Health and Human Services

I. Federal Health Care

The number one issue in health care, this year, occurred on the federal level with passage by the House of Representatives of H.R. 3962 (Dingell) which would enact the Affordable Health Care for America Act. At the time of this writing, the United States Senate is considering S. 1796 (Baucus)-- America 's Healthy Future Act of 2009. H.R. 3962 contains the following provisions:

Affordable Health Care for America Act - Requires the Secretary of Health and Human Services (HHS) to establish (1) a temporary national high-risk pool program to provide health benefits to certain uninsured individuals who have a medical condition; and (2) a temporary reinsurance program to assist participating employment-based plans with the cost of providing health benefits to retirees and their beneficiaries. Amends the Public Health Service Act, the Employee Retirement Income Security Act of 1974 (ERISA), and the Internal Revenue Code to set forth provisions governing health insurance plans and issuers, including to (1) provide for rebates to enrollees based on a plan’s medical loss ratio; (2) prohibit rescission of health insurance coverage without clear and convincing evidence of fraud; (3) require the option of extending coverage for children under 27 years of age; (4) limit preexisting condition exclusions; and (5) prohibit aggregate dollar lifetime limits on benefits. Extends COBRA coverage (health insurance continuation benefits) until an individual becomes eligible for health insurance coverage through the Health Insurance Exchange under this Act. Provides for grandfathered health insurance coverage. Establishes standards for qualified health benefits plans, including standards to (1) prohibit any preexisting condition exclusions; (2) require guaranteed availability and renewability of health insurance coverage; (3) limit premium variances, except for reasons of age, area, or family enrollment; (4) prohibit discrimination based on health status factors; and (5) require parity for mental health benefits. Requires qualified health benefits plans to provide coverage that meets the standards for the essential benefits package. Prohibits an essential benefits package from imposing any annual or lifetime limits on coverage. Lists required covered services, including hospitalization, prescription drugs, mental health services, maternity care, and children’s oral health, vision, and hearing services. Prohibits cost-sharing for preventive items and services. Limits annual cost-sharing to $5,000 for an individual and $10,000 for a family. Prohibits abortion services from being required under an essential benefits package or under a qualified health benefits plan. Establishes the Health Choices Administration as an independent agency to be headed by a Health Choices Commissioner. Establishes the Health Insurance Exchange within the Administration to facilitate access of individuals and employers to a variety of choices of affordable, quality health insurance coverage, including a public health insurance option. Requires the Commissioner to (1) contract with entities to offer health benefit plans through the Exchange to eligible individuals; (2) coordinate the distribution of affordability premium and cost-sharing credits; and (3) establish a risk-pooling mechanism for Exchange-participating health plans. Authorizes state-based Health Insurance Exchanges to operate in a state or group of states instead of the Health Insurance Exchange, with approval of the Commissioner. Requires the Commissioner to establish a Consumer Operated and Oriented Plan program (CO-OP program) under which the Commissioner may make grants and loans for the establishment and initial operation of not-for-profit, member-run, health insurance cooperatives that provide insurance through the Health Insurance Exchange or a state-based Health Insurance Exchange. Requires the HHS Secretary to offer an Exchange-participating health benefits plan. Sets forth provisions regarding the operation of the Public Health Insurance Option. Provides for an affordability premium credit and an affordability cost-sharing credit for low-income individuals participating in the Exchange. Requires employers to offer health benefits coverage to employees and make specified contributions towards such coverage or make contributions to the Exchange for employees obtaining coverage through the Exchange. Exempts businesses with payrolls below $500,000 from such requirement. Amends the Internal Revenue Code to (1) impose a surtax on the income of individuals who do not obtain health care coverage and on employers (other than small business employers) who fail to satisfy health coverage participation requirements; (2) allow a new tax credit for small business employers who provide health care coverage to their employees; (3) increase the penalty for distributions from health savings accounts not used for qualified medical expenses; (4) modify rules and contribution limits for certain employee benefit plans; (5) allow an exclusion from gross income for the value of certain medical care provided to members of Indian tribes; (6) impose a 5.4% surtax on individuals whose adjusted gross income exceeds $500,000 ($1 million for married couples filing joint returns); (7) impose a 2.5% excise tax on medical devices; (8) delay until 2020 tax rules applicable to the foreign tax credit for the worldwide allocation of interest; (9) set forth rules for the application of the economic substance doctrine and impose penalties for underpayments of tax due to transactions lacking economic substance; and (10) extend the tax exemption for employer-provided health care benefits to certain eligible beneficiaries of the taxpayer. Amends title XVIII (Medicare) of the Social Security Act (SSA) to revise provisions relating to payment, coverage, and access, including to (1) permit physician assistants to order post-hospital extended care services, and to provide for recognition of attending physician assistants as attending physicians to serve hospice patients; (2) provide adjustment to Medicare payment localities for physician services; (3) modify the Medicare payment systems to address geographic inequities; (4) limit cost-sharing for individual health services under the Medicare Advantage program; and (5) eliminate the coverage gap under Medicare.

S. 1796 contains the following provisions:

America's Healthy Future Act of 2009 (1) amends the Social Security Act (SSA) to add a new title XXII (Health Insurance Coverage) to ensure that all Americans have access to affordable and essential health benefits coverage; (2) requires all health benefits plans offered to individuals and employers in the individual and small group market to be qualified health benefits plans (QHBPs); (3) prohibits QHBPs from excluding coverage for preexisting conditions, or otherwise limiting or conditioning coverage based on any health status-related factors; (4) requires QHBPs to offer coverage in the individual and small group markets on a guaranteed issue and guaranteed renewal basis; (5) requires states to (a) establish rating areas, (b) adopt a specified risk adjustment model, and (c) establish transitional reinsurance programs for individual markets; (6) requires QHBP offerors in the individual and small group markets to consider all enrollees in a plan to be members of a single risk pool; (7) requires the Secretary of Health and Human Services (HHS) to establish (a) risk corridors for certain plan years, (b) high risk pools for individuals with preexisting conditions, (c) a temporary reinsurance program for retirees covered by employer-based plans, and (d) a program under which a state establishes one or more QHBPs to provide at least an essential benefits package to eligible individuals in lieu of offering coverage through an exchange; (8) entitles a qualified individual to the choice to enroll or not to enroll in a QHBP offered through an exchange covering the individual's state as well as QHBPs in the individual market. Requires such individuals to be United States citizens or lawful residents; (9) requires each state to establish (a) an exchange designed to facilitate enrollment in QHBPs in the individual market, and (b) a Small Business Health Options Program (SHOP) exchange designed to assist qualified small employers in facilitating the enrollment of their employees in QHBPs in either the individual or the small group market; (10) directs the Secretary to (a) establish a system allowing state residents to participate in state health subsidy programs, and (b) study methods exchange QHBPs can employ to encourage health care providers to make increased meaningful use of electronic health records; (11) prescribes the contents of an essential benefits package, including little or no cost-sharing, no annual or lifetime limits on coverage, and preventive services; (12) declares that nothing in this Act requires health care benefits plans to provide coverage for abortions. Requires the plan offeror to determine whether or not the plan provides coverage of abortion services for which federal funding (a) is prohibited or (b) is allowed. Requires the Secretary to assure that (a) at least one QHBP covers abortion services for which federal funding is prohibited or allowed, and (b) at least one QHBP that does not cover abortion services for which federal funding is allowed. Prohibits the use of premium credits and cost-sharing subsidies for QHBPs covering abortion services for which federal funding is prohibited; (13) prohibits QHBPs from discriminating against any individual health care provider or health care facility because of its willingness or unwillingness to provide, pay for, provide coverage of, or refer for abortions; (14) continues application of state and federal laws regarding abortion; (15) amends the Internal Revenue Code to (a) allow tax credits related to the purchase of health insurance through the state exchanges, and (b) impose an excise tax on individuals without essential health benefits coverage and on employers who fail to meet health insurance coverage requirements with respect to their full-time employees; (16) requires the President to (a) certify annually in the President's Budget whether or not the provisions in this Act will increase the budget deficit in the coming fiscal year, and (b) instruct the HHS Secretary and the Secretary of the Treasury to make required reductions in exchange credits and subsidies; (17) establishes a new mandatory eligibility category under SSA title XIX (Medicaid) for all non-elderly, nonpregnant individuals who are otherwise ineligible for Medicaid; (18) revises Medicaid benefits; (19) rescinds funds available in the Medicaid Improvement Fund for fiscal year 2014-2018; (20) makes appropriations for Aging and Disability Resource Center initiatives; (21) increases the federal medical assistance percentage for states to offer home and community-based services as a long-term care alternative to nursing homes; (22) creates a Community First Choice Option; (23) adds a new optional categorically needy eligibility group to Medicaid for individuals (a) with income that exceeds 133% of the poverty line, and (b) certain other individuals, but only for benefits limited to family planning services and supplies; (24) directs the Secretary to establish a grants program to support school-based health centers; (25) removes smoking cessation drugs, barbiturates, and benzodiazepines from Medicaid's excluded drug list; (26) revises requirements for Medicaid disproportionate share hospital payments; (27) directs the Secretary to establish a Federal Coordinated Health Care Office within the Centers for Medicare & Medicaid Services; (28) directs the Secretary to establish a Medicaid Quality Measurement Program; (29) revises requirements for the Medicaid and CHIP Payment and Access Commission. (CHIP refers to SSA title XXI [Children's Health Insurance Program]); (30) sets forth special rules relating to American Indians and Alaska Indians; (31) requires the Secretary to establish procedures for sharing data collected under a federal health care program on race, ethnicity, sex, primary language, type of disability, and related measures and data analyses; (32) amends SSA title V with respect to the Maternal and Child Health block grant program; (33) provides funding for abstinence education; and (34) amends the Internal Revenue Code to codify and revise the Health Insurance Portability and Accountability Act of 1996 (HIPAA) wellness program regulations.

II. Federal Stimulus Funds

One of the major health developments for California was the receipt of federal stimulus monies. Title V of the American Recovery and Reinvestment Act of 2009 (ARRA) increases the federal share of Medicaid (Medi-Cal in California ), the Federal Medical Assistance Percentage (FMAP) for 27 months (October 1, 2008 through December 2010). The FMAP increases apply only if a state conforms to certain specified requirements as contained in the ARRA. One of the key federal requirements is that states may not have eligibility standards, methodologies or procedures in place that are more restrictive than those in effect as of July 1, 2008. Any state that implemented more restrictive policies since July 1, 2008, has until July 1, 2009, to rescind them. The state would then be fully eligible for the enhanced match, retroactive to October 1, 2008. However, any state that implements more restrictive policies as of July 1, 2008, and rescinds such policies after July 1, 2009, will only be eligible for the enhanced FMAP beginning with the first calendar quarter that it restored the eligibility policies. Therefore, any state in this situation would sacrifice their enhanced FMAP dollars for all of the preceding period, i.e., from October 1, 2008 until the policy was changed as referenced. According to the DHCS, California is to receive an increase in FMAP of 11.59% from the ARRA which would provide for a 61.59% FMAP for the Medi-Cal Program from October 1, 2008 through December 2010. Specifically, this enhanced FMAP would provide California with $10.112 billion in additional federal funds for the 27-month period, assuming the federal requirements are indeed met. (The $10.112 billion in additional federal funds is the most recent estimate available at this time.) SB 24XXX (Alquist), on March 27th, was enacted making the changes to Medi-Cal eligibility reporting for children to enable California to receive its full share of enhanced FMAP funds for the Medi-Cal program, and allow the state to continue to provide health care services for children.

Another health benefit which was a result of the federal stimulus law was ensuring workers laid off from small businesses the ability to receive federal aid for health insurance. AB 23 (Jones), which was enacted, provided the assurance. ARRA provides premium assistance for health benefits under COBRA, and state mini-COBRA laws such as Cal-COBRA, for individuals and their dependents that were involuntarily terminated between September 1, 2008 and December 31, 2009. Instead of paying the entire Cal-COBRA/COBRA premium amount, eligible individuals would pay 35% of premium, and the remaining 65% would be reimbursable to the employer or health plan as a credit against certain payroll taxes. The premium assistance applies to periods of health coverage beginning on or after February 17, 2009, and lasts for up to nine months. Individuals involuntarily terminated from September 1, 2008 through February 16, 2009, who did not elect COBRA when it was first offered, or who did elect COBRA but who are no longer enrolled (for example, because they were unable to continue paying the premium), have a new opportunity to elect COBRA coverage under ARRA. This special election period begins on February 17, 2009, and ends 60 days after the required notice to the individual. However, the federal Department of Labor has advised that this special election opportunity does not apply to coverage sponsored by employers with less than 20 employees subject to state law (such as California ’s Cal-COBRA law). AB 23 implements an additional special election for Cal-COBRA similar to the election period for federal COBRA. Federal law also permits qualified beneficiaries eligible for premium assistance to switch Cal-COBRA health plans, under certain conditions. In order for the qualified beneficiary to switch COBRA coverage, the employer must permit switching coverage, the premium for the other coverage must be less, the other coverage must be offered to active employees of the employer, and the different coverage cannot be limited coverage (such as coverage that provides only dental, vision, or counseling). AB 23 authorizes this option for Cal-COBRA beneficiaries under the same terms as the federal law. According to a survey done on behalf of the California HealthCare Foundation, 18.6% of employers with three to 19 employees offer a choice of different plans (e.g., a health maintenance organization (HMO) and a preferred provider organization (PPO) product, and 24.2% of firms offer a choice of carrier. Lastly, California has approximately 8,000 public water systems. The Department of Public Health (DPH) Safe Drinking Water Program provides loans and grants to these systems for infrastructure--mainly construction of water treatment plants and systems, as well as water distribution. DPH has a “Project Priority Listing” that is used to determine the order in which projects are funded. DPH has already submitted a placeholder application to the federal government. The federal stimulus requires California to issue 50% of the funds via grants (“principal forgiveness”). State law limits “grant” funding (versus “loan” funding) to public systems that serve disadvantaged communities where median income is less than 80% of statewide median income. State law does not allow for a forgiveness of loans nor does it provide for a negative interest rate for other water systems. Presently, the “grant” amount in state law is $1 million. SB 27XXX (Negrete McLeod), Chapter 25, Statutes of 2009-10, Third Extraordinary Session, was enacted expanding the authorized uses for clean drinking water funding from the federal government pursuant to ARRA.

III. Healthy Families Program

Due to the 2009-10 budget crisis, the Healthy Families Program was cut $194 million in General Funds. The program provides comprehensive health care coverage for children who are ineligible for free Medi-Cal and whose family income is equal to or less than 250% of the federal poverty level. It is administered by the Managed Risk Medical Insurance Board (MRMIB). There are approximately 950,000 children enrolled in the program and MRMIB estimated that the budget cuts would necessitate a freeze in enrollment and the disenrollment of approximately 650,000 enrollees, beginning on October 1, 2009. To help save the program, a solution was reached between the stakeholders, the legislative leadership, and the Governor during August 2009, with the enactment of AB 1422 (Bass), Chapter 157, Statutes of 2009, which filled the shortfall through 2010.

Several stakeholders have worked closely to find a bipartisan, shared solution and these pieces are contained in AB 1422. Specifically, (1) AB 1422 extends the 2.35% gross premiums tax to Medi-Cal managed care plans until January 1, 2011. The gross premiums tax will generate approximately $157 million, which will then generate approximately $97 million in additional federal matching funds that will be given to Healthy Families, (2) this gross premiums tax will replace a 5.5% Quality Improvement Fee currently being paid by these Medi-Cal managed care plans that is set to expire in October, (3) the state First 5 Commission pledged up to $81.4 million to cover the state share of premium for children 0 to 5, (4) Healthy Families enrollees will face increased cost sharing, with premium increases ranging from $4 to $7 per child per month beginning November 1, 2009. For the lowest income families (those under 150% of federal poverty), there are no premium increases, and (5) MRMIB will increase co-pays to Healthy Families enrollees for emergency room visits, brand name drugs, and non-preventive care visits. The bill provided emergency regulatory authority to MRMIB in order to institute these changes.

The following legislation was needed to implement the fiscal provisions of AB 1422 and this came in the form of AB 1568 (Salas). AB 1568 created the Children’s Health and Human Services Special Fund in the State Treasury, into which revenues derived from the tax on Medi-Cal managed care plans, net of refunds, will be deposited. It required the monies in the Fund to be used exclusively for the purposes of the Medi-Cal program and the Healthy Families Program, as prescribed in AB 1422.

IV. Hospital Reimbursement Rates

In the last several years, hospitals have been struggling to the point that some have closed, and because of cutbacks in state funding the hospital system was on the verge of collapse.

Under existing state and federal law, California ’s Medicaid program (Medi-Cal) provides health care services to qualified low-income individuals and the costs are typically borne 50/50 by the state and federal government. Inpatient and outpatient hospital services are covered benefits under the Medi-Cal program. Federal law authorizes states to levy fees on health care providers, if the fees meet federal requirements, and many states (including California ) fund a portion of their share of Medicaid program costs through a fee on health care providers. Under these funding methods, states collect funds (through fees, taxes or other means) from providers, which are then matched to allow increased Medicaid reimbursements to be returned to those providers. California currently imposes provider fees on intermediate care facilities for the developmentally disabled, Medi-Cal managed care plans, and skilled nursing facilities, but not on hospitals.

California ’s low Medi-Cal reimbursement rates paid to hospitals has made California the lowest receiving Medicaid rate in the nation per beneficiary from the federal government. To take advantage of the 27-month increase in the FMAP (increased to 62% federal funds instead of 50%) made available through the federal income stimulus legislation a solution was crafted between the Legislature and the Governor with the enactment of AB 1383 (Jones). It imposes a quality assurance fee (QAF) on each general acute care hospital, except for those that are exempt, as a condition of participation in state-funded health insurance programs, other than the Medi-Cal program. It requires that Medi-Cal payments to hospitals under the current 1115 hospital waiver, when combined with the supplemental payments as provided by this bill, to private hospitals for inpatient and outpatient services and to non-designated public hospitals for inpatient services equal to the federal upper payment limit (UPL) for that portion of federal fiscal years 2008-2009, 2009-2010, and 2010-2011 for which CMS approves the QAF. The federal UPL is an estimate of the amount that would be paid for Medicaid services under Medicare payment principles. The gap that these supplemental payments would fill between what private and non-designated hospitals are paid under the current 1115 waiver and the federal UPL is known as federal UPL room. It provides the state with an additional $12 billion for the Medi-Cal payments to hospitals and $320 million in additional funds for health care coverage for children. In his signing of the bill message, the Governor indicated that subsequent legislation was needed to appropriate the money necessary for implementation of AB 1383. On October 26, the Legislature sent AB 188 (Jones) to the Governor which provided for the following funding: $13.5 billion (special fund) from the Hospital Quality Assurance Revenue Fund (established by AB 1383) to the Department of Health Care Services (DHCS) to increase Medi-Cal payments to hospitals until January 1, 2013, and $2 million (50% General Fund/50% federal funds) from the Private Hospital Supplemental Fund to DHCS to support administrative requirements of AB 1383. It requires $1 million General Fund to be repaid from the Hospital Quality Assurance Revenue Fund if federal approval for the QAF is granted.

An issue which received attention in the health and human services area was foster care and child welfare. A series of foster care-related bills made changes to state law in order to ensure that California continued to receive federal funding to maintain child welfare services. Legislation in this area included SB 118 (Liu) directing counties to include information about incarcerated parents who receive services required by the court to reunify that parent with his/her children; SB 597 (Liu) establishing the development of a plan for the ongoing oversight and coordination of health care services for foster youth and the development of a personalized transaction plan for a foster youth in the 90-day period before he/she ages out of foster care; AB 81 (Strickland) requiring that a foster child who changes residence pursuant to a court order or decision of a child welfare worker to be immediately deemed to meet all residency requirements for participation in interscholastic sports or other extracurricular activities; AB 154 (Evans) specifying that any savings in state funds attained from an increase in federal funding for adoption services be reinvested in the foster care and adoption service system; AB 167 (Adams) exempting a foster youth who transfers from a new school during the 11th or 12th grade from completing locally-imposed course requirements that exceed minimum state standards, if those local requirements would prevent the student from graduating while he/she remains eligible for foster care; AB 295 (Ammiano) extending the older youth adoption pilot project for six months until June 30, 2010, to provide participating counties with sufficient time to demonstrate the effectiveness of pre-adoption services for older youth who have been in the system over 18 months and are living in group homes or non-related foster families; AB 488 (Torres) allowing the Department of Social Services to renew or extend beyond a three-year time period specified performance agreements in the private, nonprofit agencies that provide child welfare services; AB 595 (Adams) tightening requirements for approving criminal background checks for foster care family homes licensing in an effort to prohibit persons convicted of specific offenses from becoming foster or adoptive parents; AB 665 (Torrico) broadening the use of the federal adoption incentive awards that are received by the state as a result of increased adoptions of older children to include other legal permanency options awardable to older foster youth in order to increase the opportunity for these youth to be placed in stable homes; AB 669 (Fong) exempting current or former foster youth age 19 years or under from California State University, University of California, and California Community Colleges in-state residency requirements for tuition and fees; AB 719 (Lowenthal) creating a 12-month transitional food stamp demonstration project that grants federally funded food stamps to foster youth for one year after their 18th birthday, while they age-out of the foster care system and no longer qualify for state aid; AB 770 (Torres) ensuring that the state maximizes the opportunities for Indian tribes to operate foster care programs for Indian children, pursuant to federal law; AB 938 (Assembly Judiciary Committee) requiring that when a child is removed from his/her parents and placed in foster care the child’s social worker must within 30 days, conduct an investigation to identify and locate the child’s adult relatives and notify them that the child has been removed from his/her parent’s home; AB 1325 (Cook) creating an alternative option to the definition of “traditional adoption” in the case of adopting a Native American child; in traditional adoption, termination of parental rights of the biological parent must occur for a Native American child to be adopted; and AB 1393 (Skinner) requiring the University of California, California State University, and the California Community Colleges to give priority for on-campus housing to emancipated foster youth.

Other health and human services legislation of note that was enacted into law included SB 112 (Oropeza) revising the training requirements for certified hemodialysis technicians; SB 117 (Corbett) extending the deadline by which the Department of Health Services is required to establish a new Medi-Cal rate reimbursement methodology for adult day health care services to August 1, 2012; SB 132 (Denham) establishing educational and registration requirements for certified polysomnographic technologies, technicians, and trainers; SB 148 (Oropeza) requiring facilities that operate mammogram machines to post notices of serious violations in areas that are visible to the patients; SB 221 (Walters) repealing the law allowing the licensure and regulation of home dialysis agencies; SB 249 (Cox) requiring the Department of Public Health to include children who are 11 to 18 years of age in any meningococcal disease public awareness campaign it implements by April 1, 2010; SB 273 (Corbett) ensuring men are eligible for domestic violence services by establishing gender neutrality in the domestic violence service statutes; SB 296 (Lowenthal) requiring health plans and insurers that provide mental health services to issue patient identification cards by July 1, 2011, and increasing the specificity of availability of information provided on their Web sites; SB 337 (Alquist) addressing the authority and governance related to health information technology funding available to California in the American Recovery and Reinvestment Act of 2009; SB 470 (Corbett) permitting, if requested by a patient, the purpose of the prescribed medication be listed on a prescription drug label; SB 471 (Romero) creating the California Stem Cell and Biotechnology Education and Workforce Development Act of 2009 to establish stem cell and biotechnology education and workforce development as a state priority; SB 499 (Ducheny) revising and extending hospital seismic safety construction and reporting requirements under specified requirements; SB 620 (Wiggins) requiring a licensed osteopathic doctor to report the Osteopathic Medical Board of California at the time of license renewal, any specialty board certification and their practice status; SB 630 (Steinberg) clarifying that medically necessary dental and orthodontic services must be covered for the purpose of reconstructive surgery that is performed for cleft palate procedures; SB 702 (DeSaulnier) expanding the list of persons who are entrusted with the supervision of children who must obtain a Trustline clearance to a business which provides temporary day care services for children whose parents are shopping at their businesses; SB 743 (Senate Health Committee) clarifying that the immunity from civil and criminal liability granted to general acute care hospitals and licensed acute psychiatric hospitals and personnel applies whether the detained person qualified for a 72-hour hold or not; SB 762 (Aanestad) prohibiting cities and counties from restricting any person from performing a procedure that falls within the scope of practice of a person licensed by the Department of Consumer Affairs; SB 788 (Wyland) establishing the Licensed Professional Clinical Counselors Act providing for the licensing and regulations of licensed professional clinical counselors; SB 6XXX (Ducheny) providing the necessary statutory changes to amend and make appropriations for the Department of Developmental Services and the Department of Social Services which are contained in the 2009-10 Budget Act; SB 10XXX (Ducheny) providing the necessary initiative changes to Proposition 63, the Mental Health Services Act, subject to the approval of the voters in order to make appropriations for the Department of Mental Health in the Budget Act of 2009 (voters rejected it at the May 19, 2009 special election); SB 13XXX (Alquist) requiring the Department of Finance to transfer $16.3 million from the Alternative and Renewable Fuel and Vehicle Technology Fund to the General Fund as a loan in order to appropriate funds for domestic violence shelters; AB 108 (Hayashi) prohibiting health care service plans and health insurers from rescinding contracts or insurance policies for any reason after 24 months following their issuance; AB 119 (Jones) eliminating the exception in current law that allows health plans and health insurers to use gender as a basis for premium, price, or charge differentials, when used on valid statistical and actuarial data starting January 1, 2011; AB 171 (Jones) establishing requirements governing the arrangement of debit cards and loans for dental services, as specified; AB 215 (Feuer) requiring skilled nursing facilities to post the overall facility rating information determined by the federal Centers for Medicare and Medicaid Services; AB 221 (Portantino) permitting HIV counselors to perform basic skin punctures for the purpose of administering rapid HIV tests; AB 235 (Hayashi) expanding the definition of “emergency services and care” to include additional screening, examination, and evaluation by medical professionals to determine if a psychiatric emergency medical condition exists; AB 287 (Beall) requiring the State Council on Developmental Disabilities to form a standing Employment First Committee; AB 303 (Beall) allowing designated public hospitals, specified county and University of California disproportionate share hospitals that contract with the California Medical Assistance Commission to serve Med-Cal patients to access federal supplement reimbursement for debt service related to seismic retrofitting; AB 359 (Nava) permitting a provider for the Every Woman Counts breast cancer screening program to use digital mammography starting January 1, 2010, and to be reimbursed by the program; AB 392 (Feuer) appropriating $1.6 million from the Federal Health Facilities Citation Penalties Account to the Department of Aging for local ombudsman programs; AB 398 (Monning) transferring the administrative duties and oversight of the California traumatic brain injury program from the Department of Mental Health to the Department of Rehabilitation, and extending the sunset date on the program to January 1, 2019; AB 407 (Beall) imposing requirements on continuing care retirement communities in the event of their permanent closure; AB 501 (Emmerson) permitting the Medical Board of California to issue a limited license to an applicant for a physician and surgeon’s license, and setting the terms of the use for the titles “Dr.” and “M.D.”; AB 665 (Torrico) expanding the use of Improving Adoption Incentive bonus dollars; AB 667 (Block) allowing a dental assistant to apply topical fluoride when operating in a school-based setting or a public health program, as specified; AB 681 (Hernandez) allowing a health care provider to disclose information about a patient’s participation in outpatient psychotherapy without requiring a written signed request from the entity requesting the information; AB 773 (Lieu) requiring long-term care facilities to post class “AA” and “A” citations for 120 days; AB 818 (Hernandez) delaying, until January 1, 2011, the implementation of a prohibition against hospitals using intravenous epidural, and enteral feeding connection devices that fit into connection ports other than the type they are intended; AB 839 (Emmerson) changing Medi-Cal provider remedies, including specifying the judicial remedy when there is a dispute over processing or payment of money; AB 896 (Galgiani) ensuring that hospitals receive adequate reimbursement for providing high cost care to seriously ill children in the California Children’s Services Program; AB 952 (Krekorian) permitting a health care provider, health services plan, or contractor to disclose medical information to an employee welfare benefit plan formed under the Taft-Hartley Act if the disclosure meets specified conditions; AB 995 (Block) exempting from tissue bank licensing requirements a licensed physician or podiatrist storing a human cell, tissue, or cellular- or tissue-based medical device or biologic product, as specified; AB 1003 (John A. Perez) allowing the number of grants awarded in the Equality in Prevention and Services for Domestic Abuse Program to be increased beyond the four grant annual limit currently permitted; AB 1020 (Emmerson) conforming state law to the federal Graeme Baker Pool and Spa Safety Act relating to public pool safety; AB 1071 (Emmerson) increasing the minimum and maximum fees that the California Board of Pharmacy may charge, and extending the sunset date to January 1, 2013, for the Medical Board of California, Board of Podiatric Medicine, Board of Registered Nursing, Board of Optometrists, Naturopathic Doctors Act, and Respiratory Care Board; AB 1113 (Lowenthal) allowing a person to gain qualifying experience for licensure as a massage and family therapist in a state correctional facility; AB 1116 (Carter) enacting the Donda West Law prohibiting elective cosmetic surgery on a patient unless prior to the surgery, the patient has received an appropriate physical examination and confirmed as up-to-date on the day of the procedure; AB 1142 (Price) placing responsibility of providing all information regarding a patient’s Medi-Cal eligibility to all hospital-based providers on the hospital treating the patient; AB 1169 (Ruskin) specifying disclosures required of continuing care retirement community providers in annual financial reports; AB 1269 (Brownley) extending eligibility for the Medi-Cal California Working Disabled Program to improve continuity of care; AB 1317 (Block) requiring a specified warning in all advertisements for human egg donations associated with the delivery of fertility treatment and requirement donors to fertility treatment centers be provided with medically accurate information regarding potential risks; AB 1438 (Conway) expanding the authority of the Department of Public Health to provide funding for safe drinking projects through grants, primarily for projects in disadvantaged communities; AB 1457 (Davis) requiring current and incoming residents of skilled nursing facilities to be informed of the name of the facility’s owner, licensee, and a single entity responsible for patient care and operation of the facility; AB 1535 (Jones) permitting audiologists to sell hearing aids, and specifying certain business practices related to the sale of hearing aids; AB 1541 (Assembly Health Committee) extending, from 30 days to 60 days, the time period an individual or dependent, who has lost or will lose coverage under the Healthy Families Program, Access for Infants and Mothers, or Medi-Cal, has to request enrollment in group coverage without being considered a late enrollee; AB 1543 (Jones) conforming changes to the requirements and standards that apply to Medicare supplement contracts and policies (Medigap policies) to comply with recent federal law affecting the benefits, the issuance, and the pricing of Medigap policies; AB 1544 (Jones) permitting a hospital in good standing to apply to the Department of Public Health to offer an outpatient service as a supplemental service without a prior onsite survey by the department; AB 1571 (Assembly Veterans Affairs Committee) requiring the Department of Mental Health to inform the Department of Veterans Affairs of services intended specifically for veterans in county mental health plans; AB 5XXX (Evans) enacting the 2009-10 Budget trailer bill in the areas of mental health, developmental disabilities, and health care services; AB 17XXX (Evans) making changes in the California Children and Families Act to make appropriations for the Department of Social Services and the Department of Developmental services in the 2009-10 Budget Act (which the voters rejected at the May 1, 2009 special election); AB 4XXXX (Evans) enacting the human services trailer bill for the 2009-10 Budget Act; AB 5XXXX (Evans) enacting the health care, public health, and mental health trailer bill for the 2009-10 Budget Act; AB 6XXXX (Evans) enacting the Medi-Cal trailer bill to the 2009 Budget Act; AB 7XXXX (Evans) providing for the Department of Health Care Services and the Department of Social Services to develop a statewide eligibility and enrollment determination process for the CalWORKs program, Medi-Cal Program, and the Supplemental Nutrition Assistance Program; AB 8XXXX (Evans) enacting the human services 2009-10 Budget trailer bill relating to CalWORKs and the Supplemental Security Income/State Supplementary Payment programs; AB 9XXXX (Evans) enacting the 2009-10 Budget trailer bill relating to developmental services; and AB 19XXXX (Evans) enacting the In-Home Supportive Services 2009-10 Budget trailer bill.

Vetoed health-related legislation included SB 158 (Wiggins) which would have required health care service plans and health insurance policies that provide coverage for cervical cancer treatment or surgery to also provide coverage for a human papillomavirus vaccine starting January 1, 2010; SB 161 (Wright) which would have required a health care service plan or health insurance policy that provides coverage for anticancer treatment to provide coverage for a prescribed orally administered anticancer medication no less favorable than intravenously administered or injected medications; SB 173 (Florez) which would have authorized the Department of Public Health to adopt regulations for the voluntary recall of food suspected of carrying an illness, infection, pathogen, contagion, toxin, or condition that, without intervention could kill or seriously affect the health of humans; SB 196 (Corbett) which would have changed the notice requirements for hospital closures; SB 212 (Florez) which would have allowed each school district with a high school to provide for the annual cleaning and sterilizing of wrestling equipment; SB 257 (Pavley) which would have provided state employees with more information concerning breastfeeding at work; SB 303 (Alquist) which would have enacted the Nursing Facility Resident Informed Consent Protection Act of 2009; SB 400 (Corbett) which would have updated the Stop Tobacco Access to Kids Enforcement Act to define electronic cigarettes under state law and to halt the sale of them; SB 674 (Negrete McLeod) which would have (1) specified healing arts licenses to include professional designations behind their names in advertisements, (2) required the Medical Board of California to adopt regulations regarding the appropriate level of physician availability needed within clinics or other settings using laser or intense pulse light devices for elective cosmetic procedures, (3) permitted the Board to adopt standards that it deems necessary for outpatient settings that offer in vitro fertilization, and (4) revised accreditation requirements and procedures; SB 820 (Negrete McLeod) which would have enhanced the disciplinary reporting and peer review process relating to various medical boards; AB 2 (De La Torre) which would have established requirements on health care service plans and health insurers related to individual health insurance application forms, medical undercuts, and notices and disclosures of rights and responsibilities, and would have prohibited an insurer from rescinding a contract or policy, as specified; AB 56 (Portantino) which would have required health insurers to provide coverage for mammography upon providers referred by July 1, 2010; AB 57 (Price) which would have required the Department of Public Health to establish a procedure for collecting and reviewing written staffing plans developed by the University of California hospitals; AB 98 (De La Torre) which would have required every individual or group health insurance policy to cover maternity services, as specified; AB 120 (Hayashi) which would have enhanced the medical peer review process; AB 217 (Beall) which would have established an alcohol and drug screening and brief intervention services program within the Medi-Cal program for the purpose of making available alcohol and drug screening and brief intervention services for Medi-Cal beneficiaries who are pregnant women or women of childbearing age; AB 244 (Beall) which would have required health plans and insurers to cover the diagnosis and medically necessary treatment of a mental illness of a person of any age under the same terms and conditions applied to other medical conditions; AB 245 (Ma) which would have required the Medical Board of California to remove an expunged misdemeanor or felony conviction within 90 days of receiving a copy of the expungement order; AB 249 (Carter) which would have increased the specificity of written patient personal property inventories for residents of long-term care facilities; AB 252 (Carter) which would have allowed the revocation of a physician’s and surgeon’s license to a person who provides elective cosmetic medical procedures or treatments in violation of the prohibition against the corporate practice of medicine; AB 324 (Beall) which would have required the Department of Aging to update the Elder Economic Security Standard Index and area agencies to use the Elder Index in their service planning; AB 369 (Yamada) which would have exempted the Ventura Veterans Home and the Lancaster Veterans Home from the moratorium prohibiting the enrollment of adult day health care centers into the Medi-Cal program; AB 503 (Furutani) which would have extended the sunset date for the Domestic Violence Advisory Council which advises the Domestic Violence Program within the Department of Public Health until January 1, 2015; AB 513 (de Leon) which would have required health plans and those health insurers that provide maternity benefits to provide coverage for lactation consultation with an international board certified lactation consultant; AB 517 (Ma) which would have established the Safe Body Art Act to provide statewide standards for persons engaged in tattooing, body piercing, and the application of permanent cosmetics; AB 543 (Ma) which would have allowed the use of Nurse-Family Partnership Program grant monies as a match for other grants administered by the Department of Public Health; AB 574 (Hill) which would have prohibited smoking in all areas of acute care hospitals, including the general hospital campus, buildings, parking areas, plazas, and sidewalks; AB 627 (Brownley) which would have required that child day care facilities meet specified health and nutritional requirements, as specified; AB 657 (Hernandez) which would have required the Office of Statewide Health Planning and Development to establish the Health Professions Workforce Task Force; AB 730 (De La Torre) which would have increased the maximum civil penalty for health insurance post-claims underwriting from $118 per violation to $5,000 per violation; AB 861 (Ruskin) which would have required the Department of Public Health to develop consolidated contracts with local health jurisdictions administering specified public health programs; AB 911 (Lieu) which would have required every licensed general acute care hospital within an emergency department to assess emergency department crowding conditions every four to eight hours, as well as develop and implement full-capacity protocols that address staffing, procedures, and operations; AB 1049 (Torrico) which would have allowed a Safely Surrendered Baby Fund income tax checkoff; AB 1132 (Jones) which would have required the Department of Motor Vehicles to make information available about organ donation as part of the online vehicle registration renewal process; AB 1397 (Hill) which would have amended guidelines that must adhered to between a physician who is providing insemination, and other advanced reproduction technology services, and a female patient; AB 1462 (Feuer) which would have required the California Medical Assistance Commission to include reimbursement for the costs of graduate medical education when negotiating contracts for inpatient care or developing specifications for competitive bidding; AB 1512 (Lieu) which would have prohibited retailers from selling, or permitting to be sold, infant formula, baby food, and drugs beyond the expiration date indicated on the product’s packaging; and AB 1577 (Coto) which would have required the Office of Problem Gambling within the Department of Alcohol and Drug Programs to include specific education and awareness outreach efforts within its existing prevention programs.