California 2023-2024 Regular Session

California Assembly Bill AB2250 Compare Versions

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1-Enrolled September 05, 2024 Passed IN Senate August 31, 2024 Passed IN Assembly August 31, 2024 Amended IN Senate August 27, 2024 Amended IN Senate August 23, 2024 Amended IN Senate August 15, 2024 Amended IN Senate June 06, 2024 CALIFORNIA LEGISLATURE 20232024 REGULAR SESSION Assembly Bill No. 2250Introduced by Assembly Member Weber(Coauthor: Assembly Member Aguiar-Curry)February 08, 2024An act to add Section 1367.57 to the Health and Safety Code, to add Section 10123.52 to the Insurance Code, and to add Section 14132.14 to the Welfare and Institutions Code, relating to health. LEGISLATIVE COUNSEL'S DIGESTAB 2250, Weber. Social determinants of health: screening and outreach.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 provides for the regulation of health insurers by the Department of Insurance. Existing law requires health care service plans and health insurers to include coverage for screening for various conditions and circumstances, including adverse childhood experiences. Existing law provides for the Medi-Cal program, 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 require a health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2027, to include coverage for screenings for social determinants of health, as defined. The bill would require providers to use standardized codes when documenting patient responses to questions asked in these screenings, and would require providers to use existing tools or protocols to conduct the screenings. The bill would require a health care service plan or health insurer to provide physicians who provide primary care services with adequate access to peer support specialists, lay health workers, social workers, or community health workers in counties where the plan or insurer has enrollees or insureds, as specified. The bill would authorize the respective departments to adopt guidance to implement its provisions until regulations are adopted, and would require the departments to coordinate in the development of guidance and regulations. Because a violation of the bills requirements by a health care service plan would be a crime, the bill would impose a state-mandated local program.This bill would make social determinants of health screenings a covered benefit for Medi-Cal beneficiaries and would require the State Department of Health Care Services or a Medi-Cal managed care plan to provide reimbursement for those screenings, as specified.The bill would provide that these provisions will be implemented only upon an appropriation by the Legislature.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 Bill TextThe people of the State of California do enact as follows:SECTION 1. Section 1367.57 is added to the Health and Safety Code, to read:1367.57. (a) A health care service plan contract, except for a specialized health care service plan, issued, amended, or renewed on or after January 1, 2027, shall include coverage and provide reimbursement to health care providers for social determinants of health screenings. During these screenings, a provider may focus or expand their questions to issues relevant to the patient and may ask these questions in the manner the provider believes is most appropriate or more likely to elicit the best response from the patient. When documenting patient responses to these screenings, providers shall use standardized codes recognized by the federal Centers for Medicare and Medicaid Services, if available. This includes the procedure codes indicating a social determinants of health screening was administered and the diagnosis code or codes indicating any social need or needs identified during the screening. Providers shall use existing tools or protocols that have been validated by the federal Centers for Medicare and Medicaid Services, the National Association of Community Health Centers, the American Academy of Family Physicians, the National Committee for Quality Assurance, or other nationally recognized organizations. These tools or protocols include, at a minimum, the domains of food insecurity, housing insecurity, and transportation needs.(b) For purposes of this section, social determinants of health means the conditions under which people are born, grow, live, work, and age, including housing, food, transportation, utilities, and personal safety.(c) A health care service plan shall provide physicians who provide primary care services with adequate access to peer support specialists, lay health workers, social workers, or community health workers as defined in Section 18998 of the Welfare and Institutions Code, including Promotores and community health representatives, in counties where the health care service plan has enrollees. The health care service plan shall inform physicians who provide primary care services of how to access these community health workers, Promotores, community health representatives, peer support specialists, lay health workers, or social workers.(d) The department may adopt guidance for health care service plans to implement this section until regulations are adopted. The director shall coordinate with the Insurance Commissioner in the development of guidance and regulations under this subdivision.(e) This section shall be implemented only upon an appropriation by the Legislature for the express purpose of this section.SEC. 2. Section 10123.52 is added to the Insurance Code, to read:10123.52. (a) A health insurance policy issued, amended, or renewed on or after January 1, 2027, shall include coverage and provide reimbursement to health care providers for social determinants of health screenings. During these screenings, a provider may focus or expand their questions to issues relevant to the patient and may ask these questions in the manner the provider believes is most appropriate or more likely to elicit the best response from the patient. When documenting patient responses to these screenings, providers shall use standardized codes recognized by the federal Centers for Medicare and Medicaid Services, if available. This includes the procedure codes indicating a social determinants of health screening was administered and the diagnosis code or codes indicating any social need or needs identified during the screening. Providers shall use existing tools or protocols that have been validated by the federal Centers for Medicare and Medicaid Services, the National Association of Community Health Centers, the American Academy of Family Physicians, the National Committee for Quality Assurance, or other nationally recognized organizations. These tools or protocols include, at a minimum, the domains of food insecurity, housing insecurity, and transportation needs.(b) For purposes of this section, social determinants of health means the conditions under which people are born, grow, live, work, and age, including housing, food, transportation, utilities, and personal safety.(c) A health insurer shall provide physicians who provide primary care services with adequate access to peer support specialists, lay health workers, social workers, or community health workers, as defined in Section 18998 of the Welfare and Institutions Code, including Promotores and community health representatives, in counties where the health insurer has insureds. The health insurer shall inform physicians who provide primary care services of how to access these community health workers, Promotores, community health representatives, peer support specialists, lay health workers, or social workers.(d) The department may adopt guidance for health insurers to implement this section until regulations are adopted. The commissioner shall coordinate with the Director of the Department of Managed Health Care in the development of guidance and regulations under this subdivision.(e) This section shall be implemented only upon an appropriation by the Legislature for the express purpose of this section.SEC. 3. Section 14132.14 is added to the Welfare and Institutions Code, to read:14132.14. (a) (1) Social determinants of health screenings for Medi-Cal beneficiaries is a covered benefit and the department or a Medi-Cal managed care plan shall provide reimbursement to a Medi-Cal provider who renders this service, unless the service is already covered under a separate covered benefit.(2) Federally qualified health centers and rural health clinics shall be reimbursed for these social determinants of health screenings at the Medi-Cal fee-for-service rate. The reimbursements to federally qualified health centers and rural health clinics shall be in addition to any other amounts payable with respect to those services, including payments received pursuant to Section 14132.100, subdivision (e) of Section 14087.325, or Article 4.1 (commencing with Section 14138.1), and shall not affect any other payments. The payments described in this paragraph shall not be subject to, or factored into, reconciliation and shall be excluded from the calculation described in subdivision (h) of Section 14132.100.(b) For purposes of this section, social determinants of health means the conditions under which people are born, grow, live, work, and age, including housing, food, transportation, utilities, and personal safety.(c) This section shall be implemented only upon an appropriation by the Legislature for the express purpose of this section.SEC. 4. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
1+Amended IN Senate August 27, 2024 Amended IN Senate August 23, 2024 Amended IN Senate August 15, 2024 Amended IN Senate June 06, 2024 CALIFORNIA LEGISLATURE 20232024 REGULAR SESSION Assembly Bill No. 2250Introduced by Assembly Member Weber(Coauthor: Assembly Member Aguiar-Curry)February 08, 2024An act to add Section 1367.39 1367.57 to the Health and Safety Code, to add Section 10123.52 to the Insurance Code, and to add Section 14132.14 to the Welfare and Institutions Code, relating to health. LEGISLATIVE COUNSEL'S DIGESTAB 2250, as amended, Weber. Social determinants of health: screening and outreach.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 provides for the regulation of health insurers by the Department of Insurance. Existing law requires health care service plans and health insurers to include coverage for screening for various conditions and circumstances, including adverse childhood experiences. Existing law provides for the Medi-Cal program, 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 require a health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2027, to include coverage for screenings for social determinants of health, as defined. The bill would require providers to use standardized codes when documenting patient responses to questions asked in these screenings, and would require providers to use existing tools or protocols to conduct the screenings. The bill would require a health care service plan or health insurer to provide physicians who provide primary care services with adequate access to peer support specialists, lay health workers, social workers, or community health workers in counties where the plan or insurer has enrollees or insureds, as specified. The bill would authorize the respective departments to adopt guidance to implement its provisions until regulations are adopted, and would require the departments to coordinate in the development of guidance and regulations. Because a violation of the bills requirements by a health care service plan would be a crime, the bill would impose a state-mandated local program.This bill would make social determinants of health screenings a covered benefit for Medi-Cal beneficiaries and would require the State Department of Health Care Services or a Medi-Cal managed care plan to provide reimbursement for those screenings, as specified.The bill would provide that these provisions will be implemented only upon an appropriation by the Legislature.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 Bill TextThe people of the State of California do enact as follows:SECTION 1.Section 1367.39 is added to the Health and Safety Code, to read:1367.39.SECTION 1. Section 1367.57 is added to the Health and Safety Code, to read:1367.57. (a) A health care service plan contract, except for a specialized health care service plan, issued, amended, or renewed on or after January 1, 2027, shall include coverage and provide reimbursement to health care providers for social determinants of health screenings. During these screenings, a provider may focus or expand their questions to issues relevant to the patient and may ask these questions in the manner the provider believes is most appropriate or more likely to elicit the best response from the patient. When documenting patient responses to these screenings, providers shall use standardized codes recognized by the federal Centers for Medicare and Medicaid Services, if available. This includes the procedure codes indicating a social determinants of health screening was administered and the diagnosis code or codes indicating any social need or needs identified during the screening. Providers shall use existing tools or protocols that have been validated by the federal Centers for Medicare and Medicaid Services, the National Association of Community Health Centers, the American Academy of Family Physicians, the National Committee for Quality Assurance, or other nationally recognized organizations. These tools or protocols include, at a minimum, the domains of food insecurity, housing insecurity, and transportation needs.(b) For purposes of this section, social determinants of health means the conditions under which people are born, grow, live, work, and age, including housing, food, transportation, utilities, and personal safety.(c) A health care service plan shall provide physicians who provide primary care services with adequate access to peer support specialists, lay health workers, social workers, or community health workers as defined in Section 18998 of the Welfare and Institutions Code, including Promotores and community health representatives, in counties where the health care service plan has enrollees. The health care service plan shall inform physicians who provide primary care services of how to access these community health workers, Promotores, community health representatives, peer support specialists, lay health workers, or social workers.(d) The department may adopt guidance for health care service plans to implement this section until regulations are adopted. The director shall coordinate with the Insurance Commissioner in the development of guidance and regulations under this subdivision.(e) This section shall be implemented only upon an appropriation by the Legislature for the express purpose of this section.SEC. 2. Section 10123.52 is added to the Insurance Code, to read:10123.52. (a) A health insurance policy issued, amended, or renewed on or after January 1, 2027, shall include coverage and provide reimbursement to health care providers for social determinants of health screenings. During these screenings, a provider may focus or expand their questions to issues relevant to the patient and may ask these questions in the manner the provider believes is most appropriate or more likely to elicit the best response from the patient. When documenting patient responses to these screenings, providers shall use standardized codes recognized by the federal Centers for Medicare and Medicaid Services, if available. This includes the procedure codes indicating a social determinants of health screening was administered and the diagnosis code or codes indicating any social need or needs identified during the screening. Providers shall use existing tools or protocols that have been validated by the federal Centers for Medicare and Medicaid Services, the National Association of Community Health Centers, the American Academy of Family Physicians, the National Committee for Quality Assurance, or other nationally recognized organizations. These tools or protocols include, at a minimum, the domains of food insecurity, housing insecurity, and transportation needs.(b) For purposes of this section, social determinants of health means the conditions under which people are born, grow, live, work, and age, including housing, food, transportation, utilities, and personal safety.(c) A health insurer shall provide physicians who provide primary care services with adequate access to peer support specialists, lay health workers, social workers, or community health workers, as defined in Section 18998 of the Welfare and Institutions Code, including Promotores and community health representatives, in counties where the health insurer has insureds. The health insurer shall inform physicians who provide primary care services of how to access these community health workers, Promotores, community health representatives, peer support specialists, lay health workers, or social workers.(d) The department may adopt guidance for health insurers to implement this section until regulations are adopted. The commissioner shall coordinate with the Director of the Department of Managed Health Care in the development of guidance and regulations under this subdivision.(e) This section shall be implemented only upon an appropriation by the Legislature for the express purpose of this section.SEC. 3. Section 14132.14 is added to the Welfare and Institutions Code, to read:14132.14. (a) (1) Social determinants of health screenings for Medi-Cal beneficiaries is a covered benefit and the department or a Medi-Cal managed care plan shall provide reimbursement to a Medi-Cal provider who renders this service, unless the service is already covered under a separate covered benefit.(2) Federally qualified health centers and rural health clinics shall be reimbursed for these social determinants of health screenings at the Medi-Cal fee-for-service rate. The reimbursements to federally qualified health centers and rural health clinics shall be in addition to any other amounts payable with respect to those services, including payments received pursuant to Section 14132.100, subdivision (e) of Section 14087.325, or Article 4.1 (commencing with Section 14138.1), and shall not affect any other payments. The payments described in this paragraph shall not be subject to, or factored into, reconciliation and shall be excluded from the calculation described in subdivision (h) of Section 14132.100.(b) For purposes of this section, social determinants of health means the conditions under which people are born, grow, live, work, and age, including housing, food, transportation, utilities, and personal safety.(c) This section shall be implemented only upon an appropriation by the Legislature for the express purpose of this section.SEC. 4. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
22
3- Enrolled September 05, 2024 Passed IN Senate August 31, 2024 Passed IN Assembly August 31, 2024 Amended IN Senate August 27, 2024 Amended IN Senate August 23, 2024 Amended IN Senate August 15, 2024 Amended IN Senate June 06, 2024 CALIFORNIA LEGISLATURE 20232024 REGULAR SESSION Assembly Bill No. 2250Introduced by Assembly Member Weber(Coauthor: Assembly Member Aguiar-Curry)February 08, 2024An act to add Section 1367.57 to the Health and Safety Code, to add Section 10123.52 to the Insurance Code, and to add Section 14132.14 to the Welfare and Institutions Code, relating to health. LEGISLATIVE COUNSEL'S DIGESTAB 2250, Weber. Social determinants of health: screening and outreach.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 provides for the regulation of health insurers by the Department of Insurance. Existing law requires health care service plans and health insurers to include coverage for screening for various conditions and circumstances, including adverse childhood experiences. Existing law provides for the Medi-Cal program, 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 require a health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2027, to include coverage for screenings for social determinants of health, as defined. The bill would require providers to use standardized codes when documenting patient responses to questions asked in these screenings, and would require providers to use existing tools or protocols to conduct the screenings. The bill would require a health care service plan or health insurer to provide physicians who provide primary care services with adequate access to peer support specialists, lay health workers, social workers, or community health workers in counties where the plan or insurer has enrollees or insureds, as specified. The bill would authorize the respective departments to adopt guidance to implement its provisions until regulations are adopted, and would require the departments to coordinate in the development of guidance and regulations. Because a violation of the bills requirements by a health care service plan would be a crime, the bill would impose a state-mandated local program.This bill would make social determinants of health screenings a covered benefit for Medi-Cal beneficiaries and would require the State Department of Health Care Services or a Medi-Cal managed care plan to provide reimbursement for those screenings, as specified.The bill would provide that these provisions will be implemented only upon an appropriation by the Legislature.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
3+ Amended IN Senate August 27, 2024 Amended IN Senate August 23, 2024 Amended IN Senate August 15, 2024 Amended IN Senate June 06, 2024 CALIFORNIA LEGISLATURE 20232024 REGULAR SESSION Assembly Bill No. 2250Introduced by Assembly Member Weber(Coauthor: Assembly Member Aguiar-Curry)February 08, 2024An act to add Section 1367.39 1367.57 to the Health and Safety Code, to add Section 10123.52 to the Insurance Code, and to add Section 14132.14 to the Welfare and Institutions Code, relating to health. LEGISLATIVE COUNSEL'S DIGESTAB 2250, as amended, Weber. Social determinants of health: screening and outreach.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 provides for the regulation of health insurers by the Department of Insurance. Existing law requires health care service plans and health insurers to include coverage for screening for various conditions and circumstances, including adverse childhood experiences. Existing law provides for the Medi-Cal program, 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 require a health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2027, to include coverage for screenings for social determinants of health, as defined. The bill would require providers to use standardized codes when documenting patient responses to questions asked in these screenings, and would require providers to use existing tools or protocols to conduct the screenings. The bill would require a health care service plan or health insurer to provide physicians who provide primary care services with adequate access to peer support specialists, lay health workers, social workers, or community health workers in counties where the plan or insurer has enrollees or insureds, as specified. The bill would authorize the respective departments to adopt guidance to implement its provisions until regulations are adopted, and would require the departments to coordinate in the development of guidance and regulations. Because a violation of the bills requirements by a health care service plan would be a crime, the bill would impose a state-mandated local program.This bill would make social determinants of health screenings a covered benefit for Medi-Cal beneficiaries and would require the State Department of Health Care Services or a Medi-Cal managed care plan to provide reimbursement for those screenings, as specified.The bill would provide that these provisions will be implemented only upon an appropriation by the Legislature.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
44
5- Enrolled September 05, 2024 Passed IN Senate August 31, 2024 Passed IN Assembly August 31, 2024 Amended IN Senate August 27, 2024 Amended IN Senate August 23, 2024 Amended IN Senate August 15, 2024 Amended IN Senate June 06, 2024
5+ Amended IN Senate August 27, 2024 Amended IN Senate August 23, 2024 Amended IN Senate August 15, 2024 Amended IN Senate June 06, 2024
66
7-Enrolled September 05, 2024
8-Passed IN Senate August 31, 2024
9-Passed IN Assembly August 31, 2024
107 Amended IN Senate August 27, 2024
118 Amended IN Senate August 23, 2024
129 Amended IN Senate August 15, 2024
1310 Amended IN Senate June 06, 2024
1411
1512 CALIFORNIA LEGISLATURE 20232024 REGULAR SESSION
1613
1714 Assembly Bill
1815
1916 No. 2250
2017
2118 Introduced by Assembly Member Weber(Coauthor: Assembly Member Aguiar-Curry)February 08, 2024
2219
2320 Introduced by Assembly Member Weber(Coauthor: Assembly Member Aguiar-Curry)
2421 February 08, 2024
2522
26-An act to add Section 1367.57 to the Health and Safety Code, to add Section 10123.52 to the Insurance Code, and to add Section 14132.14 to the Welfare and Institutions Code, relating to health.
23+An act to add Section 1367.39 1367.57 to the Health and Safety Code, to add Section 10123.52 to the Insurance Code, and to add Section 14132.14 to the Welfare and Institutions Code, relating to health.
2724
2825 LEGISLATIVE COUNSEL'S DIGEST
2926
3027 ## LEGISLATIVE COUNSEL'S DIGEST
3128
32-AB 2250, Weber. Social determinants of health: screening and outreach.
29+AB 2250, as amended, Weber. Social determinants of health: screening and outreach.
3330
3431 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 provides for the regulation of health insurers by the Department of Insurance. Existing law requires health care service plans and health insurers to include coverage for screening for various conditions and circumstances, including adverse childhood experiences. Existing law provides for the Medi-Cal program, 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 require a health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2027, to include coverage for screenings for social determinants of health, as defined. The bill would require providers to use standardized codes when documenting patient responses to questions asked in these screenings, and would require providers to use existing tools or protocols to conduct the screenings. The bill would require a health care service plan or health insurer to provide physicians who provide primary care services with adequate access to peer support specialists, lay health workers, social workers, or community health workers in counties where the plan or insurer has enrollees or insureds, as specified. The bill would authorize the respective departments to adopt guidance to implement its provisions until regulations are adopted, and would require the departments to coordinate in the development of guidance and regulations. Because a violation of the bills requirements by a health care service plan would be a crime, the bill would impose a state-mandated local program.This bill would make social determinants of health screenings a covered benefit for Medi-Cal beneficiaries and would require the State Department of Health Care Services or a Medi-Cal managed care plan to provide reimbursement for those screenings, as specified.The bill would provide that these provisions will be implemented only upon an appropriation by the Legislature.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.
3532
3633 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 provides for the regulation of health insurers by the Department of Insurance. Existing law requires health care service plans and health insurers to include coverage for screening for various conditions and circumstances, including adverse childhood experiences. Existing law provides for the Medi-Cal program, 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.
3734
3835 This bill would require a health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2027, to include coverage for screenings for social determinants of health, as defined. The bill would require providers to use standardized codes when documenting patient responses to questions asked in these screenings, and would require providers to use existing tools or protocols to conduct the screenings. The bill would require a health care service plan or health insurer to provide physicians who provide primary care services with adequate access to peer support specialists, lay health workers, social workers, or community health workers in counties where the plan or insurer has enrollees or insureds, as specified. The bill would authorize the respective departments to adopt guidance to implement its provisions until regulations are adopted, and would require the departments to coordinate in the development of guidance and regulations. Because a violation of the bills requirements by a health care service plan would be a crime, the bill would impose a state-mandated local program.
3936
4037 This bill would make social determinants of health screenings a covered benefit for Medi-Cal beneficiaries and would require the State Department of Health Care Services or a Medi-Cal managed care plan to provide reimbursement for those screenings, as specified.
4138
4239 The bill would provide that these provisions will be implemented only upon an appropriation by the Legislature.
4340
4441 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.
4542
4643 This bill would provide that no reimbursement is required by this act for a specified reason.
4744
4845 ## Digest Key
4946
5047 ## Bill Text
5148
52-The people of the State of California do enact as follows:SECTION 1. Section 1367.57 is added to the Health and Safety Code, to read:1367.57. (a) A health care service plan contract, except for a specialized health care service plan, issued, amended, or renewed on or after January 1, 2027, shall include coverage and provide reimbursement to health care providers for social determinants of health screenings. During these screenings, a provider may focus or expand their questions to issues relevant to the patient and may ask these questions in the manner the provider believes is most appropriate or more likely to elicit the best response from the patient. When documenting patient responses to these screenings, providers shall use standardized codes recognized by the federal Centers for Medicare and Medicaid Services, if available. This includes the procedure codes indicating a social determinants of health screening was administered and the diagnosis code or codes indicating any social need or needs identified during the screening. Providers shall use existing tools or protocols that have been validated by the federal Centers for Medicare and Medicaid Services, the National Association of Community Health Centers, the American Academy of Family Physicians, the National Committee for Quality Assurance, or other nationally recognized organizations. These tools or protocols include, at a minimum, the domains of food insecurity, housing insecurity, and transportation needs.(b) For purposes of this section, social determinants of health means the conditions under which people are born, grow, live, work, and age, including housing, food, transportation, utilities, and personal safety.(c) A health care service plan shall provide physicians who provide primary care services with adequate access to peer support specialists, lay health workers, social workers, or community health workers as defined in Section 18998 of the Welfare and Institutions Code, including Promotores and community health representatives, in counties where the health care service plan has enrollees. The health care service plan shall inform physicians who provide primary care services of how to access these community health workers, Promotores, community health representatives, peer support specialists, lay health workers, or social workers.(d) The department may adopt guidance for health care service plans to implement this section until regulations are adopted. The director shall coordinate with the Insurance Commissioner in the development of guidance and regulations under this subdivision.(e) This section shall be implemented only upon an appropriation by the Legislature for the express purpose of this section.SEC. 2. Section 10123.52 is added to the Insurance Code, to read:10123.52. (a) A health insurance policy issued, amended, or renewed on or after January 1, 2027, shall include coverage and provide reimbursement to health care providers for social determinants of health screenings. During these screenings, a provider may focus or expand their questions to issues relevant to the patient and may ask these questions in the manner the provider believes is most appropriate or more likely to elicit the best response from the patient. When documenting patient responses to these screenings, providers shall use standardized codes recognized by the federal Centers for Medicare and Medicaid Services, if available. This includes the procedure codes indicating a social determinants of health screening was administered and the diagnosis code or codes indicating any social need or needs identified during the screening. Providers shall use existing tools or protocols that have been validated by the federal Centers for Medicare and Medicaid Services, the National Association of Community Health Centers, the American Academy of Family Physicians, the National Committee for Quality Assurance, or other nationally recognized organizations. These tools or protocols include, at a minimum, the domains of food insecurity, housing insecurity, and transportation needs.(b) For purposes of this section, social determinants of health means the conditions under which people are born, grow, live, work, and age, including housing, food, transportation, utilities, and personal safety.(c) A health insurer shall provide physicians who provide primary care services with adequate access to peer support specialists, lay health workers, social workers, or community health workers, as defined in Section 18998 of the Welfare and Institutions Code, including Promotores and community health representatives, in counties where the health insurer has insureds. The health insurer shall inform physicians who provide primary care services of how to access these community health workers, Promotores, community health representatives, peer support specialists, lay health workers, or social workers.(d) The department may adopt guidance for health insurers to implement this section until regulations are adopted. The commissioner shall coordinate with the Director of the Department of Managed Health Care in the development of guidance and regulations under this subdivision.(e) This section shall be implemented only upon an appropriation by the Legislature for the express purpose of this section.SEC. 3. Section 14132.14 is added to the Welfare and Institutions Code, to read:14132.14. (a) (1) Social determinants of health screenings for Medi-Cal beneficiaries is a covered benefit and the department or a Medi-Cal managed care plan shall provide reimbursement to a Medi-Cal provider who renders this service, unless the service is already covered under a separate covered benefit.(2) Federally qualified health centers and rural health clinics shall be reimbursed for these social determinants of health screenings at the Medi-Cal fee-for-service rate. The reimbursements to federally qualified health centers and rural health clinics shall be in addition to any other amounts payable with respect to those services, including payments received pursuant to Section 14132.100, subdivision (e) of Section 14087.325, or Article 4.1 (commencing with Section 14138.1), and shall not affect any other payments. The payments described in this paragraph shall not be subject to, or factored into, reconciliation and shall be excluded from the calculation described in subdivision (h) of Section 14132.100.(b) For purposes of this section, social determinants of health means the conditions under which people are born, grow, live, work, and age, including housing, food, transportation, utilities, and personal safety.(c) This section shall be implemented only upon an appropriation by the Legislature for the express purpose of this section.SEC. 4. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
49+The people of the State of California do enact as follows:SECTION 1.Section 1367.39 is added to the Health and Safety Code, to read:1367.39.SECTION 1. Section 1367.57 is added to the Health and Safety Code, to read:1367.57. (a) A health care service plan contract, except for a specialized health care service plan, issued, amended, or renewed on or after January 1, 2027, shall include coverage and provide reimbursement to health care providers for social determinants of health screenings. During these screenings, a provider may focus or expand their questions to issues relevant to the patient and may ask these questions in the manner the provider believes is most appropriate or more likely to elicit the best response from the patient. When documenting patient responses to these screenings, providers shall use standardized codes recognized by the federal Centers for Medicare and Medicaid Services, if available. This includes the procedure codes indicating a social determinants of health screening was administered and the diagnosis code or codes indicating any social need or needs identified during the screening. Providers shall use existing tools or protocols that have been validated by the federal Centers for Medicare and Medicaid Services, the National Association of Community Health Centers, the American Academy of Family Physicians, the National Committee for Quality Assurance, or other nationally recognized organizations. These tools or protocols include, at a minimum, the domains of food insecurity, housing insecurity, and transportation needs.(b) For purposes of this section, social determinants of health means the conditions under which people are born, grow, live, work, and age, including housing, food, transportation, utilities, and personal safety.(c) A health care service plan shall provide physicians who provide primary care services with adequate access to peer support specialists, lay health workers, social workers, or community health workers as defined in Section 18998 of the Welfare and Institutions Code, including Promotores and community health representatives, in counties where the health care service plan has enrollees. The health care service plan shall inform physicians who provide primary care services of how to access these community health workers, Promotores, community health representatives, peer support specialists, lay health workers, or social workers.(d) The department may adopt guidance for health care service plans to implement this section until regulations are adopted. The director shall coordinate with the Insurance Commissioner in the development of guidance and regulations under this subdivision.(e) This section shall be implemented only upon an appropriation by the Legislature for the express purpose of this section.SEC. 2. Section 10123.52 is added to the Insurance Code, to read:10123.52. (a) A health insurance policy issued, amended, or renewed on or after January 1, 2027, shall include coverage and provide reimbursement to health care providers for social determinants of health screenings. During these screenings, a provider may focus or expand their questions to issues relevant to the patient and may ask these questions in the manner the provider believes is most appropriate or more likely to elicit the best response from the patient. When documenting patient responses to these screenings, providers shall use standardized codes recognized by the federal Centers for Medicare and Medicaid Services, if available. This includes the procedure codes indicating a social determinants of health screening was administered and the diagnosis code or codes indicating any social need or needs identified during the screening. Providers shall use existing tools or protocols that have been validated by the federal Centers for Medicare and Medicaid Services, the National Association of Community Health Centers, the American Academy of Family Physicians, the National Committee for Quality Assurance, or other nationally recognized organizations. These tools or protocols include, at a minimum, the domains of food insecurity, housing insecurity, and transportation needs.(b) For purposes of this section, social determinants of health means the conditions under which people are born, grow, live, work, and age, including housing, food, transportation, utilities, and personal safety.(c) A health insurer shall provide physicians who provide primary care services with adequate access to peer support specialists, lay health workers, social workers, or community health workers, as defined in Section 18998 of the Welfare and Institutions Code, including Promotores and community health representatives, in counties where the health insurer has insureds. The health insurer shall inform physicians who provide primary care services of how to access these community health workers, Promotores, community health representatives, peer support specialists, lay health workers, or social workers.(d) The department may adopt guidance for health insurers to implement this section until regulations are adopted. The commissioner shall coordinate with the Director of the Department of Managed Health Care in the development of guidance and regulations under this subdivision.(e) This section shall be implemented only upon an appropriation by the Legislature for the express purpose of this section.SEC. 3. Section 14132.14 is added to the Welfare and Institutions Code, to read:14132.14. (a) (1) Social determinants of health screenings for Medi-Cal beneficiaries is a covered benefit and the department or a Medi-Cal managed care plan shall provide reimbursement to a Medi-Cal provider who renders this service, unless the service is already covered under a separate covered benefit.(2) Federally qualified health centers and rural health clinics shall be reimbursed for these social determinants of health screenings at the Medi-Cal fee-for-service rate. The reimbursements to federally qualified health centers and rural health clinics shall be in addition to any other amounts payable with respect to those services, including payments received pursuant to Section 14132.100, subdivision (e) of Section 14087.325, or Article 4.1 (commencing with Section 14138.1), and shall not affect any other payments. The payments described in this paragraph shall not be subject to, or factored into, reconciliation and shall be excluded from the calculation described in subdivision (h) of Section 14132.100.(b) For purposes of this section, social determinants of health means the conditions under which people are born, grow, live, work, and age, including housing, food, transportation, utilities, and personal safety.(c) This section shall be implemented only upon an appropriation by the Legislature for the express purpose of this section.SEC. 4. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
5350
5451 The people of the State of California do enact as follows:
5552
5653 ## The people of the State of California do enact as follows:
54+
55+
56+
57+
5758
5859 SECTION 1. Section 1367.57 is added to the Health and Safety Code, to read:1367.57. (a) A health care service plan contract, except for a specialized health care service plan, issued, amended, or renewed on or after January 1, 2027, shall include coverage and provide reimbursement to health care providers for social determinants of health screenings. During these screenings, a provider may focus or expand their questions to issues relevant to the patient and may ask these questions in the manner the provider believes is most appropriate or more likely to elicit the best response from the patient. When documenting patient responses to these screenings, providers shall use standardized codes recognized by the federal Centers for Medicare and Medicaid Services, if available. This includes the procedure codes indicating a social determinants of health screening was administered and the diagnosis code or codes indicating any social need or needs identified during the screening. Providers shall use existing tools or protocols that have been validated by the federal Centers for Medicare and Medicaid Services, the National Association of Community Health Centers, the American Academy of Family Physicians, the National Committee for Quality Assurance, or other nationally recognized organizations. These tools or protocols include, at a minimum, the domains of food insecurity, housing insecurity, and transportation needs.(b) For purposes of this section, social determinants of health means the conditions under which people are born, grow, live, work, and age, including housing, food, transportation, utilities, and personal safety.(c) A health care service plan shall provide physicians who provide primary care services with adequate access to peer support specialists, lay health workers, social workers, or community health workers as defined in Section 18998 of the Welfare and Institutions Code, including Promotores and community health representatives, in counties where the health care service plan has enrollees. The health care service plan shall inform physicians who provide primary care services of how to access these community health workers, Promotores, community health representatives, peer support specialists, lay health workers, or social workers.(d) The department may adopt guidance for health care service plans to implement this section until regulations are adopted. The director shall coordinate with the Insurance Commissioner in the development of guidance and regulations under this subdivision.(e) This section shall be implemented only upon an appropriation by the Legislature for the express purpose of this section.
5960
6061 SECTION 1. Section 1367.57 is added to the Health and Safety Code, to read:
6162
6263 ### SECTION 1.
6364
6465 1367.57. (a) A health care service plan contract, except for a specialized health care service plan, issued, amended, or renewed on or after January 1, 2027, shall include coverage and provide reimbursement to health care providers for social determinants of health screenings. During these screenings, a provider may focus or expand their questions to issues relevant to the patient and may ask these questions in the manner the provider believes is most appropriate or more likely to elicit the best response from the patient. When documenting patient responses to these screenings, providers shall use standardized codes recognized by the federal Centers for Medicare and Medicaid Services, if available. This includes the procedure codes indicating a social determinants of health screening was administered and the diagnosis code or codes indicating any social need or needs identified during the screening. Providers shall use existing tools or protocols that have been validated by the federal Centers for Medicare and Medicaid Services, the National Association of Community Health Centers, the American Academy of Family Physicians, the National Committee for Quality Assurance, or other nationally recognized organizations. These tools or protocols include, at a minimum, the domains of food insecurity, housing insecurity, and transportation needs.(b) For purposes of this section, social determinants of health means the conditions under which people are born, grow, live, work, and age, including housing, food, transportation, utilities, and personal safety.(c) A health care service plan shall provide physicians who provide primary care services with adequate access to peer support specialists, lay health workers, social workers, or community health workers as defined in Section 18998 of the Welfare and Institutions Code, including Promotores and community health representatives, in counties where the health care service plan has enrollees. The health care service plan shall inform physicians who provide primary care services of how to access these community health workers, Promotores, community health representatives, peer support specialists, lay health workers, or social workers.(d) The department may adopt guidance for health care service plans to implement this section until regulations are adopted. The director shall coordinate with the Insurance Commissioner in the development of guidance and regulations under this subdivision.(e) This section shall be implemented only upon an appropriation by the Legislature for the express purpose of this section.
6566
6667 1367.57. (a) A health care service plan contract, except for a specialized health care service plan, issued, amended, or renewed on or after January 1, 2027, shall include coverage and provide reimbursement to health care providers for social determinants of health screenings. During these screenings, a provider may focus or expand their questions to issues relevant to the patient and may ask these questions in the manner the provider believes is most appropriate or more likely to elicit the best response from the patient. When documenting patient responses to these screenings, providers shall use standardized codes recognized by the federal Centers for Medicare and Medicaid Services, if available. This includes the procedure codes indicating a social determinants of health screening was administered and the diagnosis code or codes indicating any social need or needs identified during the screening. Providers shall use existing tools or protocols that have been validated by the federal Centers for Medicare and Medicaid Services, the National Association of Community Health Centers, the American Academy of Family Physicians, the National Committee for Quality Assurance, or other nationally recognized organizations. These tools or protocols include, at a minimum, the domains of food insecurity, housing insecurity, and transportation needs.(b) For purposes of this section, social determinants of health means the conditions under which people are born, grow, live, work, and age, including housing, food, transportation, utilities, and personal safety.(c) A health care service plan shall provide physicians who provide primary care services with adequate access to peer support specialists, lay health workers, social workers, or community health workers as defined in Section 18998 of the Welfare and Institutions Code, including Promotores and community health representatives, in counties where the health care service plan has enrollees. The health care service plan shall inform physicians who provide primary care services of how to access these community health workers, Promotores, community health representatives, peer support specialists, lay health workers, or social workers.(d) The department may adopt guidance for health care service plans to implement this section until regulations are adopted. The director shall coordinate with the Insurance Commissioner in the development of guidance and regulations under this subdivision.(e) This section shall be implemented only upon an appropriation by the Legislature for the express purpose of this section.
6768
6869 1367.57. (a) A health care service plan contract, except for a specialized health care service plan, issued, amended, or renewed on or after January 1, 2027, shall include coverage and provide reimbursement to health care providers for social determinants of health screenings. During these screenings, a provider may focus or expand their questions to issues relevant to the patient and may ask these questions in the manner the provider believes is most appropriate or more likely to elicit the best response from the patient. When documenting patient responses to these screenings, providers shall use standardized codes recognized by the federal Centers for Medicare and Medicaid Services, if available. This includes the procedure codes indicating a social determinants of health screening was administered and the diagnosis code or codes indicating any social need or needs identified during the screening. Providers shall use existing tools or protocols that have been validated by the federal Centers for Medicare and Medicaid Services, the National Association of Community Health Centers, the American Academy of Family Physicians, the National Committee for Quality Assurance, or other nationally recognized organizations. These tools or protocols include, at a minimum, the domains of food insecurity, housing insecurity, and transportation needs.(b) For purposes of this section, social determinants of health means the conditions under which people are born, grow, live, work, and age, including housing, food, transportation, utilities, and personal safety.(c) A health care service plan shall provide physicians who provide primary care services with adequate access to peer support specialists, lay health workers, social workers, or community health workers as defined in Section 18998 of the Welfare and Institutions Code, including Promotores and community health representatives, in counties where the health care service plan has enrollees. The health care service plan shall inform physicians who provide primary care services of how to access these community health workers, Promotores, community health representatives, peer support specialists, lay health workers, or social workers.(d) The department may adopt guidance for health care service plans to implement this section until regulations are adopted. The director shall coordinate with the Insurance Commissioner in the development of guidance and regulations under this subdivision.(e) This section shall be implemented only upon an appropriation by the Legislature for the express purpose of this section.
6970
7071
7172
7273 1367.57. (a) A health care service plan contract, except for a specialized health care service plan, issued, amended, or renewed on or after January 1, 2027, shall include coverage and provide reimbursement to health care providers for social determinants of health screenings. During these screenings, a provider may focus or expand their questions to issues relevant to the patient and may ask these questions in the manner the provider believes is most appropriate or more likely to elicit the best response from the patient. When documenting patient responses to these screenings, providers shall use standardized codes recognized by the federal Centers for Medicare and Medicaid Services, if available. This includes the procedure codes indicating a social determinants of health screening was administered and the diagnosis code or codes indicating any social need or needs identified during the screening. Providers shall use existing tools or protocols that have been validated by the federal Centers for Medicare and Medicaid Services, the National Association of Community Health Centers, the American Academy of Family Physicians, the National Committee for Quality Assurance, or other nationally recognized organizations. These tools or protocols include, at a minimum, the domains of food insecurity, housing insecurity, and transportation needs.
7374
7475 (b) For purposes of this section, social determinants of health means the conditions under which people are born, grow, live, work, and age, including housing, food, transportation, utilities, and personal safety.
7576
7677 (c) A health care service plan shall provide physicians who provide primary care services with adequate access to peer support specialists, lay health workers, social workers, or community health workers as defined in Section 18998 of the Welfare and Institutions Code, including Promotores and community health representatives, in counties where the health care service plan has enrollees. The health care service plan shall inform physicians who provide primary care services of how to access these community health workers, Promotores, community health representatives, peer support specialists, lay health workers, or social workers.
7778
7879 (d) The department may adopt guidance for health care service plans to implement this section until regulations are adopted. The director shall coordinate with the Insurance Commissioner in the development of guidance and regulations under this subdivision.
7980
8081 (e) This section shall be implemented only upon an appropriation by the Legislature for the express purpose of this section.
8182
8283 SEC. 2. Section 10123.52 is added to the Insurance Code, to read:10123.52. (a) A health insurance policy issued, amended, or renewed on or after January 1, 2027, shall include coverage and provide reimbursement to health care providers for social determinants of health screenings. During these screenings, a provider may focus or expand their questions to issues relevant to the patient and may ask these questions in the manner the provider believes is most appropriate or more likely to elicit the best response from the patient. When documenting patient responses to these screenings, providers shall use standardized codes recognized by the federal Centers for Medicare and Medicaid Services, if available. This includes the procedure codes indicating a social determinants of health screening was administered and the diagnosis code or codes indicating any social need or needs identified during the screening. Providers shall use existing tools or protocols that have been validated by the federal Centers for Medicare and Medicaid Services, the National Association of Community Health Centers, the American Academy of Family Physicians, the National Committee for Quality Assurance, or other nationally recognized organizations. These tools or protocols include, at a minimum, the domains of food insecurity, housing insecurity, and transportation needs.(b) For purposes of this section, social determinants of health means the conditions under which people are born, grow, live, work, and age, including housing, food, transportation, utilities, and personal safety.(c) A health insurer shall provide physicians who provide primary care services with adequate access to peer support specialists, lay health workers, social workers, or community health workers, as defined in Section 18998 of the Welfare and Institutions Code, including Promotores and community health representatives, in counties where the health insurer has insureds. The health insurer shall inform physicians who provide primary care services of how to access these community health workers, Promotores, community health representatives, peer support specialists, lay health workers, or social workers.(d) The department may adopt guidance for health insurers to implement this section until regulations are adopted. The commissioner shall coordinate with the Director of the Department of Managed Health Care in the development of guidance and regulations under this subdivision.(e) This section shall be implemented only upon an appropriation by the Legislature for the express purpose of this section.
8384
8485 SEC. 2. Section 10123.52 is added to the Insurance Code, to read:
8586
8687 ### SEC. 2.
8788
8889 10123.52. (a) A health insurance policy issued, amended, or renewed on or after January 1, 2027, shall include coverage and provide reimbursement to health care providers for social determinants of health screenings. During these screenings, a provider may focus or expand their questions to issues relevant to the patient and may ask these questions in the manner the provider believes is most appropriate or more likely to elicit the best response from the patient. When documenting patient responses to these screenings, providers shall use standardized codes recognized by the federal Centers for Medicare and Medicaid Services, if available. This includes the procedure codes indicating a social determinants of health screening was administered and the diagnosis code or codes indicating any social need or needs identified during the screening. Providers shall use existing tools or protocols that have been validated by the federal Centers for Medicare and Medicaid Services, the National Association of Community Health Centers, the American Academy of Family Physicians, the National Committee for Quality Assurance, or other nationally recognized organizations. These tools or protocols include, at a minimum, the domains of food insecurity, housing insecurity, and transportation needs.(b) For purposes of this section, social determinants of health means the conditions under which people are born, grow, live, work, and age, including housing, food, transportation, utilities, and personal safety.(c) A health insurer shall provide physicians who provide primary care services with adequate access to peer support specialists, lay health workers, social workers, or community health workers, as defined in Section 18998 of the Welfare and Institutions Code, including Promotores and community health representatives, in counties where the health insurer has insureds. The health insurer shall inform physicians who provide primary care services of how to access these community health workers, Promotores, community health representatives, peer support specialists, lay health workers, or social workers.(d) The department may adopt guidance for health insurers to implement this section until regulations are adopted. The commissioner shall coordinate with the Director of the Department of Managed Health Care in the development of guidance and regulations under this subdivision.(e) This section shall be implemented only upon an appropriation by the Legislature for the express purpose of this section.
8990
9091 10123.52. (a) A health insurance policy issued, amended, or renewed on or after January 1, 2027, shall include coverage and provide reimbursement to health care providers for social determinants of health screenings. During these screenings, a provider may focus or expand their questions to issues relevant to the patient and may ask these questions in the manner the provider believes is most appropriate or more likely to elicit the best response from the patient. When documenting patient responses to these screenings, providers shall use standardized codes recognized by the federal Centers for Medicare and Medicaid Services, if available. This includes the procedure codes indicating a social determinants of health screening was administered and the diagnosis code or codes indicating any social need or needs identified during the screening. Providers shall use existing tools or protocols that have been validated by the federal Centers for Medicare and Medicaid Services, the National Association of Community Health Centers, the American Academy of Family Physicians, the National Committee for Quality Assurance, or other nationally recognized organizations. These tools or protocols include, at a minimum, the domains of food insecurity, housing insecurity, and transportation needs.(b) For purposes of this section, social determinants of health means the conditions under which people are born, grow, live, work, and age, including housing, food, transportation, utilities, and personal safety.(c) A health insurer shall provide physicians who provide primary care services with adequate access to peer support specialists, lay health workers, social workers, or community health workers, as defined in Section 18998 of the Welfare and Institutions Code, including Promotores and community health representatives, in counties where the health insurer has insureds. The health insurer shall inform physicians who provide primary care services of how to access these community health workers, Promotores, community health representatives, peer support specialists, lay health workers, or social workers.(d) The department may adopt guidance for health insurers to implement this section until regulations are adopted. The commissioner shall coordinate with the Director of the Department of Managed Health Care in the development of guidance and regulations under this subdivision.(e) This section shall be implemented only upon an appropriation by the Legislature for the express purpose of this section.
9192
9293 10123.52. (a) A health insurance policy issued, amended, or renewed on or after January 1, 2027, shall include coverage and provide reimbursement to health care providers for social determinants of health screenings. During these screenings, a provider may focus or expand their questions to issues relevant to the patient and may ask these questions in the manner the provider believes is most appropriate or more likely to elicit the best response from the patient. When documenting patient responses to these screenings, providers shall use standardized codes recognized by the federal Centers for Medicare and Medicaid Services, if available. This includes the procedure codes indicating a social determinants of health screening was administered and the diagnosis code or codes indicating any social need or needs identified during the screening. Providers shall use existing tools or protocols that have been validated by the federal Centers for Medicare and Medicaid Services, the National Association of Community Health Centers, the American Academy of Family Physicians, the National Committee for Quality Assurance, or other nationally recognized organizations. These tools or protocols include, at a minimum, the domains of food insecurity, housing insecurity, and transportation needs.(b) For purposes of this section, social determinants of health means the conditions under which people are born, grow, live, work, and age, including housing, food, transportation, utilities, and personal safety.(c) A health insurer shall provide physicians who provide primary care services with adequate access to peer support specialists, lay health workers, social workers, or community health workers, as defined in Section 18998 of the Welfare and Institutions Code, including Promotores and community health representatives, in counties where the health insurer has insureds. The health insurer shall inform physicians who provide primary care services of how to access these community health workers, Promotores, community health representatives, peer support specialists, lay health workers, or social workers.(d) The department may adopt guidance for health insurers to implement this section until regulations are adopted. The commissioner shall coordinate with the Director of the Department of Managed Health Care in the development of guidance and regulations under this subdivision.(e) This section shall be implemented only upon an appropriation by the Legislature for the express purpose of this section.
9394
9495
9596
9697 10123.52. (a) A health insurance policy issued, amended, or renewed on or after January 1, 2027, shall include coverage and provide reimbursement to health care providers for social determinants of health screenings. During these screenings, a provider may focus or expand their questions to issues relevant to the patient and may ask these questions in the manner the provider believes is most appropriate or more likely to elicit the best response from the patient. When documenting patient responses to these screenings, providers shall use standardized codes recognized by the federal Centers for Medicare and Medicaid Services, if available. This includes the procedure codes indicating a social determinants of health screening was administered and the diagnosis code or codes indicating any social need or needs identified during the screening. Providers shall use existing tools or protocols that have been validated by the federal Centers for Medicare and Medicaid Services, the National Association of Community Health Centers, the American Academy of Family Physicians, the National Committee for Quality Assurance, or other nationally recognized organizations. These tools or protocols include, at a minimum, the domains of food insecurity, housing insecurity, and transportation needs.
9798
9899 (b) For purposes of this section, social determinants of health means the conditions under which people are born, grow, live, work, and age, including housing, food, transportation, utilities, and personal safety.
99100
100101 (c) A health insurer shall provide physicians who provide primary care services with adequate access to peer support specialists, lay health workers, social workers, or community health workers, as defined in Section 18998 of the Welfare and Institutions Code, including Promotores and community health representatives, in counties where the health insurer has insureds. The health insurer shall inform physicians who provide primary care services of how to access these community health workers, Promotores, community health representatives, peer support specialists, lay health workers, or social workers.
101102
102103 (d) The department may adopt guidance for health insurers to implement this section until regulations are adopted. The commissioner shall coordinate with the Director of the Department of Managed Health Care in the development of guidance and regulations under this subdivision.
103104
104105 (e) This section shall be implemented only upon an appropriation by the Legislature for the express purpose of this section.
105106
106107 SEC. 3. Section 14132.14 is added to the Welfare and Institutions Code, to read:14132.14. (a) (1) Social determinants of health screenings for Medi-Cal beneficiaries is a covered benefit and the department or a Medi-Cal managed care plan shall provide reimbursement to a Medi-Cal provider who renders this service, unless the service is already covered under a separate covered benefit.(2) Federally qualified health centers and rural health clinics shall be reimbursed for these social determinants of health screenings at the Medi-Cal fee-for-service rate. The reimbursements to federally qualified health centers and rural health clinics shall be in addition to any other amounts payable with respect to those services, including payments received pursuant to Section 14132.100, subdivision (e) of Section 14087.325, or Article 4.1 (commencing with Section 14138.1), and shall not affect any other payments. The payments described in this paragraph shall not be subject to, or factored into, reconciliation and shall be excluded from the calculation described in subdivision (h) of Section 14132.100.(b) For purposes of this section, social determinants of health means the conditions under which people are born, grow, live, work, and age, including housing, food, transportation, utilities, and personal safety.(c) This section shall be implemented only upon an appropriation by the Legislature for the express purpose of this section.
107108
108109 SEC. 3. Section 14132.14 is added to the Welfare and Institutions Code, to read:
109110
110111 ### SEC. 3.
111112
112113 14132.14. (a) (1) Social determinants of health screenings for Medi-Cal beneficiaries is a covered benefit and the department or a Medi-Cal managed care plan shall provide reimbursement to a Medi-Cal provider who renders this service, unless the service is already covered under a separate covered benefit.(2) Federally qualified health centers and rural health clinics shall be reimbursed for these social determinants of health screenings at the Medi-Cal fee-for-service rate. The reimbursements to federally qualified health centers and rural health clinics shall be in addition to any other amounts payable with respect to those services, including payments received pursuant to Section 14132.100, subdivision (e) of Section 14087.325, or Article 4.1 (commencing with Section 14138.1), and shall not affect any other payments. The payments described in this paragraph shall not be subject to, or factored into, reconciliation and shall be excluded from the calculation described in subdivision (h) of Section 14132.100.(b) For purposes of this section, social determinants of health means the conditions under which people are born, grow, live, work, and age, including housing, food, transportation, utilities, and personal safety.(c) This section shall be implemented only upon an appropriation by the Legislature for the express purpose of this section.
113114
114115 14132.14. (a) (1) Social determinants of health screenings for Medi-Cal beneficiaries is a covered benefit and the department or a Medi-Cal managed care plan shall provide reimbursement to a Medi-Cal provider who renders this service, unless the service is already covered under a separate covered benefit.(2) Federally qualified health centers and rural health clinics shall be reimbursed for these social determinants of health screenings at the Medi-Cal fee-for-service rate. The reimbursements to federally qualified health centers and rural health clinics shall be in addition to any other amounts payable with respect to those services, including payments received pursuant to Section 14132.100, subdivision (e) of Section 14087.325, or Article 4.1 (commencing with Section 14138.1), and shall not affect any other payments. The payments described in this paragraph shall not be subject to, or factored into, reconciliation and shall be excluded from the calculation described in subdivision (h) of Section 14132.100.(b) For purposes of this section, social determinants of health means the conditions under which people are born, grow, live, work, and age, including housing, food, transportation, utilities, and personal safety.(c) This section shall be implemented only upon an appropriation by the Legislature for the express purpose of this section.
115116
116117 14132.14. (a) (1) Social determinants of health screenings for Medi-Cal beneficiaries is a covered benefit and the department or a Medi-Cal managed care plan shall provide reimbursement to a Medi-Cal provider who renders this service, unless the service is already covered under a separate covered benefit.(2) Federally qualified health centers and rural health clinics shall be reimbursed for these social determinants of health screenings at the Medi-Cal fee-for-service rate. The reimbursements to federally qualified health centers and rural health clinics shall be in addition to any other amounts payable with respect to those services, including payments received pursuant to Section 14132.100, subdivision (e) of Section 14087.325, or Article 4.1 (commencing with Section 14138.1), and shall not affect any other payments. The payments described in this paragraph shall not be subject to, or factored into, reconciliation and shall be excluded from the calculation described in subdivision (h) of Section 14132.100.(b) For purposes of this section, social determinants of health means the conditions under which people are born, grow, live, work, and age, including housing, food, transportation, utilities, and personal safety.(c) This section shall be implemented only upon an appropriation by the Legislature for the express purpose of this section.
117118
118119
119120
120121 14132.14. (a) (1) Social determinants of health screenings for Medi-Cal beneficiaries is a covered benefit and the department or a Medi-Cal managed care plan shall provide reimbursement to a Medi-Cal provider who renders this service, unless the service is already covered under a separate covered benefit.
121122
122123 (2) Federally qualified health centers and rural health clinics shall be reimbursed for these social determinants of health screenings at the Medi-Cal fee-for-service rate. The reimbursements to federally qualified health centers and rural health clinics shall be in addition to any other amounts payable with respect to those services, including payments received pursuant to Section 14132.100, subdivision (e) of Section 14087.325, or Article 4.1 (commencing with Section 14138.1), and shall not affect any other payments. The payments described in this paragraph shall not be subject to, or factored into, reconciliation and shall be excluded from the calculation described in subdivision (h) of Section 14132.100.
123124
124125 (b) For purposes of this section, social determinants of health means the conditions under which people are born, grow, live, work, and age, including housing, food, transportation, utilities, and personal safety.
125126
126127 (c) This section shall be implemented only upon an appropriation by the Legislature for the express purpose of this section.
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128129 SEC. 4. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
129130
130131 SEC. 4. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
131132
132133 SEC. 4. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
133134
134135 ### SEC. 4.