BILL NUMBER: SB 946	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  SEPTEMBER 6, 2011
	AMENDED IN ASSEMBLY  SEPTEMBER 2, 2011
	AMENDED IN SENATE  MAY 10, 2011

INTRODUCED BY    Committee on Health   (
  Senators Hernandez (Chair), Alquist, Anderson,
Blakeslee, De León, DeSaulnier, Rubio, Strickland, and Wolk 
 )   Senators   Steinberg  
and Evans 
    (   Principal coauthor:   Senator 
 Alquist  ) 
    (   Principal coauthor:   Assembly Member
  Beall   ) 
    (   Coauthors:   Senators  
Corbett,   DeSaulnier,   Leno,   Lieu,
  Liu,   Padilla,   Pavley,   and
Wolk   ) 
    (   Coauthors:   Assembly Members 
 Ammiano,   Butler,   Dickinson,  
Eng,   Fong,   Mitchell,   Portantino,
  Williams,   and Yamada  ) 

                        MARCH 31, 2011

    An act to amend Sections 2028.5, 2290.5, and 3041 of the
Business and Professions Code, to amend Section 78910.10 of the
Education Code, to amend Sections 1367, 1375.1, 1797.98b, 113953.3,
113973, 121022, 123149.5, 127620, 130302, and 130307 of, to add
Sections 113807 and 113975 to, and to repeal Sections 130304 and
130309 of, the Health and Safety Code, to amend Section 10123.13,
10123.147, 10181.11, 10198.7, 10953, and 10959 of the Insurance Code,
and to amend Sections 5705, 5708, 5710, 5716, 5724, 5750.1, and
14132.73 of the Welfare and Institutions Code, relating to public
health.   An act to amend Section 121022 of, to add
Section 1374.74 t   o, and to add and repeal Section 1374.73
of, the Health and Safety Code, to add and repeal Sections 10144.51
and 10144.52 of the Insurance Code, and to amend Sections 5705, 5708,
5710, 5716, 5724, and 5750.1 of the Welfare and Institutions Code,
relating to health. 



	LEGISLATIVE COUNSEL'S DIGEST


   SB 946, as amended,  Committee on Health  
Steinberg  .  Public health.  Health care
coverage: mental illness: pervasive developmental disorder or autism:
public health.  
   Existing law provides for the licensure and regulation of health
care service plans by the Department of Managed Health Care. A
willful violation of these provisions is a crime. Existing law
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 benefits for specified
conditions, including certain mental health conditions.  
   This bill, effective July 1, 2012, would require those health care
service plan contracts and health insurance policies, except as
specified, to provide coverage for behavioral health treatment, as
defined, for pervasive developmental disorder or autism. The bill
would provide, however, that no benefits are required to be provided
that exceed the essential health benefits that will be required under
specified federal law. Because a violation of these provisions with
respect to health care service plans would be a crime, the bill would
impose a state-mandated local program.  
   These provisions would be inoperative July 1, 2014, and repealed
on January 1, 2015.  
   The bill would require the Department of Managed Health Care, in
conjunction with the Department of Insurance, to convene an Autism
Advisory Task Force by February 1, 2012, to provide assistance to the
department on topics related to behavioral health treatment and to
develop recommendations relating to the education, training, and
experience requirements to secure licensure from the state. The bill
would require the department to submit a report of the Task Force to
the Governor and specified members of the Legislature by December 31,
2012.  
   (1) Existing law defines "telemedicine" for purposes of various
provisions of existing law relating to the practice of medicine,
among other things.  
   This bill would replace the term with "telehealth." 

   (2) Existing law authorizes a county to establish an emergency
medical services fund for reimbursement of emergency medical services
(EMS)-related costs, and requires an annual report to the
Legislature on the implementation and status of the fund, including
the fund balance and the amount of moneys disbursed to physicians and
surgeons, for hospitals, and for other emergency medical services
purposes.  
   This bill would require the report to provide additional
information regarding the moneys collected and disbursed, including,
but not limited to, a description of the other emergency medical
services purposes, and the total amount of allowable claims
submitted, if the moneys are disbursed to hospitals on a claims
basis, and the names and contact information of the entity
responsible for the collection and disbursement of prescribed funds.
By increasing the duties of local officials, this bill would impose a
state-mandated local program.  
   (3) Existing law, the California Retail Food Code, establishes
uniform health and sanitation standards for retail food facilities,
as defined. The law requires the State Department of Public Health to
adopt regulations to implement and administer those provisions, and
delegates primary enforcement duties to local health agencies. A
violation of any of these provisions is punishable as a misdemeanor.
 
   The code requires food employees to report to the person in charge
of a food facility when a food employee has a lesion or wound that
is open or draining unless specified conditions to cover or protect
the lesion are met. The code requires all employees to wash their
hands in specified instances, including before donning gloves for
working with food. The code also requires gloves to be worn when
contacting food and food-contact surfaces under specified conditions,
including when the employee has any cuts, sores, or rashes. Gloves
are required to be changed, replaced, or washed as often as hand
washing is required.  
   This bill would require hands to be washed before initially
donning gloves and before donning gloves after specified instances
where gloves were required to be changed or replaced. The bill would
prohibit single-use gloves from being washed. The bill would also
prohibit an employee who has a lesion or wound that is open or
draining from handling food and would require a food employee who has
any cuts, sores, rashes, lesions, or wounds to cover or protect the
lesion, as specified.  
   This bill would define "hotdog" for purposes of the code.
 
    By changing the definition of a crime and increasing the duties
of local enforcement officials, this bill would impose a
state-mandated local program.  
   (4) Existing 
    Existing  law establishes various communicable disease
prevention and control programs. Existing law requires the State
Department of Public Health to establish a list of reportable
diseases and conditions and requires health care providers and
laboratories to report cases of HIV infection to the local health
officer using patient names and sets guidelines regarding these
reports. Existing law requires the local health officers to report
unduplicated HIV cases by name to the department.
   This bill would authorize the department to revise the HIV
reporting form without the adoption of a regulation, as specified.

   (5) Existing law, the Health Insurance Portability and
Accountability Implementation Act of 2001, provides, until January 1,
2013, for an office in the California Health and Human Services
Agency to assume statewide leadership and perform related activities
for the implementation of the federal Health Insurance Portability
and Accountability Act (HIPAA). Under existing law, the director of
the office is required to establish an advisory committee to obtain
information on statewide activities to implement HIPAA that is
required to meet, at a minimum, twice each year. Existing law
required that, during 2002, state entities subject to HIPAA assess
its impact on their operations and that the office report that
information to the Legislature.  
   This bill would transfer responsibility for the statewide
implementation of HIPAA to the Office of Health Information Integrity
in the California Health and Human Services Agency. The bill would
delete the requirement of 2 annual meetings for the advisory
committee, providing for meetings as required for coordination
purposes. The bill would also delete the assessment and reporting
requirements for state entities and the office, which were required
to be completed in 2002.  
   (6) Existing law, the federal Patient Protection and Affordable
Care Act, prohibits a health insurance issuer offering group or
individual health insurance coverage from imposing any preexisting
condition for children with respect to plan years beginning on or
after September 23, 2010, and for adults with respect to plan years
beginning on or after January 1, 2014. 
   Existing law prohibits the exclusion or limitation of health care
coverage for children due to any preexisting condition, except as
specified. Existing law requires a carrier to fairly and
affirmatively offer, market, and sell all of the carrier's health
benefit plans that are offered and sold to a child in each service
area in which the plan provides or arranges for health care coverage
during any open enrollment period, as specified. Existing law imposes
specified requirements on a carrier or solicitor when offering,
marketing, or selling those plans.  
   This bill would make necessary technical changes to these
provisions and correct erroneous cross-references. The bill would
revise provisions that reference "solicitor" to instead refer to an
agent or broker, as specified.  
   (7) Under 
    Under    the Bronzan-McCorquodale Act, the
State Department of Mental Health administers the provision of funds
to counties for community mental health services programs. Existing
law also permits counties to receive, under certain circumstances,
Medi-Cal reimbursement for mental health services. Under existing
law, negotiated net amounts or rates are used as the cost of services
in contracts between the state and the county and between the county
and a subprovider of services. Existing law establishes the method
for computing negotiated rates. Existing law prohibits the charges
for the care and treatment of each patient receiving service from a
county mental health program from exceeding the actual or negotiated
cost of the services.
   This bill would only allow the use of negotiated net amounts as
the cost of services in a contract between the state and a county and
the county and a subprovider of services, and would eliminate the
use of negotiated rates. The bill would also specify that the charges
for the care and treatment of each patient receiving a service from
a county mental health program shall not exceed the actual cost of
the service. 
   (8) Existing 
    Existing  law establishes the Medi-Cal program,
administered by the State Department of Health Care Services, under
which basic health care services are provided to qualified low-income
persons. The Medi-Cal program is, in part, governed and funded by
federal Medicaid provisions. Under existing law, the State Department
of Health Care Services promulgates regulations for determining
reimbursement of Short-Doyle mental health services allowable under
the Medi-Cal program. Existing law requires the State Department of
Mental Health and the State Department of Health Care Services to
jointly develop a ratesetting methodology for use in the Short-Doyle
Medi-Cal system that maximizes federal funding and utilizes, as much
as practicable, federal Medicare reimbursement principles. Existing
law requires that this ratesetting methodology contain incentives
relating to economy and efficiency.
   The bill would delete the requirement that the ratesetting
methodology in the Short-Doyle Medi-Cal system include incentives
relating to economy and efficiency. 
   (9) 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.  
   With regard to any other mandates, this bill would provide that,
if the Commission on State Mandates determines that the bill contains
costs so mandated by the state, reimbursement for those costs shall
be made pursuant to the statutory provisions noted above. 

   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. 
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

   SECTION 1.    Section 1374.73 is added to the 
 Health and Safety Code   , to read:  
   1374.73.  (a) (1) Every health care service plan contract issued,
amended, or renewed on or after July 1, 2012, that provides hospital,
medical, or surgical coverage shall provide coverage for behavioral
health treatment for pervasive developmental disorder or autism. The
coverage shall be provided in the same manner and shall be subject to
the same requirements as provided in Section 1374.72.
   (2) Notwithstanding paragraph (1), as of the date that proposed
final rulemaking for essential health benefits is issued, this
section does not require any benefits to be provided that exceed the
essential health benefits that all health plans will be required by
federal regulations to provide under Section 1302(b) of the federal
Patient Protection and Affordable Care Act (Public Law 111-148), as
amended by the federal Health Care and Education Reconciliation Act
of 2010 (Public Law 111-152).
   (3) This section shall not affect services for which an individual
is eligible pursuant to Division 4.5 (commencing with Section 4500)
of the Welfare and Institutions Code or Title 14 (commencing with
Section 95000) of the Government Code.
   (4) This section shall not affect or reduce any obligation to
provide services under an individualized education program, as
defined in Section 56032 of the Education Code, or an individualized
service plan, as described in Section 5600.4 of the Welfare and
Institutions Code, or under the Individuals with Disabilities
Education Act (20 U.S.C. Sec. 1400, et seq.) and its implementing
regulations.
   (b) Every health care service plan subject to this section shall
maintain an adequate network that includes qualified autism service
providers who supervise and employ qualified autism service
professionals or paraprofessionals who provide and administer
behavioral health treatment. Nothing shall prevent a health care
service plan from selectively contracting with providers within these
requirements.
   (c) For the purposes of this section, the following definitions
shall apply:
   (1) "Behavioral health treatment" means professional services and
treatment programs, including applied behavior analysis and other
behavior intervention programs, that develop or restore, to the
maximum extent practicable, the functioning of an individual with
pervasive developmental disorder or autism and that meet all of the
following criteria:
   (A) The treatment is prescribed by a physician and surgeon
licensed pursuant to Chapter 5 (commencing with Section 2000) of, or
a psychologist licensed pursuant to Chapter 6.6 (commencing with
Section 2900) of, Division 2 of the Business and Professions Code.
   (B) The treatment is provided under a treatment plan prescribed by
a qualified autism service provider and is administered by one of
the following:
   (i) A qualified autism service provider.
   (ii) A qualified autism service professional supervised and
employed by the qualified autism service provider.
   (iii) A qualified autism service paraprofessional supervised and
employed by a qualified autism service provider.
   (C) The treatment plan has measurable goals over a specific
timeline that is developed and approved by the qualified autism
service provider for the specific patient being treated. The
treatment plan shall be reviewed no less than once every six months
by the qualified autism service provider and modified whenever
appropriate, and shall be consistent with Section 4686.2 of the
Welfare and Institutions Code pursuant to which the qualified autism
service provider does all of the following:
   (i) Describes the patient's behavioral health impairments to be
treated.
   (ii) Designs an intervention plan that includes the service type,
number of hours, and parent participation needed to achieve the plan'
s goal and objectives, and the frequency at which the patient's
progress is evaluated and reported.
   (iii) Provides intervention plans that reflect evidence-based
practices, with demonstrated clinical efficacy in treating pervasive
developmental disorder or autism.
   (iv) Discontinues intensive behavioral intervention services when
the treatment goals and objectives are achieved or no longer
appropriate.
   (D) The treatment plan is not prescribed for purposes of providing
respite, day care, or school services and is not used to reimburse a
parent for participating in the treatment program. The treatment
plan shall be made available to the health care service plan upon
request.
   (2) "Pervasive developmental disorder or autism" shall have the
same meaning and interpretation as used in Section 1374.72.
   (3) "Qualified autism service provider" means either of the
following:
   (A) A person, entity, or group that is certified by a national
entity, such as the Behavior Analyst Certification Board, that is
accredited by the National Commission for Certifying Agencies, and
who designs, supervises, or provides treatment for pervasive
developmental disorder or autism, provided the services are within
the experience and competence of the person, entity, or group that is
nationally certified.
   (B) A person licensed as a physician and surgeon, physical
therapist, occupational therapist, psychologist, marriage and family
therapist, educational psychologist, clinical social worker,
professional clinical counselor, speech-language pathologist, or
audiologist pursuant to Division 2 (commencing with Section 500) of
the Business and Professions Code, who designs, supervises, or
provides treatment for pervasive developmental disorder or autism,
provided the services are within the experience and competence of the
licensee.
   (4) "Qualified autism service professional" means an individual
who meets all of the following criteria:
   (A) Provides behavioral health treatment.
   (B) Is employed and supervised by a qualified autism service
provider.
   (C) Provides treatment pursuant to a treatment plan developed and
approved by the qualified autism service provider.
   (D) Is a behavioral service provider approved as a vendor by a
California regional center to provide services as an Associate
Behavior Analyst, Behavior Analyst, Behavior Management Assistant,
Behavior Management Consultant, or Behavior Management Program as
defined in Section 54342 of Title 17 of the California Code of
Regulations.
   (E) Has training and experience in providing services for
pervasive developmental disorder or autism pursuant to Division 4.5
(commencing with Section 4500) of the Welfare and Institutions Code
or Title 14 (commencing with Section 95000) of the Government Code.
   (5) "Qualified autism service paraprofessional" means an
unlicensed and uncertified individual who meets all of the following
criteria:
   (A) Is employed and supervised by a qualified autism service
provider.
   (B) Provides treatment and implements services pursuant to a
treatment plan developed and approved by the qualified autism service
provider.
   (C) Meets the criteria set forth in the regulations adopted
pursuant to Section 4686.3 of the Welfare and Institutions Code.
   (D) Has adequate education, training, and experience, as certified
by a qualified autism service provider.
   (d) This section shall not apply to the following:
   (1) A specialized health care service plan that does not deliver
mental health or behavioral health services to enrollees.
   (2) A health care service plan contract in the Medi-Cal program
(Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of
the Welfare and Institutions Code).
   (3) A health care service plan contract in the Healthy Families
Program (Part 6.2 (commencing with Section 12693) of Division 2 of
the Insurance Code).
   (4) A health care benefit plan or contract entered into with the
Board of Administration of the Public Employees' Retirement System
pursuant to the Public Employees' Medical and Hospital Care Act (Part
5 (commencing with Section 22750) of Division 5 of Title 2 of the
Government Code).
   (e) Nothing in this section shall be construed to limit the
obligation to provide services under Section 1374.72.
   (f) Notwithstanding any other provision of law, in the provision
of benefits required by this section, a health care service plan may
utilize case management, network providers, utilization review
techniques, prior authorization, copayments, or other cost sharing.
   (g) This section shall become inoperative on July 1, 2014, and, as
of January 1, 2015, is repealed, unless a later enacted statute,
that becomes operative on or before January 1, 2015, deletes or
extends the dates on which it becomes inoperative and is repealed.

   SEC. 2.    Section 1374.74 is added to the  
Health and Safety Code   , to read:  
   1374.74.  (a) The department, in consultation with the Department
of Insurance, shall convene an Autism Advisory Task Force by February
1, 2012, in collaboration with other agencies, departments,
advocates, autism experts, health plan and health insurer
representatives, and other entities and stakeholders that it deems
appropriate. The Autism Advisory Task Force shall develop
recommendations regarding behavioral health treatment that is
medically necessary for the treatment of individuals with autism or
pervasive developmental disorder. The Autism Advisory Task Force
shall address at the following:
   (1) Interventions that have been scientifically validated and have
demonstrated clinical efficacy.
   (2) Interventions that have measurable treatment outcomes.
   (3) Patient selection, monitoring, and duration of therapy.
   (4) Qualifications, training, and supervision of providers.
   (5) Adequate networks of providers.
   (b) The Autism Advisory Task Force shall also develop
recommendations regarding the education, training, and experience
requirements that unlicensed individuals providing autism services
shall meet in order to secure a license from the state.
   (c) The department shall submit a report of the Autism Advisory
Task Force to the Governor, the President pro Tem of the Senate, the
Speaker of the Assembly, and the Senate and Assembly Committees on
Health by December 31, 2012, on which date the task force shall cease
to exist.  
  SECTION 1.    Section 2028.5 of the Business and
Professions Code is amended to read:
   2028.5.  (a) The board may establish a pilot program to expand the
practice of telemedicine, as defined in Section 2290.5, as it read
on January 1, 2011, in this state.
   (b) To implement this pilot program, the board may convene a
working group of interested parties from the public and private
sectors, including, but not limited to, state health-related
agencies, health care providers, health plan administrators,
information technology groups, and groups representing health care
consumers.
   (c) The purpose of the pilot program shall be to develop methods,
using a telemedicine model, to deliver throughout the state health
care to persons with chronic diseases as well as information on the
best practices for chronic disease management services and techniques
and other health care information as deemed appropriate.
   (d) The board shall make a report with its recommendations
regarding its findings to the Legislature within one calendar year of
the commencement date of the pilot program. The report shall include
an evaluation of the improvement and affordability of health care
services and the reduction in the number of complications achieved by
the pilot program.  
  SEC. 2.    Section 2290.5 of the Business and
Professions Code is amended to read:
   2290.5.  (a) (1) For the purposes of this section, "telehealth"
means the practice of health care delivery, diagnosis, consultation,
treatment, transfer of medical data, and education using interactive
audio, video, or data communications. Neither a telephone
conversation nor an electronic mail message between a health care
practitioner and patient constitutes "telehealth" for purposes of
this section.
   (2) For purposes of this section, "interactive" means an audio,
video, or data communication involving a real time (synchronous) or
near real time (asynchronous) two-way transfer of medical data and
information.
   (b) For the purposes of this section, "health care practitioner"
has the same meaning as "licentiate" as defined in paragraph (2) of
subdivision (a) of Section 805 and also includes a person licensed as
an optometrist pursuant to Chapter 7 (commencing with Section 3000).

   (c) Prior to the delivery of health care via telehealth, the
health care practitioner who has ultimate authority over the care or
primary diagnosis of the patient shall obtain verbal and written
informed consent from the patient or the patient's legal
representative. The informed consent procedure shall ensure that at
least all of the following information is given to the patient or the
patient's legal representative verbally and in writing:
   (1) The patient or the patient's legal representative retains the
option to withhold or withdraw consent at any time without affecting
the right to future care or treatment nor risking the loss or
withdrawal of any program benefits to which the patient or the
patient's legal representative would otherwise be entitled.
   (2) A description of the potential risks, consequences, and
benefits of telehealth.
   (3) All existing confidentiality protections apply.
   (4) All existing laws regarding patient access to medical
information and copies of medical records apply.
   (5) Dissemination of any patient identifiable images or
information from the telehealth interaction to researchers or other
entities shall not occur without the consent of the patient.
   (d) A patient or the patient's legal representative shall sign a
written statement prior to the delivery of health care via
telehealth, indicating that the patient or the patient's legal
representative understands the written information provided pursuant
to subdivision (a), and that this information has been discussed with
the health care practitioner, or his or her designee.
   (e) The written consent statement signed by the patient or the
patient's legal representative shall become part of the patient's
medical record.
   (f) The failure of a health care practitioner to comply with this
section shall constitute unprofessional conduct. Section 2314 shall
not apply to this section.
   (g) All existing laws regarding surrogate decisionmaking shall
apply. For purposes of this section, "surrogate decisionmaking" means
any decision made in the practice of medicine by a parent or legal
representative for a minor or an incapacitated or incompetent
individual.
   (h) Except as provided in paragraph (3) of subdivision (c), this
section shall not apply when the patient is not directly involved in
the telehealth interaction, for example when one health care
practitioner consults with another health care practitioner.
   (i) This section shall not apply in an emergency situation in
which a patient is unable to give informed consent and the
representative of that patient is not available in a timely manner.
   (j) This section shall not apply to a patient under the
jurisdiction of the Department of Corrections or any other
correctional facility.
   (k) This section shall not be construed to alter the scope of
practice of any health care provider or authorize the delivery of
health care services in a setting, or in a manner, not otherwise
authorized by law.  
  SEC. 3.    Section 3041 of the Business and
Professions Code is amended to read:
   3041.  (a) The practice of optometry includes the prevention and
diagnosis of disorders and dysfunctions of the visual system, and the
treatment and management of certain disorders and dysfunctions of
the visual system, as well as the provision of rehabilitative
optometric services, and is the doing of any or all of the following:

   (1) The examination of the human eye or eyes, or its or their
appendages, and the analysis of the human vision system, either
subjectively or objectively.
   (2) The determination of the powers or range of human vision and
the accommodative and refractive states of the human eye or eyes,
including the scope of its or their functions and general condition.
   (3) The prescribing or directing the use of, or using, any optical
device in connection with ocular exercises, visual training, vision
training, or orthoptics.
   (4) The prescribing of contact and spectacle lenses for, or the
fitting or adaptation of contact and spectacle lenses to, the human
eye, including lenses that may be classified as drugs or devices by
any law of the United States or of this state.
   (5) The use of topical pharmaceutical agents for the purpose of
the examination of the human eye or eyes for any disease or
pathological condition.
   (b) (1) An optometrist who is certified to use therapeutic
pharmaceutical agents, pursuant to Section 3041.3, may also diagnose
and treat the human eye or eyes, or any of its or their appendages,
for all of the following conditions:
   (A) Through medical treatment, infections of the anterior segment
and adnexa, excluding the lacrimal gland, the lacrimal drainage
system, and the sclera in patients under 12 years of age.
   (B) Ocular allergies of the anterior segment and adnexa.
   (C) Ocular inflammation, nonsurgical in cause except when
comanaged with the treating physician and surgeon, limited to
inflammation resulting from traumatic iritis, peripheral corneal
inflammatory keratitis, episcleritis, and unilateral nonrecurrent
nongranulomatous idiopathic iritis in patients over 18 years of age.
Unilateral nongranulomatous idiopathic iritis recurring within one
year of the initial occurrence shall be referred to an
ophthalmologist. An optometrist shall consult with an ophthalmologist
or appropriate physician and surgeon if a patient has a recurrent
case of episcleritis within one year of the initial occurrence. An
optometrist shall consult with an ophthalmologist or appropriate
physician and surgeon if a patient has a recurrent case of peripheral
corneal inflammatory keratitis within one year of the initial
occurrence.
   (D) Traumatic or recurrent conjunctival or corneal abrasions and
erosions.
   (E) Corneal surface disease and dry eyes.
   (F) Ocular pain, nonsurgical in cause except when comanaged with
the treating physician and surgeon, associated with conditions
optometrists are authorized to treat.
   (G) Pursuant to subdivision (f), glaucoma in patients over 18
years of age, as described in subdivision (j).
   (2) For purposes of this section, "treat" means the use of
therapeutic pharmaceutical agents, as described in subdivision (c),
and the procedures described in subdivision (e).
   (c) In diagnosing and treating the conditions listed in
subdivision (b), an optometrist certified to use therapeutic
pharmaceutical agents pursuant to Section 3041.3 may use all of the
following therapeutic pharmaceutical agents:
   (1) Pharmaceutical agents as described in paragraph (5) of
subdivision (a), as well as topical miotics.
   (2) Topical lubricants.
   (3) Antiallergy agents. In using topical steroid medication for
the treatment of ocular allergies, an optometrist shall consult with
an ophthalmologist if the patient's condition worsens 21 days after
diagnosis.
   (4) Topical and oral antiinflammatories. In using steroid
medication for:
   (A) Unilateral nonrecurrent nongranulomatous idiopathic iritis or
episcleritis, an optometrist shall consult with an ophthalmologist or
appropriate physician and surgeon if the patient's condition worsens
72 hours after the diagnosis, or if the patient's condition has not
resolved three weeks after diagnosis. If the patient is still
receiving medication for these conditions six weeks after diagnosis,
the optometrist shall refer the patient to an ophthalmologist or
appropriate physician and surgeon.
   (B) Peripheral corneal inflammatory keratitis, excluding Moorens
and Terriens diseases, an optometrist shall consult with an
ophthalmologist or appropriate physician and surgeon if the patient's
condition worsens 72 hours after diagnosis.
   (C) Traumatic iritis, an optometrist shall consult with an
ophthalmologist or appropriate physician and surgeon if the patient's
condition worsens 72 hours after diagnosis and shall refer the
patient to an ophthalmologist or appropriate physician and surgeon if
the patient's condition has not resolved one week after diagnosis.
   (5) Topical antibiotic agents.
   (6) Topical hyperosmotics.
   (7) Topical and oral antiglaucoma agents pursuant to the
certification process defined in subdivision (f).
   (A) The optometrist shall refer the patient to an ophthalmologist
if requested by the patient or if angle closure glaucoma develops.
   (B) If the glaucoma patient also has diabetes, the optometrist
shall consult with the physician treating the patient's diabetes in
developing the glaucoma treatment plan and shall inform the physician
in writing of any changes in the patient's glaucoma medication.
   (8) Nonprescription medications used for the rational treatment of
an ocular disorder.
   (9) Oral antihistamines.
   (10) Prescription oral nonsteroidal antiinflammatory agents.
   (11) Oral antibiotics for medical treatment of ocular disease.
   (A) If the patient has been diagnosed with a central corneal ulcer
and the central corneal ulcer has not improved 48 hours after
diagnosis, the optometrist shall refer the patient to an
ophthalmologist.
   (B) If the patient has been diagnosed with preseptal cellulitis or
dacryocystitis and the condition has not improved 48 hours after
diagnosis, the optometrist shall refer the patient to an
ophthalmologist.
   (12) Topical and oral antiviral medication for the medical
treatment of the following: herpes simplex viral keratitis, herpes
simplex viral conjunctivitis, and periocular herpes simplex viral
dermatitis; and varicella zoster viral keratitis, varicella zoster
viral conjunctivitis, and periocular varicella zoster viral
dermatitis.
   (A) If the patient has been diagnosed with herpes simplex
keratitis or varicella zoster viral keratitis and the patient's
condition has not improved seven days after diagnosis, the
optometrist shall refer the patient to an ophthalmologist. If a
patient's condition has not resolved three weeks after diagnosis, the
optometrist shall refer the patient to an ophthalmologist.
   (B) If the patient has been diagnosed with herpes simplex viral
conjunctivitis, herpes simplex viral dermatitis, varicella zoster
viral conjunctivitis, or varicella zoster viral dermatitis, and if
the patient's condition worsens seven days after diagnosis, the
optometrist shall consult with an ophthalmologist. If the patient's
condition has not resolved three weeks after diagnosis, the
optometrist shall refer the patient to an ophthalmologist.
   (13) Oral analgesics that are not controlled substances.
   (14) Codeine with compounds and hydrocodone with compounds as
listed in the California Uniform Controlled Substances Act (Division
10 (commencing with Section 11000) of the Health and Safety Code) and
the United States Uniform Controlled Substances Act (21 U.S.C. Sec.
801 et seq.). The use of these agents shall be limited to three days,
with a referral to an ophthalmologist if the pain persists.
             (d) In any case where this chapter requires that an
optometrist consult with an ophthalmologist, the optometrist shall
maintain a written record in the patient's file of the information
provided to the ophthalmologist, the ophthalmologist's response, and
any other relevant information. Upon the consulting ophthalmologist's
request and with the patient's consent, the optometrist shall
furnish a copy of the record to the ophthalmologist.
   (e) An optometrist who is certified to use therapeutic
pharmaceutical agents pursuant to Section 3041.3 may also perform all
of the following:
   (1) Corneal scraping with cultures.
   (2) Debridement of corneal epithelia.
   (3) Mechanical epilation.
   (4) Venipuncture for testing patients suspected of having
diabetes.
   (5) Suture removal, with prior consultation with the treating
physician and surgeon.
   (6) Treatment or removal of sebaceous cysts by expression.
   (7) Administration of oral fluorescein to patients suspected as
having diabetic retinopathy.
   (8) Use of an auto-injector to counter anaphylaxis.
   (9) Ordering of smears, cultures, sensitivities, complete blood
count, mycobacterial culture, acid fast stain, urinalysis, and X-rays
necessary for the diagnosis of conditions or diseases of the eye or
adnexa. An optometrist may order other types of images subject to
prior consultation with an ophthalmologist or appropriate physician
and surgeon.
   (10) Punctal occlusion by plugs, excluding laser, diathermy,
cryotherapy, or other means constituting surgery as defined in this
chapter.
   (11) The prescription of therapeutic contact lenses, including
lenses or devices that incorporate a medication or therapy the
optometrist is certified to prescribe or provide.
   (12) Removal of foreign bodies from the cornea, eyelid, and
conjunctiva with any appropriate instrument other than a scalpel or
needle. Corneal foreign bodies shall be nonperforating, be no deeper
than the midstroma, and require no surgical repair upon removal.
   (13) For patients over 12 years of age, lacrimal irrigation and
dilation, excluding probing of the nasal lacrimal tract. The board
shall certify any optometrist who graduated from an accredited school
of optometry before May 1, 2000, to perform this procedure after
submitting proof of satisfactory completion of 10 procedures under
the supervision of an ophthalmologist as confirmed by the
ophthalmologist. Any optometrist who graduated from an accredited
school of optometry on or after May 1, 2000, shall be exempt from the
certification requirement contained in this paragraph.
   (f) The board shall grant a certificate to an optometrist
certified pursuant to Section 3041.3 for the treatment of glaucoma,
as described in subdivision (j), in patients over 18 years of age
after the optometrist meets the following applicable requirements:
   (1) For licensees who graduated from an accredited school of
optometry on or after May 1, 2008, submission of proof of graduation
from that institution.
   (2) For licensees who were certified to treat glaucoma under this
section prior to January 1, 2009, submission of proof of completion
of that certification program.
   (3) For licensees who have substantially completed the
certification requirements pursuant to this section in effect between
January 1, 2001, and December 31, 2008, submission of proof of
completion of those requirements on or before December 31, 2009.
"Substantially completed" means both of the following:
   (A) Satisfactory completion of a didactic course of not less than
24 hours in the diagnosis, pharmacological, and other treatment and
management of glaucoma.
   (B) Treatment of 50 glaucoma patients with a collaborating
ophthalmologist for a period of two years for each patient that will
conclude on or before December 31, 2009.
   (4) For licensees who completed a didactic course of not less than
24 hours in the diagnosis, pharmacological, and other treatment and
management of glaucoma, submission of proof of satisfactory
completion of the case management requirements for certification
established by the board pursuant to Section 3041.10.
   (5) For licensees who graduated from an accredited school of
optometry on or before May 1, 2008, and not described in paragraph
(2), (3), or (4), submission of proof of satisfactory completion of
the requirements for certification established by the board pursuant
to Section 3041.10.
   (g) Other than for prescription ophthalmic devices described in
subdivision (b) of Section 2541, any dispensing of a therapeutic
pharmaceutical agent by an optometrist shall be without charge.
   (h) The practice of optometry does not include performing surgery.
"Surgery" means any procedure in which human tissue is cut, altered,
or otherwise infiltrated by mechanical or laser means. "Surgery"
does not include those procedures specified in subdivision (e).
Nothing in this section shall limit an optometrist's authority to
utilize diagnostic laser and ultrasound technology within his or her
scope of practice.
   (i) An optometrist licensed under this chapter is subject to
Section 2290.5 for purposes of practicing telehealth.
   (j) For purposes of this chapter, "glaucoma" means either of the
following:
   (1) All primary open-angle glaucoma.
   (2) Exfoliation and pigmentary glaucoma.
   (k) In an emergency, an optometrist shall stabilize, if possible,
and immediately refer any patient who has an acute attack of angle
closure to an ophthalmologist.  
  SEC. 4.    Section 78910.10 of the Education Code
is amended to read:
   78910.10.  (a) (1) The California Virtual Campus, pursuant to
funding provided to the Board of Governors of the California
Community Colleges for this purpose in the annual Budget Act, may
pursue all of the following purposes, to the extent funding is
available:
   (A) To enrich formal and informal educational experiences and
improve students' academic performance by supporting the development
of highly engaging, research-based innovations in teaching and
learning in K-12 public schools and the California Community
Colleges, the California State University, and the University of
California.
   (B) To enhance the awareness of, and access to, highly engaging
online courses of study, emphasizing courses of study that support a
diverse and highly skilled science, technology, engineering, and
mathematics workforce.
   (C) To support education research, the implementation of
research-based practices, and promote economic development through
the use of next generation advanced network infrastructure, services,
and network technologies that enable collaboration and resource
sharing between formal and informal educators in K-12 public schools,
the California Community Colleges, the California State University,
the University of California, independent colleges and universities,
public libraries, and community-based organizations at locations
across the state.
   (D) To increase access to next generation Internet services, 21st
century workforce development programs, and e-government services for
students and staff served or employed by education entities and
students served primarily online through partnerships with public
libraries and community-based organizations.
   (E) To enhance access to health care education and training
programs to current or future health care workers.
   (F) To manage digital assets and develop contracts for services
necessary to provide the technical and management support needed to
maximize the benefits of the high-speed, high-bandwidth network
infrastructure available to public higher education entities in
California.
   (G) Through the aggregation of demand for network enabled
technologies and related services from public education entities, and
through partnerships with the private sector, to provide education
entities with access to technical support and staff who can
facilitate statewide efforts that support innovations in teaching and
learning that are necessary to provide for a well-educated
citizenry, and economic and 21st century workforce development.
   (2) To accomplish the purposes of paragraph (1), the California
Virtual Campus may partner with local educational agencies, the State
Department of Education, the 11 regional California Technology
Assistance Projects, the California Community Colleges, the
California State University, the University of California,
independent colleges and universities, public libraries, and
community-based organizations to facilitate ongoing collaboration and
joint efforts relating to the use of technology resources and
high-speed Internet connectivity to support teaching, learning,
workforce development, and research.
   (3) Efforts conducted as a result of this chapter shall not
prohibit or otherwise exclude the ability of existing or new
educational technology programs from being developed, expanded, or
enhanced.
   (b) For purposes of this article, the following terms have the
following meanings:
   (1) "Online courses of study" means any of the following:
   (A) Online teaching, learning, and research resources, including,
but not necessarily limited to, books, course materials, video
materials, interactive lessons, tests, or software, the copyrights of
which have expired, or have been released with an intellectual
property license that permits their free use or repurposing by others
without the permission of the original authors or creators of the
learning materials or resources.
   (B) Professional development opportunities for formal and informal
educators who desire to use the resources in subparagraph (A).
   (C) Online instruction.
   (2) "Online instruction" means technology enabled online real time
(synchronous) interaction between the instructor and the student,
near time (asynchronous) interaction between the instructor and the
student, or any combination thereof.
   (c) The California Virtual Campus grant recipient may accomplish
all of the following:
   (1) Convene at least four leadership stakeholder group meetings
annually comprised of representatives from the State Department of
Education, the California Technology Assistance Project, and other
related programs administered through the department, local education
agencies, including adult education, the California Community
Colleges, the California State University, the University of
California, independent colleges and universities, the California
State Library, and representatives from community-based organizations
to ensure the efforts affecting segments represented are
appropriately meeting the needs of those segments. The leadership
stakeholder group shall also coordinate and obtain assistance with
the implementation of efforts delineated in this article, to identify
and maintain an up-to-date list of the technology resources and
tools that are necessary to support innovation in teaching and
learning, and to identify opportunities for leveraging resources and
expertise for meeting those needs in an efficient and cost-effective
manner.
   (2) Lead efforts to make online courses of study available across
the state that include, but are not limited to, the following:
   (A) Developing online courses of study that are pedagogically
sound and fully accessible, in compliance with the federal Americans
with Disabilities Act of 1990 (Public Law 101-336), by students with
varying learning styles and disabilities.
   (i) The development of K-12 online courses pursuant to this
subparagraph shall be achieved in partnership with local education
agencies and the California Technology Assistance Project.
   (ii) Online courses developed for grades K-12 pursuant to this
subparagraph shall be aligned to the California academic content
standards and guidelines for online courses.
   (B) Overseeing the development of at least 12 model online courses
of study that, collectively, would allow students to meet the
requirements of the Intersegmental General Education Transfer
Curriculum (IGETC) and at least two courses that support basic skills
education courses in English, English as a second language, or
mathematics.
   (C) Encouraging the entities listed in paragraph (1) to do both of
the following:
   (i) Make accessible to each other their courses of study that are
funded by the state.
   (ii) Allow their courses of study to be accessible to the general
public if they determine access would not inhibit their ability to
provide appropriate protection of the state's intellectual property
rights.
   (3) Ensure that the learning objects created as part of the
California Virtual Campus online courses of study with state General
Fund revenues are linked to digital content libraries that include
information about course content freely available to California
educators and students.
   (4) Develop formal partnership agreements between the entities
listed in paragraph (1) and the California Virtual Campus, including
course articulation agreements that allow qualified high school
students to accelerate the completion of requirements for a high
school diploma and a two-year or four-year degree and agreements that
provide opportunities for part-time faculty teaching online to
obtain full-time employment teaching online.
   (5) Develop formal partnership agreements with the entities listed
in paragraph (1) and others to enhance access to professional
development courses that introduce faculty, teachers, staff, and
college course developers to the conceptual development, creation,
and production methodologies that underlie the development of online
courses of study and support students' successful completion of those
courses. The professional development opportunities may include, but
not necessarily be limited to, all of the following:
   (A) Addressing issues relating to copyright, permission for the
use or reuse of material, use of resources in the public domain, and
other intellectual property concepts.
   (B) Accessibility for students with disabilities.
   (C) Factors to ensure that content is culturally relevant to a
diverse student body.
   (D) Delivery options that incorporate multiple learning styles and
strategies.
   (6) Develop formal partnership agreements with entities,
including, but not limited to, those listed in paragraph (1), to
ensure access to online professional learning communities that
incorporate the use of Internet-based collaboration tools and to
support joint discussions between K-12 educators, higher education
faculty and staff, and others to examine student performance data,
student learning objectives, curriculum, and other issues that relate
to students' academic success and preparation for the workforce.
   (7) In partnership with entities, including those listed in
paragraph (1), develop an e-portfolio system that allows
participating students to demonstrate their attainment of academic
learning objectives, skills and knowledge that relate to their career
interests, and completion of prerequisites for participation in
courses or training programs. The e-portfolio system may do all of
the following:
   (A) Ensure that student privacy is protected in accordance with
existing law.
   (B) Comply with accessibility laws for students with disabilities.

   (C) Be designed in a manner that supports the use of e-portfolio
content in the accreditation requirements of schools, colleges, and
universities.
   (8) In partnership with entities, including those listed in
paragraph (1), identify opportunities to enhance students' access to
medical education and medical services through the use of high-speed
Internet connections to the campuses, and opportunities for education
programs and services to support the telehealth efforts taking place
within the state.
   (d) The lead agency for the California Virtual Campus, in
consultation with the leadership stakeholder group described in
paragraph (1) of subdivision (c) if that group is convened by the
California Virtual Campus grant recipient, shall contract with an
independent third party with expertise in online teaching, learning,
and the development of online courses of study, as approved by the
board, to evaluate the California Virtual Campus. The evaluation
shall include, but not be limited to, an assessment of the number of
faculty, teachers, consortia, informal educators, and students that
use the online courses of study, the quality of students'
experiences, student grades earned, and the cost of the online course
content, comparing the online course content with traditional
textbooks. The board may require additional information that it
determines to be necessary to evaluate the effectiveness and
viability of the California Virtual Campus. This evaluation shall be
submitted to the Legislature no later than three years of the
enactment of this act.  
  SEC. 5.    Section 1367 of the Health and Safety
Code is amended to read:
   1367.  A health care service plan and, if applicable, a
specialized health care service plan shall meet the following
requirements:
   (a)  Facilities located in this state including, but not limited
to, clinics, hospitals, and skilled nursing facilities to be utilized
by the plan shall be licensed by the State Department of Public
Health, where licensure is required by law. Facilities not located in
this state shall conform to all licensing and other requirements of
the jurisdiction in which they are located.
   (b)  Personnel employed by or under contract to the plan shall be
licensed or certified by their respective board or agency, where
licensure or certification is required by law.
   (c)  Equipment required to be licensed or registered by law shall
be so licensed or registered, and the operating personnel for that
equipment shall be licensed or certified as required by law.
   (d)  The plan shall furnish services in a manner providing
continuity of care and ready referral of patients to other providers
at times as may be appropriate consistent with good professional
practice.
   (e)  (1)  All services shall be readily available at reasonable
times to each enrollee consistent with good professional practice. To
the extent feasible, the plan shall make all services readily
accessible to all enrollees consistent with Section 1367.03.
   (2)  To the extent that telehealth services are appropriately
provided through telehealth, as defined in subdivision (a) of Section
2290.5 of the Business and Professions Code, these services shall be
considered in determining compliance with Section 1300.67.2 of Title
28 of the California Code of Regulations.
   (3)  The plan shall make all services accessible and appropriate
consistent with Section 1367.04.
   (f)  The plan shall employ and utilize allied health manpower for
the furnishing of services to the extent permitted by law and
consistent with good medical practice.
   (g)  The plan shall have the organizational and administrative
capacity to provide services to subscribers and enrollees. The plan
shall be able to demonstrate to the department that medical decisions
are rendered by qualified medical providers, unhindered by fiscal
and administrative management.
   (h)  (1)  Contracts with subscribers and enrollees, including
group contracts, and contracts with providers, and other persons
furnishing services, equipment, or facilities to or in connection
with the plan, shall be fair, reasonable, and consistent with the
objectives of this chapter. All contracts with providers shall
contain provisions requiring a fast, fair, and cost-effective dispute
resolution mechanism under which providers may submit disputes to
the plan, and requiring the plan to inform its providers upon
contracting with the plan, or upon change to these provisions, of the
procedures for processing and resolving disputes, including the
location and telephone number where information regarding disputes
may be submitted.
   (2)  A health care service plan shall ensure that a dispute
resolution mechanism is accessible to noncontracting providers for
the purpose of resolving billing and claims disputes.
   (3)  On and after January 1, 2002, a health care service plan
shall annually submit a report to the department regarding its
dispute resolution mechanism. The report shall include information on
the number of providers who utilized the dispute resolution
mechanism and a summary of the disposition of those disputes.
   (i)  A health care service plan contract shall provide to
subscribers and enrollees all of the basic health care services
included in subdivision (b) of Section 1345, except that the director
may, for good cause, by rule or order exempt a plan contract or any
class of plan contracts from that requirement. The director shall by
rule define the scope of each basic health care service that health
care service plans are required to provide as a minimum for licensure
under this chapter. Nothing in this chapter shall prohibit a health
care service plan from charging subscribers or enrollees a copayment
or a deductible for a basic health care service or from setting
forth, by contract, limitations on maximum coverage of basic health
care services, provided that the copayments, deductibles, or
limitations are reported to, and held unobjectionable by, the
director and set forth to the subscriber or enrollee pursuant to the
disclosure provisions of Section 1363.
   (j)  A health care service plan shall not require registration
under the Controlled Substances Act of 1970 (21 U.S.C. Sec. 801 et
seq.) as a condition for participation by an optometrist certified to
use therapeutic pharmaceutical agents pursuant to Section 3041.3 of
the Business and Professions Code.
   Nothing in this section shall be construed to permit the director
to establish the rates charged subscribers and enrollees for
contractual health care services.
   The director's enforcement of Article 3.1 (commencing with Section
1357) shall not be deemed to establish the rates charged subscribers
and enrollees for contractual health care services.
   The obligation of the plan to comply with this section shall not
be waived when the plan delegates any services that it is required to
perform to its medical groups, independent practice associations, or
other contracting entities.  
  SEC. 6.    Section 1375.1 of the Health and Safety
Code is amended to read:
   1375.1.  (a) Every plan shall have and shall demonstrate to the
director that it has all of the following:
   (1) A fiscally sound operation and adequate provision against the
risk of insolvency.
   (2) Assumed full financial risk on a prospective basis for the
provision of covered health care services, except that a plan may
obtain insurance or make other arrangements for the cost of providing
to any subscriber or enrollee covered health care services, the
aggregate value of which exceeds five thousand dollars ($5,000) in
any year, for the cost of covered health care services provided to
its members other than through the plan because medical necessity
required their provision before they could be secured through the
plan, and for not more than 90 percent of the amount by which its
costs for any of its fiscal years exceed 115 percent of its income
for that fiscal year.
   (3) A procedure for prompt payment or denial of provider and
subscriber or enrollee claims, including those telehealth services,
as defined in subdivision (a) of Section 2290.5 of the Business and
Professions Code, covered by the plan. Except as provided in
                                         Section 1371, a procedure
meeting the requirements of Subchapter G of the regulations (29
C.F.R. Part 2560) under Public Law 93-406 (88 Stats. 829-1035, 29
U.S.C. Secs. 1001 et seq.) shall satisfy this requirement.
   (b) In determining whether the conditions of this section have
been met, the director shall consider, but not be limited to, the
following:
   (1) The financial soundness of the plan's arrangements for health
care services and the schedule of rates and charges used by the plan.

   (2) The adequacy of working capital.
   (3) Agreements with providers for the provision of health care
services.
   (c) For the purposes of this section, "covered health care
services" means health care services provided under all plan
contracts.  
  SEC. 7.    Section 1797.98b of the Health and
Safety Code is amended to read:
   1797.98b.  (a)  Each county establishing a fund, on January 1,
1989, and on each April 15 thereafter, shall report to the
Legislature on the implementation and status of the Emergency Medical
Services Fund. The report shall cover the preceding fiscal year, and
shall include, but not be limited to, all of the following:
   (1) The total amount of fines and forfeitures collected, the total
amount of penalty assessments collected, and the total amount of
penalty assessments deposited into the Emergency Medical Services
Fund, or, if no moneys were deposited into the fund, the reason or
reasons for the lack of deposits. The total amounts of penalty
assessments shall be listed on the basis of each statute that
provides the authority for the penalty assessment, including Sections
76000, 76000.5, and 76104 of the Government Code, and Section 42007
of the Vehicle Code.
   (2) The amount of penalty assessment funds collected under Section
76000.5 of the Government Code that are used for the purposes of
subdivision (e) of Section 1797.98a.
    (3) The fund balance and the amount of moneys disbursed under the
program to physicians and surgeons, for hospitals, and for other
emergency medical services purposes, and the amount of money
disbursed for actual administrative costs. If funds were disbursed
for other emergency medical services, the report shall provide a
description of each of those services.
    (4) The number of claims paid to physicians and surgeons, and the
percentage of claims paid, based on the uniform fee schedule, as
adopted by the county.
    (5) The amount of moneys available to be disbursed to physicians
and surgeons, descriptions of the physician and surgeon claims
payment methodologies, the dollar amount of the total allowable
claims submitted, and the percentage at which those claims were
reimbursed.
    (6) A statement of the policies, procedures, and regulatory
action taken to implement and run the program under this chapter.
    (7) The name of the physician and surgeon and hospital
administrator organization, or names of specific physicians and
surgeons and hospital administrators, contacted to review claims
payment methodologies.
   (8) A description of the process used to solicit input from
physicians and surgeons and hospitals to review payment distribution
methodology as described in subdivision (a) of Section 1797.98e.
   (9) An identification of the fee schedule used by the county
pursuant to subdivision (e) of Section 1797.98c.
   (10) (A) A description of the methodology used to disburse moneys
to hospitals pursuant to subparagraph (B) of paragraph (5) of
subdivision (b) of Section 1797.98a.
   (B) The amount of moneys available to be disbursed to hospitals.
   (C) If moneys are disbursed to hospitals on a claims basis, the
dollar amount of the total allowable claims submitted and the
percentage at which those claims were reimbursed to hospitals.
   (11) The name and contact information of the entity responsible
for each of the following:
   (A) Collection of fines, forfeitures, and penalties.
   (B) Distribution of penalty assessments into the Emergency Medical
Services Fund.
   (C) Distribution of moneys to physicians and surgeons.
   (b) (1) Each county, upon request, shall make available to any
member of the public the report required under subdivision (a).
   (2) Each county, upon request, shall make available to any member
of the public a listing of physicians and surgeons and hospitals that
have received reimbursement from the Emergency Medical Services Fund
and the amount of the reimbursement they have received. This listing
shall be compiled on a semiannual basis.  
  SEC. 8.    Section 113807 is added to the Health
and Safety Code, to read:
   113807.  "Hotdog" means a whole, cured, cooked sausage that is
skinless or stuffed in a casing, may be served in a bun or roll, and
is also known as a bologna, frank, frankfurter, furter, garlic
bologna, knockwurst, red hot, Vienna, or wiener.  
  SEC. 9.    Section 113953.3 of the Health and
Safety Code is amended to read:
   113953.3.  (a) Except as specified in subdivision (b), all
employees shall thoroughly wash their hands and that portion, if any,
of their arms exposed to direct food contact with cleanser and warm
water by vigorously rubbing together the surfaces of their lathered
hands and arms for at least 10 to 15 seconds and thoroughly rinsing
with clean running water followed by drying of cleaned hands and that
portion, if any, of their arms exposed. Employees shall pay
particular attention to the areas underneath the fingernails and
between the fingers. Employees shall wash their hands in all of the
following instances:
   (1) Immediately before engaging in food preparation, including
working with nonprepackaged food, clean equipment and utensils, and
unwrapped single-use food containers and utensils.
   (2) After touching bare human body parts other than clean hands
and clean, exposed portions of arms.
   (3) After using the toilet room.
   (4) After caring for or handling any animal allowed in a food
facility pursuant to this part.
   (5) After coughing, sneezing, using a handkerchief or disposable
tissue, using tobacco, eating, or drinking.
   (6) After handling soiled equipment or utensils.
   (7) During food preparation, as often as necessary to remove soil
and contamination and to prevent cross-contamination when changing
tasks.
   (8) When switching between working with raw food and working with
ready-to-eat food.
   (9) Before dispensing or serving food or handling clean tableware
and serving utensils in the food service area.
   (10) After engaging in other activities that contaminate the
hands.
   (11) Before initially donning gloves for working with food and
before donning gloves to replace gloves that were changed or replaced
due to the circumstances described in paragraphs (2) to (10),
inclusive.
   (b) If approved and capable of removing the types of soils
encountered in the food operations involved, an automatic handwashing
facility may be used by food employees to clean their hands.
 
  SEC. 10.    Section 113973 of the Health and
Safety Code is amended to read:
   113973.  (a) Gloves shall be worn when contacting food and
food-contact surfaces if the employee has any cuts, sores, rashes,
artificial nails, nail polish, rings (other than a plain ring, such
as a wedding band), uncleanable orthopedic support devices, or
fingernails that are not clean, smooth, or neatly trimmed.
   (b) Whenever gloves, except single-use gloves, are worn, they
shall be changed, replaced, or washed as often as handwashing is
required by this part.
   (c) If single-use gloves are used, single-use gloves shall be used
for only one task, such as working with ready-to-eat food or with
raw food of animal origin, used for no other purpose, and shall be
discarded when damaged or soiled, or when interruptions in the food
handling occur. Single-use gloves shall not be washed.
   (d) Except as specified in subdivision (e), slash-resistant gloves
that are used to protect the hands during operations requiring
cutting shall be used only with food that is subsequently cooked as
specified in Section 114004, such as frozen food or a primal cut of
meat.
   (e) Slash-resistant gloves may be used with ready-to-eat food that
will not be subsequently cooked if the slash-resistant gloves have a
smooth, durable, and nonabsorbent outer surface or if the
slash-resistant gloves are covered with a smooth, durable,
nonabsorbent glove, or a single-use glove.
   (f) Cloth gloves may not be used in direct contact with food
unless the food is subsequently cooked.  
  SEC. 11.    Section 113975 is added to the Health
and Safety Code, to read:
   113975.  (a) Except as provided in subdivision (b), an employee
who has a lesion or wound that is open or draining shall not handle
food.
   (b) In addition to wearing gloves when contacting food and
food-contact surfaces, a food employee who has a cut, sore, rash,
lesion, or wound shall do all of the following:
   (1) If the lesion is located on the hand or wrist, an impermeable
cover, such as a finger cot or stall shall protect the lesion. A
single-use glove shall be worn over the impermeable cover.
   (2) If the lesion is located on exposed portions of the arms, an
impermeable cover shall protect the lesion.
   (3) If the lesion is located on other parts of the body, a dry,
durable, tight-fitting bandage shall cover the lesion. 
   SEC. 12.   SEC. 3.   Section 121022 of
the Health and Safety Code is amended to read:
   121022.  (a) To ensure knowledge of current trends in the HIV
epidemic and to ensure that California remains competitive for
federal HIV and AIDS funding, health care providers and laboratories
shall report cases of HIV infection to the local health officer using
patient names on a form developed by the department. Local health
officers shall report unduplicated HIV cases by name to the
department on a form developed by the department.
   (b) (1) Health care providers and local health officers shall
submit cases of HIV infection pursuant to subdivision (a) by courier
service, United States Postal Service express mail or registered
mail, other traceable mail, person-to-person transfer, facsimile, or
electronically by a secure and confidential electronic reporting
system established by the department.
   (2) This subdivision shall be implemented using the existing
resources of the department.
   (c) The department and local health officers shall ensure
continued reasonable access to anonymous HIV testing through
alternative testing sites, as established by Section 120890, and in
consultation with HIV planning groups and affected stakeholders,
including representatives of persons living with HIV and health
officers.
   (d) The department shall promulgate emergency regulations to
conform the relevant provisions of Article 3.5 (commencing with
Section 2641.5) of Chapter 4 of Division 1 of Title 17 of the
California Code of Regulations, consistent with this chapter, by
April 17, 2007. Notwithstanding the Administrative Procedure Act
(Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3
of Title 2 of the Government Code), if the department revises the
form used for reporting pursuant to subdivision (a) after
consideration of the reporting guidelines published by the federal
Centers for Disease Control and Prevention, the revised form shall be
implemented without being adopted as a regulation, and shall be
filed with the Secretary of State and printed in Title 17 of the
California Code of Regulations.
   (e) Pursuant to Section 121025, reported cases of HIV infection
shall not be disclosed, discoverable, or compelled to be produced in
any civil, criminal, administrative, or other proceeding.
   (f) State and local health department employees and contractors
shall be required to sign confidentiality agreements developed by the
department that include information related to the penalties for a
breach of confidentiality and the procedures for reporting a breach
of confidentiality, prior to accessing confidential HIV-related
public health records. Those agreements shall be reviewed annually by
either the department or the appropriate local health department.
   (g)  No person shall disclose identifying information reported
pursuant to subdivision (a) to the federal government, including, but
not limited to, any agency, employee, agent, contractor, or anyone
else acting on behalf of the federal government, except as permitted
under subdivision (b) of Section 121025.
   (h) (1) Any potential or actual breach of confidentiality of
HIV-related public health records shall be investigated by the local
health officer, in coordination with the department, when
appropriate. The local health officer shall immediately report any
evidence of an actual breach of confidentiality of HIV-related public
health records at a city or county level to the department and the
appropriate law enforcement agency.
   (2) The department shall investigate any potential or actual
breach of confidentiality of HIV-related public health records at the
state level, and shall report any evidence of such a breach of
confidentiality to an appropriate law enforcement agency.
   (i) Any willful, negligent, or malicious disclosure of cases of
HIV infection reported pursuant to subdivision (a) shall be subject
to the penalties prescribed in Section 121025.
   (j) Nothing in this section shall be construed to limit other
remedies and protections available under state or federal law.

  SEC. 13.    Section 123149.5 of the Health and
Safety Code is amended to read:
   123149.5.  (a)  It is the intent of the Legislature that all
medical information transmitted during the delivery of health care
via telehealth, as defined in subdivision (a) of Section 2290.5 of
the Business and Professions Code, become part of the patient's
medical record maintained by the licensed health care provider.
   (b)  This section shall not be construed to limit or waive any of
the requirements of Chapter 1 (commencing with Section 123100) of
Part 1 of Division 106 of the Health and Safety Code. 

  SEC. 14.    Section 127620 of the Health and
Safety Code is amended to read:
   127620.  (a)  The Office of Statewide Health Planning and
Development, in conjunction with the State Department of Public
Health, shall act as the coordinating agency to develop a strategic
plan that would assist rural California to prepare for health care
reform. The plan shall assist in the coordination and integration of
all rural health care services on the birth to death continuum and
serve as an infrastructure for rural communities to establish
priorities and develop appropriate programs.
   (b)  The office shall designate representatives from provider
groups including rural hospitals, clinics, physicians, other rural
providers including psychologists, counties, beneficiaries, and other
entities directly affected by the plan. The office shall convene
meetings with the objectives of doing all of the following:
   (1)  Assessing the current status of health care in rural
communities.
   (2)  Assembling and reviewing data related to available programs
and resources for rural California.
   (3)  Assembling and reviewing data related to other states'
strategic plans for rural communities.
   (4)  Reviewing and integrating the office's rural work plan, as
appropriate.
   (5)  Making assumptions about the future of health care and
developing a strategic plan based on these assumptions.
   (c)  The rural health care strategic plan shall address all of the
following:
   (1)  The special needs of the elderly and of ethnic populations.
   (2)  Elimination of barriers in planning and coordinating health
services.
   (3)  The lack of primary and specialty providers.
   (4)  Access to emergency services.
   (5)  The role of new technologies, including, but not limited to,
telehealth.  
  SEC. 15.    Section 130302 of the Health and
Safety Code is amended to read:
   130302.  For the purposes of this division, the following
definitions apply:
   (a) "Director" means the Director of the Office of Health
Information Integrity.
   (b) "HIPAA" means the federal Health Insurance Portability and
Accountability Act.
   (c) "Office" means the Office of Health Information Integrity
established in the California Health and Human Services Agency
pursuant to Section 130200.
   (d) "State entities" means all state departments, boards,
commissions, programs, and other organizational units of the
executive branch of state government.  
  SEC. 16.    Section 130304 of the Health and
Safety Code is repealed.  
  SEC. 17.    Section 130307 of the Health and
Safety Code is amended to read:
   130307.  The director shall establish an advisory committee to
obtain information on statewide HIPAA implementation activities. The
advisory committee shall meet as required to coordinate statewide
HIPAA implementation activities with other health care stakeholders.
It is the intent of the Legislature that the committee's membership
include representatives from county government, from consumers, and
from a broad range of provider groups, such as physicians and
surgeons, clinics, hospitals, pharmaceutical companies, health care
service plans, disability insurers, long-term care facilities,
facilities for the developmentally disabled, and mental health
providers. The director shall invite key stakeholders from the
federal government, the Judicial Council, health care advocates,
nonprofit health care organizations, public health systems, and the
private sector to provide information to the committee. 

  SEC. 18.    Section 130309 of the Health and
Safety Code is repealed.  
  SEC. 19.    Section 10123.13 of the Insurance Code
is amended to read:
   10123.13.  (a) Every insurer issuing group or individual policies
of health insurance that covers hospital, medical, or surgical
expenses, including those telehealth services covered by the insurer
as defined in subdivision (a) of Section 2290.5 of the Business and
Professions Code, shall reimburse claims or any portion of any claim,
whether in state or out of state, for those expenses as soon as
practical, but no later than 30 working days after receipt of the
claim by the insurer unless the claim or portion thereof is contested
by the insurer, in which case the claimant shall be notified, in
writing, that the claim is contested or denied, within 30 working
days after receipt of the claim by the insurer. The notice that a
claim is being contested or denied shall identify the portion of the
claim that is contested or denied and the specific reasons including
for each reason the factual and legal basis known at that time by the
insurer for contesting or denying the claim. If the reason is based
solely on facts or solely on law, the insurer is required to provide
only the factual or the legal basis for its reason for contesting or
denying the claim. The insurer shall provide a copy of the notice to
each insured who received services pursuant to the claim that was
contested or denied and to the insured's health care provider that
provided the services at issue. The notice shall advise the provider
who submitted the claim on behalf of the insured or pursuant to a
contract for alternative rates of payment and the insured that either
may seek review by the department of a claim that the insurer
contested or denied, and the notice shall include the address,
Internet Web site address, and telephone number of the unit within
the department that performs this review function. The notice to the
provider may be included on either the explanation of benefits or
remittance advice and shall also contain a statement advising the
provider of its right to enter into the dispute resolution process
described in Section 10123.137. The notice to the insured may also be
included on the explanation of benefits.
   (b) If an uncontested claim is not reimbursed by delivery to the
claimant's address of record within 30 working days after receipt,
interest shall accrue and shall be payable at the rate of 10 percent
per annum beginning with the first calendar day after the 30-working
day period.
   (c) For purposes of this section, a claim, or portion thereof, is
reasonably contested when the insurer has not received a completed
claim and all information necessary to determine payer liability for
the claim, or has not been granted reasonable access to information
concerning provider services. Information necessary to determine
liability for the claims includes, but is not limited to, reports of
investigations concerning fraud and misrepresentation, and necessary
consents, releases, and assignments, a claim on appeal, or other
information necessary for the insurer to determine the medical
necessity for the health care services provided to the claimant. If
an insurer has received all of the information necessary to determine
payer liability for a contested claim and has not reimbursed a claim
determined to be payable within 30 working days of receipt of that
information, interest shall accrue and be payable at a rate of 10
percent per annum beginning with the first calendar day after the
30-working day period.
   (d) The obligation of the insurer to comply with this section
shall not be deemed to be waived when the insurer requires its
contracting entities to pay claims for covered services. 

  SEC. 20.    Section 10123.147 of the Insurance
Code is amended to read:
   10123.147.  (a) Every insurer issuing group or individual policies
of health insurance that covers hospital, medical, or surgical
expenses, including those telehealth services covered by the insurer
as defined in subdivision (a) of Section 2290.5 of the Business and
Professions Code, shall reimburse each complete claim, or portion
thereof, whether in state or out of state, as soon as practical, but
no later than 30 working days after receipt of the complete claim by
the insurer. However, an insurer may contest or deny a claim, or
portion thereof, by notifying the claimant, in writing, that the
claim is contested or denied, within 30 working days after receipt of
the complete claim by the insurer. The notice that a claim, or
portion thereof, is contested shall identify the portion of the claim
that is contested, by revenue code, and the specific information
needed from the provider to reconsider the claim. The notice that a
claim, or portion thereof, is denied shall identify the portion of
the claim that is denied, by revenue code, and the specific reasons
for the denial, including the factual and legal basis known at that
time by the insurer for each reason. If the reason is based solely on
facts or solely on law, the insurer is required to provide only the
factual or legal basis for its reason to deny the claim. The insurer
shall provide a copy of the notice required by this subdivision to
each insured who received services pursuant to the claim that was
contested or denied and to the insured's health care provider that
provided the services at issue. The notice required by this
subdivision shall include a statement advising the provider who
submitted the claim on behalf of the insured or pursuant to a
contract for alternative rates of payment and the insured that either
may seek review by the department of a claim that was contested or
denied by the insurer and the address, Internet Web site address, and
telephone number of the unit within the department that performs
this review function. The notice to the provider may be included on
either the explanation of benefits or remittance advice and shall
also contain a statement advising the provider of its right to enter
into the dispute resolution process described in Section 10123.137.
An insurer may delay payment of an uncontested portion of a complete
claim for reconsideration of a contested portion of that claim so
long                                           as the insurer pays
those charges specified in subdivision (b).
   (b) If a complete claim, or portion thereof, that is neither
contested nor denied, is not reimbursed by delivery to the claimant's
address of record within the 30 working days after receipt, the
insurer shall pay the greater of fifteen dollars ($15) per year or
interest at the rate of 10 percent per annum beginning with the first
calendar day after the 30-working-day period. An insurer shall
automatically include the fifteen dollars ($15) per year or interest
due in the payment made to the claimant, without requiring a request
therefor.
   (c) For the purposes of this section, a claim, or portion thereof,
is reasonably contested if the insurer has not received the
completed claim. A paper claim from an institutional provider shall
be deemed complete upon submission of a legible emergency department
report and a completed UB 92 or other format adopted by the National
Uniform Billing Committee, and reasonable relevant information
requested by the insurer within 30 working days of receipt of the
claim. An electronic claim from an institutional provider shall be
deemed complete upon submission of an electronic equivalent to the UB
92 or other format adopted by the National Uniform Billing
Committee, and reasonable relevant information requested by the
insurer within 30 working days of receipt of the claim. However, if
the insurer requests a copy of the emergency department report within
the 30 working days after receipt of the electronic claim from the
institutional provider, the insurer may also request additional
reasonable relevant information within 30 working days of receipt of
the emergency department report, at which time the claim shall be
deemed complete. A claim from a professional provider shall be deemed
complete upon submission of a completed HCFA 1500 or its electronic
equivalent or other format adopted by the National Uniform Billing
Committee, and reasonable relevant information requested by the
insurer within 30 working days of receipt of the claim. The provider
shall provide the insurer reasonable relevant information within 15
working days of receipt of a written request that is clear and
specific regarding the information sought. If, as a result of
reviewing the reasonable relevant information, the insurer requires
further information, the insurer shall have an additional 15 working
days after receipt of the reasonable relevant information to request
the further information, notwithstanding any time limit to the
contrary in this section, at which time the claim shall be deemed
complete.
   (d) This section shall not apply to claims about which there is
evidence of fraud and misrepresentation, to eligibility
determinations, or in instances where the plan has not been granted
reasonable access to information under the provider's control. An
insurer shall specify, in a written notice to the provider within 30
working days of receipt of the claim, which, if any, of these
exceptions applies to a claim.
   (e) If a claim or portion thereof is contested on the basis that
the insurer has not received information reasonably necessary to
determine payer liability for the claim or portion thereof, then the
insurer shall have 30 working days after receipt of this additional
information to complete reconsideration of the claim. If a claim, or
portion thereof, undergoing reconsideration is not reimbursed by
delivery to the claimant's address of record within the 30 working
days after receipt of the additional information, the insurer shall
pay the greater of fifteen dollars ($15) per year or interest at the
rate of 10 percent per annum beginning with the first calendar day
after the 30-working-day period. An insurer shall automatically
include the fifteen dollars ($15) per year or interest due in the
payment made to the claimant, without requiring a request therefor.
   (f) An insurer shall not delay payment on a claim from a physician
or other provider to await the submission of a claim from a hospital
or other provider, without citing specific rationale as to why the
delay was necessary and providing a monthly update regarding the
status of the claim and the insurer's actions to resolve the claim,
to the provider that submitted the claim.
   (g) An insurer shall not request or require that a provider waive
its rights pursuant to this section.
   (h) This section shall apply only to claims for services rendered
to a patient who was provided emergency services and care as defined
in Section 1317.1 of the Health and Safety Code in the United States
on or after September 1, 1999.
   (i) This section shall not be construed to affect the rights or
obligations of any person pursuant to Section 10123.13.
   (j) This section shall not be construed to affect a written
agreement, if any, of a provider to submit bills within a specified
time period.  
  SEC. 21    Section 10181.11 of the Insurance Code
is amended to read:
   10181.11.  (a) Whenever it appears to the department that any
person has engaged, or is about to engage, in any act or practice
constituting a violation of this article, including the filing of
inaccurate or unjustified rates or inaccurate or unjustified rate
information, the department may review the rate filing to ensure
compliance with the law.
   (b) The department may review other filings.
   (c) The department shall accept and post to its Internet Web site
any public comment on a rate increase submitted to the department
during the 60-day period described in subdivision (d) of Section
10181.7.
   (d) The department shall report to the Legislature at least
quarterly on all unreasonable rate filings.
   (e) The department shall post on its Internet Web site any changes
submitted by the insurer to the proposed rate increase, including
any documentation submitted by the insurer supporting those changes.
   (f) If the department finds that an unreasonable rate increase is
not justified or that a rate filing contains inaccurate information,
the department shall post its finding on its Internet Web site.
   (g) Nothing in this article shall be construed to impair or impede
the department's authority to administer or enforce any other
provision of this code.  
  SEC. 22.    Section 10198.7 of the Insurance Code
is amended to read:
   10198.7.  (a) No health benefit plan that covers three or more
persons and that is issued, renewed, or written by any insurer,
nonprofit hospital service plan, self-insured employee welfare
benefit plan, fraternal benefits society, or any other entity shall
exclude coverage for any individual on the basis of a preexisting
condition provision for a period greater than six months following
the individual's effective date of coverage, nor shall limit or
exclude coverage for a specific insured person by type of illness,
treatment, medical condition, or accident except for satisfaction of
a preexisting clause pursuant to this article. Preexisting condition
provisions contained in health benefit plans may relate only to
conditions for which medical advice, diagnosis, care, or treatment,
including use of prescription drugs, was recommended or received from
a licensed health practitioner during the six months immediately
preceding the effective date of coverage.
   (b) No health benefit plan that covers one or two individuals and
that is issued, renewed, or written by any insurer, self-insured
employee welfare benefit plan, fraternal benefits society, or any
other entity shall exclude coverage on the basis of a preexisting
condition provision for a period greater than 12 months following the
individual's effective date of coverage, nor shall limit or exclude
coverage for a specific insured person by type of illness, treatment,
medical condition, or accident, except for satisfaction of a
preexisting condition clause pursuant to this article. Preexisting
condition provisions contained in health benefit plans may relate
only to conditions for which medical advice, diagnosis, care, or
treatment, including use of prescription drugs, was recommended or
received from a licensed health practitioner during the 12 months
immediately preceding the effective date of coverage.
   (c) (1) Notwithstanding subdivision (a), a health benefit plan for
group coverage shall not impose any preexisting condition provision
upon any child under 19 years of age.
   (2) Notwithstanding subdivision (b), a health benefit plan for
individual coverage that is not a grandfathered plan within the
meaning of Section 1251 of the federal Patient Protection and
Affordable Care Act (Public Law 111-148) shall not impose any
preexisting condition provision upon any child under 19 years of age.

   (d) A carrier that does not utilize a preexisting condition
provision may impose a waiting or affiliation period not to exceed 60
days, before the coverage issued subject to this article shall
become effective. During the waiting or affiliation period, the
carrier is not required to provide health care services and no
premium shall be charged to the subscriber or enrollee.
   (e) A carrier that does not utilize a preexisting condition
provision in health plans that cover one or two individuals may
impose a contract provision excluding coverage for waivered
conditions. No carrier may exclude coverage on the basis of a
waivered condition for a period greater than 12 months following the
individual's effective date of coverage. A waivered condition
provision contained in health benefit plans may relate only to
conditions for which medical advice, diagnosis, care, or treatment,
including use of prescription drugs, was recommended or received from
a licensed health practitioner during the 12 months immediately
preceding the effective date of coverage.
   (f) In determining whether a preexisting condition provision, a
waivered condition provision, or a waiting or affiliation period
applies to any person, all health benefit plans shall credit the time
the person was covered under creditable coverage, provided the
person becomes eligible for coverage under the succeeding health
benefit plan within 62 days of termination of prior coverage,
exclusive of any waiting or affiliation period, and applies for
coverage under the succeeding plan within the applicable enrollment
period. A health benefit plan shall also credit any time an eligible
employee must wait before enrolling in the health benefit plan,
including any affiliation or employer-imposed waiting period.
However, if a person's employment has ended, the availability of
health coverage offered through employment or sponsored by an
employer has terminated or, an employer's contribution toward health
coverage has terminated, a carrier shall credit the time the person
was covered under creditable coverage if the person becomes eligible
for health coverage offered through employment or sponsored by an
employer within 180 days, exclusive of any waiting or affiliation
period, and applies for coverage under the succeeding plan within the
applicable enrollment period.
   (g) No health benefit plan that covers three or more persons and
that is issued, renewed, or written by any insurer, nonprofit
hospital service plan, self-insured employee welfare benefit plan,
fraternal benefits society, or any other entity may exclude late
enrollees from coverage for more than 12 months from the date of the
late enrollee's application for coverage. No insurer, nonprofit
hospital service plan, self-insured employee welfare benefit plan,
fraternal benefits society, or any other entity shall require any
premium or other periodic charge to be paid by or on behalf of a late
enrollee during the period of exclusion from coverage permitted by
this subdivision.
   (h) An individual's period of creditable coverage shall be
certified pursuant to subdivision (e) of Section 2701 of Title XXVII
of the federal Public Health Services Act, 42 U.S.C. Sec. 300gg(e).
   (i) A group health benefit plan may not impose a preexisting
condition exclusion to a condition relating to benefits for pregnancy
or maternity care.
   (j) Any entity providing aggregate or specific stop loss coverage
or any other assumption of risk with reference to a health benefit
plan shall provide that the plan meets all requirements of this
article concerning waiting periods, preexisting condition provisions,
and late enrollees.  
  SEC. 23.    Section 10953 of the Insurance Code is
amended to read:
   10953.  (a) Upon the effective date of this chapter, a carrier
shall fairly and affirmatively offer, market, and sell all of the
carrier's health benefit plans that are offered and sold to a child
or the responsible party for a child in each service area in which
the plan provides or arranges for health care coverage during any
open enrollment period, to late enrollees, and during any other
period in which state or federal law, rules, regulations, or guidance
expressly provide that a carrier shall not condition offer or
acceptance of coverage on any preexisting condition.
   (b) No carrier, agent, or broker shall, directly or indirectly,
engage in the following activities:
   (1) Encourage or direct a child or responsible party for a child
to refrain from filing an application for coverage with a carrier
because of the health status, claims experience, industry,
occupation, or geographic location, provided that the location is
within the carrier's approved service area, of the child.
   (2) Encourage or direct a child or responsible party for a child
to seek coverage from another carrier because of the health status,
claims experience, industry, occupation, or geographic location,
provided that the location is within the carrier's approved service
area, of the child.
   (c) A carrier shall not, directly or indirectly, enter into any
contract, agreement, or arrangement with an agent or broker of the
carrier that provides for or results in the payment of compensation
to the agent or broker for the sale of a health benefit plan to be
varied because of the health status, claims experience, industry,
occupation, or geographic location of the child. This subdivision
does not apply to a compensation arrangement that provides
compensation to an agent or broker of a carrier on the basis of
percentage of premium, provided that the percentage shall not vary
because of the health status, claims experience, industry,
occupation, or geographic area of the child.  
  SEC. 24.    Section 10959 of the Insurance Code is
amended to read:
   10959.  (a) All health benefit plans offered to a child or on
behalf of a child to a responsible party for a child shall conform to
the requirements of Sections 10127.18, 10273.6, and 12682.1, and
shall be renewable at the option of the child or responsible party
for a child on behalf of the child except as permitted to be
canceled, rescinded, or not renewed pursuant to Section 10273.6.
   (b) Any carrier that ceases to offer for sale new individual
health benefit plans pursuant to Section 10273.6 shall continue to be
governed by this chapter with respect to business conducted under
this chapter.
   (c) Except as authorized under Section 10958, a carrier that as of
the effective date of this chapter does not write new health benefit
plans for children in this state or that after the effective date of
this chapter ceases to write new health benefit plans for children
in this state shall be prohibited from offering for sale new
individual health benefit plans or in this state for a period of five
years from the date of notice to the commissioner. 
  SEC. 4.    Section 10144.51 is added to the  
Insurance Code   , to read:  
   10144.51.  (a) (1) Every health insurance policy issued, amended,
or renewed on or after July 1, 2012, shall provide coverage for
behavioral health treatment for pervasive developmental disorder or
autism. The coverage shall be provided in the same manner and shall
be subject to the same requirements as provided in Section 10144.5.
   (2) Notwithstanding paragraph (1), as of the date that proposed
final rulemaking for essential health benefits is issued, this
section does not require any benefits to be provided that exceed the
essential health benefits that all health insurers will be required
by federal regulations to provide under Section 1302(b) of the
federal Patient Protection and Affordable Care Act (Public Law
111-148), as amended by the federal Health Care and Education
Reconciliation Act of 2010 (Public Law 111-152).
   (3) This section shall not affect services for which an individual
is eligible pursuant to Division 4.5 (commencing with Section 4500)
of the Welfare and Institutions Code or Title 14 (commencing with
Section 95000) of the Government Code.
   (4) This section shall not affect or reduce any obligation to
provide services under an individualized education program, as
defined in Section 56032 of the Education Code, or an individualized
service plan, as described in Section 5600.4 of the Welfare and
Institutions Code, or under the Individuals with Disabilities
Education Act (20 U.S.C. Sec. 1400, et seq.) and its implementing
regulations.
   (b) Pursuant to Article 6 (commencing with Section 2240.1) of
Title 10 of the California Code of Regulations, every health insurer
subject to this section shall maintain an adequate network that
includes qualified autism service providers who supervise and employ
qualified autism service professionals or paraprofessionals who
provide and administer behavioral health treatment. Nothing shall
prevent a health insurer from selectively contracting with providers
within these requirements.
   (c) For the purposes of this section, the following definitions
shall apply:
   (1) "Behavioral health treatment" means professional services and
treatment programs, including applied behavior analysis and other
behavior intervention programs, that develop or restore, to the
maximum extent practicable, the functioning of an individual with
pervasive developmental disorder or autism, and that meet all of the
following criteria:
   (A) The treatment is prescribed by a physician and surgeon
licensed pursuant to Chapter 5 (commencing with Section 2000) of, or
a psychologist licensed pursuant to Chapter 6.6 (commencing with
Section 2900) of, Division 2 of the Business and Professions Code.
   (B) The treatment is provided under a treatment plan prescribed by
a qualified autism service provider and is administered by one of
the following:
   (i) A qualified autism service provider.
   (ii) A qualified autism service professional supervised and
employed by the qualified autism service provider.
   (iii) A qualified autism service paraprofessional supervised and
employed by a qualified autism service provider.
   (C) The treatment plan has measurable goals over a specific
timeline that is developed and approved by the qualified autism
service provider for the specific patient being treated. The
treatment plan shall be reviewed no less than once every six months
by the qualified autism service provider and modified whenever
appropriate, and shall be consistent with Section 4686.2 of the
Welfare and Institutions Code pursuant to which the qualified autism
service provider does all of the following:
   (i) Describes the patient's behavioral health impairments to be
treated.
   (ii) Designs an intervention plan that includes the service type,
number of hours, and parent participation needed to achieve the plan'
s goal and objectives, and the frequency at which the patient's
progress is evaluated and reported.
   (iii) Provides intervention plans that reflect evidence-based
practices, with demonstrated clinical efficacy in treating pervasive
developmental disorder or autism.
   (iv) Discontinues intensive behavioral intervention services when
the treatment goals and objectives are achieved or no longer
appropriate.
   (D) The treatment plan is not prescribed for purposes of providing
respite, day care, or school services and is not used to reimburse a
parent for participating in the treatment program. The treatment
plan shall be made available to the insurer upon request.
   (2) "Pervasive developmental disorder or autism" shall have the
same meaning and interpretation as used in Section 10144.5.
   (3) "Qualified autism service provider" means either of the
following:
   (A) A person, entity, or group that is certified by a national
entity, such as the Behavior Analyst Certification Board, that is
accredited by the National Commission for Certifying Agencies, and
who designs, supervises, or provides treatment for pervasive
developmental disorder or autism, provided the services are within
the experience and competence of the person, entity, or group that is
nationally certified.
   (B) A person licensed as a physician and surgeon, physical
therapist, occupational therapist, psychologist, marriage and family
therapist, educational psychologist, clinical social worker,
professional clinical counselor, speech-language pathologist, or
audiologist pursuant to Division 2 (commencing with Section 500) of
the Business and Professions Code, who designs, supervises, or
provides treatment for pervasive developmental disorder or autism,
provided the services are within the experience and competence of the
licensee.
   (4) "Qualified autism service professional" means an individual
who meets all of the following criteria:
   (A) Provides behavioral health treatment.
   (B) Is employed and supervised by a qualified autism service
provider.
   (C) Provides treatment pursuant to a treatment plan developed and
approved by the qualified autism service provider.
   (D) Is a behavioral service provider approved as a vendor by a
California regional center to provide services as an Associate
Behavior Analyst, Behavior Analyst, Behavior Management Assistant,
Behavior Management Consultant, or Behavior Management Program as
defined in Section 54342 of Title 17 of the California Code of
Regulations.
   (E) Has training and experience in providing services for
pervasive developmental disorder or autism pursuant to Division 4.5
(commencing with Section 4500) of the Welfare and Institutions Code
or Title 14 (commencing with Section 95000) of the Government Code.
   (5) "Qualified autism service paraprofessional" means an
unlicensed and uncertified individual who meets all of the following
criteria:
   (A) Is employed and supervised by a qualified autism service
provider.
   (B) Provides treatment and implements services pursuant to a
treatment plan developed and approved by the qualified autism service
provider.
   (C) Meets the criteria set forth in the regulations adopted
pursuant to Section 4686.3 of the Welfare and Institutions Code.
   (D) Has adequate education, training, and experience, as certified
by a qualified autism service provider.
   (d) This section shall not apply to the following:
   (1) A specialized health insurance policy that does not cover
mental health or behavioral health services or an accident only,
specified disease, hospital indemnity, or Medicare supplement policy.

   (2) A health insurance policy in the Medi-Cal program (Chapter 7
(commencing with Section 14000) of Part 3 of Division 9 of the
Welfare and Institutions Code).
                                                           (3) A
health insurance policy in the Healthy Families Program (Part 6.2
(commencing with Section 12693) of Division 2 of the Insurance Code).

   (4) A health care benefit plan or policy entered into with the
Board of Administration of the Public Employees' Retirement System
pursuant to the Public Employees' Medical and Hospital Care Act (Part
5 (commencing with Section 22750) of Division 5 of Title 2 of the
Government Code).
   (e) Nothing in this section shall be construed to limit the
obligation to provide services under Section 10144.5.
   (f) Notwithstanding any other provision of law, in the provision
of benefits required by this section, a health insurer may utilize
case management, network providers, utilization review techniques,
prior authorization, copayments, or other cost sharing.
   (g) This section shall become inoperative on July 1, 2014, and, as
of January 1, 2015, is repealed, unless a later enacted statute,
that becomes operative on or before January 1, 2015, deletes or
extends the dates on which it becomes inoperative and is repealed.

   SEC. 5.    Section 10144.52 is added to the 
 Insurance Code   , to read:  
   10144.52.  (a) For purposes of this part, the terms "provider,"
"professional provider," "network provider," "mental health provider,"
and "mental health professional" shall include the term "qualified
autism service provider," as defined in subdivision (c) of Section
10144.51.
   (b) This section shall become inoperative on July 1, 2014, and, as
of January 1, 2015, is repealed, unless a later enacted statute,
that becomes operative on or before January 1, 2015, deletes or
extends the dates on which it becomes inoperative and is repealed.

   SEC. 25.   SEC. 6.   Section 5705 of the
Welfare and Institutions Code is amended to read:
   5705.  (a) It is the intent of the Legislature that the use of
negotiated net amounts, as provided in this section, be given
preference in contracts for services under this division.
   (b) Negotiated net amounts may be used as the cost of services in
contracts between the state and the county or contracts between the
county and a subprovider of services, or both. A negotiated net
amount shall be determined by calculating the total budget for
services for a program or a component of a program, less the amount
of projected revenue. All participating government funding sources,
except for the Medi-Cal program (Chapter 7 (commencing with Section
14000) of Part 3 of Division 9), shall be bound to that amount as the
cost of providing all or part of the total county mental health
program as described in the county performance contract for each
fiscal year, to the extent that the governmental funding source
participates in funding the county mental health programs. Where the
State Department of Health Care Services promulgates regulations for
determining reimbursement of Short-Doyle mental health services
allowable under the Medi-Cal program, those regulations shall be
controlling as to the rates for reimbursement of Short-Doyle mental
health services allowable under the Medi-Cal program and rendered to
Medi-Cal beneficiaries. Providers under this subdivision shall report
to the State Department of Mental Health and local mental health
programs any information required by the State Department of Mental
Health in accordance with procedures established by the Director of
Mental Health.
   (c) Notwithstanding any other provision of this division or
Division 9 (commencing with Section 10000), absent a finding of
fraud, abuse, or failure to achieve contract objectives, no
restrictions, other than any contained in the contract, shall be
placed upon a provider's expenditure pursuant to this section.
   SEC. 26.   SEC. 7.   Section 5708 of the
Welfare and Institutions Code is amended to read:
   5708.  To maintain stability during the transition, counties that
contracted with the department during the 1990-91 fiscal year on a
negotiated net amount basis may continue to use the same funding
mechanism.
   SEC. 27.   SEC. 8.   Section 5710 of the
Welfare and Institutions Code is amended to read:
   5710.  (a) Charges for the care and treatment of each patient
receiving service from a county mental health program shall not
exceed the actual cost thereof as determined or approved by the
Director of Mental Health in accordance with standard accounting
practices. The director may include the amount of expenditures for
capital outlay or the interest thereon, or both, in his or her
determination of actual cost. The responsibility of a patient, his or
her estate, or his or her responsible relatives to pay the charges
and the powers of the director with respect thereto shall be
determined in accordance with Article 4 (commencing with Section
7275) of Chapter 3 of Division 7.
   (b) The Director of Mental Health may delegate to each county all
or part of the responsibility for determining the financial liability
of patients to whom services are rendered by a county mental health
program and all or part of the responsibility for determining the
ability of the responsible parties to pay for services to minor
children who are referred by a county for treatment in a state
hospital. Liability shall extend to the estates of patients and to
responsible relatives, including the spouse of an adult patient and
the parents of minor children. The Director of Mental Health may also
delegate all or part of the responsibility for collecting the
charges for patient fees. Counties may decline this responsibility as
it pertains to state hospitals, at their discretion. If this
responsibility is delegated by the director, the director shall
establish and maintain the policies and procedures for making the
determinations and collections. Each county to which the
responsibility is delegated shall comply with the policy and
procedures.
   (c) The director shall prepare and adopt a uniform sliding scale
patient fee schedule to be used in all mental health agencies for
services rendered to each patient. In preparing the uniform patient
fee schedule, the director shall take into account the existing
charges for state hospital services and those for community mental
health program services. If the director determines that it is not
practicable to devise a single uniform patient fee schedule
applicable to both state hospital services and services of other
mental health agencies, the director may adopt a separate fee
schedule for the state hospital services which differs from the
uniform patient fee schedule applicable to other mental health
agencies.
   SEC. 28.   SEC. 9.   Section 5716 of the
Welfare and Institutions Code is amended to read:
   5716.  Counties may contract with providers on a negotiated net
amount basis in the same manner as set forth in Section 5705.
   SEC. 29.   SEC.   10.   Section
5724 of the Welfare and Institutions Code is amended to read:
   5724.  (a) The department and the State Department of Health Care
Services shall jointly develop a new ratesetting methodology for use
in the Short-Doyle Medi-Cal system that maximizes federal funding and
utilizes, as much as practicable, federal medicare reimbursement
principles. The departments shall work with the counties and the
federal Health Care Financing Administration in the development of
the methodology required by this section.
   (b) Rates developed through the methodology required by this
section shall apply only to reimbursement for direct client services.

   (c) Administrative costs shall be claimed separately and shall be
limited to 15 percent of the total cost of direct client services.
   (d) The cost of performing utilization reviews shall be claimed
separately and shall not be included in administrative cost.
   (e) The rates established for direct client services pursuant to
this section shall be based on increments of time for all
noninpatient services.
   (f) The ratesetting methodology shall not be implemented until it
has received any necessary federal approvals.
   SEC. 30.   SEC. 11.   Section 5750.1 of
the Welfare and Institutions Code is amended to read:
   5750.1.  Notwithstanding Section 5750, a standard, rule, or
policy, not directly the result of a statutory or administrative law
change, adopted by the department or county during the term of an
existing county performance contract shall not apply to the
negotiated net amount terms of that contract under Sections 5705 and
5716, but shall only apply to contracts established after adoption of
the standard, rule, or policy. 
  SEC. 31.    Section 14132.73 of the Welfare and
Institutions Code is amended to read:
   14132.73.  The State Department of Health Care Services shall
allow psychiatrists to receive fee-for-service Medi-Cal reimbursement
for services provided through telehealth until June 30, 2004, or
until the State Department of Mental Health and mental health plans,
in collaboration with stakeholders, develop a method for reimbursing
psychiatric services provided through telehealth that is
administratively feasible for the mental health plans, primary care
providers, and psychiatrists providing the services, whichever occurs
later.  
  SEC. 32.    No reimbursement is required by this
act pursuant to Section 6 of Article XIII B of the California
Constitution for certain costs that may be incurred by a local agency
or school district because, in that regard, this act creates a new
crime or infraction, eliminates a crime or infraction, or changes the
penalty for a crime or infraction, within the meaning of Section
17556 of the Government Code, or changes the definition of a crime
within the meaning of Section 6 of Article XIII B of the California
Constitution.
   However, if the Commission on State Mandates determines that this
act contains other costs mandated by the state, reimbursement to
local agencies and school districts for those costs shall be made
pursuant to Part 7 (commencing with Section 17500) of Division 4 of
Title 2 of the Government Code. 
   SEC. 12.    No reimbursement is required by this act
pursuant to Section 6 of Article XIII B of the California
Constitution because the only costs that may be incurred by a local
agency or school district will be incurred because this act creates a
new crime or infraction, eliminates a crime or infraction, or
changes the penalty for a crime or infraction, within the meaning of
Section 17556 of the Government Code, or changes the definition of a
crime within the meaning of Section 6 of Article XIII B of the
California Constitution.