Health care coverage: timely access to care.

Plain English Breakdown

The official source does not provide details about enforcement actions or penalties for non-compliance with the adopted standards.

Health Care Coverage: Timely Access to Care

The bill requires state health departments and insurance agencies to work together with stakeholders to create standards that ensure timely access to perinatal units for people covered by health care plans.

What This Bill Does

• Requires the Department of Managed Health Care, the Department of Insurance, and the State Department of Health Care Services to consult with stakeholders and develop standards for the geographic accessibility of perinatal units.
• Sets a deadline of July 1, 2027, for these departments to adopt the new standards.

Who It Names or Affects

• People covered by health care plans who need access to perinatal units.
• Health care service plans that provide or arrange for hospital or physician services.
• State departments responsible for managing and regulating health care services and insurance.

Terms To Know

Medi-Cal

A government program in California that provides free or low-cost healthcare to people with limited income.

Perinatal units

Specialized hospital areas where pregnant women and newborns receive care before, during, and after birth.

Limits and Unknowns

• The bill does not specify what happens if the departments do not meet the July 1, 2027 deadline.
• It is unclear how much it will cost to implement these new standards.
• The bill's provisions become inactive and are removed from law after a certain date.

Official Summary Text

SB 32, as amended, Weber Pierson.
Health care coverage: timely access to care.
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law authorizes the provision of Medi-Cal benefits by a contracted managed care plan and requires that benefits provided by a managed care plan are subject to specified time and distance standards.
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 provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service
plan or health insurer that provides or arranges for the provision of hospital or physician services to comply with specified timely access to care requirements, including ensuring that its network has adequate capacity and availability of licensed health care providers to offer enrollees and insureds appointments that meet specified timeframes. Existing law authorizes the department director to take enforcement action against health care plans that fail to comply with these provisions, including assessing administrative penalties.
This bill would require, on or before July 1, 2027, the Department of Managed Health Care, the Department of Insurance, and the State Department of Health Care Services to consult together and with stakeholders develop and adopt standards for the geographic accessibility of perinatal units to ensure timely access for enrollees and insureds, as specified. The bill’s provisions would become inoperative on July 1, 2033, and would be repealed
on January 1, 2034.
Because a violation by a health care service plan of a standard adopted by the Department of Managed Health Care would be a crime, the bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.

Current Bill Text

Download Bill PDF