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<ns0:Id>20250SB__040295CHP</ns0:Id>
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<ns0:ActionText>INTRODUCED</ns0:ActionText>
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<ns0:Action>
<ns0:ActionText>AMENDED_ASSEMBLY</ns0:ActionText>
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<ns0:Action>
<ns0:ActionText>CHAPTERED</ns0:ActionText>
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<ns0:ActionText>APPROVED</ns0:ActionText>
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<ns0:Action>
<ns0:ActionText>FILED</ns0:ActionText>
<ns0:ActionDate>2025-10-06</ns0:ActionDate>
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<ns0:LegislativeInfo>
<ns0:SessionYear>2025</ns0:SessionYear>
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<ns0:MeasureType>SB</ns0:MeasureType>
<ns0:MeasureNum>402</ns0:MeasureNum>
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<ns0:ChapterYear>2025</ns0:ChapterYear>
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<ns0:ChapterNum>413</ns0:ChapterNum>
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<ns0:AuthorText authorType="LEAD_AUTHOR">Introduced by Senator Valladares</ns0:AuthorText>
<ns0:Authors>
<ns0:Legislator>
<ns0:Contribution>LEAD_AUTHOR</ns0:Contribution>
<ns0:House>SENATE</ns0:House>
<ns0:Name>Valladares</ns0:Name>
</ns0:Legislator>
</ns0:Authors>
<ns0:Title> An act to amend Section 2290.5 of, and to add Chapter 17 (commencing with Section 4999.200) to Division 2 of, the Business and Professions Code, to amend Sections 1367.27, 1374.72, and 1374.73 of the Health and Safety Code, to amend Sections 10133.15, 10144.5, and 10144.51 of the Insurance Code, and to amend Section 11165.7 of the Penal Code, relating to health care coverage.</ns0:Title>
<ns0:RelatingClause>health care coverage</ns0:RelatingClause>
<ns0:GeneralSubject>
<ns0:Subject>Health care coverage: autism.</ns0:Subject>
</ns0:GeneralSubject>
<ns0:DigestText>
<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 a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan contract or a health insurance policy to provide coverage for behavioral health treatment for pervasive developmental disorder or autism and defines “behavioral health treatment” to mean specified services and treatment programs, including treatment provided pursuant to a treatment plan that is prescribed by a qualified autism service provider and administered either by a qualified autism service provider or by a qualified autism service professional or qualified autism service paraprofessional. Existing law defines
“qualified autism service provider,” “qualified autism service professional,” and “qualified autism service paraprofessional” for those purposes. Those definitions are contained in the Health and Safety Code and the Insurance Code.</html:p>
<html:p>This bill would move those definitions to the Business and Professions Code. The bill would also make technical and conforming changes.</html:p>
<html:p>This bill would incorporate additional changes to Section 1367.27 of the Health and Safety Code and Section 10133.15 of the Insurance Code proposed by AB 280 to be operative only if this bill and AB 280 are enacted and this bill is enacted last.</html:p>
<html:p>This bill would incorporate additional changes to Section 1374.73 of the Health and Safety Code and Section 10144.51 of the
Insurance Code proposed by AB 951 to be operative only if this bill and AB 951 are enacted and this bill is enacted last.</html:p>
<html:p>This bill would incorporate additional changes to Section 11165.7 of the Penal Code proposed by AB 653 and SB 848, to be operative only if this bill and either or both of those bills are enacted and this bill is enacted last.</html:p>
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<ns0:DigestKey>
<ns0:VoteRequired>MAJORITY</ns0:VoteRequired>
<ns0:Appropriation>NO</ns0:Appropriation>
<ns0:FiscalCommittee>NO</ns0:FiscalCommittee>
<ns0:LocalProgram>NO</ns0:LocalProgram>
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<ns0:ImmediateEffect>NO</ns0:ImmediateEffect>
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<ns0:Election>NO</ns0:Election>
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<ns0:Preamble>The people of the State of California do enact as follows:</ns0:Preamble>
<ns0:BillSection id="id_05030CE3-921C-4706-AA6A-5535C0C8910E">
<ns0:Num>SECTION 1.</ns0:Num>
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Section 2290.5 of the
<ns0:DocName>Business and Professions Code</ns0:DocName>
is amended to read:
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<ns0:LawSection id="id_ED75E222-07BD-4B5D-AF3D-DDEFA7FABF7B">
<ns0:Num>2290.5.</ns0:Num>
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<ns0:Content>
<html:p>
(a)
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For purposes of this division, the following definitions apply:
</html:p>
<html:p>
(1)
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“Asynchronous store and forward” means the transmission of a patient’s medical information from an originating site to the health care provider at a distant site.
</html:p>
<html:p>
(2)
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“Distant site” means a site where a health care provider who provides health care services is located while providing these services via a telecommunications system.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
“Health care provider” means any of the following:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
A person who is licensed under this division.
</html:p>
<html:p>
(B)
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An associate marriage and family therapist or marriage and family therapist trainee functioning pursuant to Section 4980.43.3.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
A qualified autism service provider certified by a national entity as defined in Section 4999.200 or a qualified autism service professional as defined in Section 4999.201.
</html:p>
<html:p>
(D)
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An associate clinical social worker functioning pursuant to Section 4996.23.2.
</html:p>
<html:p>
(E)
<html:span class="EnSpace"/>
An associate professional clinical counselor or clinical counselor trainee functioning pursuant to Section 4999.46.3.
</html:p>
<html:p>
(4)
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“Originating site” means a site where a patient is located at the time health care services are
provided via a telecommunications system or where the asynchronous store and forward service originates.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
“Synchronous interaction” means a real-time interaction between a patient and a health care provider located at a distant site.
</html:p>
<html:p>
(6)
<html:span class="EnSpace"/>
“Telehealth” means the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care. Telehealth facilitates patient self-management and caregiver support for patients and includes synchronous interactions and asynchronous store and forward transfers.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
Before the delivery of health care via telehealth, the
health care provider initiating the use of telehealth shall inform the patient about the use of telehealth and obtain verbal or written consent from the patient for the use of telehealth as an acceptable mode of delivering health care services and public health. The consent shall be documented.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
This section does not preclude a patient from receiving in-person health care delivery services during a specified course of health care and treatment after agreeing to receive services via telehealth.
</html:p>
<html:p>
(d)
<html:span class="EnSpace"/>
The failure of a health care provider to comply with this section shall constitute unprofessional conduct. Section 2314 shall not apply to this section.
</html:p>
<html:p>
(e)
<html:span class="EnSpace"/>
This section does not alter the scope of practice of a health care
provider or authorize the delivery of health care services in a setting, or in a manner, not otherwise authorized by law.
</html:p>
<html:p>
(f)
<html:span class="EnSpace"/>
All laws regarding the confidentiality of health care information and a patient’s rights to the patient’s medical information shall apply to telehealth interactions.
</html:p>
<html:p>
(g)
<html:span class="EnSpace"/>
All laws and regulations governing professional responsibility, unprofessional conduct, and standards of practice that apply to a health care provider under the health care provider’s license shall apply to that health care provider while providing telehealth services.
</html:p>
<html:p>
(h)
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This section shall not apply to a patient under the jurisdiction of the Department of Corrections and Rehabilitation or any other correctional facility.
</html:p>
<html:p>
(i)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
Notwithstanding any other law and for purposes of this section, the governing body of the hospital whose patients are receiving the telehealth services may grant privileges to, and verify and approve credentials for, providers of telehealth services based on its medical staff recommendations that rely on information provided by the distant-site hospital or telehealth entity, as described in Sections 482.12, 482.22, and 485.616 of Title 42 of the Code of Federal Regulations.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
By enacting this subdivision, it is the intent of the Legislature to authorize a hospital to grant privileges to, and verify and approve credentials for, providers of telehealth services as described in paragraph (1).
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
For the purposes of this subdivision, “telehealth” shall include “telemedicine” as the term is referenced in Sections 482.12, 482.22, and 485.616 of Title 42 of the Code of Federal Regulations.
</html:p>
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<ns0:BillSection id="id_06313B85-38B5-4AC0-B73D-503703A43862">
<ns0:Num>SEC. 2.</ns0:Num>
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Chapter 17 (commencing with Section 4999.200) is added to Division 2 of the
<ns0:DocName>Business and Professions Code</ns0:DocName>
, to read:
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<ns0:LawHeading id="id_815A6A9A-32AC-4305-AEA0-44961D99304E" type="CHAPTER">
<ns0:Num>17.</ns0:Num>
<ns0:LawHeadingVersion id="id_E107071A-BB95-4209-8AF1-C9ACF84B10C0">
<ns0:LawHeadingText>Qualified Autism Service Providers</ns0:LawHeadingText>
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<ns0:LawSection id="id_858424F4-34B1-4FFD-997E-A1A7E000D804">
<ns0:Num>4999.200.</ns0:Num>
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<ns0:Content>
<html:p>“Qualified autism service provider” means an individual who meets either of the following criteria:</html:p>
<html:p>
(a)
<html:span class="EnSpace"/>
Is certified by a national entity, such as the Behavior Analyst Certification Board, with a certification that is accredited by the National Commission for Certifying Agencies who designs, supervises, or provides treatment for pervasive developmental disorder or autism, provided the services are within the experience and competence of the individual who is nationally certified.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
Is 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), and who designs, supervises, or provides treatment for pervasive developmental disorder or autism, provided the services are within the experience and competence of the licensee.
</html:p>
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</ns0:LawSection>
<ns0:LawSection id="id_8BB03049-52D1-4821-BDB6-CC5E53FF6DDC">
<ns0:Num>4999.201.</ns0:Num>
<ns0:LawSectionVersion id="id_E38CD652-45BA-47FD-B475-E57698BE00C6">
<ns0:Content>
<html:p>“Qualified autism service professional” means an individual who meets all of the following criteria:</html:p>
<html:p>
(a)
<html:span class="EnSpace"/>
Provides behavioral health treatment, which may include clinical case management and case supervision under the direction and supervision of a qualified autism service provider.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
Is supervised by a qualified autism service provider.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
Provides treatment pursuant to a treatment plan developed and approved by the qualified autism service provider.
</html:p>
<html:p>
(d)
<html:span class="EnSpace"/>
Is either of the following:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
A behavioral service provider who meets the education and experience qualifications described in Section 54342 of Title 17 of the California Code of Regulations for an Associate Behavior Analyst, Behavior Analyst, Behavior Management Assistant, Behavior Management Consultant, or Behavior Management Program.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
(A)
<html:span class="EnSpace"/>
A psychological associate, an associate marriage and family therapist, an associate clinical social worker, or an associate professional clinical counselor, as defined and regulated by the Board of Behavioral Sciences or the Board of Psychology.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
If an individual meets the requirement described in subparagraph (A), they shall also meet the criteria set forth in the regulations
adopted pursuant to Section 4686.4 of the Welfare and Institutions Code for a Behavioral Health Professional.
</html:p>
<html:p>
(e)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
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.
</html:p>
<html:p>
(f)
<html:span class="EnSpace"/>
Is employed by the qualified autism service provider or an entity or group that employs qualified autism service providers responsible for the autism treatment plan.
</html:p>
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</ns0:LawSection>
<ns0:LawSection id="id_3EFD2CB8-CC41-46C7-9D8A-3FB439E4C94A">
<ns0:Num>4999.202.</ns0:Num>
<ns0:LawSectionVersion id="id_3C989E24-1E1F-4509-BB26-2833026693F5">
<ns0:Content>
<html:p>“Qualified autism service paraprofessional” means an unlicensed and uncertified individual who meets all of the following criteria:</html:p>
<html:p>
(a)
<html:span class="EnSpace"/>
Is supervised by a qualified autism service provider or qualified autism service professional at a level of clinical supervision that meets professionally recognized standards of practice.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
Provides treatment and implements services pursuant to a treatment plan that was developed and approved by the qualified autism service provider.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
Meets the education and training qualifications described in Section 54342 of
Title 17 of the California Code of Regulations.
</html:p>
<html:p>
(d)
<html:span class="EnSpace"/>
Has adequate education, training, and experience, as certified by a qualified autism service provider or an entity or group that employs qualified autism service providers.
</html:p>
<html:p>
(e)
<html:span class="EnSpace"/>
Is employed by the qualified autism service provider or an entity or group that employs qualified autism service providers responsible for the autism treatment plan.
</html:p>
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<ns0:Num>SEC. 3.</ns0:Num>
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Section 1367.27 of the
<ns0:DocName>Health and Safety Code</ns0:DocName>
is amended to read:
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<ns0:LawSection id="id_052B22B1-FB54-4068-B2AA-9480B849E12A">
<ns0:Num>1367.27.</ns0:Num>
<ns0:LawSectionVersion id="id_AF7A2BA7-EC8C-4A75-8EFB-6B45ACC3740A">
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<html:p>
(a)
<html:span class="EnSpace"/>
Commencing July 1, 2016, a health care service plan shall publish and maintain a provider directory or directories with information on contracting providers that deliver health care services to the plan’s enrollees, including those that accept new patients. A provider directory shall not list or include information on a provider that is not currently under contract with the plan.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
A health care service plan shall provide the directory or directories for the specific network offered for each product using a consistent method of network and product naming, numbering, or other classification method that ensures the public, enrollees, potential enrollees, the department, and other state or
federal agencies can easily identify the networks and plan products in
which a provider participates. By July 31, 2017, or 12 months after the date provider directory standards are developed under subdivision (k), whichever occurs later, a health care service plan shall use the naming, numbering, or classification method developed by the department pursuant to subdivision (k).
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
An online provider directory or directories shall be available on the plan’s internet website to the public, potential enrollees, enrollees, and providers without any restrictions or limitations. The directory or directories shall be accessible without any requirement that an individual seeking the directory information demonstrate coverage with the plan, indicate interest in obtaining coverage with the plan, provide a member identification or policy number, provide any other identifying information,
or create or access an account.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
The online provider directory or directories shall be accessible on the plan’s public internet website through an identifiable link or tab and in a manner that is accessible and searchable by enrollees, potential enrollees, the public, and providers. By July 31, 2017, or 12 months after the date provider directory standards are developed under subdivision (k), whichever occurs later, the plan’s public internet website shall allow provider searches by, at a minimum, name, practice address, city, ZIP Code, California license number, National Provider Identifier number, admitting privileges to an identified hospital, product, tier, provider language or languages, provider group, hospital name, facility name, or clinic name, as appropriate.
</html:p>
<html:p>
(d)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
A health care service plan shall allow enrollees, potential enrollees, providers, and members of the public to request a printed copy of the provider directory or directories by contacting the plan through the plan’s toll-free telephone number, electronically, or in writing. A printed copy of the provider directory or directories shall include the information required in subdivisions (h) and (i). The printed copy of the provider directory or directories shall be provided to the requester by mail postmarked no later than five business days following the date of the request and may be limited to the geographic region in which the requester resides or works or intends to reside or work.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
A health care service plan shall update its printed provider directory or directories at least quarterly, or more frequently, if required
by federal law.
</html:p>
<html:p>
(e)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
The plan shall update the online provider directory or directories, at least weekly, or more frequently, if required by federal law, when informed of and upon confirmation by the plan of any of the following:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
A contracting provider is no longer accepting new patients for that product, or an individual provider within a provider group
is no longer accepting new patients.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
A provider is no longer under contract for a particular plan product.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
A provider’s practice location or other information required under subdivision (h) or (i) has changed.
</html:p>
<html:p>
(D)
<html:span class="EnSpace"/>
Upon completion of the investigation described in subdivision (o), a change is necessary based on an enrollee complaint that a provider was not accepting new patients, was otherwise not available, or whose contact information was listed incorrectly.
</html:p>
<html:p>
(E)
<html:span class="EnSpace"/>
Any other information that affects the content or accuracy of the provider directory or directories.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Upon confirmation of any of the following, the plan shall delete a provider from the directory or directories when:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
A provider has retired or otherwise has ceased to practice.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
A provider or provider group is no longer under contract with the plan for any reason.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
The contracting provider group has informed the plan that the provider is no longer associated with the provider group and is no longer under contract with the plan.
</html:p>
<html:p>
(f)
<html:span class="EnSpace"/>
The provider directory or directories shall include both an email address and a telephone number for members of the public and providers to notify the plan if the provider directory information appears to be
inaccurate. This information shall be disclosed prominently in the directory or directories and on the plan’s internet website.
</html:p>
<html:p>
(g)
<html:span class="EnSpace"/>
The provider directory or directories shall include the following disclosures informing enrollees that they are entitled to both of the following:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
Language interpreter services, at no cost to the enrollee, including how to obtain interpretation services in accordance with Section 1367.04.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Full and equal access to covered services, including enrollees with disabilities as required under the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973.
</html:p>
<html:p>
(h)
<html:span class="EnSpace"/>
A full service health care
service plan and a specialized mental health plan shall include all of the following information in the provider directory or directories:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
The provider’s name, practice location or locations, and contact information.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Type of practitioner.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
National Provider Identifier number.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
California license number and type of license.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
The area of specialty, including board certification, if any.
</html:p>
<html:p>
(6)
<html:span class="EnSpace"/>
The provider’s office email address, if available.
</html:p>
<html:p>
(7)
<html:span class="EnSpace"/>
The name of each
affiliated provider group currently under contract with the plan through which the provider sees enrollees.
</html:p>
<html:p>
(8)
<html:span class="EnSpace"/>
A listing for each of the following providers that are under contract with the plan:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
For physicians and surgeons, the provider group, and admitting privileges, if any, at hospitals contracted with the plan.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
Nurse practitioners, physician assistants, psychologists, acupuncturists, optometrists, podiatrists, chiropractors, licensed clinical social workers, marriage and family therapists, professional clinical counselors, qualified autism service providers, as defined in Section 4999.200 of the Business and Professions Code, nurse midwives, and dentists.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
For federally qualified health centers or primary care clinics, the name of the federally qualified health center or clinic.
</html:p>
<html:p>
(D)
<html:span class="EnSpace"/>
For a provider described in subparagraph (A) or (B) who is employed by a federally qualified health center or primary care clinic, and to the extent their services may be accessed and are covered through the contract with the plan, the name of the provider, and the name of the federally qualified health center or clinic.
</html:p>
<html:p>
(E)
<html:span class="EnSpace"/>
Facilities, including, but not limited to, general acute care hospitals, skilled nursing facilities, urgent care clinics, ambulatory surgery centers, inpatient hospice, residential care facilities, and inpatient rehabilitation facilities.
</html:p>
<html:p>
(F)
<html:span class="EnSpace"/>
Pharmacies,
clinical laboratories, imaging centers, and other facilities providing contracted health care services.
</html:p>
<html:p>
(9)
<html:span class="EnSpace"/>
The provider directory or directories may note that authorization or referral may be required to access some providers.
</html:p>
<html:p>
(10)
<html:span class="EnSpace"/>
Non-English language, if any, spoken by a health care provider or other medical professional as well as non-English language spoken by a qualified medical interpreter, in accordance with Section 1367.04, if any, on the provider’s staff.
</html:p>
<html:p>
(11)
<html:span class="EnSpace"/>
Identification of providers who no longer accept new patients for some or all of the plan’s products.
</html:p>
<html:p>
(12)
<html:span class="EnSpace"/>
The network tier to which the provider is assigned, if the provider is not in the lowest
tier, as applicable. Nothing in this section shall be construed to require the use of network tiers other than contract and noncontracting tiers.
</html:p>
<html:p>
(13)
<html:span class="EnSpace"/>
All other information necessary to conduct a search pursuant to paragraph (2) of subdivision (c).
</html:p>
<html:p>
(i)
<html:span class="EnSpace"/>
A vision, dental, or other specialized health care service plan, except for a specialized mental health plan, shall include all of the following information for each provider directory or directories used by the plan for its networks:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
The provider’s name, practice location or locations, and contact information.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Type of practitioner.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
National Provider Identifier number.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
California license number and type of license, if applicable.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
The area of specialty, including board certification, or other accreditation, if any.
</html:p>
<html:p>
(6)
<html:span class="EnSpace"/>
The provider’s office email address, if available.
</html:p>
<html:p>
(7)
<html:span class="EnSpace"/>
The name of each affiliated provider group or specialty plan practice group currently under contract with the plan through which the provider sees enrollees.
</html:p>
<html:p>
(8)
<html:span class="EnSpace"/>
The names of each allied health care professional to the extent there is a direct contract for those services covered through a contract with the plan.
</html:p>
<html:p>
(9)
<html:span class="EnSpace"/>
The non-English language, if any, spoken by a health care provider or other medical professional as well as non-English language spoken by a qualified medical interpreter, in accordance with Section 1367.04, if any, on the provider’s staff.
</html:p>
<html:p>
(10)
<html:span class="EnSpace"/>
Identification of providers who no longer accept new patients for some or all of the plan’s products.
</html:p>
<html:p>
(11)
<html:span class="EnSpace"/>
All other applicable information necessary to conduct a provider search pursuant to paragraph (2) of subdivision (c).
</html:p>
<html:p>
(j)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
The contract between the plan and a provider shall include a requirement that the provider inform the plan within five business days when either of the following occurs:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
The provider is not accepting new patients.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
If the provider had previously not accepted new patients, the provider is currently accepting new patients.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
If a provider who is not accepting new patients is contacted by an enrollee or potential enrollee seeking to become a new patient, the provider shall direct the enrollee or potential enrollee to both the plan for additional assistance in finding a provider and to the department to report any inaccuracy with the plan’s directory or directories.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
If an enrollee or potential enrollee informs a plan of a possible inaccuracy in the provider directory or directories, the plan shall promptly investigate,
and, if necessary, undertake corrective action within 30 business days to ensure the accuracy of the directory or directories.
</html:p>
<html:p>
(k)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
On or before December 31, 2016, the department shall develop uniform provider directory standards to permit consistency in accordance with subdivision (b) and paragraph (2) of subdivision (c) and development of a multiplan directory by another entity. Those standards shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code), until January 1, 2021. No more than two revisions of those standards shall be exempt from the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code) pursuant to this subdivision.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
In developing the standards under this subdivision, the department shall seek input from interested parties throughout the process of developing the standards and shall hold at least one public meeting. The department shall take into consideration any requirements for provider directories established by the federal Centers for Medicare and Medicaid Services and the State Department of Health Care Services.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
By July 31, 2017, or 12 months after the date provider directory standards are developed under this subdivision, whichever occurs later, a plan shall use the standards developed by the department for each product offered by the plan.
</html:p>
<html:p>
(l)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
A plan shall take appropriate steps to ensure the accuracy of
the information concerning each provider listed in the plan’s
provider directory or directories in accordance with this section, and shall, at least annually, review and update the entire provider directory or directories for each product offered. Each calendar year the plan shall notify all contracted providers described in subdivisions (h) and (i) as follows:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
For individual providers who are not affiliated with a provider group described in subparagraph (A) or (B) of paragraph (8) of subdivision (h) and providers described in subdivision (i), the plan shall notify each provider at least once every six months.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
For all other providers described in subdivision (h) who are not subject to the requirements of subparagraph (A), the plan shall notify its contracted providers to ensure that all of the providers are contacted by
the plan at least once annually.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
The notification shall include all of the following:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
The information the plan has in its directory or directories regarding the provider or provider group, including a list of networks and plan products that include the contracted provider or provider group.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
A statement that the failure to respond to the notification may result in a delay of payment or reimbursement of a claim pursuant to subdivision (p).
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
Instructions on how the provider or provider group can update the information in the provider directory or directories using the online interface developed pursuant to subdivision (m).
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
The plan shall require an affirmative response from the provider or provider group acknowledging that the notification was received. The provider or provider group shall confirm that the information in the provider directory or directories is current and accurate or update the information required to be in the directory or directories pursuant to this section, including whether or not the provider or provider group is accepting new patients for each plan product.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
If the plan does not receive an affirmative response and confirmation from the provider that the information is current and accurate or, as an alternative, updates any information required to be in the directory or directories pursuant to this section, within 30 business days, the plan shall take no more than 15
business days to verify whether the provider’s information is correct or requires updates. The plan shall document the receipt and outcome of each attempt to verify the information. If the plan is unable to verify whether the provider’s information is correct or requires updates, the plan shall notify the provider 10 business days in advance of removal that the provider will be removed from the provider directory or directories. The provider shall be removed from the provider directory or directories at the next required update of the provider directory or directories after the 10-business-day notice period. A provider shall not be removed from the provider directory or directories if they respond before the end of the 10-business-day notice period.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
General acute care hospitals shall be exempt from the requirements in paragraphs
(3) and (4).
</html:p>
<html:p>
(m)
<html:span class="EnSpace"/>
A plan shall establish policies and procedures with regard to the regular updating of its provider directory or directories, including the weekly, quarterly, and annual updates required pursuant to this section, or more frequently, if required by federal law or guidance.
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
The policies and procedures described under this subdivision shall be submitted by a plan annually to the department for approval and in a format described by the department pursuant to Section 1367.035.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Every health care service plan shall ensure processes are in place to allow providers to promptly verify or submit changes to the information required to be in the directory or directories pursuant to this section. Those
processes shall, at a minimum, include an online interface for providers to submit verification or changes electronically and shall generate an acknowledgment of receipt from the health care service plan. Providers shall verify or submit changes to information required to be in the directory or directories pursuant to this section using the process required by the health care service plan.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
The plan shall establish and maintain a process for enrollees, potential enrollees, other providers, and the public to identify and report possible inaccurate, incomplete, or misleading information currently listed in the plan’s provider directory or directories. This process shall, at a minimum, include a telephone number and a dedicated email address at which the plan will accept these reports, as well as a hyperlink on the plan’s provider directory
internet website linking to a form where the information can be reported directly to the plan through its internet website.
</html:p>
<html:p>
(n)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
This section does not prohibit a plan from requiring its provider groups or contracting specialized health care service plans to provide information to the plan that is required by the plan to satisfy the requirements of this section for each of the providers that contract with the provider group or contracting specialized health care service plan. This responsibility shall be specifically documented in a written contract between the plan and the provider group or contracting specialized health care service plan.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
If a plan requires its contracting provider groups or contracting specialized health care service plans to provide the plan
with information described in paragraph (1), the plan shall continue to retain responsibility for ensuring that the requirements of this section are satisfied.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
A provider group may terminate a contract with a provider for a pattern or repeated failure of the provider to update the information required to be in the directory or directories pursuant to this section.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
A provider group is not subject to the payment delay described in subdivision (p) if all of the following occurs:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
A provider does not respond to the provider group’s attempt to verify the provider’s information. As used in this paragraph, “verify” means to contact the provider in writing, electronically, and by telephone to confirm whether the
provider’s information is correct or requires updates.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
The provider group documents its efforts to verify the provider’s information.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
The provider group reports to the plan that the provider should be deleted from the provider group in the plan directory or directories.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
Section 1375.7, known as the Health Care Providers’ Bill of Rights, applies to any material change to a provider contract pursuant to this section.
</html:p>
<html:p>
(o)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
Whenever a health care service plan receives a report indicating that information listed in its provider directory or directories is inaccurate, the plan shall promptly investigate the
reported inaccuracy and, no later than 30 business days following receipt of the report, either verify the accuracy of the information or update the information in its provider directory or directories, as applicable.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
When investigating a report regarding its provider directory or directories, the plan shall, at a minimum, do the following:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
Contact the affected provider no later than five business days following receipt of the report.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
Document the receipt and outcome of each report. The documentation shall include the provider’s name, location, and a description of the plan’s investigation, the outcome of the investigation, and any changes or updates made to its provider directory or
directories.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
If changes to a plan’s provider directory or directories are required as a result of the plan’s investigation, the changes to the online provider directory or directories shall be made no later than the next scheduled weekly update, or the update immediately following that update, or sooner if required by federal law or regulations. For printed provider directories, the change shall be made no later than the next required update, or sooner if required by federal law or regulations.
</html:p>
<html:p>
(p)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
Notwithstanding Sections 1371 and 1371.35, a plan may delay payment or reimbursement owed to a provider or provider group as specified in subparagraph (A) or (B), if the provider or provider group fails to respond to the plan’s attempts to verify the provider’s
or provider group’s information as required under subdivision (l). The plan shall not delay payment unless it has attempted to verify the provider’s or provider group’s information. As used in this subdivision, “verify” means to contact the provider or provider group in writing, electronically, and by telephone to confirm whether the provider’s or provider group’s information is correct or requires updates. A plan may seek to delay payment or reimbursement owed to a provider or provider group only after the 10-business day notice period described in paragraph (4) of subdivision (l) has lapsed.
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
For a provider or provider group that receives compensation on a capitated or prepaid basis, the plan may delay no more than 50 percent of the next scheduled capitation payment for up to one calendar month.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
For any claims payment made to a provider or provider group, the plan may delay the claims payment for up to one calendar month beginning on the first day of the following month.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
A plan shall notify the provider or provider group 10 business days before it seeks to delay payment or reimbursement to a provider or provider group pursuant to this subdivision. If the plan delays a payment or reimbursement pursuant to this subdivision, the plan shall reimburse the full amount of any payment or reimbursement subject to delay to the provider or provider group according to either of the following timelines, as applicable:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
No later than three business days following the date on which the plan receives the information required to be submitted by the provider or
provider group pursuant to subdivision (l).
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
At the end of the one-calendar month delay described in subparagraph (A) or (B) of paragraph (1), as applicable, if the provider or provider group fails to provide the information required to be submitted to the plan pursuant to subdivision (l).
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
A plan may terminate a contract for a pattern or repeated failure of the provider or provider group to alert the plan to a change in the information required to be in the directory or directories pursuant to this section.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
A plan that delays payment or reimbursement under this subdivision shall document each instance a payment or reimbursement was delayed and report this information to the department in a format described by
the department pursuant to Section 1367.035. This information shall be submitted along with the policies and procedures required to be submitted annually to the department pursuant to paragraph (1) of subdivision (m).
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
With respect to plans with Medi-Cal managed care contracts with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000), Chapter 8 (commencing with Section 14200), or Chapter 8.75 (commencing with Section 14591) of Part 3 of Division 9 of the Welfare and Institutions Code, this subdivision shall be implemented only to the extent consistent with federal law and guidance.
</html:p>
<html:p>
(q)
<html:span class="EnSpace"/>
In circumstances where the department finds that an enrollee reasonably relied upon materially inaccurate, incomplete, or misleading information
contained in a health plan’s provider directory or directories, the department may require the health plan to provide coverage for all covered health care services provided to the enrollee and to reimburse the enrollee for any amount beyond what the enrollee would have paid, had the services been delivered by an in-network provider under the enrollee’s plan contract. Prior to requiring reimbursement in these circumstances, the department shall conclude that the services received by the enrollee were covered services under the enrollee’s plan contract. In those circumstances, the fact that the services were rendered or delivered by a noncontracting or out-of-plan provider shall not be used as a basis to deny reimbursement to the enrollee.
</html:p>
<html:p>
(r)
<html:span class="EnSpace"/>
Whenever a plan determines as a result of this section that there has been a 10 percent change in the
network for a product in a region, the plan shall file an amendment to the plan application with the department consistent with subdivision (f) of Section 1300.52 of Title 28 of the California Code of Regulations.
</html:p>
<html:p>
(s)
<html:span class="EnSpace"/>
This section applies to plans with Medi-Cal managed care contracts with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000), Chapter 8 (commencing with Section 14200), or Chapter 8.75 (commencing with Section 14591) of Part 3 of Division 9 of the Welfare and Institutions Code to the extent consistent with federal law and
guidance and state law guidance issued after January 1, 2016. Notwithstanding any other provision to the contrary in a plan contract with the State Department of Health Care Services, and to the extent consistent with federal law and guidance and state guidance issued after January 1, 2016, a Medi-Cal managed care plan that complies with the requirements of this section shall not be required to distribute a printed provider directory or directories, except as required by paragraph (1) of subdivision (d).
</html:p>
<html:p>
(t)
<html:span class="EnSpace"/>
A health plan that contracts with multiple employer welfare agreements regulated pursuant to Article 4.7 (commencing with Section 742.20) of Chapter 1 of Part 2 of Division 1 of the Insurance Code shall meet the requirements of this section.
</html:p>
<html:p>
(u)
<html:span class="EnSpace"/>
This section
shall not be construed to alter a provider’s obligation to provide health care services to an enrollee pursuant to the provider’s contract with the plan.
</html:p>
<html:p>
(v)
<html:span class="EnSpace"/>
As part of the department’s routine examination of the fiscal and administrative affairs of a health care service plan pursuant to Section 1382, the department shall include a review of the health care service plan’s compliance with subdivision (p).
</html:p>
<html:p>
(w)
<html:span class="EnSpace"/>
For purposes of this section, “provider group” means a medical group, independent practice association, or other similar group of providers.
</html:p>
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</ns0:LawSection>
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</ns0:BillSection>
<ns0:BillSection id="id_A9F34CE9-5ECA-4C72-BAE7-74DA4B796C00">
<ns0:Num>SEC. 3.5.</ns0:Num>
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Section 1367.27 of the
<ns0:DocName>Health and Safety Code</ns0:DocName>
is amended to read:
</ns0:ActionLine>
<ns0:Fragment>
<ns0:LawSection id="id_A3F1D261-EF75-4305-8649-71CB0CBD158C">
<ns0:Num>1367.27.</ns0:Num>
<ns0:LawSectionVersion id="id_201095AE-2B46-46CC-9153-1E9E129F604B">
<ns0:Content>
<html:p>
(a)
<html:span class="EnSpace"/>
A health care service plan shall publish and maintain a provider directory or directories with information on contracting providers that deliver health care services to the plan’s enrollees, including those that accept new patients. A provider directory shall not list or include information on a provider that is not currently under contract with the plan. Commencing July 1, 2026, a health care service plan shall comply with this section as it read on January 1, 2026.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
A health care service plan shall provide the directory or directories for the specific network offered for each product using a consistent method of network and product naming, numbering, or other classification method that ensures the public, enrollees, potential enrollees, contracting providers, the department, and other state or federal agencies can easily identify the networks and plan products in which a provider participates. By July 31, 2017, or 12 months after the date provider directory standards are developed under subdivision (k), whichever occurs later, a health care service plan shall use the naming, numbering, or classification method developed by the department pursuant to subdivision (k).
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
An online provider directory or
directories shall be available on the plan’s internet website to the public, potential enrollees, enrollees, and providers without any restrictions or limitations. The directory or directories shall be accessible without any requirement that an individual seeking the directory information demonstrate coverage with the plan, indicate interest in obtaining coverage with the plan, provide a member identification or policy number, provide any other identifying information, or create or access an account.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
The online provider directory or directories shall be accessible on the plan’s public
internet website
through an identifiable link or tab and in a manner that is accessible and searchable by enrollees, potential enrollees, the public, and providers. By July 31, 2017, or 12 months after the date provider directory standards are developed under subdivision (k), whichever occurs later, the plan’s public internet website shall allow provider searches by, at a minimum, name, practice address, city, ZIP Code, California license number, National Provider Identifier number, admitting privileges to an identified hospital, product, tier, provider language or languages, provider group, hospital name, facility name, or clinic name, as
appropriate, and the information provided shall be verified and accurate, consistent with this section.
</html:p>
<html:p>
(d)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
A health care service plan shall allow enrollees, potential enrollees, providers, and members of the public to request a printed copy of the provider directory or directories by contacting the plan through the plan’s toll-free telephone number, electronically, or in writing. A printed copy of the provider directory or directories shall include the information required in subdivisions (h) and (i). The printed copy of the provider directory or directories shall be provided to the requester by mail postmarked no later than five business days following the date of the request and may be limited to the geographic region in which the requester resides or works or intends to reside or work.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
A health care
service plan shall update its printed provider directory or directories at least quarterly, or more frequently, if required by federal law.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
A printed provider directory shall be dated with the date of its last update.
</html:p>
<html:p>
(e)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
The plan shall update the online provider directory or directories, at least weekly, or more frequently, if required by federal law, when informed of and upon confirmation by the plan of any of the following:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
A contracting provider is no longer accepting new patients for that product, or an individual provider within a provider group is no longer accepting new patients.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
A provider is no
longer under contract for a particular plan product.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
A provider’s practice location or other information required under subdivision (h) or (i) has changed.
</html:p>
<html:p>
(D)
<html:span class="EnSpace"/>
Upon the completion of the investigation described in subdivision (o), a change is necessary based on an enrollee complaint that a provider was not accepting new patients, was otherwise not available, or whose contact information was listed incorrectly.
</html:p>
<html:p>
(E)
<html:span class="EnSpace"/>
Any other information that affects the content or accuracy of the provider directory or directories.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Upon confirmation of any of the following, the plan shall delete
and remove a provider from the directory or directories when:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
A provider has retired or otherwise has ceased to practice.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
A provider or provider group is no longer under contract with the plan for any reason.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
The contracting provider group has informed the plan that the provider is no longer associated with the provider group and is no longer under contract with the plan.
</html:p>
<html:p>
(f)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
The provider directory or directories shall
display the date of the most recent update. The provider directory or directories shall also display a dedicated email address, telephone number, and reporting hyperlink for members of the public and providers to report possible inaccurate, incomplete, or misleading directory information. The provider directory or directories shall also state that the enrollee may submit a complaint if the enrollee believes they reasonably relied upon inaccurate, incomplete, or misleading directory information.
This information shall be disclosed prominently in the directory or directories and on the plan’s internet website.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
A health care service plan shall include prominent disclosure on its print and online provider directories of its duty to arrange coverage when behavioral health benefits are not available in-network within applicable geographic and timely access standards. The disclosure shall be included within the “Timely Access to Care” section of the directory that is required by Section 1367.031 and shall also include the geographic accessibility standards.
</html:p>
<html:p>
(g)
<html:span class="EnSpace"/>
The provider directory or directories shall include the following disclosures informing enrollees that they are entitled to both of the following:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
Language interpreter services, at no cost to the enrollee, including how to obtain interpretation services in accordance with Section 1367.04.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Full and equal access to covered services, including enrollees with disabilities as required under the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973.
</html:p>
<html:p>
(h)
<html:span class="EnSpace"/>
A full service health care service plan and a specialized mental health plan shall include all of the following information in the provider directory or directories:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
The provider’s name,
practice location or locations, and contact information, including telephone number.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Type of practitioner.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
National Provider Identifier number.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
California license number and type of license.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
The area of specialty, including board certification, if any.
</html:p>
<html:p>
(6)
<html:span class="EnSpace"/>
The provider’s office email address, if
available to an enrollee or the public.
</html:p>
<html:p>
(7)
<html:span class="EnSpace"/>
The population served, meaning adult, pediatric, or both.
</html:p>
<html:p>
(8)
<html:span class="EnSpace"/>
The name of each affiliated provider group currently under contract with the plan through which the provider sees enrollees.
</html:p>
<html:p>
(9)
<html:span class="EnSpace"/>
A listing for each of the following providers that are under contract with the plan:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
For physicians and surgeons, the provider group, and admitting privileges, if any, at hospitals contracted with the plan.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
Nurse practitioners, physician assistants, psychologists, acupuncturists, optometrists, dispensing optometrists and opticians, podiatrists, chiropractors, licensed clinical social workers, marriage and family therapists, professional clinical counselors, qualified autism service providers, as defined in Section
4999.200 of the Business and Professions Code, nurse-midwives, and dentists.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
For federally qualified health centers or primary care clinics, the name of the federally qualified health center or clinic.
</html:p>
<html:p>
(D)
<html:span class="EnSpace"/>
For a provider described in subparagraph (A) or (B) who is employed by a federally qualified health center or primary care clinic, and to the extent their services may be accessed and are covered through the contract with the plan, the name of the provider, and the name of the federally qualified health center or clinic.
</html:p>
<html:p>
(E)
<html:span class="EnSpace"/>
Facilities, including, but not limited to, general
acute care hospitals, skilled nursing facilities, urgent care clinics, ambulatory surgery centers, inpatient hospice, residential care facilities, and inpatient rehabilitation facilities.
</html:p>
<html:p>
(F)
<html:span class="EnSpace"/>
Pharmacies, clinical laboratories, imaging centers, optical dispensaries, and other facilities providing contracted health care services.
</html:p>
<html:p>
(10)
<html:span class="EnSpace"/>
The provider directory or directories may note that authorization or referral may be required to access some providers.
</html:p>
<html:p>
(11)
<html:span class="EnSpace"/>
Non-English language, if any, spoken by a health care provider or other medical professional as well as non-English language spoken by a qualified medical interpreter, in accordance with Section 1367.04, if any, on the provider’s staff.
</html:p>
<html:p>
(12)
<html:span class="EnSpace"/>
Identification of providers who no longer accept new patients for some or all of the plan’s products.
</html:p>
<html:p>
(13)
<html:span class="EnSpace"/>
Whether or not the provider is in the lowest cost-sharing tier, if the product has more than one cost-sharing tier, and the network tier to which the provider is assigned, if the provider is not in the lowest tier, as applicable. This section does not require the use of network tiers other than contract and noncontracting tiers.
</html:p>
<html:p>
(14)
<html:span class="EnSpace"/>
All other information necessary to conduct a search pursuant to paragraph (2) of subdivision (c).
</html:p>
<html:p>
(i)
<html:span class="EnSpace"/>
A vision, dental, or other specialized health care service plan, except for a specialized mental health plan, shall include all of the following information for each provider directory or directories used by the plan for its networks:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
The provider’s name, practice location or locations, and contact information, including telephone number.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Type of practitioner.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
National Provider Identifier number.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
California license number and type of license, if applicable.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
The area of specialty, including board certification, or other accreditation, if any.
</html:p>
<html:p>
(6)
<html:span class="EnSpace"/>
The provider’s office email address, if available to an enrollee or the public.
</html:p>
<html:p>
(7)
<html:span class="EnSpace"/>
The population served, meaning adult, pediatric, or both.
</html:p>
<html:p>
(8)
<html:span class="EnSpace"/>
The name of each affiliated provider group or specialty plan practice group currently under contract with the plan through which the provider sees enrollees.
</html:p>
<html:p>
(9)
<html:span class="EnSpace"/>
The names of each allied health care professional to the extent there is a direct contract for those services covered through a contract with the plan.
</html:p>
<html:p>
(10)
<html:span class="EnSpace"/>
The non-English language, if any, spoken by a health care provider or other medical professional as well as non-English language spoken by a qualified medical interpreter, in accordance with Section 1367.04, if any, on the provider’s staff.
</html:p>
<html:p>
(11)
<html:span class="EnSpace"/>
Identification of providers who no longer accept new patients for some or all of the plan’s products.
</html:p>
<html:p>
(12)
<html:span class="EnSpace"/>
All other applicable information necessary to conduct a provider search pursuant to paragraph (2) of subdivision (c).
</html:p>
<html:p>
(j)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
The contract between the plan and a provider shall include a requirement that the provider inform the plan within five business days when either of the following occurs:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
The provider is not accepting new patients.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
If the provider had previously not accepted new patients, the provider is currently accepting new patients.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
If a provider who is not accepting new patients is contacted by an enrollee or potential enrollee seeking
to become a new patient, the provider shall direct the enrollee or potential enrollee to both the plan for additional assistance in finding a provider and to the department to report any inaccuracy with the plan’s directory or directories.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
If an enrollee or potential enrollee informs a plan of a possible inaccuracy in the provider directory or directories, the plan shall promptly investigate and, if necessary, undertake corrective action within 30 business days to ensure the accuracy of the directory or directories.
</html:p>
<html:p>
(k)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
On or before December 31, 2016, the department shall develop uniform provider directory standards to permit consistency in
accordance with subdivision (b) and paragraph (2) of subdivision (c) and development of a central utility by another entity. Those standards shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code), until January 1, 2021. No more than two revisions of those standards shall be exempt from the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code) pursuant to this subdivision.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
In developing the standards under this subdivision, the department shall seek input from interested parties throughout the process of developing the standards and shall hold at least
one public meeting. The department shall take into consideration any requirements for provider directories established by the federal Centers for Medicare and Medicaid Services and the State Department of Health Care Services.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
By July 31, 2017, or 12 months after the date provider directory standards are developed under this subdivision, whichever occurs later, a plan shall use the standards developed by the department for each product offered by the plan.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
On or before January 1, 2026, the department may update a uniform format with standardized naming conventions and other aspects for each plan to use to request directory information from its providers, consistent with current law.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
(A)
<html:span class="EnSpace"/>
On or before
January 1, 2026, the department may establish a methodology and processes to ensure accuracy of provider directories and consistency with other state or federal laws, regulations, or standards. The department shall take into account existing methods, including surveys, plan-reported information, and benchmarks or submission information from a central utility by another entity.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
The department may require a health care service plan to use or designate a central utility or central utilities for those providers included in the directory and may take into consideration impact on provider financial interests, enrollee access to providers, and health care service plans. If the department requires or designates a central utility or central utilities, in developing the methodology under this section, the department shall seek input from interested parties, including providers, health care service plans, consumers, and consumer advocates, and may
hold one or more public meetings. Standards developed pursuant to paragraph (4) and this paragraph shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code) until January 1, 2029.
</html:p>
<html:p>
(i)
<html:span class="EnSpace"/>
If the department designates or requires a health care service plan to use a central utility or central utilities, the health care service plan’s contract with the utility shall require that incomplete or incorrect information submitted to the central utility shall not be conveyed to the health care service plan. The contract shall also require that the central utility notify the submitter of incomplete or inaccurate information.
</html:p>
<html:p>
(ii)
<html:span class="EnSpace"/>
If the department determines that a central utility designated or required pursuant to this subparagraph is frequently failing to provide accurate information to
health care service plans, the department may consider no longer requiring or designating that central utility for use.
</html:p>
<html:p>
(iii)
<html:span class="EnSpace"/>
A health care service plan may require providers to update their information through the central utility to update the health care service plan’s provider directory. However, if the department requires a health care service plan to use or designate a central utility or central utilities, the health care service plan shall require providers to update their information through the central utility to update the health care service plan’s provider directory.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
If the plan can demonstrate it will meet the benchmarks required in paragraph (2) of subdivision (n) without using the central utility designated in subparagraph (B), the department may allow the plan to not use the central utility. If the plan fails to meet the benchmark in the future, the department
may require the plan to use the central utility as a method to achieve higher accuracy of provider directory listings to comply with paragraph (2) of subdivision (n).
</html:p>
<html:p>
(l)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
A plan shall take appropriate steps to ensure the accuracy of the information concerning each provider listed in the plan’s provider directory or directories in accordance with this section, and shall, at least annually, review and update the entire provider directory or directories for each product offered. Each calendar year the plan shall notify all contracted providers described in subdivisions (h) and (i) as follows:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
For individual providers who are not affiliated with a provider group described in subparagraph (A) or (B) of paragraph (8) of subdivision (h) and providers described in subdivision (i), the plan shall notify each provider at least once
every six months.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
For all other providers described in subdivision (h) who are not subject to the requirements of subparagraph (A), the plan shall notify its contracted providers to ensure that all of the providers are contacted by the plan at least once annually.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
The notification shall include all of the following:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
The information the plan has in its directory or directories regarding the provider or provider group, including a list of networks and plan products that include the contracted provider or provider group.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
A statement that the failure to respond to the notification may result in a delay of payment or reimbursement of a claim pursuant to subdivision
(q).
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
Instructions on how the provider or provider group can update the information in the provider directory or directories using the online interface developed pursuant to subdivision (m).
</html:p>
<html:p>
(D)
<html:span class="EnSpace"/>
A statement that failure to respond to the notification within five calendar days may result in a notice in their provider listing that states: “As of the last directory update, this provider is actively contracting with the plan. However, the provider has not responded to verify their listing information in the last update, so information may not be up to date.”
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
The plan shall require an affirmative response from the provider or provider group acknowledging that the
notification was received. Within 30 calendar days of receiving the notification, the provider or provider group shall confirm that the information in the provider directory or directories is current and accurate or update the information required to be in the directory or directories pursuant to this section, including whether or not the provider or provider group is accepting new patients for each plan product.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
If the plan does not receive an affirmative response and confirmation from the provider that the information is current and accurate or, as an alternative, updates any information required to be in the directory or directories pursuant to this section, within 30 business days, the plan shall take no more than 15 business days to verify
whether the provider’s information is correct or requires updates. The plan shall document the receipt and outcome of each attempt to verify the information. If the plan is unable to verify whether the provider’s information is correct or requires updates, the plan shall notify the provider 10 business days in advance of removal that the provider will be removed from the provider directory or directories. The provider shall be removed from the provider directory or directories at the next required update of the provider directory or directories after the 10-business-day notice period. A provider shall not be removed from the provider directory or directories if the provider responds before the end of the 10-business-day notice period.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
If a provider that was previously removed from the provider directory or directories requests to be added back to the provider directory or directories, or if a plan requests that a provider that was previously removed from the provider directory or directories be added back to the provider directory or directories, the health care service plan shall ensure the accuracy of the information required under this section and approve the request within 10 business days of receipt if accurate.
</html:p>
<html:p>
(6)
<html:span class="EnSpace"/>
If a provider does not respond within five calendar days, a health care service plan may include the following statement in the provider listing before removing the provider from the directory: “As of the last directory update, this provider is actively contracting with the plan. However, the provider has not responded to verify their listing information in the last update, so information may
not be up to date.”
</html:p>
<html:p>
(7)
<html:span class="EnSpace"/>
General acute care hospitals shall be exempt from the requirements in paragraphs (3)
to (5), inclusive.
</html:p>
<html:p>
(m)
<html:span class="EnSpace"/>
A plan shall establish policies and procedures with regard to the regular updating of its provider directory or directories, including the weekly, quarterly, and annual updates required pursuant to this section, or more frequently, if required by federal law or guidance. Providers shall submit any changes to the information required to be in the directory within 30 calendar days of any change.
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
The policies and procedures described under this subdivision shall be submitted by a plan annually to the department for approval and in a format described by the department pursuant to Section 1367.035.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Every health care service plan shall ensure
processes are in place to allow providers to promptly verify or submit changes to the information required to be in the directory or directories pursuant to this section. Those processes shall, at a minimum, include an online interface for providers to submit verification or changes electronically and shall generate an acknowledgment of receipt from the health care service plan. Providers shall verify or submit changes to information required to be in the directory or directories pursuant to this section using the process required by the health care service plan.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
The plan shall establish and maintain a process for enrollees, potential enrollees, other providers, and the public to identify and report possible inaccurate, incomplete, or misleading information currently listed in the plan’s provider directory or directories. This process shall, at a minimum, include a telephone number and a dedicated email address at which the plan will accept
these reports, as well as a hyperlink on the plan’s provider directory
internet website linking to a form where the information can be reported directly to the plan through its internet website.
</html:p>
<html:p>
(n)
<html:span class="EnSpace"/>
A plan shall be responsible for maintaining an accurate provider directory.
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
An accurate provider directory maintains accurate information for all information to be included in the directories pursuant to subdivisions (h) and (i).
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
The accuracy percentage of a directory shall be determined by the percentage of providers for which all information required
in subdivision (h) or (i) is accurate. If there is one error that would impact a patient’s access to care on a listing for a provider, that listing is considered inaccurate.
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
On July 1, 2026, a plan’s directories shall be at least 60 percent accurate.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
On or before July 1, 2027, a plan’s directories shall be at least 80 percent accurate.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
On or before July 1, 2028, a plan’s directories shall be at least 90 percent accurate.
</html:p>
<html:p>
(D)
<html:span class="EnSpace"/>
On or before July 1, 2029, a plan’s directories shall be at least 95 percent accurate.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
A plan shall annually verify its provider directories for accuracy of all of the information required pursuant to subdivisions (h) and (i). If the department develops
a methodology and standards that permit the use of a central utility or central utilities, and if a health care service plan uses a central utility for some or all of the plan’s provider directory, the plan shall ensure that information derived from the central utility is incorporated in the plan’s provider directory unless the plan can demonstrate that the information from the central utility is inaccurate. The plan using a central utility shall continue to retain responsibility for ensuring that the requirements of this section are satisfied, including in any contract or other agreement with the central utility. The department shall develop procedures and policies on how a plan shall conduct the verifications. In addition to verifying the information required under subdivisions (h) and (i), the plan shall do all of the following:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
In verifying the accuracy of information in the provider directory or directories, determine if a provider is
actively contracting, as defined by the department pursuant to subdivision (s).
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
Annually submit its accuracy verification reports and a declaration that the accuracy verification report is true and correct to the department to ensure compliance with this section.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
Publicly post its accuracy verification reports annually on its internet website.
</html:p>
<html:p>
(D)
<html:span class="EnSpace"/>
Verification of the accuracy of the printed directory shall be based on the date of printing, which shall be provided on each page of the printed directory.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
Failure by a health care service plan to comply with this section, including failure to meet the required benchmarks for accuracy, shall result in an administrative penalty consistent with this section and this chapter. In determining the
appropriate amount of an administrative penalty, a listing inaccuracy that would impact a patient’s access to care shall be treated as a denial of access to care for covered benefits.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
When assessing administrative penalties against a health care service plan, the director shall determine the appropriate penalty amount for each violation based on one or more factors as applicable, including the factors outlined in subdivision (d) of Section 1386. The director shall take into consideration evidence provided by the plan of the plan’s policies and procedures to obtain accurate provider information pursuant to this section and the plan’s use of a central utility in assessing penalties pursuant to this section.
</html:p>
<html:p>
(6)
<html:span class="EnSpace"/>
Beginning January 1, 2029, and every five years thereafter, the penalty amounts specified in this section shall be adjusted based on the average rate of change in premium
rates for the individual and small group markets, and weighted by enrollment, since the previous adjustment.
</html:p>
<html:p>
(o)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
This section does not prohibit a plan from requiring its provider groups or contracting specialized health care service plans to provide information to the plan that is required by the plan to satisfy the requirements of this section for each of the providers that contract with the provider group or contracting specialized health care service plan. This responsibility shall be specifically documented in a written contract between the plan and the provider group or contracting specialized health care service
plan.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
If a plan requires its contracting provider groups or contracting specialized health care service plans to provide the plan with information described in paragraph (1), the plan shall continue to retain responsibility for ensuring that the requirements of this section are satisfied.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
A provider group may terminate a contract with a provider for a pattern or repeated failure of the provider to update the information required to be in the directory or directories pursuant to this section.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
A provider group is not subject to the payment delay described in subdivision (q) if all of the following occurs:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
A provider does not respond to the provider group’s attempt to verify the provider’s information. As used in this paragraph, “verify” means to contact the provider in writing, electronically, and by telephone to confirm whether the provider’s information is correct or requires updates.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
The provider group documents its efforts to verify the provider’s information.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
The provider group reports to the plan that the provider should be deleted from the provider group in the plan directory or directories.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
Section 1375.7, known as the Health Care Providers’ Bill of Rights, applies to any material change to a provider contract pursuant to this section.
</html:p>
<html:p>
(p)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
Whenever a health care service plan receives a report indicating that information listed in its provider directory or directories is inaccurate, the plan shall promptly investigate the reported inaccuracy and, no later than 30 business days following receipt of the report, either verify the accuracy of the information or update the information in its provider directory or directories, as applicable.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
When investigating a report regarding its provider directory or directories, the plan shall, at a minimum, do the following:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
Contact the affected provider no later than five business days following receipt of the report.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
Document the receipt and outcome of each report. The documentation shall include the provider’s name, location, and a description of the plan’s investigation, the outcome of the investigation, and any changes or updates made to its provider directory or directories.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
If changes to a plan’s provider directory or directories are required as a result of the plan’s investigation, the changes to the online provider directory or directories shall be made no later than the next scheduled weekly update, or the update immediately following that update, or sooner if required by federal law or regulations. For printed provider directories, the change shall be made no later than the next required update, or sooner if required by federal law or regulations.
</html:p>
<html:p>
(q)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
Notwithstanding Sections 1371 and 1371.35, a plan may delay payment or reimbursement owed to a provider or provider group as specified in subparagraph (A) or (B), if the provider or provider group fails to respond to the plan’s attempts to verify the provider’s or provider group’s information as required under subdivision (l). The plan shall not delay payment unless it has attempted to verify the provider’s or provider group’s information. As used in this subdivision, “verify” means to contact the provider or provider group in writing, electronically, and by telephone to confirm whether the provider’s or provider group’s information is correct or requires updates. A plan may seek to delay payment or reimbursement owed to a provider or provider group only after the
10-business-day
notice period described in paragraph (4) of subdivision (l) has lapsed.
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
For a provider or provider group that receives compensation on a capitated or prepaid basis, the plan may delay no more than 50 percent of the next scheduled capitation payment for up to one calendar month.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
For any claims payment made to a provider or provider group, the plan may delay the claims payment for up to one calendar month beginning on the first day of the following month.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
A plan shall notify the provider or provider group 10 business days before it seeks to delay payment or reimbursement to a provider or provider group pursuant to this subdivision. If the plan delays a payment or reimbursement pursuant to this subdivision, the plan shall reimburse the full amount of any payment or reimbursement subject to
delay to the provider or provider group according to either of the following timelines, as applicable:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
No later than three business days following the date on which the plan receives the information required to be submitted by the provider or provider group pursuant to subdivision (l).
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
At the end of the one-calendar-month delay described in subparagraph (A) or (B) of paragraph (1), as applicable, if the provider or provider group fails to provide the information required to be submitted to the plan pursuant to subdivision (l).
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
A plan may terminate a contract for a pattern or repeated failure of the
provider or provider group to alert the plan to a change in the information required to be in the directory or directories pursuant to this section.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
A plan that delays payment or reimbursement under this subdivision shall document each instance a payment or reimbursement was delayed and report this information to the department in a format described by the department pursuant to Section 1367.035. This information shall be submitted along with the policies and procedures required to be submitted annually to the department pursuant to paragraph (1) of subdivision (m).
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
With respect to plans with Medi-Cal managed care contracts with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000), Chapter 8 (commencing with Section 14200), or Chapter 8.75 (commencing with Section 14591) of
Part 3 of Division 9 of the Welfare and Institutions Code, this subdivision shall be implemented only to the extent consistent with federal law and guidance.
</html:p>
<html:p>
(r)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
In circumstances where the department finds that an enrollee reasonably relied upon
inaccurate, incomplete, or misleading information contained in a health care service plan’s provider directory or directories, the health care service plan shall arrange care and provide coverage for all covered health care services provided to the enrollee, hold the enrollee harmless for any amount beyond what the enrollee would have
paid, had the services been delivered by an in-network provider under the enrollee’s plan contract, and reimburse the provider the out-of-network amount. The provider shall not collect any additional amount from the enrollee other than the applicable in-network cost sharing, which shall count toward any in-network deductible and the out-of-pocket maximum. Before requiring reimbursement in these circumstances, the department shall conclude that the services received by the enrollee were covered services under the enrollee’s plan contract. In those circumstances, the fact that the services were rendered or delivered by a noncontracting or out-of-plan provider shall not be used as a basis to deny reimbursement to the enrollee.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
If an enrollee, by telephone call or electronic means, requests information on whether or not a provider is contracted as an in-network provider to provide covered benefits, the health care service plan shall, if the request is by telephone, tell the enrollee verbally and follow up in writing or electronic format no later than two business days after receiving the request. If the request is by electronic means, the plan shall respond in writing or electronic format no later than one business day after receiving the request. The plan shall also check if the provider is accepting new patients at the time and inform the enrollee. The plan shall retain a record of the request and the plan’s response in the enrollee’s file for at least two years after the date of the request.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
If an enrollee obtained information through the plan’s online directory or a request consistent with
paragraph (2) that a provider was an in-network provider, subsequently receives covered benefits from that provider, and the enrollee receives a bill for an amount exceeding in-network cost sharing, the enrollee shall pay no more than in-network cost sharing if any of the following apply:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
The provider is not contracting with the health care service plan as an in-network provider for that product at the time the enrollee receives otherwise covered benefits from that provider.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
The information provided regarding the provider’s network status is otherwise inaccurate, misleading, or incomplete.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
The online provider directory of the health care service plan is not accessible to enrollees at the time the enrollee seeks information and the enrollee requests information consistent with paragraph (2).
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
If the health care service plan contract uses a tiered network with two or more in-network tiers with differential cost sharing, the plan shall document the cost-sharing tier that the provider is contracted to accept and shall provide that information to the enrollee when the enrollee seeks information about the provider. If the plan provides information indicating that a provider is on a lower cost-sharing tier and that information is not accurate, then the enrollee shall owe no more than the cost sharing for the lower cost-sharing tier.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
For purposes of this subdivision, the in-network cost sharing amount for a contracted provider includes copayments, deductibles, coinsurance, and any other form of cost sharing.
</html:p>
<html:p>
(6)
<html:span class="EnSpace"/>
For purposes of this subdivision, “information” is inaccurate, incomplete, or misleading if any
information in subdivision (h) or (i) regarding the provider’s network status is inaccurate, incomplete, or misleading.
</html:p>
<html:p>
(s)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
Whenever a plan determines as a result of this section that there has been a
10-percent change in the network for a product in a region, the plan shall file an amendment to the plan application with the department consistent with subdivision (f) of Section 1300.52 of Title 28 of the California Code of Regulations.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
For a health care service plan issued, amended, or renewed on or after July 1, 2026, if the number of providers who are not actively contracting pursuant to this section and have not responded to a plan’s notifications pursuant to subdivision (l) for at least 18 months amounts to 10 percent or greater of the providers in the network for a product in a region, then the plan shall file an amendment to the plan application consistent with subdivision (f) of Section 1300.52 of Title 28 of the California Code of Regulations.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
A plan shall not use information about a provider for purposes of compliance with timely access requirements, network adequacy determination, or compliance with any other provision of this chapter if the plan cannot demonstrate to the department that the provider is actively contracting as determined by the department.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
(A)
<html:span class="EnSpace"/>
The department shall determine the definition of “actively contracting,” and consider the degree of utilization for that provider by considering if the provider has one or more claims or encounters for covered benefits to enrollees in the relevant network, unless a special circumstance applies. In determining the utilization threshold for these purposes, the department shall not set a threshold greater than at least one claim or encounter for covered benefits for an enrollee every three calendar years.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
A special
circumstance may include a provider in a rural area, a highly specialized specialist who did not provide covered benefits for an enrollee in the prior three calendar years, or other circumstances as determined by the department through the regulatory or other rulemaking process. The department may issue guidance to implement, interpret, or make specific the requirements under this subparagraph. The guidance shall be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
Consistent with Section 1360, a plan shall not advertise or otherwise represent the extent of its network, including the number or type of contracting providers, unless it is able to demonstrate that each provider is contracting.
</html:p>
<html:p>
(t)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
This section applies to plans with Medi-Cal managed care
contracts with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000), Chapter 8 (commencing with Section 14200), or Chapter 8.75 (commencing with Section 14591) of the Welfare and Institutions Code to the extent consistent with federal law, rules, guidance, and regulations and state law and guidance issued after January 1, 2016, and not prohibited or otherwise contrary to federal law, rules, guidance, and regulations.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Notwithstanding any other provision to the contrary in a plan contract with the State Department of Health Care Services, and to the extent consistent with federal law and guidance and state guidance issued after January 1, 2016, a Medi-Cal managed care plan that complies with the requirements of this section shall not be required to distribute a printed provider directory or directories, except as required by paragraph (1) of subdivision (d). All other provisions of this section apply
to plans with Medi-Cal managed care contracts.
</html:p>
<html:p>
(u)
<html:span class="EnSpace"/>
A health care service plan that contracts with multiple employer welfare agreements regulated pursuant to Article 4.7 (commencing with Section 742.20) of Chapter 1 of Part 2 of Division 1 of the Insurance Code shall meet the requirements of this section.
</html:p>
<html:p>
(v)
<html:span class="EnSpace"/>
This section shall not be construed to alter a provider’s obligation to provide health care services to an enrollee pursuant to the provider’s contract with the plan.
</html:p>
<html:p>
(w)
<html:span class="EnSpace"/>
As part of the department’s routine examination of the fiscal and administrative affairs of a health care service plan pursuant to Section 1382, the department shall include a review of the health care service plan’s compliance with subdivision (q).
</html:p>
<html:p>
(x)
<html:span class="EnSpace"/>
For purposes of this section, “provider group” means a medical group, independent practice association, or other similar group of providers.
</html:p>
<html:p>
(y)
<html:span class="EnSpace"/>
Paragraphs (2), (4), (5), (6), (7), and (8) of subdivision (n) of this section do not apply to a Medi-Cal managed care plan that contracts with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) or Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code.
</html:p>
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</ns0:BillSection>
<ns0:BillSection id="id_832CEE97-7AA7-4912-ACD9-2BF3875F4AF5">
<ns0:Num>SEC. 4.</ns0:Num>
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Section 1374.72 of the
<ns0:DocName>Health and Safety Code</ns0:DocName>
is amended to read:
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<ns0:Fragment>
<ns0:LawSection id="id_FA307053-7DD4-42E9-93AB-9489FF41E671">
<ns0:Num>1374.72.</ns0:Num>
<ns0:LawSectionVersion id="id_ACB08FAA-844A-49B3-8155-29DD5C34BE41">
<ns0:Content>
<html:p>
(a)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
Every health care service plan contract issued, amended, or renewed on or after January 1, 2021, that provides hospital, medical, or surgical coverage shall provide coverage for medically necessary treatment of mental health and substance use disorders, under the same terms and conditions applied to other medical conditions as specified in subdivision (c).
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
For purposes of this section, “mental health and substance use disorders” means a mental health condition or substance use disorder that falls under any of the diagnostic categories listed in the mental and behavioral disorders chapter of the most recent edition of the International Classification of
Diseases or that is listed in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders. Changes in terminology, organization, or classification of mental health and substance use disorders in future versions of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders or the World Health Organization’s International Statistical Classification of Diseases and Related Health Problems shall not affect the conditions covered by this section as long as a condition is commonly understood to be a mental health or substance use disorder by health care providers practicing in relevant clinical specialties.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
(A)
<html:span class="EnSpace"/>
For purposes of this section, “medically necessary treatment of a mental health or substance use disorder” means a service or product
addressing the specific needs of that patient, for the purpose of preventing, diagnosing, or treating an illness, injury, condition, or its symptoms, including minimizing the progression of that illness, injury, condition, or its symptoms, in a manner that is all of the following:
</html:p>
<html:p>
(i)
<html:span class="EnSpace"/>
In accordance with the generally accepted standards of mental health and substance use disorder care.
</html:p>
<html:p>
(ii)
<html:span class="EnSpace"/>
Clinically appropriate in terms of type, frequency, extent, site, and duration.
</html:p>
<html:p>
(iii)
<html:span class="EnSpace"/>
Not primarily for the economic benefit of the health care service plan and subscribers or for the convenience of the patient, treating physician, or other health care provider.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
This paragraph
does not limit in any way the independent medical review rights of an enrollee or subscriber under this chapter.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
For purposes of this section, “health care provider” means any of the following:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
A person who is licensed under Division 2 (commencing with Section 500) of the Business and Professions Code.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
An associate marriage and family therapist or marriage and family therapist trainee functioning pursuant to Section 4980.43.3 of the Business and Professions Code.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
A qualified autism service provider certified by a national entity as defined in Section 4999.200 of the Business and Professions Code or a qualified autism service professional as defined
in Section 4999.201 of the Business and Professions Code.
</html:p>
<html:p>
(D)
<html:span class="EnSpace"/>
An associate clinical social worker functioning pursuant to Section 4996.23.2 of the Business and Professions Code.
</html:p>
<html:p>
(E)
<html:span class="EnSpace"/>
An associate professional clinical counselor or professional clinical counselor trainee functioning pursuant to Section 4999.46.3 of the Business and Professions Code.
</html:p>
<html:p>
(F)
<html:span class="EnSpace"/>
A registered psychologist, as described in Section 2909.5 of the Business and Professions Code.
</html:p>
<html:p>
(G)
<html:span class="EnSpace"/>
A registered psychological associate, as described in Section 2913 of the Business and Professions Code.
</html:p>
<html:p>
(H)
<html:span class="EnSpace"/>
A psychology trainee or person supervised as set forth
in Section 2910 or 2911 of, or subdivision (d) of Section 2914 of, the Business and Professions Code.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
For purposes of this section, “generally accepted standards of mental health and substance use disorder care” has the same meaning as defined in paragraph (1) of subdivision (f) of Section 1374.721.
</html:p>
<html:p>
(6)
<html:span class="EnSpace"/>
A health care service plan shall not limit benefits or coverage for mental health and substance use disorders to short-term or acute treatment.
</html:p>
<html:p>
(7)
<html:span class="EnSpace"/>
All medical necessity determinations by the health care service plan concerning service intensity, level of care placement, continued stay, and transfer or discharge of enrollees diagnosed with mental health and substance use disorders shall be conducted in
accordance with the requirements of Section 1374.721. This paragraph does not deprive an enrollee of the other protections of this chapter, including, but not limited to, grievances, appeals, independent medical review, discharge, transfer, and continuity of care.
</html:p>
<html:p>
(8)
<html:span class="EnSpace"/>
A health care service plan that authorizes a specific type of treatment by a provider pursuant to this section shall not rescind or modify the authorization after the provider renders the health care service in good faith and pursuant to this authorization for any reason, including, but not limited to, the plan’s subsequent rescission, cancellation, or modification of the enrollee’s or subscriber’s contract, or the plan’s subsequent determination that it did not make an accurate determination of the enrollee’s or subscriber’s eligibility. This section shall not be construed to expand
or alter the benefits available to the enrollee or subscriber under a plan.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
The benefits that shall be covered pursuant to this section shall include, but not be limited to, the following:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
Basic health care services, as defined in subdivision (b) of Section 1345.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Intermediate services, including the full range of levels of care, including, but not limited to, residential treatment, partial hospitalization, and intensive outpatient treatment.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
Prescription drugs, if the plan contract includes coverage for prescription drugs.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
The terms and conditions applied to the benefits required by
this section, that shall be applied equally to all benefits under the plan contract, shall include, but not be limited to, all of the following patient financial responsibilities:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
Maximum annual and lifetime benefits, if not prohibited by applicable law.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Copayments and coinsurance.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
Individual and family deductibles.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
Out-of-pocket maximums.
</html:p>
<html:p>
(d)
<html:span class="EnSpace"/>
If services for the medically necessary treatment of a mental health or substance use disorder are not available in network within the geographic and timely access standards set by law or regulation, the health care service plan shall arrange
coverage to ensure the delivery of medically necessary out-of-network services and any medically necessary followup services that, to the maximum extent possible, meet those geographic and timely access standards. As used in this subdivision, to “arrange coverage to ensure the delivery of medically necessary out-of-network services” includes, but is not limited to, providing services to secure medically necessary
out-of-network options that are available to the enrollee within geographic and timely access standards. The enrollee shall pay no more than the same cost sharing that the enrollee would pay for the same covered services received from an in-network provider.
</html:p>
<html:p>
(e)
<html:span class="EnSpace"/>
This section shall not apply to contracts entered into pursuant to Chapter 7 (commencing with Section 14000) or Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code, between the State Department of Health Care Services and a health care service plan for enrolled Medi-Cal beneficiaries.
</html:p>
<html:p>
(f)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
For the purpose of compliance with this section, a health care service plan may provide coverage for all or part of the mental health and substance
use disorder services required by this section through a separate specialized health care service plan or mental
health plan, and shall not be required to obtain an additional or specialized license for this purpose.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
A health care service plan shall provide the mental health and substance use disorder coverage required by this section in its entire service area and in emergency situations as may be required by applicable laws and regulations. For purposes of this section, health care service plan contracts that provide benefits to enrollees through preferred provider contracting arrangements are not precluded from requiring enrollees who reside or work in geographic areas served by specialized health care service plans or mental health plans to secure all or part of their mental health services within those geographic areas served by specialized health care service plans or mental health plans, provided that all appropriate
mental health or substance use disorder services are actually available within those geographic service areas within timeliness standards.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
Notwithstanding any other 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, provided that these practices are consistent with Section 1374.76 of this code, and Section 2052 of the Business and Professions Code.
</html:p>
<html:p>
(g)
<html:span class="EnSpace"/>
This section shall not be construed to deny or restrict in any way the department’s authority to ensure plan compliance with this chapter.
</html:p>
<html:p>
(h)
<html:span class="EnSpace"/>
A health care service plan shall not limit benefits or coverage for
medically necessary services on the basis that those services should be or could be covered by a public entitlement program, including, but not limited to, special education or an individualized education program, Medicaid, Medicare, Supplemental Security Income, or Social Security Disability Insurance, and shall not include or enforce a contract term that excludes otherwise covered benefits on the basis that those services should be or could be covered by a public entitlement program.
</html:p>
<html:p>
(i)
<html:span class="EnSpace"/>
A health care service plan shall not adopt, impose, or enforce terms in its plan contracts or provider agreements, in writing or in operation, that undermine, alter, or conflict with the requirements of this section.
</html:p>
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</ns0:BillSection>
<ns0:BillSection id="id_F9840B15-26CD-42B6-B9F1-65A4B9073090">
<ns0:Num>SEC. 5.</ns0:Num>
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Section 1374.73 of the
<ns0:DocName>Health and Safety Code</ns0:DocName>
is amended to read:
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<ns0:LawSection id="id_98B0A4EB-DE9D-45DC-BD25-A52D6EF7FDF2">
<ns0:Num>1374.73.</ns0:Num>
<ns0:LawSectionVersion id="id_B05BA9E5-A278-482B-8576-2AA566E2F92D">
<ns0:Content>
<html:p>
(a)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
Every health care service plan contract that provides hospital, medical, or surgical coverage shall also provide coverage for behavioral health treatment for pervasive developmental disorder or autism no later than July 1, 2012. The coverage shall be provided in the same manner and is subject to the same requirements as provided in Section 1374.72.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
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).
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
This section does 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.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
This section does 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 individual service plan, as described in Section 5600.4 of the Welfare and Institutions Code, or under the federal Individuals with Disabilities Education Act (20 U.S.C. Sec. 1400 et
seq.) and its implementing regulations.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
Every health care service plan subject to this section shall maintain an adequate network that includes qualified autism service providers who supervise or employ qualified autism service professionals or paraprofessionals who provide and administer behavioral health treatment. A health care service plan is not prevented from selectively contracting with providers within these requirements.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
For the purposes of this section, the following definitions shall apply:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
“Behavioral health treatment” means professional services and treatment programs, including applied behavior analysis and evidence-based 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:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
The treatment is prescribed by a physician and surgeon licensed pursuant to Chapter 5 (commencing with Section 2000) of, or is developed by a psychologist licensed pursuant to Chapter 6.6 (commencing with Section 2900) of, Division 2 of the Business and Professions Code.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
The treatment is provided under a treatment plan prescribed by a qualified autism service provider and is administered by one of the following:
</html:p>
<html:p>
(i)
<html:span class="EnSpace"/>
A qualified autism service provider.
</html:p>
<html:p>
(ii)
<html:span class="EnSpace"/>
A qualified autism service professional
supervised by the qualified autism service provider.
</html:p>
<html:p>
(iii)
<html:span class="EnSpace"/>
A qualified autism service paraprofessional supervised by a qualified autism service provider or qualified autism service professional.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
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:
</html:p>
<html:p>
(i)
<html:span class="EnSpace"/>
Describes the patient’s
behavioral health impairments or developmental challenges that are to be treated.
</html:p>
<html:p>
(ii)
<html:span class="EnSpace"/>
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.
</html:p>
<html:p>
(iii)
<html:span class="EnSpace"/>
Provides intervention plans that utilize evidence-based practices, with demonstrated clinical efficacy in treating pervasive developmental disorder or autism.
</html:p>
<html:p>
(iv)
<html:span class="EnSpace"/>
Discontinues intensive behavioral intervention services when the treatment goals and objectives are achieved or no longer appropriate.
</html:p>
<html:p>
(D)
<html:span class="EnSpace"/>
The treatment plan is not used for
purposes of providing or for the reimbursement of respite, day care, or educational 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.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
“Qualified autism service provider” means an individual described in Section 4999.200 of the Business and Professions Code.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
“Qualified autism service professional” means an individual who meets all of the criteria set forth in Section 4999.201 of the Business and Professions Code.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
“Qualified autism service paraprofessional” means an unlicensed and uncertified individual who meets all of the criteria set forth in Section 4999.202 of the Business
and Professions Code.
</html:p>
<html:p>
(d)
<html:span class="EnSpace"/>
This section does not apply to any of the following:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
A specialized health care service plan that does not deliver mental health or behavioral health services to enrollees.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
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).
</html:p>
<html:p>
(e)
<html:span class="EnSpace"/>
This section does not limit the obligation to provide services under Section 1374.72.
</html:p>
<html:p>
(f)
<html:span class="EnSpace"/>
As provided in Section 1374.72 and in paragraph (1) of subdivision (a), 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.
</html:p>
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<ns0:BillSection id="id_9FF632A7-6C09-46FA-8DD5-7BF66AAAE8AB">
<ns0:Num>SEC. 5.5.</ns0:Num>
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Section 1374.73 of the
<ns0:DocName>Health and Safety Code</ns0:DocName>
is amended to read:
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<ns0:LawSection id="id_2F30BB14-F711-49B9-9C00-E351EC5B04E0">
<ns0:Num>1374.73.</ns0:Num>
<ns0:LawSectionVersion id="id_A3921EE1-CD7D-4859-B2D0-4A4B4B370AFF">
<ns0:Content>
<html:p>
(a)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
Every health care service plan contract that provides hospital, medical, or surgical coverage shall also provide coverage for behavioral health treatment for pervasive developmental disorder or autism no later than July 1, 2012. The coverage shall be provided in the same manner and is subject to the same requirements as provided in Section 1374.72.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Notwithstanding paragraph (1), as of the date that the 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).
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
This section does 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.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
This section does 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 individual service plan, as described in Section 5600.4 of the Welfare and Institutions Code, or under the federal Individuals with Disabilities Education Act (20 U.S.C. Sec. 1400 et
seq.) and its implementing regulations.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
Every health care service plan subject to this section shall maintain an adequate network that includes qualified autism service providers who supervise or employ qualified autism service professionals or paraprofessionals who provide and administer behavioral health treatment. A health care service plan is not prevented from selectively contracting with providers within these requirements.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
A health care service plan contract issued, amended, or renewed on or after January 1, 2026, shall not require an enrollee previously diagnosed with pervasive developmental disorder or autism to receive a rediagnosis to maintain coverage for behavioral health treatment for pervasive developmental disorder or autism.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
This subdivision does not prohibit or restrict a treating provider from reevaluating an enrollee for purposes of determining the appropriate treatment. The treatment plan shall be made available to the health care service plan upon request.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
This subdivision does not prohibit a treating provider from prescribing a rediagnosis at the discretion of the physician licensed pursuant to Chapter 5 (commencing with Section 2000) of Division 2 of the Business and Professions Code or a psychologist licensed pursuant to Chapter 6.6 (commencing with Section 2900) of Division 2 of the Business and Professions Code.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
A health care service plan shall not discontinue or delay existing treatment while waiting for a rediagnosis to be
completed.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
This subdivision does not prohibit a health care service plan from requiring utilization review. For the purpose of this section, utilization review is distinct from a rediagnosis.
</html:p>
<html:p>
(d)
<html:span class="EnSpace"/>
For the purposes of this section, the following definitions shall apply:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
“Behavioral health treatment” means professional services and treatment programs, including applied behavior analysis and evidence-based 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:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
The treatment is prescribed by
a physician and surgeon licensed pursuant to Chapter 5 (commencing with Section 2000) of, or is developed by a psychologist licensed pursuant to Chapter 6.6 (commencing with Section 2900) of, Division 2 of the Business and Professions Code.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
The treatment is provided under a treatment plan prescribed by a qualified autism service provider and is administered by one of the following:
</html:p>
<html:p>
(i)
<html:span class="EnSpace"/>
A qualified autism service provider.
</html:p>
<html:p>
(ii)
<html:span class="EnSpace"/>
A qualified autism service professional supervised by the qualified autism service provider.
</html:p>
<html:p>
(iii)
<html:span class="EnSpace"/>
A qualified autism service paraprofessional supervised by a qualified autism service provider or qualified autism service professional.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
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:
</html:p>
<html:p>
(i)
<html:span class="EnSpace"/>
Describes the patient’s behavioral health impairments or developmental challenges that are to be treated.
</html:p>
<html:p>
(ii)
<html:span class="EnSpace"/>
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.
</html:p>
<html:p>
(iii)
<html:span class="EnSpace"/>
Provides intervention plans that utilize evidence-based practices, with demonstrated clinical efficacy in treating pervasive developmental disorder or autism.
</html:p>
<html:p>
(iv)
<html:span class="EnSpace"/>
Discontinues intensive behavioral intervention services when the treatment goals and objectives are achieved or no longer appropriate.
</html:p>
<html:p>
(D)
<html:span class="EnSpace"/>
The treatment plan is not used for purposes of providing or for the reimbursement of respite, daycare, or educational 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.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
“Qualified autism service provider” means an individual described in Section 4999.200 of the Business and Professions Code.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
“Qualified autism service professional” means an individual who meets all of the criteria set forth in Section 4999.201 of the Business and Professions Code.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
“Qualified autism service paraprofessional” means an unlicensed and uncertified individual who meets all of the criteria set forth in Section 4999.202 of the Business and Professions Code.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
“Rediagnosis” means a subsequent undertaking by any method, device, or procedure, whether gratuitous or not, to ascertain or establish if a person is suffering from a physical
or mental health disorder, pursuant to Section 2038 of the Business and Professions Code. “Rediagnosis” also means prescription of a subsequent diagnosis of pervasive developmental disorders or autism to ascertain or establish if a person is suffering from a pervasive developmental disorder or autism.
</html:p>
<html:p>
(6)
<html:span class="EnSpace"/>
“Utilization review” means utilization review or utilization management functions that prospectively, retrospectively, or concurrently review and approve, modify, or deny, based in whole or in part on medical necessity to cure and relieve, treatment recommendations by physicians licensed pursuant to Chapter 5 (commencing with Section 2000) of Division 2 of the Business and Professions Code before, after, or concurrent with the provision of medical treatment services. “Utilization review” refers to an evaluation of existing treatment
to ensure an enrollee receives the proper care at the proper time.
</html:p>
<html:p>
(e)
<html:span class="EnSpace"/>
This section does not apply to either of the following:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
A specialized health care service plan that does not deliver mental health or behavioral health services to enrollees.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
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).
</html:p>
<html:p>
(f)
<html:span class="EnSpace"/>
This section does not limit the obligation to provide services under Section 1374.72.
</html:p>
<html:p>
(g)
<html:span class="EnSpace"/>
As provided in Section 1374.72 and in paragraph (1) of subdivision (a), 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.
</html:p>
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<ns0:BillSection id="id_44DA2D7C-97B9-4952-977A-E5D1C3192B98">
<ns0:Num>SEC. 6.</ns0:Num>
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Section 10133.15 of the
<ns0:DocName>Insurance Code</ns0:DocName>
is amended to read:
</ns0:ActionLine>
<ns0:Fragment>
<ns0:LawSection id="id_C0E0A55D-F69B-47E6-A33A-9A46148831DC">
<ns0:Num>10133.15.</ns0:Num>
<ns0:LawSectionVersion id="id_3961E781-2BD6-428A-8A03-01241FFE0447">
<ns0:Content>
<html:p>
(a)
<html:span class="EnSpace"/>
Commencing July 1, 2016, a health insurer that contracts with providers for alternative rates of payment pursuant to Section 10133 shall publish and maintain provider directory or directories with information on contracting providers that deliver health care services to the insurer’s insureds, including those that accept new patients. A provider directory shall not list or include information on a provider that is not currently under contract with the insurer.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
An insurer shall provide the online directory or directories for the specific network offered for each product using a consistent method of network and product naming, numbering, or other classification
method that ensures the public, insureds, potential insureds, the department, and other state or federal agencies can easily identify the networks and insurer products in which a provider participates. By July 31, 2017, or 12 months after the date provider directory standards are developed under subdivision (k), whichever occurs later, an insurer shall use the naming, numbering, or classification method developed by the department pursuant to subdivision (k).
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
An online provider directory or directories shall be available on the insurer’s internet website to the public, potential insureds, insureds, and providers without any restrictions or limitations. The directory or directories shall be accessible without any requirement that an individual seeking the directory information demonstrate coverage with the insurer,
indicate interest in obtaining coverage with the insurer, provide a member identification or policy number, provide any other identifying information, or create or access an account.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
The online provider directory or directories shall be accessible on the insurer’s public internet website through an identifiable link or tab and in a manner that is accessible and searchable by insureds, potential insureds, the public, and providers. By July 1, 2017, or 12 months after the date provider directory standards are developed under subdivision (k), whichever occurs later, the insurer’s public internet website shall allow provider searches by, at a minimum, name, practice address, city, ZIP Code, California license number, National Provider Identifier number, admitting privileges to an identified hospital, product, tier, provider language
or languages, provider group, hospital name, facility name, or clinic name, as appropriate.
</html:p>
<html:p>
(d)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
An insurer shall allow insureds, potential insureds, providers, and members of the public to request a printed copy of the provider directory or directories by contacting the insurer through the insurer’s toll-free telephone number, electronically, or in writing. A printed copy of the provider directory or directories shall include the information required in subdivisions (h) and (i). The printed copy of the provider directory or directories shall be provided to the requester by mail postmarked no later than five business days following the date of the request and may be limited to the geographic region in which the requester resides or works or intends to reside or work.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
An insurer shall update its printed provider directory or directories at least quarterly, or more frequently, if required by federal law.
</html:p>
<html:p>
(e)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
The insurer shall update the online provider directory or directories, at least weekly, or more frequently, if required by federal law, when informed of and upon confirmation by the insurer of any of the following:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
A contracting provider is no longer accepting new patients for that product, or an individual provider within a provider group is no longer accepting new patients.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
A contracted provider is no longer under contract for a particular product.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
A provider’s practice
location or other information required under subdivision (h) or (i) has changed.
</html:p>
<html:p>
(D)
<html:span class="EnSpace"/>
Upon the completion of the investigation described in subdivision (o), a change is necessary based on an insured complaint that a provider was not accepting new patients, was otherwise not available, or whose contact information was listed incorrectly.
</html:p>
<html:p>
(E)
<html:span class="EnSpace"/>
Any other information that affects the content or accuracy of the provider directory or directories.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Upon confirmation of any of the following, the insurer shall delete a provider from the directory or directories when:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
A provider has retired or otherwise has ceased to practice.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
A provider or provider group is no longer under contract with the insurer for any reason.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
The contracting provider group has informed the insurer that the provider is no longer associated with the provider group and is no longer under contract with the insurer.
</html:p>
<html:p>
(f)
<html:span class="EnSpace"/>
The provider directory or directories shall include both an email address and a telephone number for members of the public and providers to notify the insurer if the provider directory information appears to be inaccurate. This information shall be disclosed prominently in the directory or directories and on the insurer’s internet website.
</html:p>
<html:p>
(g)
<html:span class="EnSpace"/>
The provider directory or directories shall include the following disclosures informing insureds
that they are entitled to both of the following:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
Language interpreter services, at no cost to the insured, including how to obtain interpretation services in accordance with Section 10133.8.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Full and equal access to covered services, including insureds with disabilities as required under the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973.
</html:p>
<html:p>
(h)
<html:span class="EnSpace"/>
The insurer and a specialized mental health insurer shall include all of the following information in the provider directory or directories:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
The provider’s name, practice location or locations, and contact information.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Type of practitioner.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
National Provider Identifier number.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
California license number and type of license.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
The area of specialty, including board certification, if any.
</html:p>
<html:p>
(6)
<html:span class="EnSpace"/>
The provider’s office email address, if available.
</html:p>
<html:p>
(7)
<html:span class="EnSpace"/>
The name of each affiliated provider group currently under contract with the insurer through which the provider sees insureds.
</html:p>
<html:p>
(8)
<html:span class="EnSpace"/>
A listing for each of the following providers that are under contract with the insurer:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
For physicians and surgeons, the provider group, and admitting privileges, if any, at hospitals contracted with the insurer.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
Nurse practitioners, physician assistants, psychologists, acupuncturists, optometrists, podiatrists, chiropractors, licensed clinical social workers, marriage and family therapists, professional clinical counselors, qualified autism service providers, as defined in Section 4999.200 of the Business and Professions Code, nurse midwives, and dentists.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
For federally qualified health centers or primary care clinics, the name of the federally
qualified health center or clinic.
</html:p>
<html:p>
(D)
<html:span class="EnSpace"/>
For a provider described in subparagraph (A) or (B) who
is employed by a federally qualified health center or primary care clinic, and to the extent their services may be accessed and are covered through the contract with the insurer, the name of the provider, and the name of the federally qualified health center or clinic.
</html:p>
<html:p>
(E)
<html:span class="EnSpace"/>
Facilities, including, but not limited to, general acute care hospitals, skilled nursing facilities, urgent care clinics, ambulatory surgery centers, inpatient hospice, residential care facilities, and inpatient rehabilitation facilities.
</html:p>
<html:p>
(F)
<html:span class="EnSpace"/>
Pharmacies, clinical laboratories, imaging centers, and other facilities providing contracted health care services.
</html:p>
<html:p>
(9)
<html:span class="EnSpace"/>
The provider directory or directories may note that authorization or
referral may be required to access some providers.
</html:p>
<html:p>
(10)
<html:span class="EnSpace"/>
Non-English language, if any, spoken by a health care provider or other medical professional as well as non-English language spoken by a qualified medical interpreter, in accordance with Section 10133.8, if any, on the provider’s staff.
</html:p>
<html:p>
(11)
<html:span class="EnSpace"/>
Identification of providers who no longer accept new patients for some or all of the insurer’s products.
</html:p>
<html:p>
(12)
<html:span class="EnSpace"/>
The network tier to which the provider is assigned, if the provider is not in the lowest tier, as applicable. Nothing in this section shall be construed to require the use of network tiers other than contract and noncontracting tiers.
</html:p>
<html:p>
(13)
<html:span class="EnSpace"/>
All other information
necessary to conduct a search pursuant to paragraph (2) of subdivision (c).
</html:p>
<html:p>
(i)
<html:span class="EnSpace"/>
A vision, dental, or other specialized insurer, except for a specialized mental health insurer, shall include all of the following information for each provider directory or directories used by the insurer for its networks:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
The provider’s name, practice location or locations, and contact information.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Type of practitioner.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
National Provider Identifier number.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
California license number and type of license, if applicable.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
The area of specialty,
including board certification, or other
accreditation, if any.
</html:p>
<html:p>
(6)
<html:span class="EnSpace"/>
The provider’s office email address, if available.
</html:p>
<html:p>
(7)
<html:span class="EnSpace"/>
The name of each affiliated provider group or specialty insurer practice group currently under contract with the insurer through which the provider sees insureds.
</html:p>
<html:p>
(8)
<html:span class="EnSpace"/>
The names of each allied health care professional to the extent there is a direct contract for those services covered through a contract with the insurer.
</html:p>
<html:p>
(9)
<html:span class="EnSpace"/>
The non-English language, if any, spoken by a health care provider or other medical professional as well as non-English language spoken by a qualified medical interpreter, in accordance with Section 10133.8, if any, on the provider’s staff.
</html:p>
<html:p>
(10)
<html:span class="EnSpace"/>
Identification of providers who no longer accept new patients for some or all of the insurer’s products.
</html:p>
<html:p>
(11)
<html:span class="EnSpace"/>
All other applicable information necessary to conduct a provider search pursuant to paragraph (2) of subdivision (c).
</html:p>
<html:p>
(j)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
The contract between the insurer and a provider shall include a requirement that the provider inform the insurer within five business days when either of the following occurs:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
The provider is not accepting new patients.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
If the provider had previously not accepted new patients, the provider is currently accepting new patients.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
If a provider who is not accepting new patients is contacted by an insured or potential insured seeking to become a new patient, the provider shall direct the insurer or potential insured to both the insurer for additional assistance in finding a provider and to the department to report any inaccuracy with the insurer’s directory or directories.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
If an insured or potential insured informs an insurer of a possible inaccuracy in the provider directory or directories, the insurer shall promptly investigate and, if necessary, undertake corrective action within 30 business days to ensure the accuracy of the directory or directories.
</html:p>
<html:p>
(k)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
On or before December 31, 2016, the department shall develop
uniform provider directory standards to permit consistency in accordance with subdivision (b) and paragraph (2) of subdivision (c) and development of a multiplan directory by another entity. Those standards shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code), until January 1, 2021. No more than two revisions of those standards shall be exempt from the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code) pursuant to this subdivision.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
In developing the standards under this subdivision, the department shall seek input from interested parties throughout the process of developing the standards and shall hold at least one public meeting. The department shall
take into consideration any requirements for provider directories established by the federal Centers for Medicare and Medicaid Services and the State Department of Health Care Services.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
By July 31, 2017, or 12 months after the date provider directory standards are developed under this subdivision, whichever occurs later, an insurer shall use the standards developed by the department for each product offered by the insurer.
</html:p>
<html:p>
(l)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
An insurer shall take appropriate steps to ensure the accuracy of the information concerning each provider listed in the insurer’s provider directory or directories in accordance with this section, and shall, at least annually, review and update the entire provider directory or directories for each product offered. Each calendar
year the insurer shall notify all contracted providers described in subdivisions (h) and (i) as follows:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
For individual providers who are not affiliated with a provider group described in subparagraph (A) or (B) of paragraph (8) of subdivision (h) and providers described in subdivision (i), the insurer shall notify each provider at least once every six months.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
For all other providers described in subdivision (h) who are not subject to the requirements of subparagraph (A), the insurer shall notify its contracted providers to ensure that all of the providers are contacted by the insurer at least once annually.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
The notification shall include all of the following:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
The information the insurer has in its directory or directories regarding the provider or provider group, including a list of networks and products that include the contracted provider or provider group.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
A statement that the failure to respond to the notification may result in a delay of payment or reimbursement of a claim pursuant to subdivision (p).
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
Instructions on how the provider or provider group can update the information in the provider directory or directories using the online interface developed pursuant to subdivision (m).
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
The insurer shall require an affirmative response from the provider or provider group acknowledging that the notification was received. The provider or provider
group shall confirm that the information in the provider directory or directories is current and accurate or update the information required to be in the directory or directories pursuant to this section, including whether or not the provider group is accepting new patients for each product.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
If the insurer does not receive an affirmative response and confirmation from the provider that the information is current and accurate or, as an alternative, updates any information required to be in the directory or directories pursuant to this section, within 30 business days, the insurer shall take no more than 15 business days to verify whether the provider’s information is correct or requires updates. The insurer shall document the receipt and outcome of each attempt to verify the information. If the insurer is unable to verify whether
the provider’s information is correct or requires updates, the insurer shall notify the provider 10 business days in advance of removal that the provider will be removed from the directory or directories. The provider shall be removed from the directory or directories at the next required update of the provider directory or directories after the 10-business day notice period. A provider shall not be removed from the provider directory or directories if they respond before the end of the 10-business day notice period.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
General acute care hospitals shall be exempt from the requirements in paragraphs (3) and (4).
</html:p>
<html:p>
(m)
<html:span class="EnSpace"/>
An insurer shall establish policies and procedures with regard to the regular updating of its provider directory or directories, including the weekly, quarterly, and
annual updates required pursuant to this section, or more frequently, if required by federal law or guidance.
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
The policies and procedures described under this subdivision shall be submitted by an insurer annually to the department for approval and in a format described by the department.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Every insurer shall ensure processes are in place to allow providers to promptly verify or submit changes to the information required to be in the directory or directories pursuant to this section.
Those processes shall, at a minimum, include an online interface for providers to submit verification or changes electronically and shall generate an acknowledgment of receipt from the insurer. Providers shall verify or submit changes to information required to be in the directory or directories pursuant to this section using the process required by the insurer.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
The insurer shall establish and maintain a process for insureds, potential insureds, other providers, and the public to identify and report possible inaccurate, incomplete, or misleading information currently listed in the insurer’s provider directory or directories. This process shall, at a minimum, include a telephone number and a dedicated email address at which the insurer will accept these reports, as well as a hyperlink on the insurer’s provider directory
internet website linking to a form where the information can be reported directly to the insurer through its internet website.
</html:p>
<html:p>
(n)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
This section does not prohibit an insurer from requiring its provider groups or contracting specialized health insurers to provide information to the insurer that is required by the insurer to satisfy the requirements of this section for each of the providers that contract with the provider group or contracting specialized health insurer. This responsibility shall be specifically documented in a written contract between the insurer and the provider group or contracting specialized health insurer.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
If an insurer requires its contracting provider groups or contracting specialized health insurers to provide the insurer with information
described in paragraph (1), the insurer shall continue to retain responsibility for ensuring that the requirements of this section are satisfied.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
A provider group may terminate a contract with a provider for a pattern or repeated failure of the provider to update the information required to be in the directory or directories pursuant to this section.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
A provider group is not subject to the payment delay described in subdivision (p) if all of the following occurs:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
A provider does not respond to the provider group’s attempt to verify the provider’s information. As used in this paragraph, “verify” means to contact the provider in writing, electronically, and by telephone to confirm whether the provider’s
information is correct or requires updates.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
The provider group documents its efforts to verify the provider’s information.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
The provider group reports to the insurer that the provider should be deleted from the provider group in the insurer’s provider directory or directories.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
Section 10133.65, known as the Health Care Providers’ Bill of Rights, applies to any material change to a provider contract pursuant to this section.
</html:p>
<html:p>
(o)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
Whenever an insurer receives a report indicating that information listed in its provider directory or directories is inaccurate, the insurer shall promptly investigate the reported inaccuracy
and, no later than 30 business days following receipt of the report, either verify the accuracy of the information or update the information in its provider directory or directories, as applicable.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
When investigating a report regarding its provider directory or directories, the insurer shall, at a minimum, do the following:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
Contact the affected provider no later than five business days following receipt of the report.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
Document the receipt and outcome of each report. The documentation shall include the provider’s name, location, and a description of the insurer’s investigation, the outcome of the investigation, and any changes or updates made to its provider directory or directories.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
If changes to an insurer’s provider directory or directories are required as a result of the insurer’s investigation, the changes to the online provider directory or directories shall be made no later than the next scheduled weekly update, or the update immediately following that update, or sooner if required by federal law or regulations. For printed provider directories, the change shall be made no later than the next required update, or sooner if required by federal law or regulations.
</html:p>
<html:p>
(p)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
Notwithstanding Sections 10123.13 and 10123.147, an insurer may delay payment or reimbursement owed to a provider or provider group for any claims payment made to a provider or provider group for up to one calendar month beginning on the first day of the following
month, if the provider or provider group fails to respond to the insurer’s attempts to verify the provider’s information as required under subdivision (l). The insurer shall not delay payment unless it has attempted to verify the provider’s or provider group’s information. As used in this subdivision, “verify” means to contact the provider or provider group in writing, electronically, and by telephone to confirm whether the provider’s or provider group’s information is correct or requires updates. An insurer may seek to delay payment or reimbursement owed to a provider or provider group only after the 10-business day notice period described in paragraph (4) of subdivision (l) has lapsed.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
An insurer shall notify the provider or provider group 10 days before it seeks to delay payment or reimbursement to a provider or provider group pursuant
to this subdivision. If the insurer delays a payment or reimbursement pursuant to this subdivision, the insurer shall reimburse the full amount of any payment or reimbursement subject to delay to the provider or provider group according to either of the following timelines, as applicable:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
No later than three business days following the date on which the insurer receives the information required to be submitted by the provider or provider group pursuant to subdivision (l).
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
At the end of the one-calendar-month delay described in paragraph (1), if the provider or provider group fails to provide the information required to be submitted to the insurer pursuant to subdivision (l).
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
An insurer may terminate a
contract for a pattern or repeated failure of the provider or provider group to alert the insurer to a change in the information required to be in the directory or directories pursuant to this section.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
An insurer that delays payment or reimbursement under this subdivision shall document each instance a payment or reimbursement was delayed and report this information to the department in a format described by the department. This information shall be submitted along with the policies and procedures required to be submitted annually to the department pursuant to paragraph (1) of subdivision (m).
</html:p>
<html:p>
(q)
<html:span class="EnSpace"/>
In circumstances where the department finds that an insured reasonably relied upon materially inaccurate, incomplete, or misleading information contained in an insurer’s provider
directory or directories, the department may require the insurer to provide coverage for all covered health care services provided to the insured and to reimburse the insured for any amount beyond what the insured would have paid, had the services been delivered by an in-network provider under the insured’s health insurance policy. Prior to requiring reimbursement in these circumstances, the department shall conclude that the services received by the insured were covered services under the insured’s health insurance policy. In those circumstances, the fact that the services were rendered or delivered by a noncontracting or out-of-network provider shall not be used as a basis to deny reimbursement to the insured.
</html:p>
<html:p>
(r)
<html:span class="EnSpace"/>
Whenever an insurer determines as a result of this section that there has been a 10-percent change in the network for a product in
a region, the insurer shall file a statement with the commissioner.
</html:p>
<html:p>
(s)
<html:span class="EnSpace"/>
An insurer that contracts with multiple employer welfare agreements regulated pursuant to Article 4.7 (commencing with Section 742.20) of Chapter 1 of Part 2 of Division 1 shall meet the requirements of this section.
</html:p>
<html:p>
(t)
<html:span class="EnSpace"/>
This section shall not be construed to alter a provider’s obligation to provide health care services to an insured pursuant to the provider’s contract with the insurer.
</html:p>
<html:p>
(u)
<html:span class="EnSpace"/>
As part of the department’s routine examination of a health insurer pursuant to Section 730, the department shall include a review of the health insurer’s compliance with subdivision (p).
</html:p>
<html:p>
(v)
<html:span class="EnSpace"/>
For purposes of
this section, “provider group” means a medical group, independent practice association, or other similar group of providers.
</html:p>
</ns0:Content>
</ns0:LawSectionVersion>
</ns0:LawSection>
</ns0:Fragment>
</ns0:BillSection>
<ns0:BillSection id="id_74084DFD-5A79-4645-BD23-E43E9719F902">
<ns0:Num>SEC. 6.5.</ns0:Num>
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Section 10133.15 of the
<ns0:DocName>Insurance Code</ns0:DocName>
is amended to read:
</ns0:ActionLine>
<ns0:Fragment>
<ns0:LawSection id="id_0A336790-F4EE-48D4-AC6F-699D15BFC654">
<ns0:Num>10133.15.</ns0:Num>
<ns0:LawSectionVersion id="id_25566C1E-5D4B-4390-A65A-8627B13406D7">
<ns0:Content>
<html:p>
(a)
<html:span class="EnSpace"/>
A health insurer that contracts with providers for alternative rates of payment pursuant to Section 10133 shall publish and maintain a provider directory or directories with information on contracting providers that deliver health care services to the insurer’s insureds, including those that accept new patients. A provider directory shall not list or include information on a provider that is not currently under contract with the insurer.
Commencing July 1, 2026, a health insurer shall comply with this section as it read on January 1, 2026.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
An insurer shall provide the online directory or directories for the specific network offered for each product using a consistent method of network and product naming, numbering, or other classification method that ensures the public, insureds, potential insureds, contracting providers, the department, and other state or federal agencies can easily identify the networks and insurer products in which a provider participates. By July 31, 2017, or 12 months after the date provider directory standards are developed under subdivision (k), whichever occurs later, an insurer shall use the naming, numbering, or classification method developed by the department pursuant to subdivision (k).
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
An online provider directory or directories shall be available on the insurer’s internet website to the public, potential insureds, insureds, and providers without any restrictions or limitations. The directory or directories shall be accessible without any requirement that an individual seeking the directory information demonstrate coverage with the insurer, indicate interest in obtaining coverage with the insurer, provide a member identification or policy number, provide any other identifying information, or create or access an account.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
The online provider directory or directories shall be accessible on the insurer’s public
internet website through an identifiable link or tab and in a manner that is accessible and searchable by insureds, potential insureds, the public, and providers. By July 1, 2017, or 12 months after the date provider directory standards are developed under subdivision (k), whichever occurs later, the insurer’s public internet website shall allow provider searches by, at a minimum, name, practice address, city, ZIP Code, California license number, National Provider Identifier number, admitting privileges to an identified hospital, product, tier, provider language or languages, provider group, hospital name, facility name, or clinic name, as
appropriate, and the information provided shall be verified and accurate, consistent with this section.
</html:p>
<html:p>
(d)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
An insurer shall allow insureds, potential insureds, providers, and members of the public to request a printed copy of the provider directory or directories by contacting the insurer through the insurer’s toll-free telephone number, electronically, or in writing. A printed copy of the provider directory or directories shall include the information required in subdivisions (h) and (i). The printed copy of the provider directory or directories shall be provided to the requester by mail postmarked no later than five business days following the date of the request and may be limited to the geographic region in which the requester resides or works or intends to reside or work.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
An insurer shall update its
printed provider directory or directories at least quarterly, or more frequently, if required by federal law.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
A printed directory shall be dated with the date of its last update.
</html:p>
<html:p>
(e)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
The insurer shall update the online provider directory or directories, at least weekly, or more frequently, if required by federal law, when informed of and upon confirmation by the insurer of any of the following:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
A contracting provider is no longer accepting new patients for that product, or an individual provider within a provider group is no longer accepting new patients.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
A contracted provider is no longer under contract for a
particular product.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
A provider’s practice location or other information required under subdivision (h) or (i) has changed.
</html:p>
<html:p>
(D)
<html:span class="EnSpace"/>
Upon the completion of the investigation described in subdivision (o), a change is necessary based on an insured complaint that a provider was not accepting new patients, was otherwise not available, or whose contact information was listed incorrectly.
</html:p>
<html:p>
(E)
<html:span class="EnSpace"/>
Any other information that affects the content or accuracy of the provider directory or directories.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Upon confirmation of any of the following, the insurer shall delete and remove a provider from the directory or directories when:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
A provider has retired or otherwise has ceased to practice.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
A provider or provider group is no longer under contract with the insurer for any reason.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
The contracting provider group has informed the insurer that the provider is no longer associated with the provider group and is no longer under contract with the insurer.
</html:p>
<html:p>
(f)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
The provider directory or directories shall
display the date of the most recent update. The provider directory or directories shall also display a dedicated email address, telephone number, and reporting hyperlink for members of the public and providers to report possible inaccurate, incomplete, or misleading directory information. The provider directory or directories shall also state that the insured may submit a complaint if the insured believes they reasonably relied upon inaccurate, incomplete, or misleading directory information. This information shall be disclosed prominently in the directory or directories and on the insurer’s
internet website.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
An insurer shall include a prominent disclosure on its print and online provider directories of its duty to arrange coverage when behavioral health benefits are not available in-network within applicable geographic and timely access standards. The disclosure shall be included within the directory and shall also include the geographic accessibility standards.
</html:p>
<html:p>
(g)
<html:span class="EnSpace"/>
The provider directory or directories shall include the following disclosures informing insureds that they are entitled to both of the following:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
Language interpreter services, at no cost to the insured, including how to obtain interpretation services in accordance with Section
10133.8.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Full and equal access to covered services, including insureds with disabilities as required under the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973.
</html:p>
<html:p>
(h)
<html:span class="EnSpace"/>
The insurer and a specialized mental health insurer shall include all of the following information in the provider directory or directories:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
The provider’s name, practice location or locations, and contact information, including telephone number.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Type of practitioner.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
National Provider Identifier number.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
California license number and type of license.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
The area of specialty, including board certification, if any.
</html:p>
<html:p>
(6)
<html:span class="EnSpace"/>
The provider’s office email address, if available to an insured or the public.
</html:p>
<html:p>
(7)
<html:span class="EnSpace"/>
The population served, meaning adult, pediatric, or both.
</html:p>
<html:p>
(8)
<html:span class="EnSpace"/>
The name of each affiliated provider group currently under contract with the insurer through which the provider sees
insureds.
</html:p>
<html:p>
(9)
<html:span class="EnSpace"/>
A listing for each of the following providers that are under contract with the insurer:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
For physicians and surgeons, the provider group, and admitting privileges, if any, at hospitals contracted with the insurer.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
Nurse practitioners, physician assistants, psychologists, acupuncturists, optometrists, dispensing optometrists and opticians, podiatrists, chiropractors, licensed
clinical social workers, marriage and family therapists, professional clinical counselors, qualified autism service providers, as defined in Section 4999.200 of the Business and Professions Code, nurse-midwives, and dentists.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
For federally qualified health centers or primary care clinics, the name of the federally qualified health center or clinic.
</html:p>
<html:p>
(D)
<html:span class="EnSpace"/>
For a
provider described in subparagraph (A) or (B) who is employed by a federally qualified health center or primary care clinic, and to the extent their services may be accessed and are covered through the contract with the insurer, the name of the provider, and the name of the federally qualified health center or clinic.
</html:p>
<html:p>
(E)
<html:span class="EnSpace"/>
Facilities, including, but not limited to, general acute care hospitals, skilled nursing facilities, urgent care clinics, ambulatory surgery centers, inpatient hospice, residential care facilities, and inpatient rehabilitation facilities.
</html:p>
<html:p>
(F)
<html:span class="EnSpace"/>
Pharmacies, clinical laboratories, imaging centers, optical dispensaries, and other facilities providing contracted health care services.
</html:p>
<html:p>
(10)
<html:span class="EnSpace"/>
The provider directory or directories may note that authorization or referral may be required to access some providers.
</html:p>
<html:p>
(11)
<html:span class="EnSpace"/>
Non-English language, if any, spoken by a health care provider or other medical professional as well as non-English language spoken by a qualified medical interpreter, in accordance with Section 10133.8, if any, on the provider’s staff.
</html:p>
<html:p>
(12)
<html:span class="EnSpace"/>
Identification of providers who no longer accept new patients for some or all of the insurer’s products.
</html:p>
<html:p>
(13)
<html:span class="EnSpace"/>
Whether or not the provider is in the lowest cost-sharing tier, if the product has more than one cost-sharing tier, and the network tier to which the provider is assigned, if the provider is not in the lowest tier, as applicable. Nothing in this section shall be
construed to require the use of network tiers other than contract and noncontracting tiers.
</html:p>
<html:p>
(14)
<html:span class="EnSpace"/>
All other information necessary to conduct a search pursuant to paragraph (2) of subdivision (c).
</html:p>
<html:p>
(i)
<html:span class="EnSpace"/>
A vision, dental, or other specialized insurer, except for a specialized mental health insurer, shall include all of the following information for each provider directory or directories used by the insurer for its networks:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
The provider’s name, practice location or locations, and contact
information, including telephone number.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Type of practitioner.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
National Provider Identifier number.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
California license number and type of license, if applicable.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
The area of specialty, including board certification, or other accreditation, if any.
</html:p>
<html:p>
(6)
<html:span class="EnSpace"/>
The provider’s office email address, if available to an insured or the public.
</html:p>
<html:p>
(7)
<html:span class="EnSpace"/>
The population served, meaning adult, pediatric, or both.
</html:p>
<html:p>
(8)
<html:span class="EnSpace"/>
The name of each affiliated provider group or specialty insurer practice group currently under contract with the insurer through which the provider sees insureds.
</html:p>
<html:p>
(9)
<html:span class="EnSpace"/>
The names of each
allied health care professional to the extent there is a direct contract for those services covered through a contract with the insurer.
</html:p>
<html:p>
(10)
<html:span class="EnSpace"/>
The non-English language, if any, spoken by a health care provider or other medical professional as well as non-English language spoken by a qualified medical interpreter, in accordance with Section 10133.8, if any, on the provider’s staff.
</html:p>
<html:p>
(11)
<html:span class="EnSpace"/>
Identification of providers who no longer accept new patients for some or all of the insurer’s products.
</html:p>
<html:p>
(12)
<html:span class="EnSpace"/>
All other applicable information necessary to conduct a provider search pursuant to paragraph (2) of subdivision (c).
</html:p>
<html:p>
(j)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
The contract between the insurer and a provider shall include a requirement that the provider inform the insurer within five business days when either of the following occurs:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
The provider is not accepting new patients.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
If the provider had previously not accepted new patients, the provider is currently accepting new patients.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
If a provider who is not accepting new patients is contacted by an insured or potential insured seeking to become a new patient, the provider shall direct the insurer or potential insured to both the insurer for additional assistance in finding a provider and to the department to report any inaccuracy with the insurer’s directory or directories.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
If an insured or potential insured informs an insurer of a possible inaccuracy in the provider directory or directories, the insurer shall promptly investigate and, if necessary, undertake corrective action within 30 business days to ensure the accuracy of the directory or directories.
</html:p>
<html:p>
(k)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
On or before December 31, 2016, the department shall develop uniform provider directory standards to permit consistency in accordance with subdivision (b) and paragraph (2) of subdivision (c) and development of a central utility by another entity. Those standards shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code), until January 1, 2021. No more than two revisions of those standards shall be exempt from the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code) pursuant to this subdivision.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
In developing the standards under this
subdivision, the department shall seek input from interested parties throughout the process of developing the standards and shall hold at least one public meeting. The department shall take into consideration any requirements for provider directories established by the federal Centers for Medicare and Medicaid Services and the State Department of Health Care Services.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
By July 31, 2017, or 12 months after the date provider directory standards are developed under this subdivision, whichever occurs later, an insurer shall use the standards developed by the department for each product offered by the insurer.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
On or before January 1, 2026, the department may update a uniform format with standardized naming conventions and other aspects for each insurer to use to request directory information from
its providers, consistent with current law.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
(A)
<html:span class="EnSpace"/>
On or before January 1, 2026, the department may establish a methodology and processes to ensure accuracy of provider directories and consistency with other state or federal laws, regulations, or standards. The department shall take into account existing methods, including surveys, insurer-reported information, and benchmarks or submission information from a central utility by another entity.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
The department may require an insurer to use or designate a central utility or central utilities for those providers included in the directory and may take into consideration impact on provider financial interests, insured access to providers, and health insurers. If the department requires or designates a central utility or central utilities, in developing the methodology under this section, the department shall
seek input from interested parties, including providers, health insurers, consumers, and consumer advocates, and may hold one or more public meetings. Standards developed pursuant to paragraph (4) and this paragraph shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code) until January 1, 2029.
</html:p>
<html:p>
(i)
<html:span class="EnSpace"/>
If the department designates or requires an insurer to use a central utility or central utilities, the insurer’s contract with the utility shall require that incomplete or incorrect information submitted to the central utility shall not be conveyed to the insurer. The contract shall also require that the central utility notify the submitter of incomplete or inaccurate information.
</html:p>
<html:p>
(ii)
<html:span class="EnSpace"/>
If the department determines that a central utility designated or required pursuant to this
subparagraph is frequently failing to provide accurate information to insurers, the department may consider no longer requiring or designating that central utility for use.
</html:p>
<html:p>
(iii)
<html:span class="EnSpace"/>
A health insurer may require providers to update their information through the central utility to update the health insurer’s provider directory. However, if the department requires a health insurer to use or designated a central utility or central utilities, the health insurer shall require providers to update their information through the central utility to update the health insurer’s provider directory.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
If the insurer can demonstrate it will meet the benchmarks required in paragraph (2) of subdivision (n) without using the central utility designated in subparagraph (B), the department may allow the insurer to not use the central utility. If the insurer fails to meet the benchmark in the future, the
department may require the insurer to use the central utility as a method to achieve higher accuracy of provider directory listings to comply with paragraph (2) of subdivision (n).
</html:p>
<html:p>
(l)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
An insurer shall take appropriate steps to ensure the accuracy of the information concerning each provider listed in the insurer’s provider directory or directories in accordance with this section, and shall, at least annually, review and update the entire provider directory or directories for each product offered. Each calendar year the insurer shall notify all contracted providers described in subdivisions (h) and (i) as follows:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
For individual providers who are not affiliated with a provider group described in subparagraph (A) or (B) of paragraph (8) of subdivision (h) and providers described in subdivision (i), the insurer shall notify each
provider at least once every six months.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
For all other providers described in subdivision (h) who are not subject to the requirements of subparagraph (A), the insurer shall notify its contracted providers to ensure that all of the providers are contacted by the insurer at least once annually.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
The notification shall include all of the following:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
The information the insurer has in its directory or directories regarding the provider or provider group, including a list of networks and products that include the contracted provider or provider group.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
A statement that the failure to respond to the notification may result in a delay of payment or reimbursement of a claim pursuant to subdivision
(q).
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
Instructions on how the provider or provider group can update the information in the provider directory or directories using the online interface developed pursuant to subdivision (m).
</html:p>
<html:p>
(D)
<html:span class="EnSpace"/>
A statement that failure to respond to the notification within five calendar days may result in a notice in their provider listing that states: “As of the last directory update, this provider is actively participating with the insurer. However, the provider has not responded to verify their listing information in the last update, so information may not be up to date.”
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
The insurer shall require an affirmative response from the provider or provider group acknowledging
that the notification was received. Within 30 calendar days of receiving the notification, the
provider or provider group shall confirm that the information in the provider directory or directories is current and accurate or update the information required to be in the directory or directories pursuant to this section, including whether or not the provider group is accepting new patients for each product.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
If the insurer does not receive an affirmative response and confirmation from the provider that the information is current and accurate or, as an alternative, updates any information required to be in the directory or directories pursuant to this section, within 30 business days, the insurer shall take no more than 15 business days to verify whether the provider’s information is correct or requires updates. The insurer shall document the receipt and outcome of each attempt to verify the information. If the insurer is unable to verify whether the provider’s information is correct or requires updates, the insurer
shall notify the provider 10 business days in advance of removal that the provider will be removed from the directory or directories. The provider shall be removed from the directory or directories at the next required update of the provider directory or directories after the 10-business-day notice period. A provider shall not be removed from the provider directory or directories if the provider responds before the end of the
10-business-day
notice period.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
If a provider that was previously removed from the provider directory or directories requests to be added back to the provider directory or directories, or if an insurer requests that a provider that was previously removed from the provider directory or directories be added back to the provider directory or directories, the insurer shall ensure the accuracy of the request and approve the request within 10 business days of receipt if accurate.
</html:p>
<html:p>
(6)
<html:span class="EnSpace"/>
If a provider does not respond within five calendar days, a health insurer may include the following statement in the provider listing before removing the provider from the directory: “As of the last directory update, this provider is actively participating with the insurer. However, the provider has not responded to
verify their listing information in the last update, so information may not be up to date.”
</html:p>
<html:p>
(7)
<html:span class="EnSpace"/>
General acute care hospitals shall be exempt from the requirements in paragraphs (3) to (5), inclusive.
</html:p>
<html:p>
(m)
<html:span class="EnSpace"/>
An insurer shall establish policies and procedures with regard to the regular updating of its provider directory or directories, including the weekly, quarterly, and annual updates
required pursuant to this section, or more frequently, if required by federal law or guidance. Providers shall submit any changes to the information required to be in the directory within 30 calendar days of any change.
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
The policies and procedures described under this subdivision shall be submitted by an insurer annually to the department for approval and in a format described by the department.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Every insurer shall ensure processes are in place to allow providers to promptly verify or submit changes to the information required to be in the directory or directories pursuant to this section. Those processes shall, at a minimum, include an online interface for providers to submit verification or changes electronically and shall generate an acknowledgment of receipt from
the insurer. Providers shall verify or submit changes to information required to be in the directory or directories pursuant to this section using the process required by the insurer.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
The insurer shall establish and maintain a process for insureds, potential insureds, other providers, and the public to identify and report possible inaccurate, incomplete, or misleading information currently listed in the insurer’s provider directory or directories. This process shall, at a minimum, include a telephone number and a dedicated email address at which the insurer will accept these reports, as well as a hyperlink on the insurer’s provider directory
internet website linking to a form where the information can be reported directly to the insurer through its
internet website.
</html:p>
<html:p>
(n)
<html:span class="EnSpace"/>
An insurer shall be responsible for maintaining an accurate provider directory.
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
An accurate provider directory maintains accurate information for all information to be included in the directories pursuant to subdivisions (h) and (i).
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
The accuracy percentage of a directory shall be determined by the percentage of providers for which all information required in subdivision (h) or (i) is accurate. If there is one error that would impact a patient’s access to care on a listing for a provider, that listing is considered inaccurate.
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
On July 1, 2026, an insurer’s directories shall be at least 60 percent
accurate.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
On or before July 1, 2027, an insurer’s directories shall be at least 80 percent accurate.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
On or before July 1, 2028, an insurer’s directories shall be at least 90 percent accurate.
</html:p>
<html:p>
(D)
<html:span class="EnSpace"/>
On or before July 1, 2029, an insurer’s directories shall be at least 95 percent accurate.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
An insurer shall annually verify its provider directories for accuracy of all of the information required pursuant to subdivisions (h) and (i). If the department develops a methodology and standards that permit the use of a central utility or central utilities, and if an insurer uses a central utility for some or all of the insurer’s provider directory, the insurer shall ensure that information derived from the central utility is incorporated in the insurer’s
provider directory unless the insurer can demonstrate that the information from the central utility is inaccurate. The insurer using a central utility shall continue to retain responsibility for ensuring that the requirements of this section are satisfied, including in any contract or other agreement with the central utility. The department shall develop procedures and policies on how an insurer shall conduct the verifications. In addition to verifying the information required under subdivisions (h) and (i), the insurer shall do all of the following:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
In verifying the accuracy of information in the provider directory or directories, determine if a provider is actively participating, as defined by the department pursuant to subdivision (s).
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
Annually submit its accuracy verification reports and a declaration that the accuracy verification report is true and correct to the
department to ensure compliance with this section.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
Publicly post its accuracy verification reports annually on its internet website.
</html:p>
<html:p>
(D)
<html:span class="EnSpace"/>
Verification of the accuracy of the printed directory shall be based on the date of printing, which shall be provided on each page of the printed directory.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
Failure by an insurer to comply with this section, including failure to meet the required benchmarks for accuracy, shall result in an administrative penalty consistent with this section and this chapter. In determining the appropriate amount of an administrative penalty, a listing inaccuracy that would impact a patient’s access to care shall be treated as a denial of access to care for covered benefits.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
When assessing administrative penalties against a
health insurer, the department shall determine the appropriate penalty amount for each violation based on one or more factors as applicable. The department shall take into consideration evidence provided by the insurer of the insurer’s policies and procedures to obtain accurate provider information pursuant to this section, and the insurer’s use of a central utility, in assessing penalties pursuant to this section.
</html:p>
<html:p>
(6)
<html:span class="EnSpace"/>
Beginning January 1, 2030, and every five years thereafter, the penalty amounts specified in this section shall be adjusted based on the average rate of change in premium rates for the individual and small group markets, and weighted by enrollment, since the previous adjustment.
</html:p>
<html:p>
(o)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
This section does not prohibit an insurer from requiring its provider groups or contracting specialized health insurers to provide information to the insurer that is required by the insurer to satisfy the requirements of this section for each of the providers that contract with the provider group or contracting specialized health insurer. This responsibility shall be specifically documented in a written contract between the insurer and the provider group or contracting specialized health insurer.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
If an insurer requires its contracting provider groups or contracting specialized health insurers to provide the insurer with information described in paragraph (1), the insurer shall continue to retain responsibility for ensuring that the requirements of this section are satisfied.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
A provider group may terminate a contract with a
provider for a pattern or repeated failure of the provider to update the information required to be in the directory or directories pursuant to this section.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
A provider group is not subject to the payment delay described in subdivision (q) if all of the following occurs:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
A provider does not respond to the provider group’s attempt to verify the provider’s information. As used in this paragraph, “verify” means to contact the provider in writing, electronically, and by telephone to confirm whether the provider’s information is correct or requires updates.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
The provider group documents its efforts to verify the
provider’s information.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
The provider group reports to the insurer that the provider should be deleted from the provider group in the insurer’s provider directory or directories.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
Section 10133.65, known as the Health Care Providers’ Bill of Rights, applies to any material change to a provider contract pursuant to this section.
</html:p>
<html:p>
(p)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
Whenever an insurer receives a report indicating that information listed in its provider directory or directories is inaccurate, the insurer shall promptly investigate the reported
inaccuracy and, no later than 30 business days following receipt of the report, either verify the accuracy of the information or update the information in its provider directory or directories, as applicable.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
When investigating a report regarding its provider directory or directories, the insurer shall, at a minimum, do the following:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
Contact the affected provider no later than five business days following receipt of the report.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
Document the receipt and outcome of each report. The documentation shall include the provider’s name, location, and a description of the insurer’s investigation, the outcome of the investigation, and any changes or updates made to its provider directory or directories.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
If changes to an insurer’s provider
directory or directories are required as a result of the insurer’s investigation, the changes to the online provider directory or directories shall be made no later than the next scheduled weekly update, or the update immediately following that update, or sooner if required by federal law or regulations. For printed provider directories, the change shall be made no later than the next required update, or sooner if required by federal law or regulations.
</html:p>
<html:p>
(q)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
Notwithstanding Sections 10123.13 and 10123.147, an insurer may delay payment or reimbursement owed to a provider or provider group for any claims payment made to a provider or provider group
for up to one calendar month beginning on the first day of the following month, if the provider or provider group fails to respond to the insurer’s attempts to verify the provider’s information as required under subdivision (l). The insurer shall not delay payment unless it has attempted to verify the provider’s or provider group’s information. As used in this subdivision, “verify” means to contact the provider or provider group in writing, electronically, and by telephone to confirm whether the provider’s or provider group’s information is correct or requires updates. An insurer may seek to delay payment or reimbursement owed to a provider or provider group only after the 10-business-day notice period described in paragraph (4) of subdivision (l) has lapsed.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
An insurer shall notify the provider or provider group 10 days before it seeks to delay payment or reimbursement to a provider or provider group pursuant to this subdivision. If the insurer delays a payment or reimbursement pursuant to this subdivision, the insurer shall reimburse the full amount of any payment or reimbursement subject to delay to the provider or provider group according to either of the following timelines, as applicable:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
No later than three business days following the date on which the insurer receives the information required to be submitted by the provider or provider group pursuant to subdivision (l).
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
At the end of the one-calendar-month delay described in paragraph (1), if the provider or provider group fails to provide the information required to be submitted to the insurer pursuant to
subdivision (l).
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
An insurer may terminate a contract for a pattern or repeated failure of the provider or provider group to alert the insurer to a change in the information required to be in the directory or directories pursuant to this section.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
An insurer that delays payment or reimbursement under this subdivision shall document each instance a payment or reimbursement was delayed and report this information to the department in a format described by the department. This information shall be submitted along with the policies and procedures required to be submitted annually to the department pursuant to paragraph (1) of subdivision (m).
</html:p>
<html:p>
(r)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
In circumstances where the department finds that an insured reasonably relied upon inaccurate, incomplete, or misleading information contained in an insurer’s provider directory or directories, the insurer shall arrange care and provide coverage for all covered health care services provided to the insured, hold the insured harmless for any amount beyond what the insured would have paid, had the services been delivered by an in-network provider under the insured’s health insurance policy, and reimburse the provider the out-of-network amount. The provider shall not collect any
additional amount from the insured other than the applicable in-network cost sharing, which shall count toward any in-network deductible and the out-of-pocket maximum. Before requiring reimbursement in these circumstances, the department shall conclude that the services received by the insured were covered services under the insured’s health insurance policy. In those circumstances, the fact that the services were rendered or delivered by a noncontracting or out-of-network provider shall not be used as a basis to deny reimbursement to the insured.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
If an insured, by telephone call or electronic means, requests information on whether or not a provider is contracted as an in-network provider to provide covered benefits, the insurer shall, if the request is by telephone, tell the insured verbally and follow up in writing or electronic
format no later than one business day after receiving the request. If the request is by electronic means, the insurer shall respond in writing or electronic format no later than two business days after receiving the request. The insurer shall also check if the provider is accepting new patients at the time and inform the insured. The insurer shall retain a record of the request and the insurer’s response in the insured’s file for at least two years after the date of the request.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
If an insured obtained information through the insurer’s online directory or a request consistent with paragraph (2) that a provider was an in-network provider, subsequently receives covered benefits from that provider, and the insured receives a bill for an amount exceeding in-network cost sharing, the group insured shall pay no more than in-network cost sharing if any of the following apply:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
The
provider is not contracting with the insurer as an in-network provider for that product at the time the insured receives otherwise covered benefits from that provider.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
The information provided regarding the provider’s network status is otherwise inaccurate, misleading, or incomplete.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
The online provider directory of the insurer is not accessible to insureds at the time the insured seeks information and the insured requests information consistent with paragraph (2).
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
If the health insurance policy uses a tiered network with two or more in-network tiers with differential cost sharing, the insurer shall document the cost-sharing tier that the provider is contracted to accept and shall provide that information to the insured when the insured seeks information about the provider. If the insurer provides
information indicating that a provider is on a lower cost-sharing tier and that information is not accurate, then the insured shall owe no more than the cost sharing for the lower cost-sharing tier.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
For purposes of this subdivision, the in-network cost-sharing amount for a contracted provider includes copayments, deductibles, coinsurance, and any other form of cost sharing.
</html:p>
<html:p>
(6)
<html:span class="EnSpace"/>
For purposes of this subdivision, “information” is inaccurate, incomplete, or misleading if any information in subdivision (h) or (i) regarding the provider’s network status is inaccurate, incomplete, or misleading.
</html:p>
<html:p>
(s)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
Whenever an insurer determines as a result of this section that there has been a 10-percent change in the network for a product in a region, the insurer shall file a statement with the commissioner.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
For an insurance policy issued, amended, or renewed on or after July 1, 2026, if the number of providers who are not actively participating pursuant to this section and have not responded to an insurer’s notifications pursuant to subdivision (l) for at least 18 months amount to 10 percent or greater of the providers in the network for a product in a region, which is considered material consistent with subdivision (f) of Section 2240.5 of Title 10 of the California Code of Regulations, then the insurer shall file a
corrective action plan consistent with that regulation.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
An insurer shall not use information about a provider for purposes of compliance with timely access requirements, network adequacy determination, or compliance with any other provision of this chapter if the insurer cannot demonstrate to the department that the provider is actively participating as determined by the department.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
(A)
<html:span class="EnSpace"/>
The department shall determine the definition of “actively participating,” and consider the degree of utilization for that provider by considering if the provider has one or more claims or encounters for covered benefits to insureds in the relevant network, unless a special circumstance applies. In determining the utilization threshold for these purposes, the department shall not set a threshold greater than at least one claim or encounter for covered benefits for an
insured every three calendar years.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
A special circumstance may include a provider in a rural area, a highly specialized specialist who did not provide covered benefits for an insured in the prior three calendar years, or other circumstances as determined by the department through the regulatory or other rulemaking process. The department may issue guidance to implement, interpret, or make specific the requirements under this subparagraph. The guidance shall be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
An insurer shall not advertise or otherwise represent the extent of its network, including the number or type of contracting providers, unless it is able to demonstrate that each provider is contracting.
</html:p>
<html:p>
(t)
<html:span class="EnSpace"/>
An insurer that contracts with multiple employer welfare agreements regulated pursuant to Article 4.7 (commencing with Section 742.20) of Chapter 1 of Part 2 of Division 1 shall meet the requirements of this section.
</html:p>
<html:p>
(u)
<html:span class="EnSpace"/>
This section shall not be construed to alter a provider’s obligation to provide health care services to an insured pursuant to the provider’s contract with the insurer.
</html:p>
<html:p>
(v)
<html:span class="EnSpace"/>
As part of the department’s routine examination of a health insurer pursuant to Section 730, the department shall include a review of the health insurer’s compliance with subdivision (q).
</html:p>
<html:p>
(w)
<html:span class="EnSpace"/>
For purposes of this section, “provider group” means a medical group, independent practice association, or other
similar group of providers.
</html:p>
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<ns0:BillSection id="id_2A870257-5CB0-4DD8-A514-2A122308D10C">
<ns0:Num>SEC. 7.</ns0:Num>
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Section 10144.5 of the
<ns0:DocName>Insurance Code</ns0:DocName>
is amended to read:
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<ns0:LawSection id="id_B6A1C152-C6C7-4745-B696-2BADEB85310A">
<ns0:Num>10144.5.</ns0:Num>
<ns0:LawSectionVersion id="id_E238B102-B647-4864-87D2-BBE073046119">
<ns0:Content>
<html:p>
(a)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
Every disability insurance policy issued, amended, or renewed on or after January 1, 2021, that provides hospital, medical, or surgical coverage shall provide coverage for medically necessary treatment of mental health and substance use disorders, under the same terms and conditions applied to other medical conditions as specified in subdivision (c).
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
For purposes of this section, “mental health and substance use disorders” means a mental health condition or substance use disorder that falls under any of the diagnostic categories listed in the mental and behavioral disorders chapter of the most recent edition of the World Health Organization’s
International Statistical Classification of Diseases and Related Health Problems, or that is listed in the most recent version of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. Changes in terminology, organization, or classification of mental health and substance use disorders in future versions of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders or the World Health Organization’s International Statistical Classification of Diseases and Related Health Problems shall not affect the conditions covered by this section as long as a condition is commonly understood to be a mental health or substance use disorder by health care providers practicing in relevant clinical specialties.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
(A)
<html:span class="EnSpace"/>
For purposes of this section, “medically
necessary treatment of a mental health or substance use disorder” means a service or product addressing the specific needs of that patient, for the purpose of preventing, diagnosing, or treating an illness, injury, condition, or its symptoms, including minimizing the progression of an illness, injury, condition, or its symptoms, in a manner that is all of the following:
</html:p>
<html:p>
(i)
<html:span class="EnSpace"/>
In accordance with the generally accepted standards of mental health and substance use disorder care.
</html:p>
<html:p>
(ii)
<html:span class="EnSpace"/>
Clinically appropriate in terms of type, frequency, extent, site, and duration.
</html:p>
<html:p>
(iii)
<html:span class="EnSpace"/>
Not primarily for the economic benefit of the disability insurer and insureds or for the convenience of the patient, treating physician, or other health
care provider.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
This paragraph does not limit in any way the independent medical review rights of an insured or policyholder under this chapter.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
“Health care provider” means any of the following:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
A person who is licensed under Division 2 (commencing with Section 500) of the Business and Professions Code.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
An associate marriage and family therapist or marriage and family therapist trainee functioning pursuant to Section 4980.43.3 of the Business and Professions Code.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
A qualified autism service provider certified by a national entity as defined in Section 4999.200 of the Business and Professions
Code or a qualified autism service professional as defined in Section 4999.201 of the Business and Professions Code.
</html:p>
<html:p>
(D)
<html:span class="EnSpace"/>
An associate clinical social worker functioning pursuant to Section 4996.23.2 of the Business and Professions Code.
</html:p>
<html:p>
(E)
<html:span class="EnSpace"/>
An associate professional clinical counselor or professional clinical counselor trainee functioning pursuant to Section 4999.46.3 of the Business and Professions Code.
</html:p>
<html:p>
(F)
<html:span class="EnSpace"/>
A registered psychologist, as described in Section 2909.5 of the Business and Professions Code.
</html:p>
<html:p>
(G)
<html:span class="EnSpace"/>
A registered psychological assistant, as described in Section 2913 of the Business and Professions Code.
</html:p>
<html:p>
(H)
<html:span class="EnSpace"/>
A
psychology trainee or person supervised as set forth in Section 2910 or 2911 of, or subdivision (d) of Section 2914 of, the Business and Professions Code.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
For purposes of this section, “generally accepted standards of mental health and substance use disorder care” has the same meaning as defined in paragraph (1) of subdivision (f) of Section 10144.52.
</html:p>
<html:p>
(6)
<html:span class="EnSpace"/>
A disability insurer shall not limit benefits or coverage for mental health and substance use disorders to short-term or acute treatment.
</html:p>
<html:p>
(7)
<html:span class="EnSpace"/>
All medical necessity determinations made by the disability insurer concerning service intensity, level of care placement, continued stay, and transfer or discharge of insureds diagnosed with mental health and substance
use disorders shall be conducted in accordance with the requirements of Section 10144.52.
</html:p>
<html:p>
(8)
<html:span class="EnSpace"/>
A disability insurer that authorizes a specific type of treatment by a provider pursuant to this section shall not rescind or modify the authorization after the provider renders the health care service in good faith and pursuant to this authorization for any reason, including, but not limited to, the insurer’s subsequent rescission, cancellation, or modification of the insured’s or policyholder’s contract, or the insurer’s subsequent determination that it did not make an accurate determination of the insured’s or policyholder’s eligibility. This section shall not be construed to expand or alter the benefits available to the insured or policyholder under an insurance policy.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
The
benefits that shall be covered pursuant to this section shall include, but not be limited to, the following:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
Basic health care services, as defined in subdivision (b) of Section 1345 of the Health and Safety Code.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Intermediate services, including the full range of levels of care, including, but not limited to, residential treatment, partial hospitalization, and intensive outpatient treatment.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
Prescription drugs, if the policy includes coverage for prescription drugs.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
The terms and conditions applied to the benefits required by this section, that shall be applied equally to all benefits under the disability insurance policy shall include, but not be
limited to, all of the following patient financial responsibilities:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
Maximum and annual lifetime benefits, if not prohibited by applicable law.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Copayments and coinsurance.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
Individual and family deductibles.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
Out-of-pocket maximums.
</html:p>
<html:p>
(d)
<html:span class="EnSpace"/>
If services for the medically necessary treatment of a mental health or substance use disorder are not available in network within the geographic and timely access standards set by law or regulation, the disability insurer shall arrange coverage to ensure the delivery of medically necessary out-of-network services and any medically necessary
followup services that, to the maximum extent possible, meet those geographic and timely access standards. As used in this subdivision, to “arrange coverage to ensure the delivery of medically necessary out-of-network services” includes, but is not limited to, providing services to secure medically necessary out-of-network options that are available to the insured within geographic and timely access standards. The insured shall pay no more than the same cost sharing that the insured would pay for the same covered services received from an in-network provider.
</html:p>
<html:p>
(e)
<html:span class="EnSpace"/>
This section shall not apply to accident-only, specified disease, hospital indemnity, Medicare supplement, dental-only, or vision-only insurance policies.
</html:p>
<html:p>
(f)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
For the purpose of compliance with this section,
a disability insurer may provide coverage for all or part of the mental health and substance use disorder services required by this section through a separate specialized health insurance policy or mental health policy. This paragraph shall not apply to policies that are subject to Section 10112.27.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
A disability insurer shall provide the mental health and substance use disorder coverage required by this section in its entire service area and in emergency situations as may be required by applicable laws and regulations. For purposes of this section, disability insurance policies that provide benefits to insureds through preferred provider contracting arrangements are not precluded from requiring insureds who reside or work in geographic areas served by specialized health insurance policies or mental health insurance policies to
secure all or part of their mental health services within those geographic areas served by specialized health insurance policies or mental health insurance policies, provided that all appropriate mental health or substance use disorder services are actually available within those geographic service areas within timeliness standards.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
Notwithstanding any other law, in the provision of benefits required by this section, a disability insurer may utilize case management, network providers, utilization review techniques, prior authorization, copayments, or other cost sharing, provided that these practices are consistent with Section 10144.4 of this code, and Section 2052 of the Business and Professions Code.
</html:p>
<html:p>
(g)
<html:span class="EnSpace"/>
This section shall not be construed to deny or restrict in any way
the department’s authority to ensure a disability insurer’s compliance with this code.
</html:p>
<html:p>
(h)
<html:span class="EnSpace"/>
A disability insurer shall not limit benefits or coverage for medically necessary services on the basis that those services should be or could be covered by a public entitlement program, including, but not limited to, special education or an individualized education program, Medicaid, Medicare, Supplemental Security Income, or Social Security Disability Insurance, and shall not include or enforce a contract term that excludes otherwise covered benefits on the basis that those services should be or could be covered by a public entitlement program.
</html:p>
<html:p>
(i)
<html:span class="EnSpace"/>
A disability insurer shall not adopt, impose, or enforce terms in its policies or provider agreements, in writing or in operation, that undermine,
alter, or conflict with the requirements of this section.
</html:p>
<html:p>
(j)
<html:span class="EnSpace"/>
If the commissioner determines that a disability insurer has violated this section, the commissioner may, after appropriate notice and opportunity for hearing in accordance with the Administrative Procedure Act (Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government Code), by order, assess a civil penalty not to exceed five thousand dollars ($5,000) for each violation, or, if a violation was willful, a civil penalty not to exceed ten thousand dollars ($10,000) for each violation.
</html:p>
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<ns0:Num>SEC. 8.</ns0:Num>
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Section 10144.51 of the
<ns0:DocName>Insurance Code</ns0:DocName>
is amended to read:
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<ns0:Fragment>
<ns0:LawSection id="id_08C1F269-4D66-4BE4-A7E0-1BF9597DEF7B">
<ns0:Num>10144.51.</ns0:Num>
<ns0:LawSectionVersion id="id_0D134FB4-DA98-44BC-82F9-2EB1D4DA0B94">
<ns0:Content>
<html:p>
(a)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
Every health insurance policy shall also provide coverage for behavioral health treatment for pervasive developmental disorder or autism no later than July 1, 2012. The coverage shall be provided in the same manner and is subject to the same requirements as provided in Section 10144.5.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
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).
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
This section does 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.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
This section does 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 individual service plan, as described in Section 5600.4 of the Welfare and Institutions Code, or under the federal Individuals with Disabilities Education Act (20 U.S.C. Sec. 1400 et seq.) and its implementing regulations.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
Pursuant to Article 6 (commencing with Section 2240) of Subchapter 2 of Chapter 5 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 or employ qualified autism service professionals or paraprofessionals who provide and administer behavioral health treatment. A health insurer is not prevented from selectively contracting with providers within these requirements.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
For the purposes of this section, the following definitions shall apply:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
“Behavioral health treatment” means professional services and treatment programs, including applied behavior analysis and evidence-based
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:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
The treatment is prescribed by a physician and surgeon licensed pursuant to Chapter 5 (commencing with Section 2000) of, or is developed by a psychologist licensed pursuant to Chapter 6.6 (commencing with Section 2900) of, Division 2 of the Business and Professions Code.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
The treatment is provided under a treatment plan prescribed by a qualified autism service provider and is administered by one of the following:
</html:p>
<html:p>
(i)
<html:span class="EnSpace"/>
A qualified autism service provider.
</html:p>
<html:p>
(ii)
<html:span class="EnSpace"/>
A qualified autism service professional supervised by the qualified autism service provider.
</html:p>
<html:p>
(iii)
<html:span class="EnSpace"/>
A qualified autism service paraprofessional supervised by a qualified autism service provider or qualified autism service professional.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
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:
</html:p>
<html:p>
(i)
<html:span class="EnSpace"/>
Describes the patient’s behavioral health impairments or developmental challenges that are to be treated.
</html:p>
<html:p>
(ii)
<html:span class="EnSpace"/>
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.
</html:p>
<html:p>
(iii)
<html:span class="EnSpace"/>
Provides intervention plans that utilize evidence-based practices, with demonstrated clinical efficacy in treating pervasive developmental disorder or autism.
</html:p>
<html:p>
(iv)
<html:span class="EnSpace"/>
Discontinues intensive behavioral intervention services when the treatment goals and objectives are achieved or no longer appropriate.
</html:p>
<html:p>
(D)
<html:span class="EnSpace"/>
The treatment plan is not used for purposes of providing or for the reimbursement of respite, day care, or educational 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.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
“Qualified autism service provider” means an individual described in Section 4999.200 of the Business and Professions Code.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
“Qualified autism service professional” means an individual who meets all of the criteria set forth in Section 4999.201 of the Business and Professions Code.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
“Qualified autism service paraprofessional” means an unlicensed and uncertified individual who meets all of the criteria
set forth in Section 4999.202 of the Business and Professions Code.
</html:p>
<html:p>
(d)
<html:span class="EnSpace"/>
This section does not apply to any the following:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
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.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
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).
</html:p>
<html:p>
(e)
<html:span class="EnSpace"/>
This section does not limit the obligation to provide services under Section 10144.5.
</html:p>
<html:p>
(f)
<html:span class="EnSpace"/>
As provided in
Section 10144.5 and in paragraph (1) of subdivision (a), 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.
</html:p>
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<ns0:Num>SEC. 8.5.</ns0:Num>
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Section 10144.51 of the
<ns0:DocName>Insurance Code</ns0:DocName>
is amended to read:
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<ns0:LawSection id="id_C3C5386F-BBFF-480C-A567-A3EF3E0C2132">
<ns0:Num>10144.51.</ns0:Num>
<ns0:LawSectionVersion id="id_848D11CF-DF69-4211-9F19-6BE3F908EC1B">
<ns0:Content>
<html:p>
(a)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
Every health insurance policy shall also provide coverage for behavioral health treatment for pervasive developmental disorder or autism no later than July 1, 2012. The coverage shall be provided in the same manner and is subject to the same requirements as provided in Section 10144.5.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Notwithstanding paragraph (1), as of the date that the 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).
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
This section does 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.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
This section does 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 individual service plan, as described in Section 5600.4 of the Welfare and Institutions Code, or under the federal Individuals with Disabilities Education Act (20 U.S.C. Sec. 1400 et seq.) and its implementing regulations.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
Pursuant to Article 6 (commencing with Section 2240) of Subchapter 2 of Chapter 5 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 or employ qualified autism service professionals or paraprofessionals who provide and administer behavioral health treatment. A health insurer is not prevented from selectively contracting with providers within these requirements.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
A health insurance policy issued, amended, or renewed on or after January 1, 2026, shall not require an insured previously diagnosed with pervasive developmental disorder or autism to receive a rediagnosis to maintain coverage for behavioral health treatment
for pervasive developmental disorder or autism.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
This subdivision does not prohibit or restrict a treating provider from reevaluating an insured for purposes of determining the appropriate treatment. The treatment plan shall be made available to the insurer upon request.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
This subdivision does not prohibit a treating provider from prescribing a rediagnosis at the discretion of the physician licensed pursuant to Chapter 5 (commencing with Section 2000) of Division 2 of the Business and Professions Code or a psychologist licensed
pursuant to Chapter 6.6 (commencing with Section 2900) of Division 2 of the Business and Professions Code.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
A health insurer shall not discontinue or delay existing treatment while waiting for a rediagnosis to be completed.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
This subdivision does not prohibit a health insurer from requiring utilization review. For the purpose of this section, utilization review is distinct from a rediagnosis.
</html:p>
<html:p>
(d)
<html:span class="EnSpace"/>
For the purposes of this section, the following definitions shall apply:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
“Behavioral health treatment” means professional services and treatment programs, including applied behavior analysis and evidence-based 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:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
The treatment is prescribed by a physician and surgeon licensed pursuant to Chapter 5 (commencing with Section 2000) of, or is developed by a psychologist licensed pursuant to Chapter 6.6 (commencing with Section 2900) of, Division 2 of the Business and Professions Code.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
The treatment is provided under a treatment plan prescribed by a qualified autism service provider and is administered by one of the following:
</html:p>
<html:p>
(i)
<html:span class="EnSpace"/>
A qualified autism service provider.
</html:p>
<html:p>
(ii)
<html:span class="EnSpace"/>
A
qualified autism service professional supervised by the qualified autism service provider.
</html:p>
<html:p>
(iii)
<html:span class="EnSpace"/>
A qualified autism service paraprofessional supervised by a qualified autism service provider or qualified autism service professional.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
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:
</html:p>
<html:p>
(i)
<html:span class="EnSpace"/>
Describes the patient’s behavioral health impairments or developmental challenges that are to be treated.
</html:p>
<html:p>
(ii)
<html:span class="EnSpace"/>
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.
</html:p>
<html:p>
(iii)
<html:span class="EnSpace"/>
Provides intervention plans that utilize evidence-based practices, with demonstrated clinical efficacy in treating pervasive developmental disorder or autism.
</html:p>
<html:p>
(iv)
<html:span class="EnSpace"/>
Discontinues intensive behavioral intervention services when the treatment goals and objectives are achieved or no longer appropriate.
</html:p>
<html:p>
(D)
<html:span class="EnSpace"/>
The treatment plan is not used for purposes of providing or for the reimbursement of respite, daycare, or educational 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.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
“Qualified autism service provider” means an individual described in Section 4999.200 of the Business and Professions Code.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
“Qualified autism service professional” means an individual who meets all of the criteria set forth in Section 4999.201 of the Business and Professions Code.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
“Qualified autism service paraprofessional” means an unlicensed and uncertified individual who meets all of the criteria set
forth in Section 4999.202 of the Business and Professions Code.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
“Rediagnosis” means a subsequent undertaking by any method, device, or procedure, whether gratuitous or not, to ascertain or establish if a person is suffering from a physical or mental health disorder, pursuant to Section 2038 of the Business and Professions Code. “Rediagnosis” also means prescription of a subsequent diagnosis of pervasive developmental disorders or autism to ascertain or establish if a person is suffering from a pervasive developmental disorder or autism.
</html:p>
<html:p>
(6)
<html:span class="EnSpace"/>
“Utilization review” means utilization review or utilization management functions that prospectively, retrospectively, or concurrently review and approve, modify, or deny, based in whole or in part on medical necessity to cure and relieve,
treatment recommendations by physicians licensed pursuant to Chapter 5 (commencing with Section 2000) of Division 2 of the Business and Professions Code before, after, or concurrent with the provision of medical treatment services. “Utilization review” refers to an evaluation of existing treatment to ensure the insured receives the proper care at the proper time.
</html:p>
<html:p>
(e)
<html:span class="EnSpace"/>
This section does not apply to either of the following:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
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.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
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).
</html:p>
<html:p>
(f)
<html:span class="EnSpace"/>
This section does not limit the obligation to provide services under Section 10144.5.
</html:p>
<html:p>
(g)
<html:span class="EnSpace"/>
As provided in Section 10144.5 and in paragraph (1) of subdivision (a), 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.
</html:p>
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<ns0:BillSection id="id_FB05889A-BEFC-4DE8-8953-9F5C8919D45A">
<ns0:Num>SEC. 9.</ns0:Num>
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Section 11165.7 of the
<ns0:DocName>Penal Code</ns0:DocName>
is amended to read:
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<ns0:Fragment>
<ns0:LawSection id="id_8E7E5255-1BF9-4466-B69D-21E7D301507B">
<ns0:Num>11165.7.</ns0:Num>
<ns0:LawSectionVersion id="id_7E4AAAF3-CEDC-4FAB-A913-200F6E8A02EC">
<ns0:Content>
<html:p>
(a)
<html:span class="EnSpace"/>
As used in this article, “mandated reporter” is defined as any of the following:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
A teacher.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
An instructional aide.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
A teacher’s aide or teacher’s assistant employed by a public or private school.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
A classified employee of a public school.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
An administrative officer or supervisor of child welfare and attendance, or a certificated pupil personnel employee of a public or private school.
</html:p>
<html:p>
(6)
<html:span class="EnSpace"/>
An administrator of a public or private day camp.
</html:p>
<html:p>
(7)
<html:span class="EnSpace"/>
An administrator or employee of a public or private youth center, youth recreation program, or youth organization.
</html:p>
<html:p>
(8)
<html:span class="EnSpace"/>
An administrator, board member, or employee of a public or private organization whose duties require direct contact and supervision of children, including a foster family agency.
</html:p>
<html:p>
(9)
<html:span class="EnSpace"/>
An employee of a county office of education or the State Department of Education whose duties bring the employee into contact with children on a regular basis.
</html:p>
<html:p>
(10)
<html:span class="EnSpace"/>
A licensee, an administrator, or an employee of a licensed child daycare facility or
community care facility, except those licensed community care facilities exclusively serving adults and seniors.
</html:p>
<html:p>
(11)
<html:span class="EnSpace"/>
A Head Start program teacher.
</html:p>
<html:p>
(12)
<html:span class="EnSpace"/>
A licensing worker or licensing evaluator employed by a licensing agency, as defined in Section 11165.11.
</html:p>
<html:p>
(13)
<html:span class="EnSpace"/>
A public assistance worker.
</html:p>
<html:p>
(14)
<html:span class="EnSpace"/>
An employee of a childcare institution, including, but not limited to, foster parents, group home personnel, and personnel of residential care facilities.
</html:p>
<html:p>
(15)
<html:span class="EnSpace"/>
A social worker, probation officer, or parole officer.
</html:p>
<html:p>
(16)
<html:span class="EnSpace"/>
An employee of a school
district police or security department.
</html:p>
<html:p>
(17)
<html:span class="EnSpace"/>
A person who is an administrator or presenter of, or a counselor in, a child abuse prevention program in a public or private school.
</html:p>
<html:p>
(18)
<html:span class="EnSpace"/>
A district attorney investigator, inspector, or local child support agency caseworker, unless the investigator, inspector, or caseworker is working with an attorney appointed pursuant to Section 317 of the Welfare and Institutions Code to represent a minor.
</html:p>
<html:p>
(19)
<html:span class="EnSpace"/>
A peace officer, as defined in Chapter 4.5 (commencing with Section 830) of Title 3 of Part 2, who is not otherwise described in this section.
</html:p>
<html:p>
(20)
<html:span class="EnSpace"/>
A firefighter, except for volunteer firefighters.
</html:p>
<html:p>
(21)
<html:span class="EnSpace"/>
A physician and surgeon, psychiatrist, psychologist, dentist, resident, intern, podiatrist, chiropractor, licensed nurse, dental hygienist, optometrist, marriage and family therapist, clinical social worker, professional clinical counselor, or any other person who is currently licensed under Division 2 (commencing with Section 500) of the Business and Professions Code.
</html:p>
<html:p>
(22)
<html:span class="EnSpace"/>
An emergency medical technician I or II, paramedic, or other person certified pursuant to Division 2.5 (commencing with Section 1797) of the Health and Safety Code.
</html:p>
<html:p>
(23)
<html:span class="EnSpace"/>
A psychological assistant registered pursuant to Section 2913 of the Business and Professions Code.
</html:p>
<html:p>
(24)
<html:span class="EnSpace"/>
A marriage
and family therapist trainee, as defined in subdivision (c) of Section 4980.03 of the Business and Professions Code.
</html:p>
<html:p>
(25)
<html:span class="EnSpace"/>
An unlicensed associate marriage and family therapist registered under Section 4980.44 of the Business and Professions Code.
</html:p>
<html:p>
(26)
<html:span class="EnSpace"/>
A state or county public health employee who treats a minor for venereal disease or any other condition.
</html:p>
<html:p>
(27)
<html:span class="EnSpace"/>
A coroner.
</html:p>
<html:p>
(28)
<html:span class="EnSpace"/>
A medical examiner or other person who performs autopsies.
</html:p>
<html:p>
(29)
<html:span class="EnSpace"/>
A commercial film and photographic print or image processor as specified in subdivision (e) of Section 11166. As used in this article, “commercial film
and photographic print or image processor” means a person who develops exposed photographic film into negatives, slides, or prints, or who makes prints from negatives or slides, or who prepares, publishes, produces, develops, duplicates, or prints any representation of information, data, or an image, including, but not limited to, any film, filmstrip, photograph, negative, slide, photocopy, videotape, video laser disc, computer hardware, computer software, computer floppy disk, data storage medium, CD-ROM, computer-generated equipment, or
computer-generated image, for compensation. The term includes any employee of that person; it does not include a person who develops film or makes prints or images for a public agency.
</html:p>
<html:p>
(30)
<html:span class="EnSpace"/>
A child visitation monitor. As used in this article, “child visitation monitor” means a person who, for financial compensation, acts as a monitor of a visit between a child and another person when the monitoring of that visit has been ordered by a court of law.
</html:p>
<html:p>
(31)
<html:span class="EnSpace"/>
An animal control officer or humane society officer. For the purposes of this article, the following terms have the following meanings:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
“Animal control officer” means a person employed by a city, county, or city and county for the purpose of enforcing animal control
laws or regulations.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
“Humane society officer” means a person appointed or employed by a public or private entity as a humane officer who is qualified pursuant to Section 14502 or 14503 of the Corporations Code.
</html:p>
<html:p>
(32)
<html:span class="EnSpace"/>
A clergy member, as specified in subdivision (d) of Section 11166. As used in this article, “clergy member” means a priest, minister, rabbi, religious practitioner, or similar functionary of a church, temple, or recognized denomination or organization.
</html:p>
<html:p>
(33)
<html:span class="EnSpace"/>
Any custodian of records of a clergy member, as specified in this section and subdivision (d) of Section 11166.
</html:p>
<html:p>
(34)
<html:span class="EnSpace"/>
An employee of any police department, county sheriff’s department,
county probation department, or county welfare department.
</html:p>
<html:p>
(35)
<html:span class="EnSpace"/>
An employee or volunteer of a Court Appointed Special Advocate program, as defined in Rule 5.655 of the California Rules of Court.
</html:p>
<html:p>
(36)
<html:span class="EnSpace"/>
A custodial officer, as defined in Section 831.5.
</html:p>
<html:p>
(37)
<html:span class="EnSpace"/>
A person providing services to a minor child under Section 12300 or 12300.1 of the Welfare and Institutions Code.
</html:p>
<html:p>
(38)
<html:span class="EnSpace"/>
An alcohol and drug counselor. As used in this article, an “alcohol and drug counselor” is a person providing counseling, therapy, or other clinical services for a state licensed or certified drug, alcohol, or drug and alcohol treatment program. However, alcohol or drug abuse, or both
alcohol and drug abuse, is not, in and of itself, a sufficient basis for reporting child abuse or neglect.
</html:p>
<html:p>
(39)
<html:span class="EnSpace"/>
A clinical counselor trainee, as defined in subdivision (g) of Section 4999.12 of the Business and Professions Code.
</html:p>
<html:p>
(40)
<html:span class="EnSpace"/>
An associate professional clinical counselor registered under Section 4999.42 of the Business and Professions Code.
</html:p>
<html:p>
(41)
<html:span class="EnSpace"/>
An employee or administrator of a public or private postsecondary educational institution, whose duties bring the administrator or employee into contact with children on a regular basis, or who supervises those whose duties bring the administrator or employee into contact with children on a regular basis, as to child abuse or neglect occurring on that institution’s premises or at an
official activity of, or program conducted by, the institution. Nothing in this paragraph shall be construed as altering the lawyer-client privilege as set forth in Article 3 (commencing with Section 950) of Chapter 4 of Division 8 of the Evidence Code.
</html:p>
<html:p>
(42)
<html:span class="EnSpace"/>
An athletic coach, athletic administrator, or athletic director employed by any public or private school that provides any combination of instruction for kindergarten, or grades 1 to 12, inclusive.
</html:p>
<html:p>
(43)
<html:span class="EnSpace"/>
(A)
<html:span class="EnSpace"/>
A commercial computer technician as specified in subdivision (e) of Section 11166. As used in this article, “commercial computer technician” means a person who works for a company that is in the business of repairing, installing, or otherwise servicing a computer or computer component, including, but
not limited to, a computer part, device, memory storage or recording mechanism, auxiliary storage recording or memory capacity, or any other material relating to the operation and maintenance of a computer or computer network system, for a fee. An employer who provides an electronic communications service or a remote computing service to the public shall be deemed to comply with this article if that employer complies with Section 2258A of Title 18 of the United States Code.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
An employer of a commercial computer technician may implement internal procedures for facilitating reporting consistent with this article. These procedures may direct employees who are mandated reporters under this paragraph to report materials described in subdivision (e) of Section 11166 to an employee who is designated by the employer to receive the reports. An
employee who is designated to receive reports under this subparagraph shall be a commercial computer technician for purposes of this article. A commercial computer technician who makes a report to the designated employee pursuant to this subparagraph shall be deemed to have complied with the requirements of this article and shall be subject to the protections afforded to mandated reporters, including, but not limited to, those protections afforded by Section 11172.
</html:p>
<html:p>
(44)
<html:span class="EnSpace"/>
Any athletic coach, including, but not limited to, an assistant coach or a graduate assistant involved in coaching, at public or private postsecondary educational institutions.
</html:p>
<html:p>
(45)
<html:span class="EnSpace"/>
An individual certified by a licensed foster family agency as a certified family home, as defined in Section 1506 of the Health and
Safety Code.
</html:p>
<html:p>
(46)
<html:span class="EnSpace"/>
An individual approved as a resource family, as defined in Section 1517 of the Health and Safety Code and Section 16519.5 of the Welfare and Institutions Code.
</html:p>
<html:p>
(47)
<html:span class="EnSpace"/>
A qualified autism service provider, a qualified autism service professional, or a qualified autism service paraprofessional as defined in Chapter 17 (commencing with Section 4999.200) of Division 2 of the Business and Professions Code.
</html:p>
<html:p>
(48)
<html:span class="EnSpace"/>
A human resource employee of a business subject to Part 2.8 (commencing with Section 12900) of Division 3 of Title 2 of the Government Code that employs minors. For purposes of this section, a “human resource employee” is the employee or employees designated by the employer to accept any complaints
of misconduct as required by Chapter 6 (commencing with Section 12940) of Part 2.8 of Division 3 of Title 2 of the Government Code.
</html:p>
<html:p>
(49)
<html:span class="EnSpace"/>
An adult person whose duties require direct contact with and supervision of minors in the performance of the minors’ duties in the workplace of a business subject to Part 2.8 (commencing with Section 12900) of Division 3 of Title 2 of the Government Code is a mandated reporter of sexual abuse, as defined in Section 11165.1. Nothing in this paragraph shall be construed to modify or limit the person’s duty to report known or suspected child abuse or neglect when the person is acting in some other capacity that would otherwise make the person a mandated reporter.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
Except as provided in paragraph (35) of subdivision (a), volunteers of
public or private organizations whose duties require direct contact with and supervision of children are not mandated reporters but are encouraged to obtain training in the identification and reporting of child abuse and neglect and are further encouraged to report known or suspected instances of child abuse or neglect to an agency specified in Section 11165.9.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
Except as provided in subdivision (d) and paragraph (2), employers are strongly encouraged to provide their employees who are mandated reporters with training in the duties imposed by this article. This training shall include training in child abuse and neglect identification and training in child abuse and neglect reporting. Whether or not employers provide their employees with training in child abuse and neglect identification and reporting, the employers
shall provide their employees who are mandated reporters with the statement required pursuant to subdivision (a) of Section 11166.5.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Employers subject to paragraphs (48) and (49) of subdivision (a) shall provide their employees who are mandated reporters with training in the duties imposed by this article. This training shall include training in child abuse and neglect identification and training in child abuse and neglect reporting. The training requirement may be met by completing the general online training for mandated reporters offered by the Office of Child Abuse Prevention in the State Department of Social Services.
</html:p>
<html:p>
(d)
<html:span class="EnSpace"/>
Pursuant to Section 44691 of the Education Code, school districts, county offices of education, state special schools and diagnostic centers operated
by the State Department of Education, and charter schools shall annually train their employees and persons working on their behalf specified in subdivision (a) in the duties of mandated reporters under the child abuse reporting laws. The training shall include, but not necessarily be limited to, training in child abuse and neglect identification and child abuse and neglect reporting.
</html:p>
<html:p>
(e)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
On and after January 1, 2018, pursuant to Section 1596.8662 of the Health and Safety Code, a childcare licensee applicant shall take training in the duties of mandated reporters under the child abuse reporting laws as a condition of licensure, and a childcare administrator or an employee of a licensed child daycare facility shall take training in the duties of mandated reporters during the first 90 days when that administrator or employee
is employed by the facility.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
A person specified in paragraph (1) who becomes a licensee, administrator, or employee of a licensed child daycare facility shall take renewal mandated reporter training every two years following the date on which that person completed the initial mandated reporter training. The training shall include, but not necessarily be limited to, training in child abuse and neglect identification and child abuse and neglect reporting.
</html:p>
<html:p>
(f)
<html:span class="EnSpace"/>
Unless otherwise specifically provided, the absence of training shall not excuse a mandated reporter from the duties imposed by this article.
</html:p>
<html:p>
(g)
<html:span class="EnSpace"/>
Public and private organizations are encouraged to provide their volunteers whose duties require direct contact with and supervision
of children with training in the identification and reporting of child abuse and neglect.
</html:p>
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<ns0:BillSection id="id_0B88EEE7-8205-49B6-882D-0A2E15BA0855">
<ns0:Num>SEC. 9.1.</ns0:Num>
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Section 11165.7 of the
<ns0:DocName>Penal Code</ns0:DocName>
is amended to read:
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<ns0:Fragment>
<ns0:LawSection id="id_568CBD07-B849-4FAB-BC39-160171D3EA23">
<ns0:Num>11165.7.</ns0:Num>
<ns0:LawSectionVersion id="id_8A74B92B-EA8D-458D-B312-14D655F2922F">
<ns0:Content>
<html:p>
(a)
<html:span class="EnSpace"/>
As used in this article, “mandated reporter” is defined as any of the following:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
A teacher.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
An instructional aide.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
A teacher’s aide or teacher’s assistant employed by a public or private school.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
A classified employee of a public school.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
An administrative officer or supervisor of child welfare and attendance, or a certificated pupil personnel employee of a public or private school.
</html:p>
<html:p>
(6)
<html:span class="EnSpace"/>
An administrator of a public or
private day camp.
</html:p>
<html:p>
(7)
<html:span class="EnSpace"/>
An administrator or employee of a public or private youth center, youth recreation program, or youth organization.
</html:p>
<html:p>
(8)
<html:span class="EnSpace"/>
An administrator, board member, or employee of a public or private organization whose duties require direct contact and supervision of children, including a foster family agency.
</html:p>
<html:p>
(9)
<html:span class="EnSpace"/>
An employee of a county office of education or the State Department of Education whose duties bring the employee into contact with children on a regular basis.
</html:p>
<html:p>
(10)
<html:span class="EnSpace"/>
A licensee, an administrator, or an employee of a licensed child daycare facility or community care facility, except those licensed community care facilities exclusively serving adults and seniors.
</html:p>
<html:p>
(11)
<html:span class="EnSpace"/>
A Head
Start program teacher.
</html:p>
<html:p>
(12)
<html:span class="EnSpace"/>
A licensing worker or licensing evaluator employed by a licensing agency, as defined in Section 11165.11.
</html:p>
<html:p>
(13)
<html:span class="EnSpace"/>
A public assistance worker.
</html:p>
<html:p>
(14)
<html:span class="EnSpace"/>
An employee of a childcare institution, including, but not limited to, foster parents, group home personnel, and personnel of residential care facilities.
</html:p>
<html:p>
(15)
<html:span class="EnSpace"/>
A social worker, probation officer, or parole officer.
</html:p>
<html:p>
(16)
<html:span class="EnSpace"/>
An employee of a school district police or security department.
</html:p>
<html:p>
(17)
<html:span class="EnSpace"/>
A person who is an administrator or presenter of, or a counselor in, a child abuse prevention program in a public or private school.
</html:p>
<html:p>
(18)
<html:span class="EnSpace"/>
A district attorney investigator, inspector, or local child support agency caseworker, unless the investigator, inspector, or caseworker is working with an attorney appointed pursuant to Section 317 of the Welfare and Institutions Code to represent a minor.
</html:p>
<html:p>
(19)
<html:span class="EnSpace"/>
A peace officer, as defined in Chapter 4.5 (commencing with Section 830) of Title 3 of Part 2, who is not otherwise described in this section.
</html:p>
<html:p>
(20)
<html:span class="EnSpace"/>
A firefighter, except for volunteer firefighters.
</html:p>
<html:p>
(21)
<html:span class="EnSpace"/>
A physician and surgeon, psychiatrist, psychologist, dentist, resident, intern, podiatrist, chiropractor, licensed nurse, dental hygienist, optometrist, marriage and family therapist, clinical social worker, professional clinical counselor, or any other person who is currently licensed under
Division 2 (commencing with Section 500) of the Business and Professions Code.
</html:p>
<html:p>
(22)
<html:span class="EnSpace"/>
An emergency medical technician I or II, paramedic, or other person certified pursuant to Division 2.5 (commencing with Section 1797) of the Health and Safety Code.
</html:p>
<html:p>
(23)
<html:span class="EnSpace"/>
A psychological assistant registered pursuant to Section 2913 of the Business and Professions Code.
</html:p>
<html:p>
(24)
<html:span class="EnSpace"/>
A marriage and family therapist trainee, as defined in subdivision (c) of Section 4980.03 of the Business and Professions Code.
</html:p>
<html:p>
(25)
<html:span class="EnSpace"/>
An unlicensed associate marriage and family therapist registered under Section 4980.44 of the Business and Professions Code.
</html:p>
<html:p>
(26)
<html:span class="EnSpace"/>
A state or county public health employee who treats a minor for venereal
disease or any other condition.
</html:p>
<html:p>
(27)
<html:span class="EnSpace"/>
A coroner.
</html:p>
<html:p>
(28)
<html:span class="EnSpace"/>
A medical examiner or other person who performs autopsies.
</html:p>
<html:p>
(29)
<html:span class="EnSpace"/>
A commercial film and photographic print or image processor as specified in subdivision (e) of Section 11166. As used in this article, “commercial film and photographic print or image processor” means a person who develops exposed photographic film into negatives, slides, or prints, or who makes prints from negatives or slides, or who prepares, publishes, produces, develops, duplicates, or prints any representation of information, data, or an image, including, but not limited to, any film, filmstrip, photograph, negative, slide, photocopy, videotape, video laser disc, computer hardware, computer software, computer floppy disk, data storage medium, CD-ROM, computer-generated equipment, or
computer-generated image, for compensation. The term includes any employee of that person; it does not include a person who develops film or makes prints or images for a public agency.
</html:p>
<html:p>
(30)
<html:span class="EnSpace"/>
A child visitation monitor. As used in this article, “child visitation monitor” means a person who, for financial compensation, acts as a monitor of a visit between a child and another person when the monitoring of that visit has been ordered by a court of law.
</html:p>
<html:p>
(31)
<html:span class="EnSpace"/>
An animal control officer or humane society officer. For the purposes of this article, the following terms have the following meanings:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
“Animal control officer” means a person employed by a city, county, or city and county for the purpose of enforcing animal control laws or regulations.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
“Humane
society officer” means a person appointed or employed by a public or private entity as a humane officer who is qualified pursuant to Section 14502 or 14503 of the Corporations Code.
</html:p>
<html:p>
(32)
<html:span class="EnSpace"/>
A clergy member, as specified in subdivision (d) of Section 11166. As used in this article, “clergy member” means a priest, minister, rabbi, religious practitioner, or similar functionary of a church, temple, or recognized denomination or organization.
</html:p>
<html:p>
(33)
<html:span class="EnSpace"/>
Any custodian of records of a clergy member, as specified in this section and subdivision (d) of Section 11166.
</html:p>
<html:p>
(34)
<html:span class="EnSpace"/>
An employee of any police department, county sheriff’s department, county probation department, or county welfare department.
</html:p>
<html:p>
(35)
<html:span class="EnSpace"/>
An employee or volunteer of a Court Appointed Special Advocate
program, as defined in Rule 5.655 of the California Rules of Court.
</html:p>
<html:p>
(36)
<html:span class="EnSpace"/>
A custodial officer, as defined in Section 831.5.
</html:p>
<html:p>
(37)
<html:span class="EnSpace"/>
A person providing services to a minor child under Section 12300 or 12300.1 of the Welfare and Institutions Code.
</html:p>
<html:p>
(38)
<html:span class="EnSpace"/>
An alcohol and drug counselor. As used in this article, an “alcohol and drug counselor” is a person providing counseling, therapy, or other clinical services for a state licensed or certified drug, alcohol, or drug and alcohol treatment program. However, alcohol or drug abuse, or both alcohol and drug abuse, is not, in and of itself, a sufficient basis for reporting child abuse or neglect.
</html:p>
<html:p>
(39)
<html:span class="EnSpace"/>
A clinical counselor trainee, as defined in subdivision (g) of Section 4999.12 of the Business and Professions
Code.
</html:p>
<html:p>
(40)
<html:span class="EnSpace"/>
An associate professional clinical counselor registered under Section 4999.42 of the Business and Professions Code.
</html:p>
<html:p>
(41)
<html:span class="EnSpace"/>
An employee or administrator of a public or private postsecondary educational institution, whose duties bring the administrator or employee into contact with children on a regular basis, or who supervises those whose duties bring the administrator or employee into contact with children on a regular basis, as to child abuse or neglect occurring on that institution’s premises or at an official activity of, or program conducted by, the institution. Nothing in this paragraph shall be construed as altering the lawyer-client privilege as set forth in Article 3 (commencing with Section 950) of Chapter 4 of Division 8 of the Evidence Code.
</html:p>
<html:p>
(42)
<html:span class="EnSpace"/>
An athletic coach, athletic administrator, or
athletic director employed by any public or private school that provides any combination of instruction for kindergarten, or grades 1 to 12, inclusive.
</html:p>
<html:p>
(43)
<html:span class="EnSpace"/>
(A)
<html:span class="EnSpace"/>
A commercial computer technician as specified in subdivision (e) of Section 11166. As used in this article, “commercial computer technician” means a person who works for a company that is in the business of repairing, installing, or otherwise servicing a computer or computer component, including, but not limited to, a computer part, device, memory storage or recording mechanism, auxiliary storage recording or memory capacity, or any other material relating to the operation and maintenance of a computer or computer network system, for a fee. An employer who provides an electronic communications service or a remote computing service to the public shall be deemed to comply with this article if that employer complies with Section 2258A of Title 18 of the United States
Code.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
An employer of a commercial computer technician may implement internal procedures for facilitating reporting consistent with this article. These procedures may direct employees who are mandated reporters under this paragraph to report materials described in subdivision (e) of Section 11166 to an employee who is designated by the employer to receive the reports. An employee who is designated to receive reports under this subparagraph shall be a commercial computer technician for purposes of this article. A commercial computer technician who makes a report to the designated employee pursuant to this subparagraph shall be deemed to have complied with the requirements of this article and shall be subject to the protections afforded to mandated reporters, including, but not limited to, those protections afforded by Section 11172.
</html:p>
<html:p>
(44)
<html:span class="EnSpace"/>
Any athletic coach, including, but not
limited to, an assistant coach or a graduate assistant involved in coaching, at public or private postsecondary educational institutions.
</html:p>
<html:p>
(45)
<html:span class="EnSpace"/>
An individual certified by a licensed foster family agency as a certified family home, as defined in Section 1506 of the Health and Safety Code.
</html:p>
<html:p>
(46)
<html:span class="EnSpace"/>
An individual approved as a resource family, as defined in Section 1517 of the Health and Safety Code and Section 16519.5 of the Welfare and Institutions Code.
</html:p>
<html:p>
(47)
<html:span class="EnSpace"/>
A qualified autism service provider, a qualified autism service professional, or a qualified autism service
paraprofessional as defined in Chapter 17 (commencing with Section 4999.200) of Division 2 of the Business and Professions Code.
</html:p>
<html:p>
(48)
<html:span class="EnSpace"/>
A human resource employee of a business subject to Part 2.8 (commencing with Section 12900) of Division 3 of Title 2 of the Government Code that employs minors. For purposes of this section, a “human resource employee” is the employee or employees designated by the employer to accept any complaints of misconduct as required by Chapter 6 (commencing with Section 12940) of Part 2.8 of Division 3 of Title 2 of the Government Code.
</html:p>
<html:p>
(49)
<html:span class="EnSpace"/>
An adult person whose duties require direct contact with and supervision of minors in the performance of the minors’ duties in the workplace of a business subject to Part 2.8 (commencing
with Section 12900) of Division 3 of Title 2 of the Government Code is a mandated reporter of sexual abuse, as defined in Section 11165.1. Nothing in this paragraph shall be construed to modify or limit the person’s duty to report known or suspected child abuse or neglect when the person is acting in some other capacity that would otherwise make the person a mandated reporter.
</html:p>
<html:p>
(50)
<html:span class="EnSpace"/>
An individual employed as a talent agent, talent manager, or talent coach, who provides services to a minor.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
Except as provided in paragraph (35) of subdivision (a), volunteers of public or private organizations whose duties require direct contact with and supervision of children are not mandated reporters but are encouraged to obtain training in the identification and reporting of child abuse
and neglect and are further encouraged to report known or suspected instances of child abuse or neglect to an agency specified in Section 11165.9.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
Except as provided in subdivision (d) and paragraph (2), employers are strongly encouraged to provide their employees who are mandated reporters with training in the duties imposed by this article. This training shall include training in child abuse and neglect identification and training in child abuse and neglect reporting. Whether or not employers provide their employees with training in child abuse and neglect identification and reporting, the employers shall provide their employees who are mandated reporters with the statement required pursuant to subdivision (a) of Section 11166.5.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Employers subject to paragraphs (48) and (49) of subdivision (a) shall provide their employees who are mandated
reporters with training in the duties imposed by this article. This training shall include training in child abuse and neglect identification and training in child abuse and neglect reporting. The training requirement may be met by completing the general online training for mandated reporters offered by the Office of Child Abuse Prevention in the State Department of Social Services.
</html:p>
<html:p>
(d)
<html:span class="EnSpace"/>
Pursuant to Section 44691 of the Education Code, school districts, county offices of education, state special schools and diagnostic centers operated by the State Department of Education, and charter schools shall annually train their employees and persons working on their behalf specified in subdivision (a) in the duties of mandated reporters under the child abuse reporting laws. The training shall include, but not necessarily be limited to, training in child abuse and neglect identification and child abuse and neglect reporting.
</html:p>
<html:p>
(e)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
On and after January 1, 2018, pursuant to Section 1596.8662 of the Health and Safety Code, a childcare licensee applicant shall take training in the duties of mandated reporters under the child abuse reporting laws as a condition of licensure, and a childcare administrator or an employee of a licensed child daycare facility shall take training in the duties of mandated reporters during the first 90 days when that administrator or employee is employed by the facility.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
A person specified in paragraph (1) who becomes a licensee, administrator, or employee of a licensed child daycare facility shall take renewal mandated reporter training every two years following the date on which that person completed the initial mandated reporter training. The training shall include, but not necessarily be limited to, training in child abuse and neglect identification
and child abuse and neglect reporting.
</html:p>
<html:p>
(f)
<html:span class="EnSpace"/>
Unless otherwise specifically provided, the absence of training shall not excuse a mandated reporter from the duties imposed by this article.
</html:p>
<html:p>
(g)
<html:span class="EnSpace"/>
Public and private organizations are encouraged to provide their volunteers whose duties require direct contact with and supervision of children with training in the identification and reporting of child abuse and neglect.
</html:p>
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</ns0:BillSection>
<ns0:BillSection id="id_31A4BEF4-0019-4F3B-AD7A-EE412994396F">
<ns0:Num>SEC. 9.2.</ns0:Num>
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Section 11165.7 of the
<ns0:DocName>Penal Code</ns0:DocName>
is amended to read:
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<ns0:LawSection id="id_10FDE2F7-5F06-48FA-B7C0-A0A49710B6FB">
<ns0:Num>11165.7.</ns0:Num>
<ns0:LawSectionVersion id="id_E143DF97-0C18-404B-B2C5-D4C55503EF39">
<ns0:Content>
<html:p>
(a)
<html:span class="EnSpace"/>
As used in this article, “mandated reporter” is defined as any of the following:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
An employee, volunteer, or governing board or body member of a school district, county office of education, charter school, or private school. For purposes of this paragraph, a volunteer is a person who is over 18 years of age and who interacts with pupils outside of the immediate supervision and control of the pupil’s parent or guardian or a school employee.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
An employee, volunteer, or board member of a public or private school, contractor to a school district, county office of education, charter school, state special school or diagnostic center operated by the State Department of Education, or private school whose duties require contact with or supervision of pupils at that school district, county office of education, charter school, state special school or diagnostic center operated by the State Department of Education, or private school. For purposes of this paragraph, a
volunteer is a person who is over 18 years of age and who interacts with pupils outside of the immediate supervision and control of the pupil’s parent or guardian or a school employee.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
An employee or volunteer assigned to a state special school or diagnostic center operated by the State Department of Education. For purposes of this paragraph, a volunteer is a person who is over 18 years of age and who interacts with pupils outside of the immediate supervision and control of the pupil’s parent or guardian or a school employee.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
[Reserved]
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
[Reserved]
</html:p>
<html:p>
(6)
<html:span class="EnSpace"/>
An administrator of a public or private day camp.
</html:p>
<html:p>
(7)
<html:span class="EnSpace"/>
An administrator or employee of a public or
private youth center, youth recreation program, or youth organization.
</html:p>
<html:p>
(8)
<html:span class="EnSpace"/>
An administrator, board member, or employee of a public or private organization whose duties require direct contact and supervision of children, including a foster family agency.
</html:p>
<html:p>
(9)
<html:span class="EnSpace"/>
[Reserved]
</html:p>
<html:p>
(10)
<html:span class="EnSpace"/>
A licensee, an administrator, or an employee of a licensed child
daycare facility or community care facility, except those licensed community care facilities exclusively serving adults and seniors.
</html:p>
<html:p>
(11)
<html:span class="EnSpace"/>
A Head Start program teacher.
</html:p>
<html:p>
(12)
<html:span class="EnSpace"/>
A licensing worker or licensing evaluator employed by a licensing agency, as defined in Section 11165.11.
</html:p>
<html:p>
(13)
<html:span class="EnSpace"/>
A public assistance worker.
</html:p>
<html:p>
(14)
<html:span class="EnSpace"/>
An employee of a childcare institution, including, but not limited to, foster parents, group home personnel, and personnel of residential care facilities.
</html:p>
<html:p>
(15)
<html:span class="EnSpace"/>
A social worker, probation officer, or parole officer.
</html:p>
<html:p>
(16)
<html:span class="EnSpace"/>
[Reserved]
</html:p>
<html:p>
(17)
<html:span class="EnSpace"/>
A person who is an administrator or presenter of, or a counselor in, a child abuse prevention program in a public or private school.
</html:p>
<html:p>
(18)
<html:span class="EnSpace"/>
A district attorney investigator, inspector, or local child support agency caseworker, unless the investigator, inspector, or caseworker is working with an attorney appointed pursuant to Section 317 of the Welfare and Institutions Code to represent a minor.
</html:p>
<html:p>
(19)
<html:span class="EnSpace"/>
A peace officer, as defined in Chapter 4.5 (commencing with Section 830) of Title 3 of Part 2, who is not otherwise described in this section.
</html:p>
<html:p>
(20)
<html:span class="EnSpace"/>
A firefighter, except for volunteer firefighters.
</html:p>
<html:p>
(21)
<html:span class="EnSpace"/>
A physician and surgeon, psychiatrist, psychologist, dentist, resident, intern, podiatrist, chiropractor, licensed nurse, dental hygienist, optometrist, marriage and family therapist, clinical social worker, professional clinical counselor, or any other person who is currently licensed under Division 2 (commencing with Section 500) of the Business and Professions Code.
</html:p>
<html:p>
(22)
<html:span class="EnSpace"/>
An emergency medical technician I or II, paramedic, or other person certified pursuant to Division 2.5 (commencing with Section 1797) of the Health and Safety Code.
</html:p>
<html:p>
(23)
<html:span class="EnSpace"/>
A psychological assistant registered pursuant to Section 2913 of the Business and Professions Code.
</html:p>
<html:p>
(24)
<html:span class="EnSpace"/>
A marriage and family therapist trainee, as defined in subdivision (c) of Section 4980.03 of the Business and Professions Code.
</html:p>
<html:p>
(25)
<html:span class="EnSpace"/>
An unlicensed associate marriage and family therapist registered under Section 4980.44 of the Business and Professions Code.
</html:p>
<html:p>
(26)
<html:span class="EnSpace"/>
A state or county public health employee who treats a minor for venereal disease or any other condition.
</html:p>
<html:p>
(27)
<html:span class="EnSpace"/>
A coroner.
</html:p>
<html:p>
(28)
<html:span class="EnSpace"/>
A medical examiner or other person who performs autopsies.
</html:p>
<html:p>
(29)
<html:span class="EnSpace"/>
A commercial film and photographic print or image processor as specified in subdivision (e) of Section 11166. As used in this article, “commercial film and photographic print or image processor” means a person who develops exposed photographic film into negatives, slides, or prints, or who makes prints from negatives or slides, or who prepares, publishes, produces,
develops, duplicates, or prints any representation of information, data, or an image, including, but not limited to, any film, filmstrip, photograph, negative, slide, photocopy, videotape, video laser disc, computer hardware, computer software, computer floppy disk, data storage medium, CD-ROM, computer-generated equipment, or computer-generated image, for compensation. The term includes any employee of that person; it does not include a person who develops film or makes prints or images for a public agency.
</html:p>
<html:p>
(30)
<html:span class="EnSpace"/>
A child visitation monitor. As used in this article, “child visitation monitor” means a person who, for financial compensation, acts as a monitor of a visit between a child and another person when the monitoring of that visit has been ordered by a court of law.
</html:p>
<html:p>
(31)
<html:span class="EnSpace"/>
An animal control officer or humane society officer. For the purposes of this article, the following terms
have the following meanings:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
“Animal control officer” means a person employed by a city, county, or city and county for the purpose of enforcing animal control laws or regulations.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
“Humane society officer” means a person appointed or employed by a public or private entity as a humane officer who is qualified pursuant to Section 14502 or 14503 of the Corporations Code.
</html:p>
<html:p>
(32)
<html:span class="EnSpace"/>
A clergy member, as specified in subdivision (d) of Section 11166. As used in this article, “clergy member” means a priest, minister, rabbi, religious practitioner, or similar functionary of a church, temple, or recognized denomination or organization.
</html:p>
<html:p>
(33)
<html:span class="EnSpace"/>
Any custodian of records of a clergy member, as specified in this section and subdivision (d) of Section 11166.
</html:p>
<html:p>
(34)
<html:span class="EnSpace"/>
An employee of any police department, county sheriff’s department, county probation department, or county welfare department.
</html:p>
<html:p>
(35)
<html:span class="EnSpace"/>
An employee or volunteer of a Court Appointed Special Advocate program, as defined in Rule 5.655 of the California Rules of Court.
</html:p>
<html:p>
(36)
<html:span class="EnSpace"/>
A custodial officer, as defined in Section 831.5.
</html:p>
<html:p>
(37)
<html:span class="EnSpace"/>
A person providing services to a minor child under Section 12300 or 12300.1 of the Welfare and Institutions Code.
</html:p>
<html:p>
(38)
<html:span class="EnSpace"/>
An alcohol and drug counselor. As used in this article, an “alcohol and drug counselor” is a person providing counseling, therapy, or other clinical services for a state licensed or certified drug, alcohol, or drug and alcohol treatment program. However,
alcohol or drug abuse, or both alcohol and drug abuse, is not, in and of itself, a sufficient basis for reporting child abuse or neglect.
</html:p>
<html:p>
(39)
<html:span class="EnSpace"/>
A clinical counselor trainee, as defined in subdivision (g) of Section 4999.12 of the Business and Professions Code.
</html:p>
<html:p>
(40)
<html:span class="EnSpace"/>
An associate professional clinical counselor registered under Section 4999.42 of the Business and Professions Code.
</html:p>
<html:p>
(41)
<html:span class="EnSpace"/>
An employee or administrator of a public or private postsecondary educational institution, whose duties bring the administrator or employee into contact with children on a regular basis, or who supervises those whose duties bring the administrator or employee into contact with children on a regular basis, as to child abuse or neglect occurring on that institution’s premises or at an official activity of, or program conducted by, the
institution. Nothing in this paragraph shall be construed as altering the lawyer-client privilege as set forth in Article 3 (commencing with Section 950) of Chapter 4 of Division 8 of the Evidence Code.
</html:p>
<html:p>
(42)
<html:span class="EnSpace"/>
An athletic coach, athletic administrator, or athletic director employed by any public or private school that provides any combination of instruction for kindergarten, or grades 1 to 12, inclusive.
</html:p>
<html:p>
(43)
<html:span class="EnSpace"/>
(A)
<html:span class="EnSpace"/>
A commercial computer technician as specified in subdivision (e) of Section 11166. As used in this article, “commercial computer technician” means a person who works for a company that is in the business of repairing, installing, or otherwise servicing a computer or computer component, including, but not limited to, a computer part, device, memory storage or recording mechanism, auxiliary storage recording or memory capacity, or any other material
relating to the operation and maintenance of a computer or computer network system, for a fee. An employer who provides an electronic communications service or a remote computing service to the public shall be deemed to comply with this article if that employer complies with Section 2258A of Title 18 of the United States Code.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
An employer of a commercial computer technician may implement internal procedures for facilitating reporting consistent with this article. These procedures may direct employees who are mandated reporters under this paragraph to report materials described in subdivision (e) of Section 11166 to an employee who is designated by the employer to receive the reports. An employee who is designated to receive reports under this subparagraph shall be a commercial computer technician for purposes of this article. A commercial computer technician who makes a report to the designated employee pursuant to this subparagraph shall
be deemed to have complied with the requirements of this article and shall be subject to the protections afforded to mandated reporters, including, but not limited to, those protections afforded by Section 11172.
</html:p>
<html:p>
(44)
<html:span class="EnSpace"/>
Any athletic coach, including, but not limited to, an assistant coach or a graduate assistant involved in coaching, at public or private postsecondary educational institutions.
</html:p>
<html:p>
(45)
<html:span class="EnSpace"/>
An individual certified by a licensed foster family agency as a certified family home, as defined in Section 1506 of the Health and Safety Code.
</html:p>
<html:p>
(46)
<html:span class="EnSpace"/>
An individual approved as a resource family, as defined in Section 1517 of the Health and Safety Code and Section 16519.5 of the Welfare and Institutions Code.
</html:p>
<html:p>
(47)
<html:span class="EnSpace"/>
A qualified autism service provider, a qualified
autism service professional, or a qualified autism service paraprofessional as defined in
Chapter 17 (commencing with Section 4999.200) of Division 2 of the Business and Professions Code.
</html:p>
<html:p>
(48)
<html:span class="EnSpace"/>
A human resource employee of a business subject to Part 2.8 (commencing with Section 12900) of Division 3 of Title 2 of the Government Code that employs minors. For purposes of this section, a “human resource employee” is the employee or employees designated by the employer to accept any complaints of misconduct as required by Chapter 6 (commencing with Section 12940) of Part 2.8 of Division 3 of Title 2 of the Government Code.
</html:p>
<html:p>
(49)
<html:span class="EnSpace"/>
An adult person whose duties require direct contact with and supervision of minors in the performance of the minors’ duties in the workplace of a business subject to Part 2.8 (commencing with Section 12900) of Division 3 of Title 2 of the Government Code is a mandated reporter of sexual abuse, as defined in
Section 11165.1. Nothing in this paragraph shall be construed to modify or limit the person’s duty to report known or suspected child abuse or neglect when the person is acting in some other capacity that would otherwise make the person a mandated reporter.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
Except as provided in paragraphs (1), (2), (3), and (35) of subdivision (a), volunteers of public or private organizations whose duties require direct contact with and supervision of children are not mandated reporters but are encouraged to obtain training in the identification and reporting of child abuse and neglect and are further encouraged to report known or suspected instances of child abuse or neglect to an agency specified in Section 11165.9.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
Except as provided in subdivision (d) and paragraph (2), employers are strongly encouraged to provide their employees who are mandated reporters with training in the duties imposed by this article. This training shall include training in child abuse and neglect identification and training in child abuse and neglect reporting. Whether or not employers provide their employees with training in child abuse and neglect identification and reporting, the employers shall provide their employees who are mandated reporters with the statement required pursuant to subdivision (a) of Section 11166.5.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Employers subject to paragraphs (48) and (49) of subdivision (a) shall provide their employees who are mandated reporters with training in the duties imposed by this article. This training shall include training in child abuse and neglect identification and training
in child abuse and neglect reporting. The training requirement may be met by completing the general online training for mandated reporters offered by the Office of Child Abuse Prevention in the State Department of Social Services.
</html:p>
<html:p>
(d)
<html:span class="EnSpace"/>
Pursuant to Section 44691 of the Education Code, school districts, county offices of education, state special schools and diagnostic centers operated by the State Department of Education, charter schools, and, commencing July 1, 2026, private schools,
shall annually train their employees and persons working on their behalf specified in subdivision (a) in the duties of mandated reporters under the child abuse reporting laws. The training shall include, but not necessarily be limited to, training in child abuse and neglect identification and child abuse and neglect reporting.
</html:p>
<html:p>
(e)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
On and after January 1, 2018, pursuant to Section 1596.8662 of the Health and Safety Code, a childcare licensee applicant shall take training in the duties of mandated reporters under the child abuse reporting laws as a condition of licensure, and a childcare administrator or an employee of a licensed child daycare facility shall take training in the duties of mandated reporters during the first 90 days when that administrator or employee is employed by the facility.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
A person specified in paragraph (1) who
becomes a licensee, administrator, or employee of a licensed child daycare facility shall take renewal mandated reporter training every two years following the date on which that person completed the initial mandated reporter training. The training shall include, but not necessarily be limited to, training in child abuse and neglect identification and child abuse and neglect reporting.
</html:p>
<html:p>
(f)
<html:span class="EnSpace"/>
Unless otherwise specifically provided, the absence of training shall not excuse a mandated reporter from the duties imposed by this article.
</html:p>
<html:p>
(g)
<html:span class="EnSpace"/>
Public and private organizations are encouraged to provide their volunteers whose duties require direct contact with and supervision of children with training in the identification and reporting of child abuse and neglect.
</html:p>
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<ns0:BillSection id="id_232B1475-F452-4C49-9072-58A5FCF8C9AF">
<ns0:Num>SEC. 9.3.</ns0:Num>
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Section 11165.7 of the
<ns0:DocName>Penal Code</ns0:DocName>
is amended to read:
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<ns0:LawSection id="id_C9B4E775-894F-48A4-AFE4-6C57E456195D">
<ns0:Num>11165.7.</ns0:Num>
<ns0:LawSectionVersion id="id_862ADFF8-6750-46EC-A8B4-3CD30D96D657">
<ns0:Content>
<html:p>
(a)
<html:span class="EnSpace"/>
As used in this article, “mandated reporter” is defined as any of the following:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
An employee, volunteer, or governing board or body member of a school district, county office of education, charter school, or private school. For purposes of this paragraph, a volunteer is a person who is over 18 years of age and who interacts with pupils outside of the immediate supervision and control of the pupil’s parent or guardian or a school employee.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
An employee, volunteer, or board member of a public or private school, contractor to a school district, county office of education, charter school, state special school or diagnostic center operated by the State Department of Education, or private school whose duties require contact with or supervision of pupils at that school district, county office of education, charter school, state special school or diagnostic
center operated by the State Department of Education, or private school. For purposes of this paragraph, a volunteer is a person who is over 18 years of age and who interacts with pupils outside of the immediate supervision and control of the pupil’s parent or guardian or a school employee.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
An employee or volunteer assigned to a state special school or diagnostic center operated by the State Department of Education. For purposes of this paragraph, a volunteer is a person who is over 18 years of age and who interacts with pupils outside of the immediate supervision and control of the pupil’s parent or guardian or a school employee.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
[Reserved]
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
[Reserved]
</html:p>
<html:p>
(6)
<html:span class="EnSpace"/>
An administrator of a public or private day camp.
</html:p>
<html:p>
(7)
<html:span class="EnSpace"/>
An administrator or employee of a public or private youth center, youth recreation program, or youth organization.
</html:p>
<html:p>
(8)
<html:span class="EnSpace"/>
An administrator, board member, or employee of a public or private organization whose duties require direct contact and supervision of children, including a foster family agency.
</html:p>
<html:p>
(9)
<html:span class="EnSpace"/>
[Reserved]
</html:p>
<html:p>
(10)
<html:span class="EnSpace"/>
A licensee, an administrator, or an employee of a licensed child daycare facility or community care facility, except those licensed community care facilities exclusively serving adults and seniors.
</html:p>
<html:p>
(11)
<html:span class="EnSpace"/>
A Head Start program teacher.
</html:p>
<html:p>
(12)
<html:span class="EnSpace"/>
A licensing worker or licensing evaluator employed by a licensing agency, as defined in Section 11165.11.
</html:p>
<html:p>
(13)
<html:span class="EnSpace"/>
A public assistance worker.
</html:p>
<html:p>
(14)
<html:span class="EnSpace"/>
An employee of a childcare institution, including, but not limited to, foster parents, group home personnel, and personnel of residential care facilities.
</html:p>
<html:p>
(15)
<html:span class="EnSpace"/>
A social worker, probation officer, or parole officer.
</html:p>
<html:p>
(16)
<html:span class="EnSpace"/>
[Reserved]
</html:p>
<html:p>
(17)
<html:span class="EnSpace"/>
A person who is an administrator or presenter of, or a counselor in, a child abuse prevention program in a public or private school.
</html:p>
<html:p>
(18)
<html:span class="EnSpace"/>
A district attorney investigator, inspector, or local child support agency caseworker, unless the investigator, inspector, or caseworker is working with an attorney appointed pursuant to Section 317 of the Welfare and Institutions Code to represent a minor.
</html:p>
<html:p>
(19)
<html:span class="EnSpace"/>
A peace officer, as defined in Chapter 4.5 (commencing with Section 830) of Title 3 of Part 2, who is not otherwise described in this section.
</html:p>
<html:p>
(20)
<html:span class="EnSpace"/>
A firefighter, except for volunteer firefighters.
</html:p>
<html:p>
(21)
<html:span class="EnSpace"/>
A physician and surgeon, psychiatrist, psychologist, dentist, resident, intern, podiatrist, chiropractor, licensed nurse, dental hygienist, optometrist, marriage and family therapist, clinical social worker, professional clinical counselor, or any other person who is currently licensed under Division 2 (commencing with Section 500) of the Business and Professions Code.
</html:p>
<html:p>
(22)
<html:span class="EnSpace"/>
An emergency medical technician I or II, paramedic, or other person certified pursuant to Division 2.5 (commencing with Section 1797) of the Health and Safety Code.
</html:p>
<html:p>
(23)
<html:span class="EnSpace"/>
A psychological assistant registered pursuant to Section 2913 of the Business and Professions Code.
</html:p>
<html:p>
(24)
<html:span class="EnSpace"/>
A marriage and family therapist trainee, as defined in subdivision (c) of Section 4980.03 of the Business and Professions Code.
</html:p>
<html:p>
(25)
<html:span class="EnSpace"/>
An unlicensed associate marriage and family therapist registered under Section 4980.44 of the Business and Professions Code.
</html:p>
<html:p>
(26)
<html:span class="EnSpace"/>
A state or county public health employee who treats a minor for venereal disease or any other condition.
</html:p>
<html:p>
(27)
<html:span class="EnSpace"/>
A coroner.
</html:p>
<html:p>
(28)
<html:span class="EnSpace"/>
A medical examiner or other person who performs autopsies.
</html:p>
<html:p>
(29)
<html:span class="EnSpace"/>
A commercial film and photographic print or image processor as specified in subdivision (e) of Section 11166. As used in this article, “commercial film and photographic print or image processor” means a person who develops exposed photographic film into negatives, slides, or prints, or who makes prints from negatives or slides, or who prepares, publishes, produces,
develops, duplicates, or prints any representation of information, data, or an image, including, but not limited to, any film, filmstrip, photograph, negative, slide, photocopy, videotape, video laser disc, computer hardware, computer software, computer floppy disk, data storage medium, CD-ROM, computer-generated equipment, or computer-generated image, for compensation. The term includes any employee of that person; it does not include a person who develops film or makes prints or images for a public agency.
</html:p>
<html:p>
(30)
<html:span class="EnSpace"/>
A child visitation monitor. As used in this article, “child visitation monitor” means a person who, for financial compensation, acts as a monitor of a visit between a child and another person when the monitoring of that visit has been ordered by a court of law.
</html:p>
<html:p>
(31)
<html:span class="EnSpace"/>
An animal control officer or humane society officer. For the purposes of this article, the following terms
have the following meanings:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
“Animal control officer” means a person employed by a city, county, or city and county for the purpose of enforcing animal control laws or regulations.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
“Humane society officer” means a person appointed or employed by a public or private entity as a humane officer who is qualified pursuant to Section 14502 or 14503 of the Corporations Code.
</html:p>
<html:p>
(32)
<html:span class="EnSpace"/>
A clergy member, as specified in subdivision (d) of Section 11166. As used in this article, “clergy member” means a priest, minister, rabbi, religious practitioner, or similar functionary of a church, temple, or recognized denomination or organization.
</html:p>
<html:p>
(33)
<html:span class="EnSpace"/>
Any custodian of records of a clergy member, as specified in this section and subdivision (d) of Section 11166.
</html:p>
<html:p>
(34)
<html:span class="EnSpace"/>
An employee of any police department, county sheriff’s department, county probation department, or county welfare department.
</html:p>
<html:p>
(35)
<html:span class="EnSpace"/>
An employee or volunteer of a Court Appointed Special Advocate program, as defined in Rule 5.655 of the California Rules of Court.
</html:p>
<html:p>
(36)
<html:span class="EnSpace"/>
A custodial officer, as defined in Section 831.5.
</html:p>
<html:p>
(37)
<html:span class="EnSpace"/>
A person providing services to a minor child under Section 12300 or 12300.1 of the Welfare and Institutions Code.
</html:p>
<html:p>
(38)
<html:span class="EnSpace"/>
An alcohol and drug counselor. As used in this article, an “alcohol and drug counselor” is a person providing counseling, therapy, or other clinical services for a state licensed or certified drug, alcohol, or drug and alcohol treatment program. However,
alcohol or drug abuse, or both alcohol and drug abuse, is not, in and of itself, a sufficient basis for reporting child abuse or neglect.
</html:p>
<html:p>
(39)
<html:span class="EnSpace"/>
A clinical counselor trainee, as defined in subdivision (g) of Section 4999.12 of the Business and Professions Code.
</html:p>
<html:p>
(40)
<html:span class="EnSpace"/>
An associate professional clinical counselor registered under Section 4999.42 of the Business and Professions Code.
</html:p>
<html:p>
(41)
<html:span class="EnSpace"/>
An employee or administrator of a public or private postsecondary educational institution, whose duties bring the administrator or employee into contact with children on a regular basis, or who supervises those whose duties bring the administrator or employee into contact with children on a regular basis, as to child abuse or neglect occurring on that institution’s premises or at an official activity of, or program conducted by, the
institution. Nothing in this paragraph shall be construed as altering the lawyer-client privilege as set forth in Article 3 (commencing with Section 950) of Chapter 4 of Division 8 of the Evidence Code.
</html:p>
<html:p>
(42)
<html:span class="EnSpace"/>
An athletic coach, athletic administrator, or athletic director employed by any public or private school that provides any combination of instruction for kindergarten, or grades 1 to 12, inclusive.
</html:p>
<html:p>
(43)
<html:span class="EnSpace"/>
(A)
<html:span class="EnSpace"/>
A commercial computer technician as specified in subdivision (e) of Section 11166. As used in this article, “commercial computer technician” means a person who works for a company that is in the business of repairing, installing, or otherwise servicing a computer or computer component, including, but not limited to, a computer part, device, memory storage or recording mechanism, auxiliary storage recording or memory capacity, or any other material
relating to the operation and maintenance of a computer or computer network system, for a fee. An employer who provides an electronic communications service or a remote computing service to the public shall be deemed to comply with this article if that employer complies with Section 2258A of Title 18 of the United States Code.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
An employer of a commercial computer technician may implement internal procedures for facilitating reporting consistent with this article. These procedures may direct employees who are mandated reporters under this paragraph to report materials described in subdivision (e) of Section 11166 to an employee who is designated by the employer to receive the reports. An employee who is designated to receive reports under this subparagraph shall be a commercial computer technician for purposes of this article. A commercial computer technician who makes a report to the designated employee pursuant to this subparagraph shall
be deemed to have complied with the requirements of this article and shall be subject to the protections afforded to mandated reporters, including, but not limited to, those protections afforded by Section 11172.
</html:p>
<html:p>
(44)
<html:span class="EnSpace"/>
Any athletic coach, including, but not limited to, an assistant coach or a graduate assistant involved in coaching, at public or private postsecondary educational institutions.
</html:p>
<html:p>
(45)
<html:span class="EnSpace"/>
An individual certified by a licensed foster family agency as a certified family home, as defined in Section 1506 of the Health and Safety Code.
</html:p>
<html:p>
(46)
<html:span class="EnSpace"/>
An individual approved as a resource family, as defined in Section 1517 of the Health and Safety Code and Section 16519.5 of the Welfare and Institutions Code.
</html:p>
<html:p>
(47)
<html:span class="EnSpace"/>
A qualified autism service provider, a qualified
autism service professional, or a qualified autism service paraprofessional as defined in
Chapter 17 (commencing with Section 4999.200) of Division 2 of the Business and Professions Code.
</html:p>
<html:p>
(48)
<html:span class="EnSpace"/>
A human resource employee of a business subject to Part 2.8 (commencing with Section 12900) of Division 3 of Title 2 of the Government Code that employs minors. For purposes of this section, a “human resource employee” is the employee or employees designated by the employer to accept any complaints of misconduct as required by Chapter 6 (commencing with Section 12940) of Part 2.8 of Division 3 of Title 2 of the Government Code.
</html:p>
<html:p>
(49)
<html:span class="EnSpace"/>
An adult person whose duties require direct contact with and supervision of minors in the performance of the minors’ duties in the workplace of a business subject to Part 2.8 (commencing with Section 12900) of Division 3 of Title 2 of the Government Code is a mandated reporter of sexual abuse, as defined in
Section 11165.1. Nothing in this paragraph shall be construed to modify or limit the person’s duty to report known or suspected child abuse or neglect when the person is acting in some other capacity that would otherwise make the person a mandated reporter.
</html:p>
<html:p>
(50)
<html:span class="EnSpace"/>
An individual employed as a talent agent, talent manager, or talent coach, who provides services to a minor.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
Except as provided in paragraphs (1), (2), (3), and (35) of subdivision (a), volunteers of public or private organizations whose duties require direct contact with and supervision of children are not
mandated reporters but are encouraged to obtain training in the identification and reporting of child abuse and neglect and are further encouraged to report known or suspected instances of child abuse or neglect to an agency specified in Section 11165.9.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
Except as provided in subdivision (d) and paragraph (2), employers are strongly encouraged to provide their employees who are mandated reporters with training in the duties imposed by this article. This training shall include training in child abuse and neglect identification and training in child abuse and neglect reporting. Whether or not employers provide their employees with training in child abuse and neglect identification and reporting, the employers shall provide their employees who are mandated reporters with the statement required pursuant to subdivision (a) of Section 11166.5.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Employers
subject to paragraphs (48) and (49) of subdivision (a) shall provide their employees who are mandated reporters with training in the duties imposed by this article. This training shall include training in child abuse and neglect identification and training in child abuse and neglect reporting. The training requirement may be met by completing the general online training for mandated reporters offered by the Office of Child Abuse Prevention in the State Department of Social Services.
</html:p>
<html:p>
(d)
<html:span class="EnSpace"/>
Pursuant to Section 44691 of the Education Code, school districts, county offices of education, state special schools and diagnostic centers operated by the State Department of Education, charter schools, and, commencing July 1, 2026, private schools,
shall annually train their employees and persons working on their behalf specified in subdivision (a) in the duties of mandated reporters under the child abuse reporting laws. The training shall include, but not necessarily be limited to, training in child abuse and neglect identification and child abuse and neglect reporting.
</html:p>
<html:p>
(e)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
On and after January 1, 2018, pursuant to Section 1596.8662 of the Health and Safety Code, a childcare licensee applicant shall take training in the duties of mandated reporters under the child abuse reporting laws as a condition of licensure, and a childcare administrator or an employee of a licensed child daycare facility shall take training in the duties of mandated reporters during the first 90 days when that administrator or employee is employed by the facility.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
A person specified in paragraph (1) who
becomes a licensee, administrator, or employee of a licensed child daycare facility shall take renewal mandated reporter training every two years following the date on which that person completed the initial mandated reporter training. The training shall include, but not necessarily be limited to, training in child abuse and neglect identification and child abuse and neglect reporting.
</html:p>
<html:p>
(f)
<html:span class="EnSpace"/>
Unless otherwise specifically provided, the absence of training shall not excuse a mandated reporter from the duties imposed by this article.
</html:p>
<html:p>
(g)
<html:span class="EnSpace"/>
Public and private organizations are encouraged to provide their volunteers whose duties require direct contact with and supervision of children with training in the identification and reporting of child abuse and neglect.
</html:p>
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</ns0:BillSection>
<ns0:BillSection id="id_42C09C0B-DC5F-4B0F-85D0-5935D60A823B">
<ns0:Num>SEC. 10.</ns0:Num>
<ns0:Content>
<html:p>Section 3.5 of this bill incorporates amendments to Section 1367.27 of the Health and Safety Code proposed by both this bill and Assembly Bill 280. That section of this bill shall only become operative if (1) both bills are enacted and become effective on or before January 1, 2026, (2) each bill amends Section 1367.27 of the Health and Safety Code, and (3) this bill is enacted after Assembly Bill 280, in which case Section 3 of this bill shall not become operative.</html:p>
</ns0:Content>
</ns0:BillSection>
<ns0:BillSection id="id_E6B5587D-E928-4550-94CA-B43F1BBB84E1">
<ns0:Num>SEC. 11.</ns0:Num>
<ns0:Content>
<html:p>Section 5.5 of this bill incorporates amendments to Section 1374.73 of the Health and Safety Code proposed by both this bill and AB 951. That section of this bill shall only become operative if (1) both bills are enacted and become effective on or before January 1, 2026, (2) each bill amends Section 1374.73 of the Health and Safety Code, and (3) this bill is enacted after AB 951, in which case Section 5 of this bill shall not become operative.</html:p>
</ns0:Content>
</ns0:BillSection>
<ns0:BillSection id="id_C94B0A64-389D-4A2D-94B0-F1245C8EE8A5">
<ns0:Num>SEC. 12.</ns0:Num>
<ns0:Content>
<html:p>Section 6.5 of this bill incorporates amendments to Section 10133.15 of the Insurance Code proposed by both this bill and Assembly Bill 280. That section of this bill shall only become operative if (1) both bills are enacted and become effective on or before January 1, 2026, (2) each bill amends Section 10133.15 of the Insurance Code, and (3) this bill is enacted after Assembly Bill 280, in which case Section 6 of this bill shall not become operative.</html:p>
</ns0:Content>
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<ns0:BillSection id="id_EFA6C6AB-6142-4033-AFD8-582B080B55C7">
<ns0:Num>SEC. 13.</ns0:Num>
<ns0:Content>
<html:p>Section 8.5 of this bill incorporates amendments to Section 10144.51 of the Insurance Code proposed by both this bill and AB 951. That section of this bill shall only become operative if (1) both bills are enacted and become effective on or before January 1, 2026, (2) each bill amends Section 10144.51 of the Insurance Code, and (3) this bill is enacted after AB 951, in which case Section 8 of this bill shall not become operative.</html:p>
</ns0:Content>
</ns0:BillSection>
<ns0:BillSection id="id_E5788EAC-490B-4CE8-B6B1-9737997C9F68">
<ns0:Num>SEC. 14.</ns0:Num>
<ns0:Content>
<html:p>
(a)
<html:span class="EnSpace"/>
Section 9.1 of this bill incorporates amendments to Section 11165.7 of the Penal Code proposed by both this bill and Assembly Bill 653. That section of this bill shall only become operative if (1) both bills are enacted and become effective on or before January 1, 2026, (2) each bill amends Section 11165.7 of the Penal Code, (3) Senate Bill 848 is not enacted or as enacted does not amend that section, and (4) this bill is enacted after Assembly Bill 653, in which case Sections 9, 9.2, and 9.3 of this bill shall not become operative.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
Section 9.2 of this bill incorporates amendments to Section 11165.7 of the Penal Code proposed by both this bill and Senate Bill 848. That section of this bill shall only become operative if (1) both bills are enacted and become effective on or before January 1, 2026, (2) each bill amends Section 11165.7 of the Penal Code, (3) Assembly Bill 653 is not enacted or as enacted does not amend that section, and (4) this bill is enacted after Senate Bill 848, in which case Sections 9, 9.1, and 9.3 of this bill shall not become operative.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
Section 9.3 of this bill incorporates amendments to Section 11165.7 of the Penal Code proposed by this bill, Assembly Bill 653, and Senate Bill 848. That section of this bill shall only become operative if (1) all three bills are enacted and become effective on or before January 1, 2026, (2) all three bills amend Section 11165.7 of the Penal Code,
and (3) this bill is enacted after Assembly Bill 653 and Senate Bill 848, in which case Sections 9, 9.1, and 9.2 of this bill shall not become operative.
</html:p>
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</ns0:BillSection>
</ns0:Bill>
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