(1) Existing law establishes the Health Care Affordability Reserve Fund and authorizes the Controller to use funds in the Health Care Affordability Reserve Fund for cashflow loans to the General Fund. Existing law authorizes a loan from the Health Care Affordability Reserve Fund to the General Fund and requires the loan to be repaid in the 2025–26 fiscal year. This bill would delay repayment of the loan and require 3 payments of $200,000,000 over 3 fiscal years beginning with the 2026–27 fiscal year. (2) Existing law provides for the licensure and regulation of health facilities, clinics, home health agencies, and hospice agencies, as defined, by the State Department of Public Health. A violation of these provisions by a licensee is a crime. Existing law prescribes the method for determining licensing and certification fees and requires the department to annually post on its internet website a list of the estimated department fees for the facilities that it licenses. This bill would require the posted fees to include, but not be limited to, annual licensing, report of change application, and written notification fees, and would make conforming changes to reflect the inclusion of fees other than annual fees. The bill would establish late payment penalties for delinquent fees, as specified. The bill would revise existing licensing provisions for those facilities, to replace references to the department and its Licensing and Certification Division with references to the Licensing and Certification Program (program) . The bill would delete various obsolete provisions, including a related fee schedule, and would replace references to renewal fees with references to an annual license fee. (3) Existing law requires any person, firm, association, partnership, or corporation desiring a license for clinics, home health agencies, and hospice agencies to submit an application containing specified information to the department. This bill would require the application information to be provided to the program upon initial application for licensure. The bill would require any change in the information that requires the licensee to submit a report of change or written notification to the program to be provided within 10 business days of the change along with any applicable fee, unless otherwise specified. Because a violation of the bill's requirements by those facilities would be a crime, the bill would impose a state-mandated local program. (4) Existing law establishes the Office of Oral Health within the State Department of Public Health. Existing law requires the department to maintain a dental program in order to, among other things, develop comprehensive dental health plans to maximize utilization of all resources. Existing law, the Song-Brown Health Care Workforce Training Act, creates a state medical contract program with specified educational entities and programs to maximize the delivery of primary care to specific areas of California where there is a recognized unmet priority need for those services. This bill would, until June 30, 2029, require the Office of Oral Health to support the establishment of community-based clinical education rotations for dental students in their final year or dental residents. The bill would require the office to compile data and prepare a report to be submitted to the Legislature on or before July 1, 2027, on specified desired outcomes. (5) Existing law, the California Healthcare, Research and Prevention Tobacco Tax Act of 2016, an initiative measure approved as Proposition 56 at the November 8, 2016, statewide general election, increases taxes imposed on distributors of cigarettes and tobacco products and requires all revenues to be deposited into the California Healthcare, Research and Prevention Tobacco Tax Act of 2016 Fund, a continuously appropriated fund. That act allocates those revenues for specified purposes, including $30,000,000 to provide funding to the State Department of Public Health state dental program, as specified. Under existing law, if there is a reduction in revenues resulting from a reduction in the consumption of cigarettes and tobacco products due to the additional taxes imposed on cigarettes, the amount of funds allocated to specified programs, including the state dental program, is required to be reduced proportionally. If the allocations to the state dental program are reduced, existing law backfills the reduced amount by continuously appropriating moneys from the General Fund in an amount equivalent to the reduction, so that the total funding for the state dental program remains at $30,000,000 annually. This bill would repeal the continuous appropriation to the state dental program that occurs upon a reduction of allocated funds to the program. (6) Existing law establishes within the State Treasury the Litigation Deposits Fund (LDF) , under the control of the Department of Justice and consisting of moneys received as litigation deposits for which the state is a party to the litigation. The state is a party to a settlement related to electronic cigarettes through which it receives funds for nicotine use remediation. This bill would establish the Electronic Cigarette Settlements Fund within the State Treasury and would require the State Department of Public Health to administer the fund. The bill would require the Controller, upon order of the Department of Finance, to transfer funds received in the LDF payable to the Department of Justice from the People of the State of California v. JUUL Labs, Inc., et al. settlement that are allocated to e-cigarette programs to the fund. The bill would require moneys in the fund, upon appropriation by the Legislature, to be used for activities in accordance with the terms of the settlement and specified department notices. The bill would specify that these provisions would remain operative only until July 1, 2035. (7) Existing law requires the State Department of Public Health to examine the causes of communicable diseases occurring or likely to occur in the state, and to establish a list of reportable diseases. Existing law requires local health officers to immediately report to the department every discovered or known case or suspected case of those reportable diseases and, in the case of a local epidemic, to report, as requested by the department, all facts concerning the disease, and the measures taken to abate and prevent its spread. This bill would authorize the department to develop and administer a syndromic surveillance program and, subject to an appropriation, to either designate an existing system or to create a new system that would be required, at a minimum, to provide public health practitioners access to an electronic health system to rapidly collect, evaluate, share, and store syndromic surveillance data, as specified. The bill would require general acute care hospitals with emergency departments to submit specified data electronically to the system in accordance with the schedule, standards, and requirements established by the department, unless the hospital reports its data to the local health department and the local health department reports that data to the department, as specified. The bill would authorize the sharing of collected data with specified entities, including the federal Centers for Disease Control, state and local government entities, and persons with a valid scientific interest, as specified, subject to specified confidentiality requirements. Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest. This bill would make legislative findings to that effect. (8) Existing law prohibits a person from being tried or adjudged to punishment while that person is mentally incompetent. Existing law establishes a process by which, if the mental competency of a defendant is in doubt, the defendant's mental competency is evaluated and, if found to be mentally incompetent, the defendant may be committed to the State Department of State Hospitals (DSH) with the goal of returning the defendant to competency, as specified. This bill would require DSH to coordinate with the sheriff in the county of commitment to transport a defendant who has been committed to a DSH facility once a placement in the facility is available and would require DSH to notify the sheriff and the court if the defendant has not been transported within 90 days from the date of commitment, as specified. The bill would, if the sheriff fails to deliver the defendant within the required period of time, stay the commitment and remove the defendant from the waiting list until notice is provided that the defendant is available for transportation. (9) Under existing law, if a defendant is committed to a DSH facility, the court must provide specified documents to DSH, including the defendant's medical records, before the defendant is admitted to the facility. This bill would also, if DSH determines that additional medical or mental health records are required for continuity of care, require any public or private entity holding such records to release the records to DSH upon request, as specified. (10) Existing law requires DSH, upon a determination that the defendant has regained mental competence, to immediately certify that fact to the court by filing a certificate of restoration with the court. Existing law requires the sheriff to deliver the defendant to the court no later than 10 days following the filing of a certificate of restoration. Existing law provides that the state shall only pay for 10 hospital days following filing of the certificate This bill would clarify that the state will only pay for 10 calendar days in which the defendant remains confined in a DSH facility following the filing of the certificate. (11) Under existing law, if a defendant is issued a certificate of restoration or becomes mentally competent after conservatorship, but is not released either on bail or a promise to appear, the defendant may, as specified, be returned to a facility for continued treatment. This bill would clarify that the defendant may be returned only on the recommendation of the person that issued the certificate of restoration and that the defendant shall be returned to a DSH facility at the discretion of, and as directed by, DSH. The bill would also require the recommendation to include a recommendation regarding the involuntary administration of medication and requires the court to review the recommendation, and, as appropriate, issue or continue an order for the involuntary administration of medication, as specified. (12) Existing law authorizes the Department of Motor Vehicles (DMV) to issue an identification card to an eligible applicant, as specified. Existing law provides a procedure for a person being released from the custody of a county jail, federal correctional facility, or state hospital facility to obtain a replacement identification card. Existing law also provides a procedure for a person being released from a state correctional facility to obtain an original or replacement identification card. This bill would provide a procedure for a patient being released from a state hospital facility to also obtain an original identification card. The bill would remove the requirement that an applicant for a replacement identification card have no outstanding identification card fees and would remove the requirement that an applicant for a replacement identification card have a usable photo on file with the DMV if the applicant has a new photo taken. The bill would require the State Department of State Hospitals to assist the applicant in applying for an identification card, as specified, including assistance with obtaining qualifying documentation. (13) Existing law establishes 5 separate minimum wage schedules for covered health care employees, as defined, depending on the nature of the employer, and makes a violation of these minimum wage requirements a misdemeanor. Existing law requires, for any covered health care facility employer, as defined, with 10,000 or more full-time equivalent employees (FTEE) , as defined, any covered health care facility employer that is a part of an integrated health care delivery system or a health care system with 10,000 or more FTEEs, a covered health care facility employer that is a dialysis clinic or is a person that owns, controls, or operates a dialysis clinic, or a covered health facility owned, affiliated, or operated by a county with a population of more than 5,000,000 as of January 1, 2023, the minimum wage for covered health care employees to be $23 per hour from July 1, 2024, to June 30, 2025, inclusive, $24 per hour from July 1, 2025, to June 30, 2026, inclusive, and $25 per hour from July 1, 2026, and until as adjusted, as specified. Existing law requires, for any hospital that is a hospital with a high governmental payor mix, an independent hospital with an elevated governmental payor mix, a rural independent covered health care facility, or a covered health care facility that is owned, affiliated, or operated by a county with a population of less than 250,000 as of January 1, 2023, as those terms are defined, the minimum wage for covered health care employees to be $18 per hour from July 1, 2024, to June 30, 2033, inclusive, and $25 per hour from July 1, 2033, and until as adjusted, as specified. Existing law requires, for specified clinics that meet certain requirements, the minimum wage for covered health care employees to be $21 per hour from July 1, 2024, to June 30, 2026, inclusive, and $22 per hour from July 1, 2026, to June 30, 2027, inclusive, and $25 from July 1, 2027, and until as adjusted, as specified. Existing law requires, for all other covered health care facility employers, the minimum wage for covered health care employees to be $21 per hour from July 1, 2024, to June 30, 2026, inclusive, $23 per hour from July 1, 2026, to June 30, 2028, inclusive, and $25 per hour from July 1, 2028, and until as adjusted, as specified. Existing law also separately requires, for a licensed skilled nursing facility, as described, in specified circumstances the minimum wage for certain other covered health care employees, as described, to be $21 per hour from July 1, 2024, to June 30, 2026, inclusive, $23 per hour from July 1, 2026, to June 30, 2028, inclusive, and $25 per hour from July 1, 2028, and until as adjusted, as specified. This bill would provide for a delay of the implementation dates of the above-described minimum wage increases until either of 2 events occur, as specified. (14) Existing law defines various terms for purposes of these provisions relating to minimum wage schedules for covered health care employees, including a covered health care employee, covered health care facility, and full-time equivalent employee. Existing law excludes certain characteristics from the definition of a covered health care employee, including any work performed in the public sector where the primary duties performed are not health care services. Existing law excludes certain entities from the definition of a covered health facility, including a skilled nursing facility owned, controlled, or operated by the state. Existing law defines a full-time equivalent employee as the total paid hours at a covered health care facility, as specified, as per Department of Health Care Access and Information guidance, divided by 2,080. This bill would, instead, exclude from the definition of a covered health care employee any work performed by a public employee where the public employee is not primarily engaged in services, as described, performed for a covered health care facility. For purposes of the definition of a covered health care facility, the bill would, instead, delete the exclusion of a skilled nursing facility owned, controlled, or operated by the State Department of State Hospitals from that definition, and would additionally exclude from that definition any health care facility, as described, that is owned, controlled, or operated by the state or any state agency, as defined, of the executive branch. The bill would define full-time equivalent employee as the total hours paid at a covered health care facility, as specified, divided by 2,080 and would specify the determination of the number of full-time equivalent employees. (15) Existing law requires a health care minimum wage to be enforceable by, among other things, the Labor Commissioner. This bill would require a health care minimum wage to be enforceable by the Labor Commissioner through specified procedures. The bill would require the Department of Industrial Relations to amend, supplement, and republish the Industrial Welfare Commission's wage orders to be consistent with these minimum wage provisions, as specified. The bill would require every employer subject to these provisions to post a copy of the order as amended, supplemented, and republished by the Department of Industrial Relations, as specified, and to provide to each employee on the effective date of the earliest minimum wage increase a written notice, as provided. For covered health care employment where the compensation of the employee is on a salary basis, existing law requires the employee to earn a monthly salary equivalent to no less than 150 percent of the health care worker minimum wage or 200 percent of the minimum wage, as described, for full-time employment in order to qualify as exempt from the payment of minimum wage and overtime under state law, including where the employer is the state, a political subdivision of the state, the University of California, or a municipality. This bill would instead qualify an employee as exempt from the payment of minimum wage and overtime, as described above, if the employer is a political subdivision of the state, a health care district, the University of California, or a municipality. (16) Existing law requires the Department of Health Care Access and Information to publish on their internet website a list of all covered health care facility employers, as specified, and a list of all hospitals that qualify as a hospital with a high governmental payor mix, independent hospital with an elevated governmental payor mix, or a rural independent covered health care facility. If a covered health care facility believes that they were inappropriately excluded from the list of hospitals that qualify as a hospital with a high governmental payor mix, independent hospital with an elevated governmental payor mix, or a rural independent covered health care facility, existing law authorizes the health facility to file a request with the Department of Health Care Access and Information to be classified as a hospital with a high governmental payor mix, independent hospital with an elevated governmental payor mix, or a rural independent covered health care facility. Existing law requires the requesting hospital to provide, among other things, the payor mix of the requesting hospital, as specified. This bill would require the lists described above to only include those covered health care facility employers included in the Department of Health Care Access and Information's 2021 Pivot Table, as described. The bill would require the requesting hospital to provide, among other things, the revised Annual Disclosure Report, as provided, that reflects the payor mix of the requesting hospital, as specified. (17) Existing law requires the Department of Industrial Relations, in collaboration with the State Department of Health Care Services and the Department of Health Care Access and Information, to develop, by March 1, 2024, a waiver program for covered health care facilities, as described, which would authorize a covered health care facility to apply for and receive a temporary pause or alternative phase in the schedule of the health care minimum wage requirements, as specified. In order to obtain a waiver, existing law requires a covered health care facility to demonstrate that compliance with the minimum wage requirements would raise doubts about the covered health care facility's ability to continue as a going concern under generally accepted accounting principles, as specified. In order to obtain a waiver, this bill would instead require a covered health care facility to demonstrate at the time the waiver application is submitted that it includes, among other things, the covered health care facility's, and any parent or affiliated company's, most recent audited financial statements, as specified, and a declaration verifying that the contents of the documents contained in the waiver request are true and correct. The bill would require the Department of Industrial Relations to make approved financial information available on its internet website, and would require the Department of Health Care Access and Information to make the audited financial information submitted in conjunction with an approved waiver available on its internet website, as specified. If a waiver is issued, the bill would require any covered health care facility affected by the waiver to, within 10 days of notice from the Department of Industrial Relations, to, among other things, provide to each covered health care employee, a specified written notice, informing the covered health care employee the covered health care facility had applied for and received a one-year waiver of the increase of the minimum wage and stating the applicable minimum wage. The bill would authorize the Department of Industrial Relations and Department of Health Care Access and Information to enter into exclusive or nonexclusive contracts, or amend existing contracts, on a bid or negotiated basis, for purposes of implementing the minimum wage schedule provisions. By expanding the requirements relating to health care minimum wages, the violation of which would be a crime, the bill would impose a state-mandated local program. (18) Existing law authorizes the department to contract with a county to help fund the development or expansion of pretrial diversion, as specified. Existing law requires a county so contracted to quarterly report data and outcomes to the department, regarding those individuals targeted by the contract and in the program. This bill would instead require the county to report monthly, as specified, and would make other conforming changes. (19) Existing law, the Bronzan-McCorquodale Act, contains provisions governing the operation and financing of community mental health services for persons with mental disorders in every county through locally administered and locally controlled community mental health programs. Under existing law, mental health services are provided through contracts with county mental health programs and the department is authorized to temporarily withhold funds or impose monetary sanctions on a county behavioral health department that is not in compliance with the contract. This bill would require that certain funds collected as a result of sanctions between July 1, 2024, and June 30, 2027, be deposited in the General Fund for use, upon an appropriation by the Legislature, for the nonfederal share of Medi-Cal costs for health care services furnished to specified groups. (20) Existing law, the Mental Health Services Act (MHSA) , an initiative measure enacted by the voters as Proposition 63 at the November 2, 2004, statewide general election, funds a system of county mental health plans for the provision of mental health services. The MHSA establishes the Mental Health Services Fund. Existing law, the Behavioral Health Services Act (BHSA) , approved by the voters as Proposition 1 at the March 5, 2024, statewide primary election, commencing January 1, 2025, revises and recasts the MHSA by, among other things, creating the Behavioral Health Services Fund. Existing law requires that any moneys remaining in the Mental Health Services Fund on January 1, 2025, be transferred to the Behavioral Health Services Fund. This bill would make conforming technical changes consistent with the creation of, and the transfer of moneys to, the Behavioral Health Services Fund, operative January 1, 2025. The bill would make technical, nonsubstantive changes. (21) Existing law, the California Special Supplemental Nutrition Food Program for Women, Infants, and Children (WIC Program) , authorizes establishment of a statewide program, administered by the State Department of Public Health, for providing nutritional food supplements to low-income pregnant women, low-income postpartum and lactating women, and low-income infants and children under 5 years of age, who have been determined to be at nutritional risk. Existing law requires the department, in order to effectively manage and administer the federal and state requirements for the vendors in the WIC Program, to establish requirements for peer groups and a corresponding reimbursement system, criteria used for vendor authorization, and WIC Program-authorized foods. Existing law authorizes the department to implement, interpret, or make specific these provisions by bulletin or similar instruction. Existing law requires the department to notify and consult with affected stakeholders in the process of implementing, interpreting, or making specific these provisions, and requires the notice to provide opportunity for written comment. Existing law requires any final action to be published on the department's internet website no later than 120 days after the consultation with stakeholders or the last day for comments, whichever is later, and deems the final action withdrawn if the department fails to meet this requirement. This bill would require the department to additionally establish requirements for online shopping and retail food delivery systems. The bill would also require the department to publish the final action no later than 180 days after the consultation with stakeholders or the last day for comments, whichever is later. The bill would authorize the department, without taking regulatory action, to implement, interpret, or make specific all of the above-mentioned provisions by means of all-county letters, plan letters, information notices, provider bulletins, or other similar instruction. The bill would authorize the department to modify or repeal specified WIC Program requirements by bulletin or similar instruction, without taking further regulatory action, if certain criteria are met. (22) Existing law establishes the Children and Youth Behavioral Health Initiative, administered by the California Health and Human Services Agency and its departments, as applicable. Under existing law, the purpose of the initiative is to transform the state's behavioral health system into an innovative ecosystem in which all children and youth 25 years of age or younger, regardless of payer, are screened, supported, and served for emerging and existing behavioral health needs. Existing law requires the State Department of Health Care Services, or a contracted vendor, to provide competitive grants to qualified entities to build partnerships, capacity, and infrastructure supporting ongoing school-linked behavioral health services, among other purposes, for children and youth 25 years of age or younger. For these purposes, existing law requires the department to develop and maintain a school-linked statewide fee schedule for outpatient mental health or substance use disorder treatment provided to a student who is 25 years of age or younger at a schoolsite. Existing law requires the department to develop and maintain a school-linked statewide provider network of schoolsite behavioral health counselors. This bill would authorize the department to contract with an entity to administer the school-linked statewide behavioral health provider network. The bill would require the entity that administers that network to create and administer a process for enrolling and credentialing eligible practitioners and providers and a process for the submission and reimbursement of their claims. The bill would require those practitioners and providers to comply with the enrollment, credentialing, and claims processes. The bill would also require a health care service plan, insurer, or Medi-Cal managed care plan that covers necessary schoolsite services, as specified, to comply with all administrative requirements to cover and reimburse the services set forth by the network administrator. The bill would establish the Behavioral Health Schoolsite Fee Schedule Administration Fund in the State Treasury for specified purposes. The bill would require the department to establish and charge a fee for participating health care service plans, insurers, or Medi-Cal managed care plans to be used to cover the reasonable cost of administering the school-linked behavioral health provider network, as specified. The bill would authorize the department to periodically update the amount and structure of the fee, as specified. The bill would require revenues generated from the fees, less refunds, to be deposited into the fund. This bill would limit the money in the fund to be used upon appropriation by the Legislature, as specified, and would require interest and dividends earned on moneys in the fund to be retained in the fund for specified purposes. (23) Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. This bill would, for dates of service no sooner than July 1, 2024, require the department to establish a directed payment reimbursement methodology, or revise one or more existing directed payment reimbursement methodologies, applicable to children's hospitals, as specified. The bill would require Medi-Cal managed care plans to reimburse children's hospitals in accordance with the requirements of the directed payment arrangement established by the department and any guidance issued by the department to implement these provisions. The bill would, commencing no sooner than July 1, 2024, continuously appropriate $115,000,000 on an annual basis to the department from the General Fund to support payments implemented pursuant to these provisions. The bill would authorize the department to reduce the amount of reimbursements, as specified, if the Protect Access to Healthcare Act of 2024 is approved by the voters and if children's hospitals receive increased reimbursement rates or payments under certain provisions. The bill would include related legislative intent with regard to these provisions. (24) Existing law imposes a managed care organization (MCO) provider tax, administered and assessed by the department, on licensed health care service plans and managed care plans contracted with the department. Under existing law, proceeds from the taxes are available, upon appropriation, for the purpose of funding specified subcomponents to support the Medi-Cal program, including certain payments to Medi-Cal managed care plan and transfers to the Medi-Cal Provider Payment Reserve Fund. Existing law requires the department, upon appropriation, to use moneys transferred to that fund for purposes of funding targeted increases to Medi-Cal payments or other investments, as specified. This bill would remove, as one of the designated expenditures from that fund, a $75,000,000 annual transfer to the University of California for expanding graduate medical education programs. The bill would instead add, as designated expenditures from that fund, a $40,000,000 transfer to support workforce investments, increased costs relating to continuous eligibility for children up to 5 years of age as described below, and departmental administrative costs for implementing the Medi-Cal Provider Payment Increases and Investments (PPI) Act described below. Under the bill, increased costs for targeted increases would instead be made pursuant to the PPI Act. The bill would repeal those additions if specified provisions relating to the MCO provider tax are approved by the voters at the November 5, 2024, statewide general election. If those specified provisions are approved by the voters, the bill would instead remove, as a designated expenditure, increased costs for targeted increases to Medi-Cal payments or other investments based on a plan submitted by the department to the Legislature as part of the 2024–25 Governor's Budget. The bill would repeal provisions regarding that plan. Under the bill, community health workers would be an eligible provider type for rate increases specified in related provisions under existing law. (25) Existing law requires the department, upon appropriation, to establish a supplemental payment pool for nonhospital 340B community clinics, relating to discount drug purchasing. This bill would require the department to establish and implement a directed payment program under which a qualifying nonhospital 340B community clinic may earn payments from contracted Medi-Cal managed care plans, subject to an appropriation and any necessary federal approvals. The bill would set forth the criteria and methodologies for that program, including links to the Medi-Cal Provider Payment Reserve Fund. Under the bill, for any calendar year in which this program is implemented, neither the department nor a Medi-Cal managed care plan would be required to make the payments specified in the above-described supplemental payment pool. The bill would make conforming changes by repealing the supplemental payment pool-related provisions if certain conditions are met. (26) This bill would establish the Medi-Cal Provider Payment Increases and Investments (PPI) Act in order to, among other things, improve access to high-quality care for Medi-Cal members and promote provider participation in the Medi-Cal program. The bill would require the department to seek federal approval for various PPI components, including reimbursement increases for professional services, ground emergency medical transport services, abortion services, family planning services, and certain other applicable services, for updating the reimbursement methodology for optional hearing aid benefits, for eliminating certain rate reductions as described below, and for increases to the amount of directed payments for qualifying nonhospital 340B community clinics as described above. The bill would set forth various provisions to implement those PPI components, including reimbursement methodologies and procedures involving Medi-Cal managed care plans. Under the bill, payments implemented under PPI would be supported by MCO provider tax revenue or other state funds appropriated by the Legislature, as specified. Except for the portion related to abortion services, the bill would condition PPI implementation on receipt of any necessary federal approvals and the availability of federal financial participation. If a later enacted statute restricts the availability of moneys, including with regard to the MCO provider tax, the bill would require the department to implement PPI or related provisions to the extent that the department determines PPI remains feasible, as specified. The bill would authorize the Director of Health Care Services to make any necessary modifications, as specified. (27) Existing law sets forth various Medi-Cal payment reductions by specified percentages, including a 10% reduction, for certain services and providers. This bill would make an exception to some of those payment reductions for physician and professional services, and for abortion services, subject to implementation of the related PPI provisions described above. (28) Existing law establishes the Healthy Families Program, the Medi-Cal Access Program, and the County Children's Health Initiative Program. Existing law sets forth provisions, operative on January 1, 2025, or as otherwise specified, for the continuous eligibility of an applicable child under those programs up to 5 years of age. This bill would shift implementation of that continuous eligibility from 2025 to 2026. The bill would also make some changes to the implementation criteria for that continued eligibility. (29) Under this bill, if specified provisions relating to the MCO provider tax are approved by the voters at the November 5, 2024, statewide general election, most of the changes made by the bill to the provisions listed in paragraphs (24) through (28) would become inoperative, as specified. (30) Existing law requires, for the duration of the COVID-19 emergency period, the State Department of Health Care Services to implement any federal Medicaid program waiver or flexibility approved by the federal Centers for Medicare and Medicaid Services related to that emergency. Existing law requires, upon expiration of the COVID-19 emergency period and subject to any necessary federal approvals, the department to continue to reimburse the administration of a COVID-19 vaccine at 100% of the Medicare national equivalent rate in effect at the time of vaccine administration without geographic adjustment. This bill would instead require the department to align COVID-19 vaccine administration payments to payment reimbursement structures for vaccines administered in accordance with the Medi-Cal State Plan. (31) Existing law requires the State Department of Health Care Services, subject to federal approval, to establish and implement a program or programs under which a designated public hospital system or a district and municipal public hospital, as defined, may earn performance-based quality incentive payments from the Medi-Cal managed care plan with which they contract, as specified. Existing law requires the department, subject to federal approval, to require each Medi-Cal managed care plan to increase contract services payments to designated public hospital systems by amounts determined under a directed payment methodology that meets certain federal requirements. This bill would also apply the requirement for increased directed payments to district and municipal public hospitals commencing with the 2023 calendar year. The bill would make certain changes to the directed payment methodology and would make conforming changes to related provisions. Under existing law, the nonfederal share of the portion of the capitation rates specifically associated with directed payments and for the quality incentive payments may consist of voluntary intergovernmental transfers (IGTs) of funds provided by the hospitals and their affiliated governmental entities, or other public entities, as specified. Existing law prohibits the department from assessing a specified fee on an IGT or any other similar fee. This bill would remove that prohibition on a fee assessment and would instead authorize the department to assess a fee not to exceed 5% on IGTs to reimburse the department for the administrative costs of operating the programs under these provisions and for the support of the Medi-Cal program. The bill would make various other changes to related provisions with regard to, among other things, fiscal or rate years during which payments are made. (32) Existing law requires the State Department of Health Care Services, subject to federal approval, to design and implement an IGT program, with voluntary participation, relating to Medi-Cal managed care services provided by nondesignated public hospitals, as defined, in order to increase capitation payments for the purpose of increasing their reimbursement. Existing law requires that the increased capitation payments be actuarially equivalent to the increased fee-for-service payments made pursuant to a certain other IGT program to the extent permissible under federal law. This bill would repeal the above-described provisions relating to capitation payments. (33) Existing law establishes the California Advancing and Innovating Medi-Cal (CalAIM) initiative, subject to federal approval, to follow the predecessor California Medi-Cal 2020 Demonstration Project. Under CalAIM, a designated public hospital is defined as any one of the hospitals identified in the California Medi-Cal 2020 Demonstration Project, and any successor, that is operated by a county, a city and county, the University of California, or a special hospital authority, or any additional public hospital to the extent identified as a designated public hospital in the CalAIM Terms and Conditions. This bill would make various changes to the definition of a designated public hospital, including changes to the name or scope of certain hospitals and the addition of other hospitals. (34) Existing law requires the State Department of Health Care Services to establish and maintain a plan, known as the County Administrative Cost Control Plan, whereby costs for county administration of the determination of eligibility for Medi-Cal benefits are effectively controlled within the amounts annually appropriated for that administration. Existing law expresses the intent of the Legislature not to appropriate funds for certain cost-of-doing-business adjustments, as described, for specified fiscal years. This bill would additionally express the intent of the Legislature not to appropriate funds for the cost-of-doing-business adjustment for the 2024–25 to 2027–28, inclusive, fiscal years. (35) Existing law requires the State Department of Health Care Services, upon appropriation, to establish a clinic workforce stabilization retention payment program under Medi-Cal to provide funds to eligible qualified clinics, as defined, to make retention payments to their eligible employees for the public purposes of providing stability in the California qualified clinic workforce and retaining qualified health care workers. To the extent that any appropriated funds remain after the department has distributed funds to eligible qualified clinics for employee retention payments, existing law requires that those excess funds be used for qualified clinic workforce training, as described below. Under existing law, upon the order of the Director of Finance, any retention payment funding returned under related provisions or unexpended funds left over from a specified appropriation in the Budget Act of 2022 are transferred and available for expenditure or encumbrance through June 30, 2028, to fund workforce development programs that support primary care in clinics, as specified. This bill would delete the provisions that require that excess funds be used for qualified clinic workforce training and the provisions that require the transfer of returned or unexpended funds and their availability for workforce development programs. (36) Existing law establishes the Distressed Hospital Loan Program, administered by the Department of Health Care Access and Information, in order to provide interest-free cashflow loans to not-for-profit hospitals and public hospitals in significant financial distress or to governmental entities representing a closed hospital, except as otherwise provided, to prevent the closure of, or facilitate the reopening of, those hospitals. Existing law establishes the Distressed Hospital Loan Program Fund, with moneys in the fund being continuously appropriated for the department. Existing law authorizes the Department of Finance to transfer up to $150,000,000 from the General Fund and up to $150,000,000 from the Medi-Cal Provider Payment Reserve Fund to the Distressed Hospital Loan Program Fund in state fiscal year 2023–24 to implement the program. Existing law authorizes the department to allocate an amount not to exceed 5% of total program funds to administer the program, as specified. Existing law requires any funds transferred to be available for encumbrance or expenditure until June 30, 2026. This bill would instead require any funds transferred to be available for encumbrance or expenditure until December 31, 2031. By extending the amount of time continuously appropriated funds are available for encumbrance and expenditure, the bill would make an appropriation. (37) Existing law creates the California Major Risk Medical Insurance Program (MRMIP) , which is administered by the State Department of Health Care Services, to provide major risk medical coverage through participating health plans to eligible residents of the state who are unable to secure adequate private health care coverage. If a health care service plan or health insurer rejects a dependent to be added to an individual grandfathered health plan, rejects an applicant for a Medicare supplement policy due to the applicant having end-stage renal disease, or offers an individual grandfathered health plan to an applicant at a rate that is higher than the standard rate, existing law requires the plan or insurer to inform the applicant about MRMIP. This bill would require the department to cease to provide coverage through MRMIP on December 31, 2024. The bill would require the department to direct participating health plans to inform subscribers of the transition of coverage at specified intervals, complete payments to, or payment reconciliations with, participating health plans or other contractors, process appeals, and conduct other necessary termination activities. Upon request of the California Health Benefit Exchange (HBEX) the bill would require the department to disclose information to HBEX to assist MRMIP subscribers to transition to coverage through HBEX, as specified. Commencing November 1, 2024, and ending when the transition of coverage is complete, the bill would require the department to provide monthly updates to the Assembly Committees on Health and Budget and the Senate Committees on Health and Budget and Fiscal Review about the transition of subscribers. The bill would require a plan or insurer that rejects an above-described application or makes an above-described offer to inform the applicant about MRMIP only if the rejection or offer is before July 1, 2024. Existing law establishes the Major Risk Medical Insurance Fund and the Health Care Services Plan Fines and Penalties Fund and continuously appropriates moneys in the funds, except as specified, to the department for purposes of MRMIP. Existing law also establishes the Managed Care Administrative Fines and Penalties Fund, from which certain amounts are to be transferred to the Health Care Services Plan Fines and Penalties Fund and continuously appropriated to the department for purposes of MRMIP. This bill would instead continuously appropriate moneys in the Health Care Services Plan Fines and Penalties Fund to fund the nonfederal share of health care services for children, adults, seniors, persons with disabilities, and dual-eligible beneficiaries in the Medi-Cal program. By changing the purposes of a continuously appropriated fund, the bill would make an appropriation. (38) Existing law establishes the Behavioral Health Services Oversight and Accountability Commission to promote transformational change in California's behavioral health system, among other things. Beginning January 1, 2025, existing law requires the commission to have an Executive Director, who is responsible for management over the administrative, fiscal, and program performance of the commission. Existing law requires the commission to award grants to county mental health or behavioral health departments to fund partnerships between educational and county mental health entities. Existing law authorizes the commission to exclusive or nonexclusive contracts, or amend existing contracts, on a bid or negotiated basis to implement that requirement. Until January 1, 2025, existing law exempts those contracts from contracting requirements applicable only to state contracts. This bill would extend that exemption from contracting requirements indefinitely. The bill would authorize the commission to delegate to the Executive Director any power, duty, purpose, function, or jurisdiction that the commission may lawfully delegate, and would authorize the Executive Director to redelegate, as specified. Beginning January 1, 2025, existing law creates the Behavioral Health Services Act Innovation Partnership Fund in the State Treasury to fund a program, administered by the commission, to award grants to private, public, and nonprofit partners to promote development of innovative mental health and substance use disorder programs and practices. This bill would authorize private donations or grants, federal or state grants, any interest on amounts in the fund, and moneys previously allocated that are returned to the fund, as specified, to be paid into the fund. (39) Existing law authorizes the State Public Health Officer, to the extent allowable under federal law, and upon the availability of funds, to expend money from the AIDS Drug Assistance Program (ADAP) Rebate Fund for the HIV infection prevention program to cover the costs of prescribed ADAP formulary medications for the prevention of HIV infection and other specified costs. The AIDS Drug Assistance Program Rebate Fund is a continuously appropriated fund. This bill would, to the extent that the activities are an allowable use of the funds, authorize the State Department of Public Health to spend up to $23,000,000 to conduct other programs and grants related to the treatment and prevention of HIV and AIDS, such as increase the financial eligibility standards for ADAP, modify the ADAP formulary, and to create, develop, or contract for needs assessment analysis, as specified, among others. The bill would require the State Department of Public Health to report to the Legislature a plan for modernization and expansion of ADAP, as described. By adding to the purposes of a continuously appropriated fund, the bill would make an appropriation. (40) The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that with regard to certain mandates no reimbursement is required by this act for a specified reason. With regard to any other mandates, this bill would provide that, if the Commission on State Mandates determines that the bill contains costs so mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above. (41) This bill would declare that it is to take effect immediately as a bill providing for appropriations related to the Budget Bill.