Bill Text: CA SB1180 | 2023-2024 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Health care coverage: emergency medical services.

Spectrum: Partisan Bill (Democrat 3-0)

Status: (Passed) 2024-09-28 - Chaptered by Secretary of State. Chapter 884, Statutes of 2024. [SB1180 Detail]

Download: California-2023-SB1180-Amended.html

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Amended  IN  Assembly  June 24, 2024

Amended  IN  Senate  May 16, 2024

Amended  IN  Senate  April 29, 2024

CALIFORNIA LEGISLATURE— 2023–2024 REGULAR SESSION

Senate Bill

No. 1180

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Introduced by Senator Ashby
(Coauthor: Senator Wahab)
(Coauthor: Assembly Member Bonta)

February 14, 2024

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An act to add Section 1371.51 to the Health and Safety Code, to add Section 10126.61 to the Insurance Code, and to add Section 14132.13 to the Welfare and Institutions Code, relating to health care coverage.

LEGISLATIVE COUNSEL'S DIGEST

SB 1180, as amended, Ashby. Health care coverage: emergency medical services.

Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law requires health care service plan contracts and health insurance policies to provide coverage for certain services and treatments, including medical transportation services. Existing law establishes the Medi-Cal program, administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services, including emergency medical transport. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.

Existing law, until January 1, 2031, authorizes a local emergency medical services (EMS) agency to develop a community paramedicine or triage to alternate destination program that, among other things, provides case management services to frequent EMS users or triage paramedic assessments, respectively.

This bill would require a health care service plan contract or health insurance policy issued, amended, or renewed on or after January July 1, 2025, to establish a process to reimburse for services provided by a community paramedicine program, a triage to alternate destination program, and a mobile integrated health program, as defined. The

The bill would require those contracts and policies to require an enrollee or insured who receives covered services from a noncontracting program to pay no more than the same cost-sharing amount that they would pay for the same covered services received from a contracting program. The bill would specify the reimbursement process and amount for a noncontracting program. Because prohibit reimbursement rates adopted pursuant to this provision from exceeding the health care service plan’s or health insurer’s usual and customary charges for services rendered.

Because a willful violation of these provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program.

The bill would also make services provided by these programs covered benefits under the Medi-Cal program. The bill would condition this Medi-Cal coverage on an appropriation, receipt of any necessary federal approvals, and the availability of federal financial participation.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Digest Key

Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: YES  

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Bill Text

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

SECTION 1.

 Section 1371.51 is added to the Health and Safety Code, to read:

1371.51.

 (a) A health care service plan contract issued, amended, or renewed on or after January July 1, 2025, shall establish a process to reimburse for services provided by a community paramedicine program, triage to alternate destination program, or mobile integrated health program.

(b) (1) A health care service plan contract issued, amended, or renewed on or after January July 1, 2025, shall require an enrollee who receives covered services from a noncontracting community paramedicine program, triage to alternate destination program, or mobile integrated health program to pay no more than the same cost-sharing amount that the enrollee would pay for the same covered services received from a contracting community paramedicine program, triage to alternate destination program, or mobile integrated health program.

(2)Reimbursement for a noncontracting community paramedicine program, triage to alternate destination program, or mobile integrated health program shall follow the same process as described in Section 1371.56.

(2) Notwithstanding any other law, reimbursement rates adopted pursuant to this subdivision shall not exceed the health care service plan’s usual and customary charges for services rendered.

(c) For purposes of this section, the following definitions apply:

(1) “Community paramedicine program” means a program defined in Section 1815.

(2) “Mobile integrated health program” means a team of licensed health care practitioners, operating within their scope of practice, who provide mobile health services to support the emergency medical services system.

(3) “Triage to alternate destination program” means a program defined in Section 1819.

SEC. 2.

 Section 10126.61 is added to the Insurance Code, to read:

10126.61.

 (a) A health insurance policy issued, amended, or renewed on or after January July 1, 2025, shall establish a process to reimburse for services provided by a community paramedicine program, triage to alternate destination program, or mobile integrated health program.

(b) (1) A health insurance policy issued, amended, or renewed on or after January July 1, 2025, shall require an insured who receives covered services from a noncontracting community paramedicine program, triage to alternate destination program, or mobile integrated health program to pay no more than the same cost-sharing amount that the insured would pay for the same covered services received from a contracting community paramedicine program, triage to alternate destination program, or mobile integrated health program.

(2)Reimbursement for a noncontracting community paramedicine program, triage to alternate destination program, or mobile integrated health program shall follow the same process as described in Section 10126.66.

(2) Notwithstanding any other law, reimbursement rates adopted pursuant to this subdivision shall not exceed the health insurer’s usual and customary charges for services rendered.

(c) For purposes of this section, the following definitions apply:

(1) “Community paramedicine program” means a program defined in Section 1815 of the Health and Safety Code.

(2) “Mobile integrated health program” means a team of licensed health care practitioners, operating within their scope of practice, who provide mobile health services to support the emergency medical services system.

(3) “Triage to alternate destination program” means a program defined in Section 1819 of the Health and Safety Code.

SEC. 3.

 Section 14132.13 is added to the Welfare and Institutions Code, to read:

14132.13.

 (a) Services provided by a community paramedicine program, triage to alternate destination program, or mobile integrated health program are covered benefits under the Medi-Cal program.

(b) The department shall develop rates of reimbursement for services provided by a community paramedicine program, triage to alternate destination program, or mobile integrated health program in consultation with community paramedicine programs, triage to alternate destination programs, and mobile integrated health programs.

(c) This section shall be implemented only to the extent that the department obtains any necessary federal waivers or other federal approvals and that federal financial participation is available and not otherwise jeopardized.

(d) Implementation of this section shall be subject to an appropriation made by the Legislature for the purpose of this section.

(e) For purposes of this section, the following definitions apply:

(1) “Community paramedicine program” means a program defined in Section 1815 of the Health and Safety Code.

(2) “Mobile integrated health program” means a team of licensed health care practitioners, operating within their scope of practice, who provide mobile health services to support the emergency medical services system.

(3) “Triage to alternate destination program” means a program defined in Section 1819 of the Health and Safety Code.

SEC. 4.

 No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.