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<ns0:Id>20250AB__235398AMD</ns0:Id>
<ns0:VersionNum>98</ns0:VersionNum>
<ns0:History>
<ns0:Action>
<ns0:ActionText>INTRODUCED</ns0:ActionText>
<ns0:ActionDate>2026-02-19</ns0:ActionDate>
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<ns0:Action>
<ns0:ActionText>AMENDED_ASSEMBLY</ns0:ActionText>
<ns0:ActionDate>2026-03-16</ns0:ActionDate>
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<ns0:SessionYear>2025</ns0:SessionYear>
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<ns0:MeasureNum>2353</ns0:MeasureNum>
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<ns0:AuthorText authorType="LEAD_AUTHOR">Introduced by Assembly Member Pacheco</ns0:AuthorText>
<ns0:AuthorText authorType="COAUTHOR_ORIGINATING">(Coauthor: Assembly Member Petrie-Norris)</ns0:AuthorText>
<ns0:Authors>
<ns0:Legislator>
<ns0:Contribution>LEAD_AUTHOR</ns0:Contribution>
<ns0:House>ASSEMBLY</ns0:House>
<ns0:Name>Pacheco</ns0:Name>
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<ns0:Legislator>
<ns0:Contribution>COAUTHOR</ns0:Contribution>
<ns0:House>ASSEMBLY</ns0:House>
<ns0:Name>Petrie-Norris</ns0:Name>
</ns0:Legislator>
</ns0:Authors>
<ns0:Title>An act to amend Sections 127660 and 127662 of the Health and Safety Code, relating to health care. </ns0:Title>
<ns0:RelatingClause>health care</ns0:RelatingClause>
<ns0:GeneralSubject>
<ns0:Subject>Health Mandates Review Program.</ns0:Subject>
</ns0:GeneralSubject>
<ns0:DigestText>
<html:p>Existing law requests the University of California to establish the California Health Benefit Review Program (CHBRP) to assess legislation proposing to mandate a health care benefit or service or repeal a mandated benefit or service and to prepare a written analysis. Existing law authorizes an appropriate policy or fiscal committee chairperson, the Speaker of the Assembly, or the President pro Tempore of the Senate to request that written analysis. Under existing law, a written analysis is requested to be provided to the Legislature not later than 60 days after a request for analysis is made. Existing law establishes the Health Care Benefits Fund, funded by an annual fee on health care service plans and health insurers, to support the University of California and CHBRP.</html:p>
<html:p>This bill would request the University of California to establish the Health Mandates Review Program to assess legislation proposing to mandate new or additional services or activities for a designated provider, beginning no later than January 1, 2028. The bill would require the appropriate policy or fiscal committee within the legislation’s house of origin to request the program to assess legislation if the legislation is expected to affect the operations of a majority of the state’s hospitals, or a majority of hospitals within a recognized class of hospitals, by requiring specified actions. The bill would request the Health Mandates Review Program to provide a written analysis of the legislation, as specified, and would request that the analysis include information on specified impacts. The bill would request that the program publish an annual summary of legislation it analyzed and that it convene a workgroup of members with relevant expertise in hospital finance or
operations to advise on the development and implementation of the program.</html:p>
<html:p>This bill would establish the Health Care Mandates Fund in the State Treasury to support the University of California and its work in implementing the Health Mandates Review Program, including providing bill analyses. The bill would require the Department of Health Care Access and Information to annually transfer an unspecified amount from the California Health Data and Planning Fund to the Health Care Mandates Fund starting in the 2027–28 fiscal year.</html:p>
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<ns0:VoteRequired>MAJORITY</ns0:VoteRequired>
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<ns0:FiscalCommittee>YES</ns0:FiscalCommittee>
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<ns0:Bill id="bill">
<ns0:Preamble>The people of the State of California do enact as follows:</ns0:Preamble>
<ns0:BillSection id="id_FF1D3E1A-4365-4526-90B9-AC5F0281CCB0">
<ns0:Num>SECTION 1.</ns0:Num>
<ns0:Content>
<html:p>
(a)
<html:span class="EnSpace"/>
The Legislature finds and declares all of the following:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
There is an increasing number of proposals that mandate health care providers to provide specific services or activities.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Some of these health care services or activities could potentially result in better health outcomes that would be in the public interest.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
Mandated health care services and activities contribute to the
cost and lack of affordability of health care for patients, providers, payers, and purchasers.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
It is the intent of the Legislature that this act do all of the following:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
Ensure that all residents of this state have reasonable access to affordable, high-quality, and equitable health care.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Facilitate the provision of high-quality, cost-effective, and equitable health care services by providing current, credible data and information to the Governor and the Legislature for the purpose of evaluating proposed legislation.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
Identify an independent, nonpartisan body with the requisite capabilities to estimate the cost to Californians of legislative proposals that mandate new services or activities for hospitals.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
Ensure that the independent, nonpartisan body publish a written analysis of the estimated costs of legislative proposals that significantly affect the public health, the delivery and administration of hospital services, the cost of health care services, health care affordability, and the financial stability of hospitals.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
Therefore, it is the intent of the Legislature that the Health Mandates Review Program conduct a systematic review of proposed mandated or mandatorily offered services and activities that affect hospitals before enactment of the legislation. This review will assist the Governor and the Legislature to determine if mandating a particular service or activity is in the public interest.
</html:p>
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<ns0:Num>SEC. 2.</ns0:Num>
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Section 127660 of the
<ns0:DocName>Health and Safety Code</ns0:DocName>
is amended to read:
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<ns0:Num>127660.</ns0:Num>
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<ns0:Content>
<html:p>
(a)
<html:span class="EnSpace"/>
The Legislature hereby requests the University of California to establish the California Health Benefit Review Program to assess legislation proposing to mandate a benefit or service and legislation proposing to repeal a mandated benefit or service, and to prepare a written analysis with relevant data on the following:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
Public health impacts, including, but not limited to, all of the following:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
The impact on the health of the community, including the reduction of communicable disease and the benefits of prevention such as those provided by childhood immunizations and prenatal care.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
The impact on the health of the community, including diseases and conditions where disparities in outcomes associated with the social determinants of health as well as gender, race, sexual orientation, or gender identity are established in peer-reviewed scientific and medical literature.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
The extent to which the benefit or service reduces premature death and the economic loss associated with disease.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Medical impacts, including, but not limited to, all of the following:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
The extent to
which the benefit or service is generally recognized by the medical community as being effective in the screening, diagnosis, or treatment of a condition or disease, as demonstrated by a review of scientific and peer-reviewed medical literature.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
The extent to which the benefit or service is generally available and utilized by treating physicians.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
The contribution of the benefit or service to the health status of the population, including the results of any research demonstrating the efficacy of the benefit or service compared to alternatives, including not providing the benefit or service.
</html:p>
<html:p>
(D)
<html:span class="EnSpace"/>
The extent to which mandating or repealing the benefits or services would not diminish or eliminate access to currently available health care benefits or services.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
Financial impacts, including, but not limited to, all of the following:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
The extent to which the coverage or repeal of coverage will increase or decrease the benefit or cost of the benefit or service.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
The extent to which the coverage or repeal of coverage will increase the utilization of the benefit or service, or will be a substitute for, or affect the cost of, alternative benefits or services.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
The extent to which the coverage or repeal of coverage will increase or decrease the administrative expenses of health care service plans and health insurers and the premium and expenses of subscribers, enrollees, and policyholders.
</html:p>
<html:p>
(D)
<html:span class="EnSpace"/>
The impact of this coverage or repeal of coverage on the total cost of health care.
</html:p>
<html:p>
(E)
<html:span class="EnSpace"/>
The impact of this coverage or repeal of coverage on anticipated costs or savings estimated upon implementation for one subsequent calendar year, or, if applicable, two subsequent calendar years through a long-range estimate.
</html:p>
<html:p>
(F)
<html:span class="EnSpace"/>
The potential cost or savings to the private sector, including the impact on small employers as defined in paragraph (1) of subdivision (l) of Section 1357, the Public Employees’ Retirement System, other retirement systems funded by the state or by a local government, individuals purchasing individual health insurance, and publicly funded state health insurance programs, including the Medi-Cal program.
</html:p>
<html:p>
(G)
<html:span class="EnSpace"/>
The extent to which costs resulting from lack of coverage or repeal of coverage are or would be shifted to other payers, including both public and private entities.
</html:p>
<html:p>
(H)
<html:span class="EnSpace"/>
The extent to which mandating or repealing the proposed benefit or service would not diminish or eliminate access to currently available health care benefits or services.
</html:p>
<html:p>
(I)
<html:span class="EnSpace"/>
The extent to which the benefit or service is generally utilized by a significant portion of the population.
</html:p>
<html:p>
(J)
<html:span class="EnSpace"/>
The extent to which health care coverage for the benefit or service is already generally available.
</html:p>
<html:p>
(K)
<html:span class="EnSpace"/>
The level of public demand for health care coverage for the benefit or service, including the level of interest of collective bargaining agents in negotiating privately for inclusion of this coverage in group contracts, and the extent to which the mandated benefit or service is covered by self-funded employer groups.
</html:p>
<html:p>
(L)
<html:span class="EnSpace"/>
In assessing and preparing a written analysis of the financial impact of legislation proposing to mandate a benefit or service and legislation proposing to repeal a mandated benefit or service pursuant to this paragraph, the Legislature requests the University of California to use a certified actuary or other person with relevant knowledge and expertise to determine the financial impact.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
The impact on essential health benefits, as defined in Section 1367.005 of this code and Section 10112.27 of the Insurance Code, and the impact on the California Health Benefit Exchange.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
The Legislature further requests that the California Health Benefit Review Program assess legislation that impacts health insurance benefit design, cost sharing, premiums, and other health insurance topics.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
The
Legislature requests that the University of California provide every analysis to the appropriate policy and fiscal committees of the Legislature not later than 60 days, or in a manner and pursuant to a timeline agreed to by the Legislature and the California Health Benefit Review Program, after receiving a request made pursuant to Section 127661. In addition, the Legislature requests that the university post every analysis on the
internet and make every analysis available to the public upon request.
</html:p>
<html:p>
(d)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
The Legislature further requests that the University of California establish the Health Mandates Review Program to assess legislation proposing to mandate new or additional services or activities for hospitals beginning no later than January 1, 2028.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
The appropriate policy or fiscal committee within the legislation’s house of origin shall request that the Health Mandates Review Program assess legislation if the legislation is expected to affect the operations of a majority of the state’s hospitals, or a majority of hospitals within a recognized class of hospitals, by requiring hospitals to hire new staff or otherwise increase workforce costs, purchase or
lease new equipment, make physical alterations to their facilities, or provide additional discounted or charitable care.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
After receiving a request made pursuant to this subdivision, the Legislature requests that the Health Mandates Review Program provide a written analysis of the legislation to the appropriate policy and fiscal committees of the Legislature not later than 72 hours before the legislation is to be heard in the relevant fiscal committee of the house of origin, or in a manner and pursuant to a timeline agreed to by the Legislature and the Health Mandates Review Program.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
The Legislature requests that the written analysis provided pursuant to paragraph (3) include analysis of all of the following impacts:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
To the extent applicable and feasible within the timeframe for the request, hospital care
delivery impacts, including all of the following:
</html:p>
<html:p>
(i)
<html:span class="EnSpace"/>
The extent to which the proposed mandated service or activity is generally recognized as effective in the screening, diagnosis, treatment, or prevention of a condition or disease, as demonstrated by a review of scientific and peer-reviewed literature.
</html:p>
<html:p>
(ii)
<html:span class="EnSpace"/>
The extent to which the proposed mandated service or activity is generally currently utilized by hospitals.
</html:p>
<html:p>
(iii)
<html:span class="EnSpace"/>
The results of research demonstrating the efficacy of the proposed mandated service or activity compared to alternatives, including not providing the service or activity.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
To the extent applicable and feasible within the timeframe for the request, public health impacts, including both of the following:
</html:p>
<html:p>
(i)
<html:span class="EnSpace"/>
The impact of the mandated service or activity on the health of patients and the community, including the reduction and prevention of disease and disparities in health outcomes, premature death, and economic loss associated with disease.
</html:p>
<html:p>
(ii)
<html:span class="EnSpace"/>
The results of any research demonstrating the efficacy of the activity or service compared to alternatives, including not providing the activity or service.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
Financial impacts, including all of the following:
</html:p>
<html:p>
(i)
<html:span class="EnSpace"/>
The extent to which the mandate will affect the cost of providing and administering hospital services or affect the cost of providing uncompensated care.
</html:p>
<html:p>
(ii)
<html:span class="EnSpace"/>
The extent to which the proposed mandated service or activity may affect access
to currently available health care services or affect the financial stability of hospitals.
</html:p>
<html:p>
(iii)
<html:span class="EnSpace"/>
The extent to which the mandate will increase or decrease the utilization of hospital services or will be a substitute for, or affect the cost of, services at other sites of care.
</html:p>
<html:p>
(iv)
<html:span class="EnSpace"/>
Impacts on the cost of health care for patients, purchasers, and payers, including commercial payers, the Medi-Cal program, and the federal Medicare Program.
</html:p>
<html:p>
(v)
<html:span class="EnSpace"/>
The total effect on the cost of health care services resulting from the proposed mandated service or activity compared to the total cost of health care in California.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
To the extent feasible and applicable, the Legislature requests that the written analysis provided pursuant to paragraph (3) separately identify
impacts for different recognized classes of hospitals and for the major payer categories of the Medi-Cal program, the federal Medicare Program, and commercial payers.
</html:p>
<html:p>
(6)
<html:span class="EnSpace"/>
To prepare the written analysis provided pursuant to paragraph (3), the Health Mandates Review Program may make and execute contracts and interagency agreements consistent with its duties under this chapter.
</html:p>
<html:p>
(7)
<html:span class="EnSpace"/>
There shall not be an independent review board process by the state for full data access to all claims payer database and hospital discharge data.
</html:p>
<html:p>
(8)
<html:span class="EnSpace"/>
On or before December 31 of each year, and no sooner than following the completion of an analysis pursuant to paragraph (3), the Legislature requests that the University of California’s Health Mandates Review Program publish a summary of legislation analyzed by the Health Mandates Review
Program enacted in the same year that mandates new or additional services or activities, as well as their impacts on cost if a written analysis was conducted.
</html:p>
<html:p>
(9)
<html:span class="EnSpace"/>
The Legislature requests the Health Mandates Review Program to convene a workgroup of members with relevant expertise in hospital finance or operations to advise on the development and implementation of the program.
</html:p>
<html:p>
(e)
<html:span class="EnSpace"/>
As used in this
section:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
“Hospital” means a health facility described in subdivision (a) or (b) of Section 1250.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
“Legislation proposing to mandate a benefit or service” means a proposed statute that requires a health care service plan or a health insurer, or both, to do any of the following:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
Permit a person insured or covered under the policy or contract to obtain health care treatment or services from a particular type of health care provider.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
Offer or provide coverage for the screening, diagnosis, or treatment of a particular disease or condition.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
Offer or provide coverage of a particular type
of health care treatment or service, or of medical equipment, medical supplies, or drugs used in connection with a health care treatment or service.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
“Legislation proposing to mandate new or additional services or activities” means a proposed statute that requires hospitals to offer or provide specific services or perform specific activities that have not previously been required. This includes changes to existing requirements that are expected to increase the cost of providing existing services or performing existing activities.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
“Legislation proposing to repeal a mandated benefit or service” means a proposed statute that would repeal an existing requirement that a health care service plan or a health insurer, or both, do any of the following:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
Permit a person insured or covered under the policy or contract to obtain health care treatment or services from a particular type of health care provider.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
Offer or provide coverage for the screening, diagnosis, or treatment of a particular disease or condition.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
Offer or provide coverage of a particular type of health care treatment or service, or of medical equipment, medical supplies, or drugs used in connection with a health care treatment or service.
</html:p>
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<ns0:Num>SEC. 3.</ns0:Num>
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Section 127662 of the
<ns0:DocName>Health and Safety Code</ns0:DocName>
is amended to read:
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<ns0:Num>127662.</ns0:Num>
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<ns0:Content>
<html:p>
(a)
<html:span class="EnSpace"/>
In order to effectively support the University of California and its work in implementing the California Health Benefit Review Program, there is hereby established in the State Treasury, the Health Care Benefits Fund. The university’s work in providing the bill analyses pursuant to subdivisions (a) to (c), inclusive, of Section 127660 shall be supported from
this
fund.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
For the 2026–27 to 2032–33 fiscal years, inclusive, each health care service plan, except a specialized health care service plan, and each health insurer offering health insurance, as defined in Section 106 of the Insurance Code, shall be assessed an annual fee in an amount determined through regulation. The amount of the fee shall be determined by the Department of Managed Health Care and the Department of Insurance in consultation with the university and shall be limited to the amount necessary to fund the actual and necessary expenses of the university and its work in implementing this chapter. The total annual assessment on health care service plans and health insurers shall not exceed three million two hundred thousand dollars ($3,200,000).
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
The Department of Managed Health Care and the Department of Insurance, in coordination with the
university, shall assess the health care service plans and health insurers, respectively, for the costs required to fund the university’s activities pursuant to subdivision (b).
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
Health care service plans shall be notified of the assessment on or before June 15 of each year with the annual assessment notice issued pursuant to Section 1356. The assessment pursuant to this section is separate and independent of the assessments in Section 1356.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Health insurers shall be noticed of the assessment in accordance with the notice for the annual assessment or quarterly premium tax revenues.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
The assessed fees required pursuant to subdivision (b) shall be paid on an annual basis no later than August 1 of each year. The Department of Managed Health Care and the Department of Insurance shall forward the assessed fees to
the Controller for deposit in the Health Care Benefits Fund immediately following their receipt.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
“Health insurance,” as used in this subdivision, does not include Medicare supplement, vision-only, dental-only, or CHAMPUS supplement insurance, or hospital indemnity, accident-only, or specified disease insurance that does not pay benefits on a fixed benefit, cash payment only basis.
</html:p>
<html:p>
(d)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
In order to effectively support the University of California and its work in implementing the Health Mandates Review Program, there is hereby established in the State Treasury the Health Care Mandates Fund. The University of California’s work in providing bill analyses pursuant to subdivision (d) of Section 127660 shall be supported from this fund.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Notwithstanding any other law, starting in the 2027–28 fiscal year, and no later than August 1 of each year, the Department of Health Care Access and Information shall transfer ____ dollars ($____) from the California Health Data and Planning Fund, created pursuant to subdivision (g) of Section 127280, to the Health Care Mandates Fund.
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