The bill would also create an expensive administrative challenge for both hospitals and CDPH, as they would have to obtain, store, transmit, and coordinate several forms for each of the 500,000 babies born in California annually.

AB 918 (Garcia, D-Coachella)

Follow

Signed by the governor on Oct. 8

AB 918 forms the Imperial Valley Healthcare District. The district’s initial board of directors will be required to enter negotiations with El Centro Regional Medical Center to decide the terms of acquisition of the hospital and finalize those terms by Nov. 5, 2024.

AB 869 (Wood, D-Healdsburg)

Support if Amended

Two-year bill

AB 869 would prioritize certain smaller hospitals for the existing Small and Rural Hospital Relief Program, which is funded by the e-cigarette tax. This would allow them to get assessments for the cost of retrofitting their hospital and give certain smaller rural hospitals and certain district hospitals a five-year extension of the 2030 seismic deadline. It would also allow certain smaller rural and district hospitals, if they have experienced a financial hardship, an indefinite extension beyond 2035, until funds are appropriated by the state. Amendments taken on March 7 provide additional criteria that health care districts can meet to be eligible for the extensions under the bill.

AB 1471 (Pellerin, D-Santa Cruz)

Support

Signed by the governor on Oct. 4

AB 1471 extends — for Santa Clara Valley Medical Center — the Jan. 1, 2025, deadline for hospital buildings to be able to withstand an earthquake. Under the bill, the hospital instead has until July 1, 2026, for all its buildings to meet these seismic requirements.

SB 759 (Grove, R- Bakersfield) 

Support

Two-year bill

SB 759 would extend the 2030 seismic deadline for hospitals to 2040.

AB 33 (Bains, D-Bakersfield)

Support

Signed by the governor on Oct. 13

AB 33 establishes the Fentanyl Misuse and Overdose Prevention Task Force to undertake various actions related to fentanyl abuse. These actions include collecting and organizing fentanyl abuse data and evaluating approaches to increase public awareness. The task force will be co-chaired by the attorney general and the state public health officer and is required to report its findings and recommendations to the governor and the Legislature by Dec. 1, 2025. 

SB 19 (Seyarto, R-Murrieta)

Support

Signed by the governor on Oct. 13

SB 19 establishes the Fentanyl Misuse and Overdose Prevention Task Force. This task force will assemble stakeholders to collect and organize data on the extent of fentanyl misuse in California. The data will be used to identify the resources necessary to respond to this new form of synthetic opioid abuse.

SB 641 (Roth, D-Riverside)

Support

Vetoed on Oct. 8

SB 641 would have ensured that all dosage strengths of opioid antagonists, such as naloxone, are available through the Naloxone Distribution Project.

ACA 1 (Aguiar-Curry, D-Winters)

Follow

Passed the Senate on Sept. 14. Must be approved by California voters.

If passed by voters, ACA 1 would lower the voter threshold from a two-thirds majority to a 55% majority to approve local bonds and certain special taxes for affordable housing, public infrastructure, downpayment assistance and permanent supportive housing projects.

AB 1156 (Bonta, D-Oakland)

Oppose

Two-year bill

AB 1156 would create a rebuttable presumption in the workers’ compensation system that an infectious disease, respiratory disease, cancer, PTSD, musculoskeletal injury, or respiratory disease, including COVID-19 and its variants, arose out of work for any hospital direct patient care worker.

AB 689 (W. Carrillo, D-Los Angeles)

Co-sponsor

Held in Senate Appropriations Committee on Sept. 1.

AB 689 is CHA/SEIU’s co-sponsored bill to help address the health care workforce crisis. The proposal would provide health care employees with priority registration when enrolling in community college courses and would also require that community colleges set aside at least 15% of slots in their impacted courses for current health care employees. This would ensure that health care employees have full access to the courses they need to complete their training as quickly as possible.

AB 1695 (Gipson, D-Gardena)

Support

Two-year bill

AB 1695 would create the Nursing Pathway Pilot Program, which would reduce the barriers to enrolling in community college nursing programs, thereby increasing the training and retention of more nurses at all levels.

SB 352 (Padilla, D-El Centro)

Follow

Two-year bill

SB 352 would direct the California Workforce Development Board, along with the secretary of the Labor and Workforce Development Agency and the director of the Department of Housing and Community Development, to examine housing costs by county, regionally, and in the state. They must then create a formula to determine how much the local minimum wage must be for a full-time worker to afford a decent standard of living, including appropriate housing, in that county. Beginning in 2024 and by Dec. 15 of each year, the board must recommend to the Legislature the minimum wage for a full-time minimum wage earner to afford a decent standard of living in each county, regionally, and in the state. The board must also recommend a method to annually adjust figures to account for housing cost inflation, as well as inflation broadly.