Amended  IN  Senate  August 15, 2024
Amended  IN  Senate  June 06, 2024

CALIFORNIA LEGISLATURE— 2023–2024 REGULAR SESSION

Assembly Bill
No. 2250

Introduced by Assembly Member Weber
(Coauthor: Assembly Member Aguiar-Curry)

February 08, 2024

An act to add Section 1367.37 to the Health and Safety Code, to add Section 10123.52 to the Insurance Code, and to add Section 14132.14 to the Welfare and Institutions Code, relating to health.


LEGISLATIVE COUNSEL'S DIGEST


AB 2250, as amended, Weber. Social determinants of health: screening and outreach.
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 health care service plans and health insurers to include coverage for screening for various conditions and circumstances, including adverse childhood experiences. Existing law provides for the Medi-Cal program, administered by the State Department of Health Care Services and 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.
This bill would require a health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2027, to include coverage for screenings for social determinants of health, as defined. The bill would require providers to use specified tools or protocols when documenting patient responses to questions asked in these screenings. The bill would require a health care service plan or health insurer to provide physicians who provide primary care services with adequate access to peer support specialists, lay health workers, social workers, or community health workers in counties where the plan or insurer has enrollees or insureds, as specified. The bill would authorize the respective departments to adopt guidance to implement its provisions until regulations are adopted, and would require the departments to coordinate in the development of guidance and regulations. Because a violation of the bill’s requirements by a health care service plan would be a crime, the bill would impose a state-mandated local program.
This bill would make social determinants of health screenings a covered benefit for Medi-Cal beneficiaries and would require the State Department of Health Care Services or a Medi-Cal managed care plan to provide reimbursement for those screenings, as specified.
The bill would provide that these provisions will be implemented only upon an appropriation by the Legislature.
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.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: YES  

The people of the State of California do enact as follows:


SECTION 1.

 Section 1367.37 is added to the Health and Safety Code, to read:

1367.37.
 (a) A health care service plan contract, except for a specialized health care service plan, issued, amended, or renewed on or after January 1, 2027, shall include coverage and provide reimbursement to health care providers for social determinants of health screenings. During these screenings, a provider may focus or expand their questions to issues relevant to the patient and may ask these questions in the manner the provider believes is most appropriate or more likely to elicit the best response from the patient. When documenting patient responses to these screenings, providers shall use existing tools or protocols that have been validated by the federal Centers for Medicare and Medicaid Services, the National Association of Community Health Centers, the American Academy of Family Physicians, the National Committee for Quality Assurance, or other nationally recognized organizations and that include, at a minimum, the domains of food insecurity, housing insecurity, and transportation needs.
(b) For purposes of this section, “social determinants of health” means the conditions under which people are born, grow, live, work, and age, including housing, food, transportation, utilities, and personal safety.
(c) A health care service plan shall provide physicians who provide primary care services with adequate access to peer support specialists, lay health workers, social workers, or community health workers as defined in Section 18998 of the Welfare and Institutions Code, including Promotores and community health representatives, in counties where the health care service plan has enrollees. The health care service plan shall inform physicians who provide primary care services of how to access these community health workers, Promotores, community health representatives, peer support specialists, lay health workers, or social workers.
(d) The department may adopt guidance for health care service plans to implement this section until regulations are adopted. The director shall coordinate with the Insurance Commissioner in the development of guidance and regulations under this subdivision.
(e) This section shall be implemented only upon an appropriation by the Legislature for the express purpose of this section.

SEC. 2.

 Section 10123.52 is added to the Insurance Code, to read:

10123.52.
 (a) A health insurance policy issued, amended, or renewed on or after January 1, 2027, shall include coverage and provide reimbursement to health care providers for social determinants of health screenings. During these screenings, a provider may focus or expand their questions to issues relevant to the patient and may ask these questions in the manner the provider believes is most appropriate or more likely to elicit the best response from the patient. When documenting patient responses to these screenings, providers shall use existing tools or protocols that have been validated by the federal Centers for Medicare and Medicaid Services, the National Association of Community Health Centers, the American Academy of Family Physicians, the National Committee for Quality Assurance, or other nationally recognized organizations and that include, at a minimum, the domains of food insecurity, housing insecurity, and transportation needs.
(b) For purposes of this section, “social determinants of health” means the conditions under which people are born, grow, live, work, and age, including housing, food, transportation, utilities, and personal safety.
(c) A health insurer shall provide physicians who provide primary care services with adequate access to peer support specialists, lay health workers, social workers, or community health workers, as defined in Section 18998 of the Welfare and Institutions Code, including Promotores and community health representatives, in counties where the health insurer has insureds. The health insurer shall inform physicians who provide primary care services of how to access these community health workers, Promotores, community health representatives, peer support specialists, lay health workers, or social workers.
(d) The department may adopt guidance for health insurers to implement this section until regulations are adopted. The commissioner shall coordinate with the Director of the Department of Managed Health Care in the development of guidance and regulations under this subdivision.
(e) This section shall be implemented only upon an appropriation by the Legislature for the express purpose of this section.

SEC. 3.

 Section 14132.14 is added to the Welfare and Institutions Code, to read:

14132.14.
 (a) (1) Social determinants of health screenings for Medi-Cal beneficiaries is a covered benefit and the department or a Medi-Cal managed care plan shall provide reimbursement to a Medi-Cal provider who renders this service, unless the service is already covered under a separate covered benefit.
(2) Federally qualified health centers and rural health clinics shall be reimbursed for these social determinants of health screenings at the Medi-Cal fee-for-service rate. The reimbursements to federally qualified health centers and rural health clinics shall be in addition to any other amounts payable with respect to those services, including payments received pursuant to Section 14132.100, subdivision (e) of Section 14087.325, or Article 4.1 (commencing with Section 14138.1), and shall not affect any other payments. The payments described in this paragraph shall not be subject to, or factored into, reconciliation and shall be excluded from the calculation described in subdivision (h) of Section 14132.100.
(b) For purposes of this section, “social determinants of health” means the conditions under which people are born, grow, live, work, and age, including housing, food, transportation, utilities, and personal safety.
(c) This section shall be implemented only upon an appropriation by the Legislature for the express purpose of this section.

SEC. 4.

 No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.