CAFP Positions on Legislation
CAFP Sponsored Legislation
AB 315 (Wood) Pharmacy benefits management transparency.
This bill would create two new categories of licensure within the Board of Pharmacy. The first requires all Pharmacy Benefit Managers (PBMs) to obtain a license with the Board and to provide information concerning each person beneficially interested in the PBM or any person with management or control over the licensed PBM. The second form of licensure is that of a Designated Pharmacy Benefit Manager Representative (DPBMR) whose role within a PBM will be to protect the public health and safety in the handling, storage, warehousing, distribution and shipment of dangerous drugs and dangerous devices within each premise of a licensed PBM. Finally, this bill requires each licensed PBM to report certain aggregate data related to rebates, discounts, and price concessions from drug manufacturers and the savings that are passed on to clients.
AB 2895 (Arambula and Bonta) Primary Care Spending Transparency Act
This bill requires health plans/insurers to report total primary care medical expenditures (claims-based and non-claims-based) to the Department of Managed Health Care or Department of Insurance, including:
- The percentage of medical expenses allocated to primary care compared to overall medical expenditures.
- The methods plans/insurers use to financially support primary care.
The bill also will create a Primary Care Payment Reform Collaborative, composed of a wide range of health care stakeholders and experts, to help provide health plans/insurers and others with proven strategies to support primary care. The Collaborative will help align payment and infrastructure investments and offer guidance on how to improve the annual collection and reporting of primary care expenditure data.
SB 641 (Lara) Controlled Substance Utilization Review and Evaluation System: privacy.
This bill stipulates that the Department of Justice shall only provide data obtained from CURES to a federal, state, or local law enforcement agency pursuant to a valid court order or warrant based on probable cause and issued at the request of a federal, state, or local law enforcement agency engaged in an open and active investigation regarding prescription drug abuse or diversion of prescription of controlled substances involving the individual to whom the requested information pertains. It also would require the Department of Justice to establish policies, procedures, and regulations regarding the use, access, evaluation, management, implementation, operation, storage, disclosure, and security of the information within CURES.
CAFP Priority Legislation
AB 1751 (Low) Controlled substances: CURES database.
This bill authorizes the Department of Justice (DOJ) to enter into an agreement with an entity operating an interstate data share hub for purposes of participating in interjurisdictional information sharing between prescription drug monitoring systems (PDMPs) across state lines. While this functionality could serve to benefit physicians who potentially could analyze a patient's full controlled substance prescription history, including any prescriptions filled across state lines, the privacy requirement in the bill only extends the same patient privacy and data security standards currently in place for direct access of CURES. Amendments sought would add patient privacy protections to protect patient medical information if CURES data is to be shared through an interstate database. These privacy protections would include a warrant requirement for law enforcement prior to accessing prescriber and patient information within confidential medical records.
Position: Oppose Unless Amended
AB 1963 (Waldron) Medi-Cal: reimbursement: opioid addiction treatment.
This bill would require the DHCS to raise Medi-Cal reimbursement rates for opioid addiction treatment to certified providers. According to the National Survey on Drug Use and Health, 90 percent of Californians who needed addiction treatment in 2016 didn't receive it. A California Society for Addiction Medicine study found that 56 percent of physicians surveyed whose patients had insurance experienced difficulties accessing medication-assisted treatment (MAT).
AB 2018 (Maienschein) Mental health workforce: loan forgiveness, repayment and scholarship.
This bill would define “practice setting” under the Steve Thompson Loan Repayment Program to include a program or facility operated by, or contracted to, a county mental health plan. The bill would require the guidelines to include providing early loan repayment consideration for all trainees who otherwise satisfy the program’s requirements.
AB 2086 (Gallagher) Controlled substances: CURES database.
This bill would allow prescribers to access the CURES database for a list of patients for whom that prescriber is listed as a prescriber in the CURES database.
AB 2202 (Gray) University of California: school of medicine.
This bill seeks to secure ongoing funding for the development and construction of the University of California, Merced School of Medicine.
AB 2203 (Gray) Medi-Cal: primary care services.
This bill would increase the Medi-Cal reimbursement rate for primary care services to 100 percent of the Medicare rate in both fee-for-service and Medi-Cal managed care. The bill defines primary care providers as either a physician or a practitioner working under physician supervision with a specialty designation of family medicine, general internal medicine, or pediatric medicine.
AB 2256 (Santiago) Law enforcement agencies: opioid antagonist.
Current law authorizes pharmacies to furnish naloxone or other opioid antagonist to offices of education and schools. This bill would additionally authorize pharmacies to furnish naloxone to law enforcement.
AB 2275 (Arambula) Medi-Cal managed care: quality assessment, performance improvement.
This bill requires the DHCS to establish a quality assessment and performance improvement and financial incentive program for all Medi-Cal managed care plans. The program would require plans to meet annual improvements in quality measures and reduction of health disparities. The bill also requires DHCS to establish a public stakeholder process to plan, develop, and oversee the program that includes, at minimum, consumer advocates and the Medi-Cal managed care plans.
AB 2289 (Weber) Pupil rights: pregnant and parenting pupils.
This bill allows a school to give parenting pupils six to eight weeks of leave after giving birth, depending on whether the birth was natural or by caesarian section, and up to four weeks of leave for the parent who did not give birth. Additionally, the bill makes changes to the school funding structure to ensure that schools are not penalized financially for the pupil's absence. Finally, the bill requires a school district to provide guidelines for makeup work plan development to a pupil absent due to pregnancy and allows four absences per school year to care for a sick child without requiring a doctor's note.
AB 2311 (Arambula) Medicine: trainees: international medical graduates.
This bill removes the sunset on the pilot program for international medical graduates to do pre-residency training at the UCLA David Geffen School of Medicine. CAFP is a long-time supporter of this program and the previous legislation that created it.
AB 2384 (Arambula) Medication-assisted treatment.
Would require a drug formulary maintained by a health care service plan, including a Medi-Cal managed plan, or health insurer to include, at a minimum, specified prescription drugs for the medication-assisted treatment, as defined, of substance abuse disorders. The bill would provide that medication-assisted treatment is presumed to be medically necessary, and is not subject to specified requirements of a health care service plan or policy of health insurance, including prior authorization and an annual or lifetime dollar limit.
AB 2430 (Arambula) Medi-Cal: program for aged and disabled persons.
This bill would increase Medi-Cal eligibility for seniors and disabled individuals whose income is between 123 percent of the federal poverty level (FPL) and 138 percent of FPL to create consistency in eligibility and expand coverage to 60,000 seniors and disabled individuals.
AB 2434 (Bloom) Strategic Growth Council: Health in All Policies Task Force.
This bill would require the council to establish a Health in All Policies (HiAP) Task Force for the purposes of incorporating health, equity, and sustainability considerations into decision-making across sectors and policy areas. The bill would require the task force to, among other things, take specified actions to advance the council’s goals of improving air and water quality, protecting natural resources and agricultural lands, increasing the availability of affordable housing, improving infrastructure programs, promoting public health, planning sustainable communities, and meeting the state’s climate change goals. The bill would require the task force to collaborate with the State Department of Public Health and representatives of state agencies and departments represented on the council to achieve its goals, and to prepare and submit a report to the council containing specified information and recommendations relating to achieving the council’s goals.
AB 2472 (Wood) Health care coverage: Medi-Cal: public purchase option.
This bill would require the State Department of Health Care Services (DHCS) to apply to the US Department of Health and Human Services for federal waivers to permit individuals whose income is greater than the income eligibility threshold for Medi-Cal benefits to purchase coverage under the Medi-Cal program through a separate public purchase option. The bill would require the DHCS Director to report to the health and budget committees of the Legislature on its progress in this regard by January 1, 2020. The bill would require the department to prepare an implementation plan for the public purchase option by March 1, 2020.
AB 2499 (Arambula) Health care coverage: medical loss ratios.
Current law requires health care service plans and health insurers to provide annual rebates to enrollees if the ratio amount of the premium revenue spent on clinical services for enrollees is less than 85 percent in the large group market and 80 percent in the small group and individual markets. AB 2499 would increase these percentages to 90 percent in the large group market and to 85 percent in the small and individual markets. Also, current law requires health care service plans and health insurers comply with a minimum medical loss ratio (MLR) of 85 percent in the large group market and 80% in small group and individual market. AB 2499 would change the current minimum MLR requirements for health care service plans and health insurers from 85 to 90 percent in the large group market, from 80 to 85 percent in the individual market. The MLR for small group contracts would remain at 80 percent.
AB 2502 (Wood) Health care: Payments database.
This bill would establish all-payer claims database no later than January 1, 2020, to gather information on the actual cost of services. The bill would require all uses of data made pursuant to these provisions to comply with all applicable state and federal laws for the protection of the privacy and security of data. The bill would also establish a review committee composed of a broad spectrum of health care stakeholders and experts to advise HHS on the establishment, implementation and ongoing administration of the California Health Care Payments Database.
AB 2526 (Rubio) Temporary emergency gun violence restraining orders.
Current law requires a written petition to the court from the requesting officer before a restraining order can be issued. This bill would allow a court to issue a restraining order orally after the officer submits a signed declaration to the court reciting the oral statements provided to the court supporting the restraining order request.
AB 2579 (Burke) Special Supplemental Nutrition Program for Women, Infants, and Children.
This bill would require the DHCS to design, promulgate, and implement policies and procedures for an automated enrollment gateway system, operational no later than January 1, 2019, allowing children applying to the WIC Program to obtain express lane eligibility for, and to facilitate application for enrollment in, the Medi-Cal program, and allowing pregnant women applying to the WIC Program to obtain presumptive eligibility for the Medi-Cal program or the Medi-Cal Access Program, to the extent federal financial participation is available.
AB 2597 (Arambula) Programs in Medical Education.
This bill would appropriate $9,350,000 from the General Fund to the Regents of the University of California to support Programs in Medical Education (PRIME), and would require the university to fully fund, at minimum, the 2018–19 level of full-time student enrollment in PRIME for the 2019–20 academic year. The bill would require the university, as a condition of receipt of future appropriated moneys for PRIME, to expand full-time student enrollment in PRIME for the 2020–21, 2021–22, and 2022–23 academic years by 25, 50, and 100 percent, respectively, from the 2018–19 level.
AB 2668 (Allen) Immunizations: pupils not immunized.
This bill would delete private institutions, including private elementary and secondary schools, child care centers, day nurseries, nursery schools, family day care homes, and development centers, from immunization requirements, thereby allowing pupils who do not meet those immunization requirements to enroll in those institutions. The bill would require the State Department of Education to award a grant to a parent or guardian of a child who would otherwise be eligible to attend a public elementary or secondary school, child care center, day nursery, nursery school, family day care home, or development center, except for the child not meeting those immunization requirements, to fund the child’s attendance at a private elementary or secondary school, child care center, day nursery, nursery school, family day care home, or development center.
AB 2674 (Aguiar-Curry) Health Care Service Plans: Disciplinary Actions
This bill would require the Department of Managed Health Care (DMHC) to investigate provider complaints that a health care service plan has underpaid or failed to pay the provider in violation of the Knox-Keene Act and would establish a procedure for a provider to file a complaint with the department. If the DMHC finds that a health care service plan has unlawfully underpaid a provider, AB 2674 would require the penalty amount to, at a minimum, equal the amount of the underpayment plus interest. In addition, the enforcement action also would make the provider whole by requiring the health care service plan to compensate the provider for the full amount of the unlawful underpayment plus interest.
AB 2785 (Rubio) Student services: lactation accommodations.
This bill requires California Community Colleges and the California State University to provide reasonable accommodations for lactating students, including access to a private and secure room, other than a restroom, to express milk or breastfeed. The bill would also require that lactating students be given a reasonable amount of time to express milk or breastfeed, and prohibit a student from incurring an academic penalty as a result of this time.
AB 2789 (Wood) Health care practitioners: prescriptions: electronic transmission.
This bill seeks to implement mandatory electronic prescribing (e-prescribing) by January 1, 2021. While e-prescribing is desired by many prescribers, mandating its use is unnecessary and premature in the absence of reliable technological compatibility at this time.
Position: Oppose Unless Amended to develop standards to ensure functionality between pharmacy systems and prescriber e-prescribing systems, ensure internet reliability, address cost barriers to entire system replacements and remove the punishment of actions against a prescriber's license.
AB 2861 Medi-Cal: telehealth: substance use disorder services.
This bill allows providers of telehealth services for substance use disorders to be reimbursed by Medi-Cal.
AB 2863 (Nazarian) Pharmacy: prescriptions: pharmacy benefit manager: cost.
This bill would limit the amount a health care service plan, health insurer or pharmacy benefit manager may require an enrollee or insured to pay at the point of sale for a covered prescription to the lesser of the applicable cost-sharing amount or the retail price. The bill would prohibit a health care service plan, health insurer, or pharmacy benefit manager from requiring a pharmacy to charge or collect a copayment from an enrollee or insured that exceeds the total submitted charges by the network pharmacy. The bill would require the amount paid for a prescription to be applied to the enrollee’s or insured’s deductible and out-of-pocket maximum if the enrollee or insured pays the retail price.
AB 2965 (Arambula) Medi-Cal: immigration status: adults.
This bill would extend eligibility for full-scope Medi-Cal benefits to individuals of all ages who are otherwise eligible for those benefits but for their immigration status.
AB 3087 (Kalra) – Health Care rates: Payment Board and limitations.
This bill would increase license fees for health care providers, plans and facilities to pay for the creation of the California Health Care Cost, Quality, and Equity Commission, an independent state agency to control in-state health care costs and set the amounts accepted as payment by health plans, hospitals, physicians, physician groups and other health care providers. The bill specifies that the base amount shall be a percentage of Medicare rates not lower than 100% of Medicare rates. This bill would exempt a Medi-Cal managed health care plan or individuals receiving coverage through Medicare or another federal health program from the bill’s provisions. The bill would require the commission to obtain the information necessary to determine total health care expenditures and to set a global cap for total health care expenditures. The bill would prohibit a health care provider from billing or collecting an amount other than the applicable cost sharing from an individual, and would provide that an individual would not owe a health care provider an amount other than that applicable cost sharing.
The Commission would have nine members, including the Secretary of California Health and a CalPERS representative, as well as:
(A) One individual with demonstrated expertise in health care policy.
(B) One individual with demonstrated expertise in health care delivery.
(C) One health economist.
(D) One consumer advocate.
(E) One individual with demonstrated expertise in health care financing, including alternative payment methodologies.
(F) One representative of a labor union organization who serves as a trustee of a trust fund organized under state or federal law.
(G) One representative of an organization of employers with demonstrated expertise in health care purchasing.
Lastly, the Commission would be required to establish an appeal process to consider adjustments to the base amounts. The Commission would award reasonable fees to a person or organization that represents purchasers’ interests and made a substantial contribution to a regulation, order, or decision.
SB 835 (Glazer) Parks: smoking ban.
This bill would prohibit smoking in state parks. The prohibition includes e-cigarettes and vaping and provides for an exemption for props used for filming and federally recognized tribal ceremonies.
SB 836 State beaches: smoking ban.
This bill prohibits smoking and the disposal of used cigar or cigarette waste on state beaches. The prohibition includes e-cigarettes and vaping and provides for an exemption for props used for filming and federally recognized tribal ceremonies.
SB 910 (Hernandez) Short-term limited duration health insurance.
This bill, commencing January 1, 2019, would prohibit a health insurer from issuing, selling, renewing or offering a short-term limited duration health insurance policy for health care coverage in this state.
SB 945 (Atkins) Breast and Cervical Cancer Treatment Program.
This bill would repeal the caps on treatment in the state Breast and Cervical Cancer Treatment Program (BCCTP). Currently, treatment for program enrollees is limited to 18 months for breast cancer and 24 months for cervical cancer regardless of whether they continue to require treatment.
SB 974 (Lara) Medi-Cal: immigration status: adults.
This bill expands eligibility for full-scope Medi-Cal benefits to individuals regardless of immigration status.
SB 1021 (Wiener) Prescription drugs.
This bill would expand the current requirement for health plans to cover antiretroviral drug treatments for medically necessary treatment of AIDS/HIV to include antiretroviral drug treatments for prevention of AIDS/HIV. The bill extends current non-grandfathered health plan and health insurer formulary tier definitions to grandfathered health plan and health insurers. SB 1021 also would prohibit a plan's prescription drug benefit from requiring the enrollee from paying coinsurance or copayments if the retail price of the product is less than the enrollee's coinsurance or copayment.
SB 1023 (Hernandez) Reproductive health care coverage.
This bill amends current law to clarify that health care service plans, health insurers, and Medi-Cal managed care plans may cover sexual and reproductive health care services that are provided through telehealth according to clinical guidelines. The bill requires that the Family PACT program cover services provided by a Family PACT provider through direct video and telephonic communications, or direct or asynchronous care provided through a smart phone application. SB 1023 would authorize providers to determine program eligibility and enroll eligible clients remotely using program policies developed by the State Department of Healthcare Services.
SB 1034 (Mitchell) Health care: mammograms.
This bill makes permanent a law passed in 2012 which required a dense breast notification to be included as part of a mammography report including this statement: “Your mammogram shows that your breast tissue is dense. Dense breast tissue is common and is not abnormal. However, dense breast tissue can make it harder to evaluate the results of your mammogram and may also be associated with an increased risk of breast cancer. This information about the results of your mammogram is given to you to raise your awareness and to inform your conversations with your doctor. Together, you can decide which screening options are right for you. A report of your results was sent to your physician.” CAFP has seen no data supporting the notion that this law has led to improved patient outcomes.
SB 1108 (Hernandez) Medi-Cal: conditions of eligibility or coverage.
This bill would prohibit DHCS from seeking or obtaining a Medicaid demonstration project or waiver to require employment waiting periods, time limits or coverage lockouts as a condition of Medi-Cal eligibility or coverage.
SB 1125 (Atkins) Federally qualified health center and rural health clinic services.
This bill authorizes Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to bill Medi-Cal for two visits if a patient is provided mental health services on the same day as other medical services. Currently DHCS will only reimburse these clinics for one visit, even if multiple providers are seen in one day, leading to inadequate reimbursement for the services provided.
SB 1240 (Stone) Prescription drugs: CURES database.
This bill requires a prescribing physician to include on a prescription the ICD-10 code or the condition or purpose for which the drug is being prescribed, unless the patient requests this information to be omitted. It also would require a prescription transmitted orally to include either an ICD-10 Code of a description of the condition or purpose for which the drug is being prescribed.
SB 1264 (Stone) Medi-Cal: hypertension medication management: pharmacists.
This bill would authorize an advanced practice pharmacist to provide hypertension medication management services to Medi-Cal beneficiaries, as well as access the state health information exchange and any relevant continuity of care documents maintained by a health facility. This bill would include hypertension medication management services as a covered pharmacist service under the Medi-Cal program.
SB 1426 (Stone) Pharmacists: authority to prescribe and dispense dangerous drugs and devices.
Existing law generally prohibits a pharmacist from dispensing a dangerous drug or dangerous device except upon the prescription of an authorized prescriber, but it does allow a pharmacist to furnish nicotine replacement products, certain vaccines, and self-administered hormonal contraceptives, without a prescription in accordance with specified protocols and conditions. An advanced practice pharmacist may initiate, adjust or discontinuing drug therapy. This bill would require the Pharmacy Board to convene a Public Health and Pharmacy Formulary Advisory Committee to advise the board in promulgating regulations to establish a formulary of drugs and devices that an advanced practice pharmacist may furnish to a patient.
SB 1448 (Hill) Healing arts licensees: probation status: disclosure.
This bill will require a physician to provide a disclosure to a patient, the patient’s guardian or health care surrogate before the patient’s first visit following a probationary order made on and after July 1, 2019. The disclosure shall include the licensee’s probation status, the length of the probation and the probation end date, all practice restrictions placed on the licensee by the board, the board’s telephone number, and an explanation of how the patient can find further information on the licensee’s probation on the licensee’s profile page on the board’s online license information Internet Web site. The physician shall obtain the patient’s, the guardian’s or the health care surrogate’s signature on a separate copy of that disclosure.
A licensee shall not be required to provide a disclosure if any of the following applies:
(1) The patient is unconscious or otherwise unable to comprehend the disclosure and sign the copy of the disclosure and a guardian or health care surrogate is unavailable to comprehend the disclosure and sign the copy.
(2) The visit occurs in an emergency room or an urgent care facility or the visit is unscheduled, including consultations in inpatient facilities.
(3) The licensee who will be treating the patient during the visit is not known to the patient until immediately prior to the start of the visit.
(4) The licensee does not have a direct treatment relationship with the patient.
Beginning July 1, 2019, the board shall provide the following information in plain view on the licensee’s profile page on the board’s online license information Internet Web site:
(1) For probation imposed pursuant to a stipulated settlement, the causes alleged in the operative accusation along with a designation identifying those causes by which the licensee has expressly admitted guilt and a statement that acceptance of the settlement is not an admission of guilt.
(2) For probation imposed by an adjudicated decision of the board, the causes for probation stated in the final probationary order.
(3) For a licensee granted a probationary license, the causes by which the probationary license was imposed.
(4) The length of the probation and end date.
(5) All practice restrictions placed on the license by the board.