| 1 | | - | Senate Bill No. 1180 CHAPTER 884An act to add Section 1371.51 to the Health and Safety Code, to add Section 10126.61 to the Insurance Code, and to add Section 14132.13 to the Welfare and Institutions Code, relating to health care coverage. [ Approved by Governor September 28, 2024. Filed with Secretary of State September 28, 2024. ] LEGISLATIVE COUNSEL'S DIGESTSB 1180, Ashby. Health care coverage: emergency medical services. Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law requires health care service plan contracts and health insurance policies to provide coverage for certain services and treatments, including medical transportation services. Existing law establishes the Medi-Cal program, administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services, including emergency medical transport. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.Existing law, until January 1, 2031, authorizes a local emergency medical services (EMS) agency to develop a community paramedicine or triage to alternate destination program that, among other things, provides case management services to frequent EMS users or triage paramedic assessments, respectively.This bill would require a health care service plan contract or health insurance policy issued, amended, or renewed on or after July 1, 2025, to establish a process to reimburse for services provided by a community paramedicine program, a triage to alternate destination program, and a mobile integrated health program, as defined.The bill would require those contracts and policies to require an enrollee or insured who receives covered services from a noncontracting program to pay no more than the same cost-sharing amount that they would pay for the same covered services received from a contracting program. The bill would prohibit reimbursement rates adopted pursuant to this provision from exceeding the health care service plans or health insurers usual and customary charges for services rendered.Because a willful violation of these provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program.The bill would also make services provided by these programs covered benefits under the Medi-Cal program. The bill would condition this Medi-Cal coverage on an appropriation, receipt of any necessary federal approvals, and the availability of federal financial participation.The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.This bill would provide that no reimbursement is required by this act for a specified reason.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES Bill TextThe people of the State of California do enact as follows:SECTION 1. Section 1371.51 is added to the Health and Safety Code, to read:1371.51. (a) A health care service plan contract issued, amended, or renewed on or after July 1, 2025, shall establish a process to reimburse for services provided by a community paramedicine program, triage to alternate destination program, or mobile integrated health program.(b) (1) A health care service plan contract issued, amended, or renewed on or after July 1, 2025, shall require an enrollee who receives covered services from a noncontracting community paramedicine program, triage to alternate destination program, or mobile integrated health program to pay no more than the same cost-sharing amount that the enrollee would pay for the same covered services received from a contracting community paramedicine program, triage to alternate destination program, or mobile integrated health program.(2) Notwithstanding any other law, reimbursement rates adopted pursuant to this subdivision shall not exceed the health care service plans usual and customary charges for services rendered.(c) For purposes of this section, the following definitions apply:(1) Community paramedicine program means a program defined in Section 1815.(2) Mobile integrated health program means a team of licensed health care practitioners, operating within their scope of practice, who provide mobile health services to support the emergency medical services system.(3) Triage to alternate destination program means a program defined in Section 1819.SEC. 2. Section 10126.61 is added to the Insurance Code, to read:10126.61. (a) A health insurance policy issued, amended, or renewed on or after July 1, 2025, shall establish a process to reimburse for services provided by a community paramedicine program, triage to alternate destination program, or mobile integrated health program.(b) (1) A health insurance policy issued, amended, or renewed on or after July 1, 2025, shall require an insured who receives covered services from a noncontracting community paramedicine program, triage to alternate destination program, or mobile integrated health program to pay no more than the same cost-sharing amount that the insured would pay for the same covered services received from a contracting community paramedicine program, triage to alternate destination program, or mobile integrated health program.(2) Notwithstanding any other law, reimbursement rates adopted pursuant to this subdivision shall not exceed the health insurers usual and customary charges for services rendered.(c) For purposes of this section, the following definitions apply:(1) Community paramedicine program means a program defined in Section 1815 of the Health and Safety Code.(2) Mobile integrated health program means a team of licensed health care practitioners, operating within their scope of practice, who provide mobile health services to support the emergency medical services system.(3) Triage to alternate destination program means a program defined in Section 1819 of the Health and Safety Code.SEC. 3. Section 14132.13 is added to the Welfare and Institutions Code, to read:14132.13. (a) Services provided by a community paramedicine program, triage to alternate destination program, or mobile integrated health program are covered benefits under the Medi-Cal program.(b) The department shall develop rates of reimbursement for services provided by a community paramedicine program, triage to alternate destination program, or mobile integrated health program in consultation with community paramedicine programs, triage to alternate destination programs, and mobile integrated health programs.(c) This section shall be implemented only to the extent that the department obtains any necessary federal waivers or other federal approvals and that federal financial participation is available and not otherwise jeopardized.(d) Implementation of this section shall be subject to an appropriation made by the Legislature for the purpose of this section.(e) For purposes of this section, the following definitions apply:(1) Community paramedicine program means a program defined in Section 1815 of the Health and Safety Code.(2) Mobile integrated health program means a team of licensed health care practitioners, operating within their scope of practice, who provide mobile health services to support the emergency medical services system.(3) Triage to alternate destination program means a program defined in Section 1819 of the Health and Safety Code.SEC. 4. No reimbursement is required by this act pursuant to Section 6 of Article 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. |
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| 1 | + | Enrolled September 04, 2024 Passed IN Senate August 30, 2024 Passed IN Assembly August 28, 2024 Amended IN Assembly June 24, 2024 Amended IN Senate May 16, 2024 Amended IN Senate April 29, 2024 CALIFORNIA LEGISLATURE 20232024 REGULAR SESSION Senate Bill No. 1180Introduced by Senator Ashby(Coauthor: Senator Wahab)(Coauthor: Assembly Member Bonta)February 14, 2024An act to add Section 1371.51 to the Health and Safety Code, to add Section 10126.61 to the Insurance Code, and to add Section 14132.13 to the Welfare and Institutions Code, relating to health care coverage. LEGISLATIVE COUNSEL'S DIGESTSB 1180, Ashby. Health care coverage: emergency medical services. Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law requires health care service plan contracts and health insurance policies to provide coverage for certain services and treatments, including medical transportation services. Existing law establishes the Medi-Cal program, administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services, including emergency medical transport. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.Existing law, until January 1, 2031, authorizes a local emergency medical services (EMS) agency to develop a community paramedicine or triage to alternate destination program that, among other things, provides case management services to frequent EMS users or triage paramedic assessments, respectively.This bill would require a health care service plan contract or health insurance policy issued, amended, or renewed on or after July 1, 2025, to establish a process to reimburse for services provided by a community paramedicine program, a triage to alternate destination program, and a mobile integrated health program, as defined.The bill would require those contracts and policies to require an enrollee or insured who receives covered services from a noncontracting program to pay no more than the same cost-sharing amount that they would pay for the same covered services received from a contracting program. The bill would prohibit reimbursement rates adopted pursuant to this provision from exceeding the health care service plans or health insurers usual and customary charges for services rendered.Because a willful violation of these provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program.The bill would also make services provided by these programs covered benefits under the Medi-Cal program. The bill would condition this Medi-Cal coverage on an appropriation, receipt of any necessary federal approvals, and the availability of federal financial participation.The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.This bill would provide that no reimbursement is required by this act for a specified reason.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES Bill TextThe people of the State of California do enact as follows:SECTION 1. Section 1371.51 is added to the Health and Safety Code, to read:1371.51. (a) A health care service plan contract issued, amended, or renewed on or after July 1, 2025, shall establish a process to reimburse for services provided by a community paramedicine program, triage to alternate destination program, or mobile integrated health program.(b) (1) A health care service plan contract issued, amended, or renewed on or after July 1, 2025, shall require an enrollee who receives covered services from a noncontracting community paramedicine program, triage to alternate destination program, or mobile integrated health program to pay no more than the same cost-sharing amount that the enrollee would pay for the same covered services received from a contracting community paramedicine program, triage to alternate destination program, or mobile integrated health program.(2) Notwithstanding any other law, reimbursement rates adopted pursuant to this subdivision shall not exceed the health care service plans usual and customary charges for services rendered.(c) For purposes of this section, the following definitions apply:(1) Community paramedicine program means a program defined in Section 1815.(2) Mobile integrated health program means a team of licensed health care practitioners, operating within their scope of practice, who provide mobile health services to support the emergency medical services system.(3) Triage to alternate destination program means a program defined in Section 1819.SEC. 2. Section 10126.61 is added to the Insurance Code, to read:10126.61. (a) A health insurance policy issued, amended, or renewed on or after July 1, 2025, shall establish a process to reimburse for services provided by a community paramedicine program, triage to alternate destination program, or mobile integrated health program.(b) (1) A health insurance policy issued, amended, or renewed on or after July 1, 2025, shall require an insured who receives covered services from a noncontracting community paramedicine program, triage to alternate destination program, or mobile integrated health program to pay no more than the same cost-sharing amount that the insured would pay for the same covered services received from a contracting community paramedicine program, triage to alternate destination program, or mobile integrated health program.(2) Notwithstanding any other law, reimbursement rates adopted pursuant to this subdivision shall not exceed the health insurers usual and customary charges for services rendered.(c) For purposes of this section, the following definitions apply:(1) Community paramedicine program means a program defined in Section 1815 of the Health and Safety Code.(2) Mobile integrated health program means a team of licensed health care practitioners, operating within their scope of practice, who provide mobile health services to support the emergency medical services system.(3) Triage to alternate destination program means a program defined in Section 1819 of the Health and Safety Code.SEC. 3. Section 14132.13 is added to the Welfare and Institutions Code, to read:14132.13. (a) Services provided by a community paramedicine program, triage to alternate destination program, or mobile integrated health program are covered benefits under the Medi-Cal program.(b) The department shall develop rates of reimbursement for services provided by a community paramedicine program, triage to alternate destination program, or mobile integrated health program in consultation with community paramedicine programs, triage to alternate destination programs, and mobile integrated health programs.(c) This section shall be implemented only to the extent that the department obtains any necessary federal waivers or other federal approvals and that federal financial participation is available and not otherwise jeopardized.(d) Implementation of this section shall be subject to an appropriation made by the Legislature for the purpose of this section.(e) For purposes of this section, the following definitions apply:(1) Community paramedicine program means a program defined in Section 1815 of the Health and Safety Code.(2) Mobile integrated health program means a team of licensed health care practitioners, operating within their scope of practice, who provide mobile health services to support the emergency medical services system.(3) Triage to alternate destination program means a program defined in Section 1819 of the Health and Safety Code.SEC. 4. No reimbursement is required by this act pursuant to Section 6 of Article 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. |
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| 14 | 26 | | |
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| 15 | 27 | | LEGISLATIVE COUNSEL'S DIGEST |
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| 16 | 28 | | |
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| 17 | 29 | | ## LEGISLATIVE COUNSEL'S DIGEST |
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| 18 | 30 | | |
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| 19 | 31 | | SB 1180, Ashby. Health care coverage: emergency medical services. |
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| 20 | 32 | | |
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| 21 | 33 | | Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law requires health care service plan contracts and health insurance policies to provide coverage for certain services and treatments, including medical transportation services. Existing law establishes the Medi-Cal program, administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services, including emergency medical transport. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.Existing law, until January 1, 2031, authorizes a local emergency medical services (EMS) agency to develop a community paramedicine or triage to alternate destination program that, among other things, provides case management services to frequent EMS users or triage paramedic assessments, respectively.This bill would require a health care service plan contract or health insurance policy issued, amended, or renewed on or after July 1, 2025, to establish a process to reimburse for services provided by a community paramedicine program, a triage to alternate destination program, and a mobile integrated health program, as defined.The bill would require those contracts and policies to require an enrollee or insured who receives covered services from a noncontracting program to pay no more than the same cost-sharing amount that they would pay for the same covered services received from a contracting program. The bill would prohibit reimbursement rates adopted pursuant to this provision from exceeding the health care service plans or health insurers usual and customary charges for services rendered.Because a willful violation of these provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program.The bill would also make services provided by these programs covered benefits under the Medi-Cal program. The bill would condition this Medi-Cal coverage on an appropriation, receipt of any necessary federal approvals, and the availability of federal financial participation.The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.This bill would provide that no reimbursement is required by this act for a specified reason. |
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| 22 | 34 | | |
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| 23 | 35 | | Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law requires health care service plan contracts and health insurance policies to provide coverage for certain services and treatments, including medical transportation services. Existing law establishes the Medi-Cal program, administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services, including emergency medical transport. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. |
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| 24 | 36 | | |
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| 25 | 37 | | Existing law, until January 1, 2031, authorizes a local emergency medical services (EMS) agency to develop a community paramedicine or triage to alternate destination program that, among other things, provides case management services to frequent EMS users or triage paramedic assessments, respectively. |
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| 26 | 38 | | |
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| 27 | 39 | | This bill would require a health care service plan contract or health insurance policy issued, amended, or renewed on or after July 1, 2025, to establish a process to reimburse for services provided by a community paramedicine program, a triage to alternate destination program, and a mobile integrated health program, as defined. |
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| 28 | 40 | | |
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| 29 | 41 | | The bill would require those contracts and policies to require an enrollee or insured who receives covered services from a noncontracting program to pay no more than the same cost-sharing amount that they would pay for the same covered services received from a contracting program. The bill would prohibit reimbursement rates adopted pursuant to this provision from exceeding the health care service plans or health insurers usual and customary charges for services rendered. |
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| 30 | 42 | | |
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| 31 | 43 | | Because a willful violation of these provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program. |
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| 32 | 44 | | |
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| 33 | 45 | | The bill would also make services provided by these programs covered benefits under the Medi-Cal program. The bill would condition this Medi-Cal coverage on an appropriation, receipt of any necessary federal approvals, and the availability of federal financial participation. |
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| 34 | 46 | | |
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| 35 | 47 | | 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. |
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| 36 | 48 | | |
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| 37 | 49 | | This bill would provide that no reimbursement is required by this act for a specified reason. |
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| 38 | 50 | | |
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| 39 | 51 | | ## Digest Key |
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| 40 | 52 | | |
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| 41 | 53 | | ## Bill Text |
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| 42 | 54 | | |
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| 43 | 55 | | The people of the State of California do enact as follows:SECTION 1. Section 1371.51 is added to the Health and Safety Code, to read:1371.51. (a) A health care service plan contract issued, amended, or renewed on or after July 1, 2025, shall establish a process to reimburse for services provided by a community paramedicine program, triage to alternate destination program, or mobile integrated health program.(b) (1) A health care service plan contract issued, amended, or renewed on or after July 1, 2025, shall require an enrollee who receives covered services from a noncontracting community paramedicine program, triage to alternate destination program, or mobile integrated health program to pay no more than the same cost-sharing amount that the enrollee would pay for the same covered services received from a contracting community paramedicine program, triage to alternate destination program, or mobile integrated health program.(2) Notwithstanding any other law, reimbursement rates adopted pursuant to this subdivision shall not exceed the health care service plans usual and customary charges for services rendered.(c) For purposes of this section, the following definitions apply:(1) Community paramedicine program means a program defined in Section 1815.(2) Mobile integrated health program means a team of licensed health care practitioners, operating within their scope of practice, who provide mobile health services to support the emergency medical services system.(3) Triage to alternate destination program means a program defined in Section 1819.SEC. 2. Section 10126.61 is added to the Insurance Code, to read:10126.61. (a) A health insurance policy issued, amended, or renewed on or after July 1, 2025, shall establish a process to reimburse for services provided by a community paramedicine program, triage to alternate destination program, or mobile integrated health program.(b) (1) A health insurance policy issued, amended, or renewed on or after July 1, 2025, shall require an insured who receives covered services from a noncontracting community paramedicine program, triage to alternate destination program, or mobile integrated health program to pay no more than the same cost-sharing amount that the insured would pay for the same covered services received from a contracting community paramedicine program, triage to alternate destination program, or mobile integrated health program.(2) Notwithstanding any other law, reimbursement rates adopted pursuant to this subdivision shall not exceed the health insurers usual and customary charges for services rendered.(c) For purposes of this section, the following definitions apply:(1) Community paramedicine program means a program defined in Section 1815 of the Health and Safety Code.(2) Mobile integrated health program means a team of licensed health care practitioners, operating within their scope of practice, who provide mobile health services to support the emergency medical services system.(3) Triage to alternate destination program means a program defined in Section 1819 of the Health and Safety Code.SEC. 3. Section 14132.13 is added to the Welfare and Institutions Code, to read:14132.13. (a) Services provided by a community paramedicine program, triage to alternate destination program, or mobile integrated health program are covered benefits under the Medi-Cal program.(b) The department shall develop rates of reimbursement for services provided by a community paramedicine program, triage to alternate destination program, or mobile integrated health program in consultation with community paramedicine programs, triage to alternate destination programs, and mobile integrated health programs.(c) This section shall be implemented only to the extent that the department obtains any necessary federal waivers or other federal approvals and that federal financial participation is available and not otherwise jeopardized.(d) Implementation of this section shall be subject to an appropriation made by the Legislature for the purpose of this section.(e) For purposes of this section, the following definitions apply:(1) Community paramedicine program means a program defined in Section 1815 of the Health and Safety Code.(2) Mobile integrated health program means a team of licensed health care practitioners, operating within their scope of practice, who provide mobile health services to support the emergency medical services system.(3) Triage to alternate destination program means a program defined in Section 1819 of the Health and Safety Code.SEC. 4. No reimbursement is required by this act pursuant to Section 6 of Article 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. |
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| 44 | 56 | | |
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| 45 | 57 | | The people of the State of California do enact as follows: |
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| 46 | 58 | | |
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| 47 | 59 | | ## The people of the State of California do enact as follows: |
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| 48 | 60 | | |
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| 49 | 61 | | SECTION 1. Section 1371.51 is added to the Health and Safety Code, to read:1371.51. (a) A health care service plan contract issued, amended, or renewed on or after July 1, 2025, shall establish a process to reimburse for services provided by a community paramedicine program, triage to alternate destination program, or mobile integrated health program.(b) (1) A health care service plan contract issued, amended, or renewed on or after July 1, 2025, shall require an enrollee who receives covered services from a noncontracting community paramedicine program, triage to alternate destination program, or mobile integrated health program to pay no more than the same cost-sharing amount that the enrollee would pay for the same covered services received from a contracting community paramedicine program, triage to alternate destination program, or mobile integrated health program.(2) Notwithstanding any other law, reimbursement rates adopted pursuant to this subdivision shall not exceed the health care service plans usual and customary charges for services rendered.(c) For purposes of this section, the following definitions apply:(1) Community paramedicine program means a program defined in Section 1815.(2) Mobile integrated health program means a team of licensed health care practitioners, operating within their scope of practice, who provide mobile health services to support the emergency medical services system.(3) Triage to alternate destination program means a program defined in Section 1819. |
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| 50 | 62 | | |
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| 51 | 63 | | SECTION 1. Section 1371.51 is added to the Health and Safety Code, to read: |
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| 52 | 64 | | |
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| 53 | 65 | | ### SECTION 1. |
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| 54 | 66 | | |
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| 55 | 67 | | 1371.51. (a) A health care service plan contract issued, amended, or renewed on or after July 1, 2025, shall establish a process to reimburse for services provided by a community paramedicine program, triage to alternate destination program, or mobile integrated health program.(b) (1) A health care service plan contract issued, amended, or renewed on or after July 1, 2025, shall require an enrollee who receives covered services from a noncontracting community paramedicine program, triage to alternate destination program, or mobile integrated health program to pay no more than the same cost-sharing amount that the enrollee would pay for the same covered services received from a contracting community paramedicine program, triage to alternate destination program, or mobile integrated health program.(2) Notwithstanding any other law, reimbursement rates adopted pursuant to this subdivision shall not exceed the health care service plans usual and customary charges for services rendered.(c) For purposes of this section, the following definitions apply:(1) Community paramedicine program means a program defined in Section 1815.(2) Mobile integrated health program means a team of licensed health care practitioners, operating within their scope of practice, who provide mobile health services to support the emergency medical services system.(3) Triage to alternate destination program means a program defined in Section 1819. |
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| 56 | 68 | | |
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| 57 | 69 | | 1371.51. (a) A health care service plan contract issued, amended, or renewed on or after July 1, 2025, shall establish a process to reimburse for services provided by a community paramedicine program, triage to alternate destination program, or mobile integrated health program.(b) (1) A health care service plan contract issued, amended, or renewed on or after July 1, 2025, shall require an enrollee who receives covered services from a noncontracting community paramedicine program, triage to alternate destination program, or mobile integrated health program to pay no more than the same cost-sharing amount that the enrollee would pay for the same covered services received from a contracting community paramedicine program, triage to alternate destination program, or mobile integrated health program.(2) Notwithstanding any other law, reimbursement rates adopted pursuant to this subdivision shall not exceed the health care service plans usual and customary charges for services rendered.(c) For purposes of this section, the following definitions apply:(1) Community paramedicine program means a program defined in Section 1815.(2) Mobile integrated health program means a team of licensed health care practitioners, operating within their scope of practice, who provide mobile health services to support the emergency medical services system.(3) Triage to alternate destination program means a program defined in Section 1819. |
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| 58 | 70 | | |
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| 59 | 71 | | 1371.51. (a) A health care service plan contract issued, amended, or renewed on or after July 1, 2025, shall establish a process to reimburse for services provided by a community paramedicine program, triage to alternate destination program, or mobile integrated health program.(b) (1) A health care service plan contract issued, amended, or renewed on or after July 1, 2025, shall require an enrollee who receives covered services from a noncontracting community paramedicine program, triage to alternate destination program, or mobile integrated health program to pay no more than the same cost-sharing amount that the enrollee would pay for the same covered services received from a contracting community paramedicine program, triage to alternate destination program, or mobile integrated health program.(2) Notwithstanding any other law, reimbursement rates adopted pursuant to this subdivision shall not exceed the health care service plans usual and customary charges for services rendered.(c) For purposes of this section, the following definitions apply:(1) Community paramedicine program means a program defined in Section 1815.(2) Mobile integrated health program means a team of licensed health care practitioners, operating within their scope of practice, who provide mobile health services to support the emergency medical services system.(3) Triage to alternate destination program means a program defined in Section 1819. |
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| 60 | 72 | | |
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| 61 | 73 | | |
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| 62 | 74 | | |
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| 63 | 75 | | 1371.51. (a) A health care service plan contract issued, amended, or renewed on or after July 1, 2025, shall establish a process to reimburse for services provided by a community paramedicine program, triage to alternate destination program, or mobile integrated health program. |
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| 64 | 76 | | |
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| 65 | 77 | | (b) (1) A health care service plan contract issued, amended, or renewed on or after July 1, 2025, shall require an enrollee who receives covered services from a noncontracting community paramedicine program, triage to alternate destination program, or mobile integrated health program to pay no more than the same cost-sharing amount that the enrollee would pay for the same covered services received from a contracting community paramedicine program, triage to alternate destination program, or mobile integrated health program. |
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| 66 | 78 | | |
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| 67 | 79 | | (2) Notwithstanding any other law, reimbursement rates adopted pursuant to this subdivision shall not exceed the health care service plans usual and customary charges for services rendered. |
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| 68 | 80 | | |
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| 69 | 81 | | (c) For purposes of this section, the following definitions apply: |
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| 70 | 82 | | |
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| 71 | 83 | | (1) Community paramedicine program means a program defined in Section 1815. |
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| 72 | 84 | | |
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| 73 | 85 | | (2) Mobile integrated health program means a team of licensed health care practitioners, operating within their scope of practice, who provide mobile health services to support the emergency medical services system. |
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| 74 | 86 | | |
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| 75 | 87 | | (3) Triage to alternate destination program means a program defined in Section 1819. |
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| 76 | 88 | | |
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| 77 | 89 | | SEC. 2. Section 10126.61 is added to the Insurance Code, to read:10126.61. (a) A health insurance policy issued, amended, or renewed on or after July 1, 2025, shall establish a process to reimburse for services provided by a community paramedicine program, triage to alternate destination program, or mobile integrated health program.(b) (1) A health insurance policy issued, amended, or renewed on or after July 1, 2025, shall require an insured who receives covered services from a noncontracting community paramedicine program, triage to alternate destination program, or mobile integrated health program to pay no more than the same cost-sharing amount that the insured would pay for the same covered services received from a contracting community paramedicine program, triage to alternate destination program, or mobile integrated health program.(2) Notwithstanding any other law, reimbursement rates adopted pursuant to this subdivision shall not exceed the health insurers usual and customary charges for services rendered.(c) For purposes of this section, the following definitions apply:(1) Community paramedicine program means a program defined in Section 1815 of the Health and Safety Code.(2) Mobile integrated health program means a team of licensed health care practitioners, operating within their scope of practice, who provide mobile health services to support the emergency medical services system.(3) Triage to alternate destination program means a program defined in Section 1819 of the Health and Safety Code. |
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| 78 | 90 | | |
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| 79 | 91 | | SEC. 2. Section 10126.61 is added to the Insurance Code, to read: |
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| 80 | 92 | | |
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| 81 | 93 | | ### SEC. 2. |
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| 82 | 94 | | |
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| 83 | 95 | | 10126.61. (a) A health insurance policy issued, amended, or renewed on or after July 1, 2025, shall establish a process to reimburse for services provided by a community paramedicine program, triage to alternate destination program, or mobile integrated health program.(b) (1) A health insurance policy issued, amended, or renewed on or after July 1, 2025, shall require an insured who receives covered services from a noncontracting community paramedicine program, triage to alternate destination program, or mobile integrated health program to pay no more than the same cost-sharing amount that the insured would pay for the same covered services received from a contracting community paramedicine program, triage to alternate destination program, or mobile integrated health program.(2) Notwithstanding any other law, reimbursement rates adopted pursuant to this subdivision shall not exceed the health insurers usual and customary charges for services rendered.(c) For purposes of this section, the following definitions apply:(1) Community paramedicine program means a program defined in Section 1815 of the Health and Safety Code.(2) Mobile integrated health program means a team of licensed health care practitioners, operating within their scope of practice, who provide mobile health services to support the emergency medical services system.(3) Triage to alternate destination program means a program defined in Section 1819 of the Health and Safety Code. |
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| 84 | 96 | | |
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| 85 | 97 | | 10126.61. (a) A health insurance policy issued, amended, or renewed on or after July 1, 2025, shall establish a process to reimburse for services provided by a community paramedicine program, triage to alternate destination program, or mobile integrated health program.(b) (1) A health insurance policy issued, amended, or renewed on or after July 1, 2025, shall require an insured who receives covered services from a noncontracting community paramedicine program, triage to alternate destination program, or mobile integrated health program to pay no more than the same cost-sharing amount that the insured would pay for the same covered services received from a contracting community paramedicine program, triage to alternate destination program, or mobile integrated health program.(2) Notwithstanding any other law, reimbursement rates adopted pursuant to this subdivision shall not exceed the health insurers usual and customary charges for services rendered.(c) For purposes of this section, the following definitions apply:(1) Community paramedicine program means a program defined in Section 1815 of the Health and Safety Code.(2) Mobile integrated health program means a team of licensed health care practitioners, operating within their scope of practice, who provide mobile health services to support the emergency medical services system.(3) Triage to alternate destination program means a program defined in Section 1819 of the Health and Safety Code. |
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| 86 | 98 | | |
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| 87 | 99 | | 10126.61. (a) A health insurance policy issued, amended, or renewed on or after July 1, 2025, shall establish a process to reimburse for services provided by a community paramedicine program, triage to alternate destination program, or mobile integrated health program.(b) (1) A health insurance policy issued, amended, or renewed on or after July 1, 2025, shall require an insured who receives covered services from a noncontracting community paramedicine program, triage to alternate destination program, or mobile integrated health program to pay no more than the same cost-sharing amount that the insured would pay for the same covered services received from a contracting community paramedicine program, triage to alternate destination program, or mobile integrated health program.(2) Notwithstanding any other law, reimbursement rates adopted pursuant to this subdivision shall not exceed the health insurers usual and customary charges for services rendered.(c) For purposes of this section, the following definitions apply:(1) Community paramedicine program means a program defined in Section 1815 of the Health and Safety Code.(2) Mobile integrated health program means a team of licensed health care practitioners, operating within their scope of practice, who provide mobile health services to support the emergency medical services system.(3) Triage to alternate destination program means a program defined in Section 1819 of the Health and Safety Code. |
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| 88 | 100 | | |
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| 89 | 101 | | |
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| 90 | 102 | | |
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| 91 | 103 | | 10126.61. (a) A health insurance policy issued, amended, or renewed on or after July 1, 2025, shall establish a process to reimburse for services provided by a community paramedicine program, triage to alternate destination program, or mobile integrated health program. |
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| 92 | 104 | | |
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| 93 | 105 | | (b) (1) A health insurance policy issued, amended, or renewed on or after July 1, 2025, shall require an insured who receives covered services from a noncontracting community paramedicine program, triage to alternate destination program, or mobile integrated health program to pay no more than the same cost-sharing amount that the insured would pay for the same covered services received from a contracting community paramedicine program, triage to alternate destination program, or mobile integrated health program. |
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| 94 | 106 | | |
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| 95 | 107 | | (2) Notwithstanding any other law, reimbursement rates adopted pursuant to this subdivision shall not exceed the health insurers usual and customary charges for services rendered. |
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| 96 | 108 | | |
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| 97 | 109 | | (c) For purposes of this section, the following definitions apply: |
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| 98 | 110 | | |
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| 99 | 111 | | (1) Community paramedicine program means a program defined in Section 1815 of the Health and Safety Code. |
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| 100 | 112 | | |
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| 101 | 113 | | (2) Mobile integrated health program means a team of licensed health care practitioners, operating within their scope of practice, who provide mobile health services to support the emergency medical services system. |
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| 102 | 114 | | |
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| 103 | 115 | | (3) Triage to alternate destination program means a program defined in Section 1819 of the Health and Safety Code. |
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| 104 | 116 | | |
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| 105 | 117 | | SEC. 3. Section 14132.13 is added to the Welfare and Institutions Code, to read:14132.13. (a) Services provided by a community paramedicine program, triage to alternate destination program, or mobile integrated health program are covered benefits under the Medi-Cal program.(b) The department shall develop rates of reimbursement for services provided by a community paramedicine program, triage to alternate destination program, or mobile integrated health program in consultation with community paramedicine programs, triage to alternate destination programs, and mobile integrated health programs.(c) This section shall be implemented only to the extent that the department obtains any necessary federal waivers or other federal approvals and that federal financial participation is available and not otherwise jeopardized.(d) Implementation of this section shall be subject to an appropriation made by the Legislature for the purpose of this section.(e) For purposes of this section, the following definitions apply:(1) Community paramedicine program means a program defined in Section 1815 of the Health and Safety Code.(2) Mobile integrated health program means a team of licensed health care practitioners, operating within their scope of practice, who provide mobile health services to support the emergency medical services system.(3) Triage to alternate destination program means a program defined in Section 1819 of the Health and Safety Code. |
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| 106 | 118 | | |
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| 107 | 119 | | SEC. 3. Section 14132.13 is added to the Welfare and Institutions Code, to read: |
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| 108 | 120 | | |
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| 109 | 121 | | ### SEC. 3. |
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| 110 | 122 | | |
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| 111 | 123 | | 14132.13. (a) Services provided by a community paramedicine program, triage to alternate destination program, or mobile integrated health program are covered benefits under the Medi-Cal program.(b) The department shall develop rates of reimbursement for services provided by a community paramedicine program, triage to alternate destination program, or mobile integrated health program in consultation with community paramedicine programs, triage to alternate destination programs, and mobile integrated health programs.(c) This section shall be implemented only to the extent that the department obtains any necessary federal waivers or other federal approvals and that federal financial participation is available and not otherwise jeopardized.(d) Implementation of this section shall be subject to an appropriation made by the Legislature for the purpose of this section.(e) For purposes of this section, the following definitions apply:(1) Community paramedicine program means a program defined in Section 1815 of the Health and Safety Code.(2) Mobile integrated health program means a team of licensed health care practitioners, operating within their scope of practice, who provide mobile health services to support the emergency medical services system.(3) Triage to alternate destination program means a program defined in Section 1819 of the Health and Safety Code. |
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| 112 | 124 | | |
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| 113 | 125 | | 14132.13. (a) Services provided by a community paramedicine program, triage to alternate destination program, or mobile integrated health program are covered benefits under the Medi-Cal program.(b) The department shall develop rates of reimbursement for services provided by a community paramedicine program, triage to alternate destination program, or mobile integrated health program in consultation with community paramedicine programs, triage to alternate destination programs, and mobile integrated health programs.(c) This section shall be implemented only to the extent that the department obtains any necessary federal waivers or other federal approvals and that federal financial participation is available and not otherwise jeopardized.(d) Implementation of this section shall be subject to an appropriation made by the Legislature for the purpose of this section.(e) For purposes of this section, the following definitions apply:(1) Community paramedicine program means a program defined in Section 1815 of the Health and Safety Code.(2) Mobile integrated health program means a team of licensed health care practitioners, operating within their scope of practice, who provide mobile health services to support the emergency medical services system.(3) Triage to alternate destination program means a program defined in Section 1819 of the Health and Safety Code. |
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| 114 | 126 | | |
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| 115 | 127 | | 14132.13. (a) Services provided by a community paramedicine program, triage to alternate destination program, or mobile integrated health program are covered benefits under the Medi-Cal program.(b) The department shall develop rates of reimbursement for services provided by a community paramedicine program, triage to alternate destination program, or mobile integrated health program in consultation with community paramedicine programs, triage to alternate destination programs, and mobile integrated health programs.(c) This section shall be implemented only to the extent that the department obtains any necessary federal waivers or other federal approvals and that federal financial participation is available and not otherwise jeopardized.(d) Implementation of this section shall be subject to an appropriation made by the Legislature for the purpose of this section.(e) For purposes of this section, the following definitions apply:(1) Community paramedicine program means a program defined in Section 1815 of the Health and Safety Code.(2) Mobile integrated health program means a team of licensed health care practitioners, operating within their scope of practice, who provide mobile health services to support the emergency medical services system.(3) Triage to alternate destination program means a program defined in Section 1819 of the Health and Safety Code. |
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| 116 | 128 | | |
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| 117 | 129 | | |
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| 118 | 130 | | |
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| 119 | 131 | | 14132.13. (a) Services provided by a community paramedicine program, triage to alternate destination program, or mobile integrated health program are covered benefits under the Medi-Cal program. |
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| 120 | 132 | | |
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| 121 | 133 | | (b) The department shall develop rates of reimbursement for services provided by a community paramedicine program, triage to alternate destination program, or mobile integrated health program in consultation with community paramedicine programs, triage to alternate destination programs, and mobile integrated health programs. |
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| 122 | 134 | | |
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| 123 | 135 | | (c) This section shall be implemented only to the extent that the department obtains any necessary federal waivers or other federal approvals and that federal financial participation is available and not otherwise jeopardized. |
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| 124 | 136 | | |
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| 125 | 137 | | (d) Implementation of this section shall be subject to an appropriation made by the Legislature for the purpose of this section. |
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| 126 | 138 | | |
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| 127 | 139 | | (e) For purposes of this section, the following definitions apply: |
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| 128 | 140 | | |
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| 129 | 141 | | (1) Community paramedicine program means a program defined in Section 1815 of the Health and Safety Code. |
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| 130 | 142 | | |
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| 131 | 143 | | (2) Mobile integrated health program means a team of licensed health care practitioners, operating within their scope of practice, who provide mobile health services to support the emergency medical services system. |
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| 132 | 144 | | |
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| 133 | 145 | | (3) Triage to alternate destination program means a program defined in Section 1819 of the Health and Safety Code. |
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| 134 | 146 | | |
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| 135 | 147 | | 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. |
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| 136 | 148 | | |
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| 137 | 149 | | 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. |
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| 138 | 150 | | |
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| 139 | 151 | | 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. |
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| 140 | 152 | | |
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| 141 | 153 | | ### SEC. 4. |
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