Bill Text: CA SB1180 | 2023-2024 | Regular Session | Introduced
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Health care coverage: emergency medical services.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Engrossed) 2024-05-22 - In Assembly. Read first time. Held at Desk. [SB1180 Detail]
Download: California-2023-SB1180-Introduced.html
Bill Title: Health care coverage: emergency medical services.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Engrossed) 2024-05-22 - In Assembly. Read first time. Held at Desk. [SB1180 Detail]
Download: California-2023-SB1180-Introduced.html
CALIFORNIA LEGISLATURE—
2023–2024 REGULAR SESSION
Senate Bill
No. 1180
| Introduced by Senator Ashby |
February 14, 2024 |
An act to add Section 1371.51 to the Health and Safety Code, to add Section 10126.61 to the Insurance Code, and to add Section 14132.13 to the Welfare and Institutions Code, relating to health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
SB 1180, as introduced, Ashby.
Health care coverage: emergency medical services.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law requires health care service plan contracts and health insurance policies to provide coverage for certain services and treatments, including medical transportation services. Existing law provides for the Medi-Cal program, administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services, including emergency medical transport. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.
Existing law, until January 1, 2031, authorizes a local emergency medical services (EMS) agency to
develop a community paramedicine or triage to alternate destination program that, among other things, provides case management services to frequent EMS users and triage paramedic assessments.
This bill would require a health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2025, to include coverage for services provided by a community paramedicine program, a triage to alternate destination program, and a mobile integrated health program. The bill would require those plans and policies to require an enrollee or insured who receives covered services from a noncontracting program to pay no more than the same cost-sharing amount they would pay for the same covered services received from a contracting program. The bill would specify the reimbursement process and amount for a noncontracting program. Because a willful violation of these provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program. The
bill would also make services provided by these programs covered benefits under the Medi-Cal program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
Digest Key
Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YESBill Text
The people of the State of California do enact as follows:
SECTION 1.
Section 1371.51 is added to the Health and Safety Code, to read:1371.51.
(a) A health care service plan contract issued, amended, or renewed on or after January 1, 2025, shall include coverage for services provided by a community paramedicine program, triage to alternate destination program, or mobile integrated health program.(b) (1) A health care service plan contract issued, amended, or renewed on or after January 1, 2025, shall require an enrollee who receives covered services from a noncontracting community paramedicine program, triage to alternate destination program, or mobile integrated health program to pay no more than the same cost-sharing amount that the enrollee would pay for the same covered services received from a contracting community paramedicine program, triage to alternate destination program, or mobile integrated health program.
(2) Reimbursement for a noncontracting community paramedicine program, triage to alternate destination program, or mobile integrated health program shall follow the same process as described in Section 1371.56.
(c) For purposes of this section:
(1) “Community paramedicine program” means a program defined in Section 1815.
(2) “Mobile integrated health program” means a fire department-based team of licensed health care practitioners, operating within their scope of practice, who provide mobile health services to support the emergency medical services system.
(3) “Triage to alternate destination program” means a program defined in Section 1819.
SEC. 2.
Section 10126.61 is added to the Insurance Code, to read:10126.61.
(a) A health insurance policy issued, amended, or renewed on or after January 1, 2025, shall include coverage for services provided by a community paramedicine program, triage to alternate destination program, or mobile integrated health program.(b) (1) A health insurance policy issued, amended, or renewed on or after January 1, 2025, shall require an insured who receives covered services from a noncontracting community paramedicine program, triage to alternate destination program, or mobile integrated health program to pay no more than the same cost-sharing amount that the insured would pay for the same covered services received from a contracting community paramedicine program, triage to alternate destination program, or mobile integrated health program.
(2) Reimbursement for a noncontracting community paramedicine program, triage to alternate destination program, or mobile integrated health program shall follow the same process as described in Section 10126.66.
(c) For purposes of this section:
(1) “Community paramedicine program” means a program defined in Section 1815 of the Health and Safety Code.
(2) “Mobile integrated health program” means a fire department-based team of licensed health care practitioners, operating within their scope of practice, who provide mobile health services to support the emergency medical services system.
(3) “Triage to alternate destination program” means a program defined in Section 1819 of the Health and Safety Code.
SEC. 3.
Section 14132.13 is added to the Welfare and Institutions Code, to read:14132.13.
(a) Services provided by a community paramedicine program, triage to alternate destination program, or mobile integrated health program are covered benefits under the Medi-Cal program.(b) The department shall develop rates of reimbursement for services provided by a community paramedicine program, triage to alternate destination program, or mobile integrated health program in consultation with community paramedicine programs, triage to alternate destination programs, and mobile integrated health programs.
(c) For purposes of this section:
(1) “Community paramedicine program” means a program defined in Section 1815 of the Health and Safety Code.
(2) “Mobile integrated health program” means a fire department-based team of licensed
health care practitioners, operating within their scope of practice, who provide mobile health services to support the emergency medical services system.
(3) “Triage to alternate destination program” means a program defined in Section 1819 of the Health and Safety Code.
