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<ns0:Id>20250AB__261398AMD</ns0:Id>
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<ns0:ActionText>INTRODUCED</ns0:ActionText>
<ns0:ActionDate>2026-02-20</ns0:ActionDate>
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<ns0:ActionText>AMENDED_ASSEMBLY</ns0:ActionText>
<ns0:ActionDate>2026-03-19</ns0:ActionDate>
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<ns0:SessionYear>2025</ns0:SessionYear>
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<ns0:MeasureType>AB</ns0:MeasureType>
<ns0:MeasureNum>2613</ns0:MeasureNum>
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<ns0:AuthorText authorType="LEAD_AUTHOR">Introduced by Assembly Member Sharp-Collins</ns0:AuthorText>
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<ns0:Legislator>
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<ns0:House>ASSEMBLY</ns0:House>
<ns0:Name>Sharp-Collins</ns0:Name>
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<ns0:Title> An act to add Section 1373.655 to the Health and Safety Code, relating to health care. </ns0:Title>
<ns0:RelatingClause>health care</ns0:RelatingClause>
<ns0:GeneralSubject>
<ns0:Subject>Health care service plans: provider network transitions.</ns0:Subject>
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<html:p>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’s requirements a crime. Existing law requires a health care service plan to notify an enrollee at least 60 days before the termination date of a contract between a health care service plan and a provider group or a general acute care hospital to which the enrollee is assigned. If the plan reaches an agreement with a terminated provider after sending that notice, existing law requires the plan to offer each affected enrollee the option to return to that provider and to reassign the enrollee to another provider if the enrollee does not exercise that option.</html:p>
<html:p>This bill would require a health care service plan to automatically reinstate the enrollee to the enrollee’s previously assigned primary care provider or provider group if a provider network transition is materially delayed, terminated, rescinded, or otherwise fails within 120 days of an enrollee reassignment and that provider or provider group remains contracted with the plan. If, after that failure, the previously assigned provider is no longer contracted with the plan, the bill would require the plan to offer continuity of care or arrange for out-of-network care at in-network cost sharing, as specified. Because a willful violation of these provisions would be a crime, this bill would impose a state-mandated local program.</html:p>
<html:p>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.</html:p>
<html:p>This bill would provide that no reimbursement is required by this act for a specified reason.</html:p>
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<ns0:FiscalCommittee>YES</ns0:FiscalCommittee>
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<ns0:Preamble>The people of the State of California do enact as follows:</ns0:Preamble>
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<ns0:Num>SECTION 1.</ns0:Num>
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Section 1373.655 is added to the
<ns0:DocName>Health and Safety Code</ns0:DocName>
, to read:
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<ns0:Num>1373.655.</ns0:Num>
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(a)
<html:span class="EnSpace"/>
Notwithstanding subdivision (e) of Section 1373.65, if a provider network transition is materially delayed, terminated, rescinded, or otherwise fails within 120 days of an enrollee reassignment conducted pursuant to Section 1373.65, the health care service plan shall automatically reinstate the enrollee to the enrollee’s previously assigned primary care provider or provider group, if that provider or provider group remains contracted with the plan.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
Automatic reinstatement pursuant to subdivision (a) shall occur without requiring any of the following:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
A request from the enrollee.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
A continuity of
care determination pursuant to Section 1373.96.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
A grievance or appeal filed by the enrollee.
</html:p>
<html:p>
(c)
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A health care service plan shall provide written notice to the enrollee within five business days of reinstatement that includes all of the following:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
Confirmation of reassignment to the prior provider.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Information regarding the enrollee’s right to select a different provider.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
Contact information for assistance in scheduling care.
</html:p>
<html:p>
(d)
<html:span class="EnSpace"/>
If a provider network transition is materially delayed, terminated, rescinded, or otherwise fails within 120 days of an enrollee reassignment conducted pursuant to Section 1373.65 and
the previously assigned provider is no longer contracted with the plan, the plan shall do one of the following:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
Offer continuity of care pursuant to Section 1373.96.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Arrange for out-of-network care at in-network cost sharing until a reassignment that complies with Section 1367 of this code and Section 1300.67.2.2 of Title 28 of the California Code of Regulations can be effectuated.
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<html:p>
(e)
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A reinstatement conducted pursuant to this section shall not be deemed a new transfer for purposes of Section 1300.67.1.3 of Title 28 of the California Code of Regulations.
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<html:p>
(f)
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For purposes of this section, “provider network transition” includes a merger, acquisition, affiliation, or contractual arrangement that results in the reassignment of enrollees to a
different primary care provider, provider group, or health facility pursuant to Section 1373.65.
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<ns0:Num>SEC. 2.</ns0:Num>
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No reimbursement is required by this act pursuant to Section 6 of Article XIII
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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
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B of the California Constitution.
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